Party but Promise to Always Remember

Hello everyone! 

I hope your weekends were lovely. I had a very busy weekend that included both a track meet and a yoga triathlon (what? a yoga triathlon? yeah it was amazing). But honestly, I used my weekend mostly to reflect on what I experienced on Thursday and Friday, my LAST days at Bridges.

It was a bittersweet ending--as many endings are--but I couldn't have asked for a better send-off. The amazing staff at Bridges bought cake and snacks on Thursday to celebrate the end of both my and Cassie's internships. I did not expect something like that at all and was so unbelievably touched by it! (Randy, Anna, Ali, Emily, Kris...if any of you are reading this, thank you again! You are all amazing). This internship experience could have gone in so many directions, but the staff members at Bridges were all so warm and inviting that I didn't feel at all out of place. I cannot express how thankful I am for that.

Anywho, Thusday was an amazing beginning of the end at Bridges. Kris, the OT at Bridges let me sit in on both her morning group session (where we threw around an inflatable ball to a metronome beat) and on a formal patient evaluation. Yes, I finally saw a MOCA test being administered. Remember this thing?

At one point, I thought I would be able to use the MOCA in my research, but it is a little bit too quantitative for my project and would be much better for a long term study. Nevertheless, I was fascinated by Kris's evaluation and loved watching how the patient filled out each part of the assessment.

My favorite part of the day on Thursday was definitely art therapy, though. Later in the afternoon, we opened the art room for some media exploration. My favorite project--mandalas- made a return! And I was even more thrilled to help the patients use my favor medium: watercolor!

Like last time we did the mandalas, we were able to collect Likert scale data from the patients before and after they created their beautiful pieces of art. Eight patients, Ms. Endreson, Cassie, and I sat in a circle around the art tables and worked for about 20 minutes on these wonderful pieces:

Oil pastel was also an option for the patients, and this guy certainly liked that medium better.

Same artist as above image

"A Clock with No Hands"
This patient sat next to me and was very frustrated, claiming that she didn't know what she was doing the whole time. But  I think she was pleased to see a finished product. She was very careful about the red color and became quite focused at times. 

I can't blame this patient for seeing a circle as a face. He proudly called this a self portrait! 

This one is one of my personal favorites for some reason. It just has a lot of energy that I like. The artist who created this came in for a few minutes, threw down some paint, and left right away. 

"The black represents my depression," said the artist who created this piece

Here is an example of a patient who has an art background and does art outside of Bridges. She wasn't completely satisfied with this piece because she doesn't like watercolor, but at least she tried!

Out of all eight patients, four of them increased their Likert scale numbers, meaning they became more relaxed during the activity. The other four--including the artists who created the red clock and the desert scene-- decreased their scores and said they felt a little bit more anxious. 

After that enjoyable mandate activity (well, it was enjoyable for some at least), Ms. Endreson joined me and my mother for a farewell dinner in Tucson that night. We went to this adorable little restaurant called Agustin Kitchen. Why am I telling you about this? Well...the food was delicious and if you're ever in Tucson I highly recommend Agustin, but I'm also telling you because the food was beautiful! I almost lost it when Ms. Endreson's gnocchi dish came out of the kitchen in a beautiful mandala design (also, please enjoy a lovely image of me and Ms. Endreson. You haven't seen a picture of her yet huh? Well, better late than never): 

Friday was just as perfect as Thursday. Ms. Endreson and I sat down one last time with a patient to play the Value Game. And I have to say--not just because it was the last value game--it was the absolute best value game yet. The patient we sat with had an art background and was higher functioning so she had no problems following directions. We can caller her Tammie for now (not her actual name). 

Tammy came into Ms. Endreson's office frustrated and tired. A particular patient in the ward was being very loud and keeping Tammie up at night and for a while, it seemed like that was the only thing we were going to hear about from her, but as we diverted her focus to the value cards, she began to focus more on herself. 

