BETTY
Betty is a 32 year old single mother of one who has been diagnosed with severe psychiatric disorders after a history of physical and mental abuse.

TOBY
Toby is a seven year old foster child with a range of physical impairments caused by a subdural hematoma sustained as a result of child abuse.

JANE
Jane is a 43 year old mother of two who was involved in a motor vehicle accident which resulted in cervical strain. She is presently unable to perform occupational activities in the areas of leisure and productivity.

Painting,whether used therapeutically or for leisure, can be varied in terms of the materials used, processes required, and the type of end product desired. The names given to the different types of painting revolve around the basic materials used, for example:

• acrylic painting
• water-color painting
• oil painting

and the technique employed:

• finger painting
• sponge painting
• brush painting

Aside from the paints themselves, painting requires few other materials, making it an inexpensive and suitable activity for almost all people in many different environments. These materials are:

• water/other dilutant
• palette
• paper/canvas
• paint brushes
• smock/old shirt
• easel (optional)
• jars/containers

The general steps involved in painting:

1. set up easel and paper
2. prepare paints,place paints on palette
3. fill jars with dilutant (ie: water)
4. get out paintbrushes or sponges
5. put on smock
6. begin painting
7. when finished painting, clean up ( put away supplies, wash brushes, etc.)

The nature of painting itself is fun and interesting, but it can be modified for adults so it can serve as a serious hobby or even a career .

Finger painting focuses on the fun of experimenting with colors, and is not structured with respect to the end result. Often finger painting is used as a play activity for children, as it is interesting and poses no danger when non-toxic materials are used.

Painting provides many avenues for stimulating creativity and expression of feelings through the range of colors, shapes, and brush strokes involved in its process, and the diverse nature of images which can be created. Discussion about the content of a painting can also become detailed and meaningful. In this sense, painting as a therapeutic activity can be used to overcome mental/emotional deficits.

Painting can also be viewed as a physical activity, as biomechanics are central to its process. The following groups of muscles are called into play in different degrees, depending on the type of painting being done:

• elbow and wrist extensors and flexors
• shoulder elevators, depressors, medial and lateral rotators
• neck extensors, flexors and rotators
• muscles involved in hand and finger grip

Fine motor skills, as well as upper extemity and neck range of motion (ROM) are also required in painting, although this activity can be graded for those with decreased range of motion. Examples of how this is done will be explored in Toby's case study.

With regard to our clients, an interest checklist has been administered, with the results showing painting to be compatible with the wishes of each individual. This lends itself to the assumption that all three clients will initially and continually show a strong interest in this activity which has been agreed upon between us, the Occupational Therapists, and the clients themselves, to be the therapeutic medium of choice.

Painting is apprropriate for the various roles played by each of our three clients:

• Mother (Betty, Jane)
• Playmate (Betty, Jane, Toby)
• Sibling (Toby)
• Teacher/ Child "Entertainer" (Betty, Jane)
• Student (Toby)
• Child (Toby)

Painting shows its therapeutic value most obviously with respect to its gradability. As a therapeutic medium, painting can be graded to reflect each client's needs:

• COGNITIVELY--finger painting, paint by number, direct copying of a picture/object, transferring meaningful images from mind to canvas
• PHYSICALLY--altering grip requirements by adjusting the circumference of the brush handle, increasing R.O.M. by increasing canvas size, changing position of the pallette, lowering/raising easel level
• INTERPERSONALLY--having client paint one-on-one with the therapist, alone or in a group
• INTRAPERSONALLY--varying and increasing the degree to which emotions are explored both verbally and in the painting itself

We have used painting therapeutically in various ways for our three clients,BETTY,TOBY, JANE.

Jessica Swick, Melissa Stiles, Shelly Ellaschuk, Jennifer Gokiert