One of the reasons I loved this value game so much was how Tammie went about organizing her card choices. As she selected the image cards that were important to her and not important to her, she strategically placed them out on the table in front of her in a way that was meaningful to her. Things that were more important sat higher up on the table (further from her) and things that had connections were grouped together. 

Another reason why I loved this final value game was Tammie's own remarks. When we handed her the value cards with only words on them, she (like all of the other patients) took much longer to organize them. As she flipped thought the cards, she continually asked: "Can we just go back to pictures please?" When I asked her what the different was between the two sets of cards was she responded: "Pictures connect to my soul and bring the feelings up...with words, they're just words and I see them and think 'oh gosh...' " 

Finally, the last reason I loved this value game session so much was the end result. As Tammie came to the end of her word selections we laid out her images and saw if any corresponded. Tammie made 5 matches! Yes, this might just mean that our brains work similarly and she saw the same values in the images as I did, but I loved that she was able to see how put together her choices were. Here are Tammie's final choices: 

As Friday came to a close, the reality began to dawn on me that I was going to walk through the sliding doors of St. Mary's hospital for the last time. I was sad but also felt rather accomplished. My mind thought back to the morning's art activity. I participated with the patients in an activity geared toward problem solving. Each patient was supposed to fill in a card with the words "I have a problem with..." on it. Then the cards would be shuffled, each patient would be presented with someone else's problem, and they would have to draw a solution to that problem. 

My card read: "I have a problem with....saying goodbye to people. It's never fun." 

Marcus (again not a real name) was the patient who had to solve my problem and draw the solution. He has paranoid schizophrenia, but loves to create art and some of his pieces are my absolute favorites. Here is what he came up with: 

When I asked Marcus what the writing said, he explained to me it read: "Party but promise to always remember." 

I absolutely loved his solution to my problem. It was the perfect combination of lighthearted and meaningful, which is exactly why I used it as the title of this blog post. This is my last post about my time at Bridges (I will definitely have a real concluding post with a link to my presentation and other concluding findings) but I don't want it to be a sad post. Like Marcus said, we have to party but promise to remember. I hope you all can celebrate this last blog post along with me but also not forget some of the things I wrote over the past ten weeks. I know I certainly won't! 

Thank you all so much, 

Tia :) 

The Human Form

Hello all!

This past Thursday and Friday marked my second to last visit to Tucson. I can't believe this project has gone by so fast! I was looking through my notes the other day (I keep a whole separate journal of notes about my experiences at Bridges) and the number of people I have met and learned from is absolutely incredible. I plan on making my last visit next week really count.

Anyway, I figured I would share a few things from last week. There were thirteen patients at Bridges! That is the most I have seen, and the great thing was that almost all of the patients were willing to participate in group meetings.

Thursday started out with an early group session. I tried my best to learn names of new patients as we sat around a table and passed a giant inflatable ball around. The patients really seemed to enjoy the physical activity involved in group and all shared answers to questions like "What did you come here to do?" "What kind of positive qualities do you need in your life?" and "What did you get out of this group discussion?"

The physical aspect of the morning group got me thinking and I suggested to Ms. Endreson an art activity I read about in an art therapy book I had been skimming before (you can check out the book here if you're interested). The activity I suggested had to do with the physical human form. Patients are supplied with a blank template of a human body and asked to do a "somatic check-in" of sorts. By using colors and shapes, they are supposed to express on the template their feelings of anxiety and how their bodies respond to that anxiety. I really liked the idea of a body template because it forced the patients to really think about themselves. It reminded me of a fun activity I saw when I was browsing YouTube for art therapy related things. The activity in the video below is definitely different and probably suits a higher functioning crowd better, but it still incorporates the human body outline, which I love (also its just a really fun and well filmed video) :

Anyway, six patients joined us in the afternoon for the body template activity. The plan was to have the patients fill out a Likert scale before they filled out their body templates, then talk about ways to relieve their stress and anxiety, and then have them illustrate the different ways they could manage their stress. The Likert scale didn't really work out; the patients didn't really follow instructions and many were rather demented or psychotic. But we did end up with some interesting pieces:

 

 

Ms. Endreson and I tried to sit down with the patients and talk with them after they all started finishing up with their work. Some gave their pieces titles and explained parts of their artwork. For example, the artist who created the piece on the left in the second row explained that the orange box represented his heart and the gold in the head area represented a gold plate in his head. 

At the end of the session, each patient shared their work and explained their choices. 

Friday was a bit more sleepy at Bridges and a lot of patients seemed very lethargic. But one of the bright sides to having a sleepy day at Bridges is the opportunity to have individual sessions with patients. When the floor was *Q-word* (the nurses always joke with me not to say "quiet" on the unit because I might jinx it and all of a sudden it will be crazy and loud again), Ms. Endreson and I invited one of the patients who was awake to join us in her office for another session of the Value Game. 

This patient--we can call him M-- was the first male patient to play the Value Game with us. He was much higher functioning than the past few patients we worked with on the game so it was refreshing to see someone who could follow the directions. As he shuffled through the pictures I noticed him categorizing a lot of the genders in the images, often separating men and women. 

Overall, the images brought up a lot of different stories and had deeper meaning but M made many of the same choices with images as he did words. I could tell he was a bit uncomfortable in the setting, with both me and Ms. Endreson staring at him as he made his value choices, but I think he did reflect a bit and got to really evaluate what was important to him. 

I've been putting a lot of time into my final presentation at this point and I love going through all the projects we've done at Bridges. I hope my final trip to Tucson includes some more amazing art. I'll be sure to share :) 

Until then, 

Tia 

On the Importance of the Circle

Hello all! Sorry again for my delayed blog post. I had quite an eventful time down in Tucson these past couple days and I wanted to have a good amount of time to sit down and record it all.

Okay, to start, you're probably wondering about the title of this post...

"What's so important about circles, Tia?"

Well, my day at Bridges on Thursday was all about circles. Our art therapy project was mandalas. If you've never heard of such a thing, a mandala is a circular design. All mandalas share a few key characteristics:

1. A central point

2. A geometric nature

3. Symmetry of pattern

4. A purpose of representing the oneness of the universe, formed of multiple, diverse, and sometimes seemingly chaotic elements

Ms. Endreson and I knew the patients at Bridges were not going to be very familiar with mandalas so I spent my morning creating an example:

The materials I used were colored pencil, pastel, and marker 

The scale pictured is a Likert scale, a psychometric scale commonly used in research that employs surveys. The plan for the day was to measure patient stress levels before a mandala activity, immediately after, and after discussion using this scale. The scale is pretty simple, ranging from 1 to 10. Ms. Endreson and I had patients take three deep breaths and tell us how "tight" or "soft" their chests felt (to give them a more physical way to measure their stress). 1 was very tight, while 10 was very soft. The higher their number, the better they felt.

As you can see, when I made my example, I filled out my own Likert stress scale. I already felt pretty good at an 8, but after a bit of mandala action, I was a bit more relaxed at a 9.5.

Before we had the patients start on the art activity, we held a talking group session for about an hour. The importance of a circle came up immediately when Ms. Endreson pointed out the shape of our group seating. Yep, you guessed it: we were all sitting in a circle. There is something very significant about sitting in a circle with a group of people. It's as if the information shared within that circle gains a new importance and the members of the circle all connect in a new way.

During the group we talked with the patients about finding a balance and knowing when they are "good enough" or "feeling bad." One of the ideas I found very interesting was one that Ms. Endreson and explained to me earlier that day. Life itself is a circular journey; this is why, when we get rid of bad habits or change a pattern, we often feel strange. Sometimes, we encounter that bad habit or problem again and we become frustrated (we feel like are just going in circles). But it is important to know that going full circle doesn't mean you haven't made any progress; it means you have come to a "new level of mastery."

This idea was very applicable to many of the Bridges patients, who often leave and return to Bridges several times. One of the members in the group that day had been in and out of rehab more that 30 times. I found the idea of a circle and new levels very hopeful, and I hope the patients did as well.

Now onto the mandalas. Here are some of the brilliant pieces created by the patients. We gave each patient a blank circle template with a center point and told them to work for about 10 minutes. They worked for about 20 minutes and many became quite focused. We also had the patients give their pieces titles, which you can read in the captions:

The Star of Hearts

The Many Facets of My Life

Two Sharks Teeth

Our Earth 1st (This one was actually created by Cassie, the ASU Social Work Student who works in Bridges and decided to join us!)

Astronaut Ball

We provided the patients with oil and chalk pastels, a medium that was new to many of them. The artist of "Astronaut Ball" was so trilled with the new medium that he created two pieces and found new techniques of blending and smudging with the oil pastels. "I surprised myself!"he said, "I don't know how I did that." He was very eager to share each little detail of his work. 

The Likert scales either stayed the same or went up. The highest jump in the scale was a 3 to 8.5 from the artist who created the "Two Shark Teeth" piece. When asked how she felt while she was creating the pieces she responded: "I just let it take me." 

The artist who created "The Star of Hearts," when asked why he added in the stars, responded: "Well, they said 'let us in' so I just let them in!" 

After we exchanged complements and discussed our pieces, we checked in again with the patients and asked how they ranked on the Likert scale. One patient's score decreased from an 8.5 to a 7, but all the others increased by at least 1. 

Friday was a much slower day in the ward, but still very productive. I spent a long time reading through some articles that Ms. Endreson and I were able to retrieve from the hospital library in addition to an interesting study that one of Ms. Endreson's students conducted titled Improving the Effectiveness of Cognitive Based Therapies. The other two articles I read were titled The Use of Art Therapy with Persons with Dementia by Kirsten Camartin and Creativity and Dementia: Does Artistic activity affect well-being beyond the art class? by Susan M. Gross et al. 

I found the article by Susan M. Gross very applicable to my own project. It was a very structured study that used a well-being rating scale along with actual control and experimental groups. I of course cannot conduct such a detailed study, so reading about one was incredibly eye-opening. Overall, the study found that the well-being of patients did increase. 

In addition to dissecting several articles on Friday, I was also able to observe another session with the Value Game. A new patient with severe dementia seemed to form some sort of attachment to Ms. Endreson and I, so we had her sit down with us and take a look at the images. Of course, because of her dementia, she was not able to follow the formal directions of the game, but (like with the last few patients) she did enjoy the experience and did reveal some stories that she would have otherwise not been able to string together. The visuals prompted many responses from her, and she did have a few obvious favorites: 

We noted that each of her favorites contained a pair of companions. She made her love of dogs very obvious as well. 

Finally, at the end of the day on Friday (after the patients all took very long naps) we had a fun little activity of creating "Fantasy Pocket Books." I folded pieces of paper together to create tiny little books that patients could fill with images they picked from magazines. The images were meant to represent the things they would like to have if everything in their lives was magically fixed completely. Five patients wandered in by the end of the session and all perused through the magazines at their leisure. Two patients had severe dementia, so Ms. Endreson and I had to sit with them and flip through the pages until we saw their faces light up or heard them mention something like "Oh, that's beautiful" or "So cute." 

One patient was obviously hungry because he filled his picture book with images of food. The first page of his book read: "I love food and here are a few of the things I would love to eat." Other patients filled theirs with images of fish or images of flowers and gems. Ultimately, at the end of the day, each one of them had something small and personal to put in their pocket and serve as a little pick-me-up. 

I was so pleased with all the amazing work the patients did these past couple days and I am so glad I could share it with you. I only have two more weeks left on site, so I'm going to make the most of it. I hope to share some more awesome art with you soon! 

Until then, 

Tia 

The Power of Ownership

Hello all! I apologize sincerely about posting so late. I turned around and headed back to Tucson right away last week on Tuesday. When I got back home, I had some training to do for a track meet on Saturday. And before I knew it, the week was over!

Anyway, I'm here again to tell you about some of the wonderful art and creativity I observed at Bridges. To start off, I'd like to tell you about this book I am reading as a supplement to my observation at Bridges. It's called Art as Therapy and is written by Alain de Botton and John Armstrong.

In addition to it's beautiful aesthetically pleasing blue/green cover, it is also filled with captivating images of masterpieces, from artists like Jean-Baptiste Regnault and David Hockney. 

I've noticed that it's definitely focused more on viewing artwork than making artwork, but a lot of the points it makes are just as applicable to the creative process. The "thesis"--if you will-- of the book is that "art (a category that includes works of design architecture and craft) is a therapeutic medium that can help guide, exhort and console its viewers, enabling them to become better versions of themselves."

De Botton and Armstrong propose that art is a "tool" that helps us, as humans, overcome seven psychological frailties (things we cannot do on our own): Remembering, Hope, Sorrow, Rebalancing, Self-Understanding, Growth, and Appreciation.  If you have some spare time, I would definitely recommend giving it a quick read! It might save you from ever leaving an art museum confused or dissatisfied ever again.

But back to Bridges. On Tuesday, I arrived at the ward and took a little time to improve the value game by adding a few more images and values. Our group session that day was focused on a different kind of art form: poetry! We spent the beginning of the group (as we almost always do) going through introductions. One of the patients was being discharged very soon, so the introductions included a bit of a send-off for this patient. I could really feel the wonderful sense of community that develops among the patients even only after a few days together.

The poetry activity developed even more of a sense of community because it was a group poem! Each of the five patients in the room received a card with a half a sentence on it. They each then completed their sentence and added it to the poem. We then asked the patients to create personal poems by drawing inspiration from the group poem (which, I admit, was a bit incoherent). Most patients lost motivation at this point, but everyone seemed to enjoy a nice group activity, to say the least.

Tuesday and Wednesday art therapy was open studio. Many of the patients wanted to continue on pieces they had already started, including their adorable birdhouses. I've noticed the popularity of the birdhouses is rather significant. I would imagine it's because they are these special objects that the patients can take ownership of. And they make lovely gifts. One patient is adamant about her plan to give her birdhouse to her granddaughter. The fact that she had the ability in the Bridges ward to create something if substance to give to someone she loves certainly improves her mood. This aspect of art therapy really hits home for me, because my grandmother did something very similar when she was very sick in the hospital. She created this lovely frame as a gift:

That picture of me and my brother was added much later. 

No, it doesn't contain any deep symbolism or metaphor. No, it's not a groundbreaking work of art that exposed any sort of hidden talent. But it is her creation, and I've noticed that (with any piece of art) having ownership of something is simply enough for patients.

Anyway, I digress. On Wednesday at Bridges, Ms. Endreson and I gave the Value Game a few more tests. They were certainly more casual than the previous sessions. We approached two patients with the images and got very different responses. The first patient--we can call her R--has severe dementia. This was the first time we tried the game on a patient who wasn't higher functioning. As expected, R could not follow the directions we gave her to pick out her favorites, but she did spend quite a while staring at all the images and picking out a few here and there that she found interesting. At the very least, the images sparked some memories for her and started conversation.

The second patient we worked with, patient J, had just been admitted and was very disgruntled. She expressed a lot of dissatisfaction with a few of the images; she didn't like the way people looked in certain pictures or couldn't understand "what was going on." Just like with R, J did not follow the "rules," but she started conversation and showed a bit of interests.

Hopefully I will be able to give the value game a few more tests when I head back to Tucson....tomorrow actually! I have three more weeks left and I'll be in Tucson each week on Thursday and Friday. I'm sure I'll meet some new patients tomorrow! And I promise to be more diligent with my blog posts this week. Expect to see more tomorrow :)

Until then!
Tia