Denise Ramos

May 18, 2017

OTA 102

Character Paper
The client that I will be developing a treatment plan for is Daisy Randone that stars in
the book/movie Girl, Interrupted. Daisy has been diagnosed with the eating disorder of
Bulimia Nervosa and with an anxiety disorder of Obsessive- Compulsive Disorder. Each of these
diagnoses are impacting her ability to engage in a meaningful life within society. The eating
disorder of Bulimia Nervosa is described in the 19th edition of the Merck Manuel as recurrent
episodes of binge eating followed by some form of excessive compensatory behavior such as
purging in the form of self-induced vomiting, laxative, diuretic abuse or fasting (Porter &
Kaplan, The Merck Manuel, 2011). There were a few signs that Daisy displayed in order to be
diagnosed with Bulimia Nervosa, for example Daisy has frequent episodes of binge eating
where she consumes a whole rotisserie chicken in one sitting which can normally feed about
three to four individuals. She only eats inside of her room while she is alone, she has stated that
she prefers to eat alone and not have anyone watching her. After she eats she purges with the
use of laxatives which she obtains by trading the medications that were administered to her
with other patients who are being administered laxatives. Daisy is of normal weight and
consistently compares her weight and looks to other individuals such as movie stars and limits
herself to eating only chicken, she is obsessed with the chicken that her father brings to her
from his deli. Daisy also displays signs of Obsessive Compulsive Disorder which is described in
the Merck Manuel as anxiety provoking ideas, images or impulses and by urges to do
something that will lesion the anxiety. Daisys OCD stems from her obsession with her
appearance, her anxiety of gaining weight and being fat drives her to purge the food that she is
consuming so that she will be able achieve/maintain a desired weight, her obsession with her
appearance also drives her to inflict self-injury of cutting her wrists . She is also obsessed with
the rotisserie chicken that her father brings her and eats only that chicken the same way each
time. The chicken is placed on the same white plate, she neatly cleans off the bones to the
chicken and sorts the bones on the plate in a certain manner. After she consumes the entire
chicken her obsession with the chicken leads her to saves the bones underneath her bed, she
believes that by the time she has saved 14 chickens caucuses it will be time for her to go home
The treatment sessions for Daisy have been planned by using the frame of reference
known as the Model of Human Occupation. This theory is a system based practice model that
looks as humans as an open system, in which one change that is made can change the whole
system. MOHO states that humans constantly interact and are affected by their environments
through the process of taking in, processing and responding to information (Wagenfeld , 2016).
The treatment sessions for Daisy will utilize MOHOs interventional strategy of restoration that
focuses on her thought process and motivation when making choices which is known as
Volition and helping her to develop habits which is referred to as habituation and it looks at her
performance within the environment. We will be encouraging her and helping her to develop
strategies on how to change certain actions or thoughts which will help her to develop healthy
habits and will also help with achieving her short term and long term goals that have been
developed in a collaborate effort between Daisy and multiple health care practitioners.
Through my interview with Daisy I have learned about her relationships with her family
and friends and about the life she envisions for herself once she is released from the psychiatric
hospital that she has voluntarily admitted herself to. Daisy is a 20 year old female that admits
herself to a psychiatric hospital every year before Thanksgiving, her total length of stay is
usually about three months. She has a hard time making friends and is not very sociable she
comes off as agitated when other patients living in the psychiatric hospital try to approach.
Daisy spends most of her day at the psychiatric hospital isolated in her room, and she does not
like for anyone to visit her room however there is only one individual that she allows to enter
her room. Her appearance is important to her she enjoys keeping up with her appearance such
as styling her hair and exercising which is one of the activities she takes part in often at the
psychiatric hospital. She loves butterflies and has plans to decorate the apartment that she will
be moving in to for the first time with different types of butterflies. She is excited about moving
into her own apartment since this will be the first time that she will be living on her own, she
also loves cats and plans to get a cat. She has a close relationship with her father who visits her
often he supports her emotionally and financially and she only eats chicken specifically only the
rotisserie chicken from her fathers deli, she believes that any other type of food makes her sick
and cause her to throw up. Through a collaborated effort between Daisy and few health care
practitioners which includes her occupational therapist three short term goals have been
identified and one long term goal has been established. Her ultimate long term goal is to break
the routine of admitting herself to the psychiatric hospital every year by managing to live
independently for a full year. In order to reach this long term goal three short term goals have
been identified, the first goal is Daisy will be able to plan and prepare healthy and balanced
meals that incorporated her favorite rotisserie chicken so that she is able to prepare these
meals when living independently. The second goal is Daisy will work on improving her self-
image and self-esteem which will help her to overcome issues she encounters when living
independently. The last goal is Daisy will participate in social building activities that will help her
develop meaning full relationships so that she does not isolate herself when living
independently. These goals will help her to develop habits that will help her to be successful
when living independently, although she has a great relationship with her father the goals set
will help her to develop skills so that she does not have to relay completely only on her fathers
support.
 The treatment sessions will take place at McLean psychiatric hospital, which is the
psychiatric hospital that she has admitted herself to. The sessions will be held once a week for
the following three weeks and will be 50 minutes long.
The treatment sessions will go as follows
Session 1 of 3 Meal Planning
Goal: Daisy will be able to plan and prepare for healthy and balanced meals that incorporated
her favorite rotisserie chicken so that she is able to prepare these meals when living
independently.

Format:
10 minutes: Discuss with Daisy the importance planning and implementing healthy & balanced
means, discuss any fears she has with consuming certain types of foods
15 minutes: Activity #1 Creating a Stop light
20 minutes: Activity #2 Plan and prepare a meal
5 minutes: Close the treatment session by reviewing what she learned, she will be asked open
ended questions regarding her confidence level with meal planning,
Activity:
Activity #1 For the first activity Daisy will create a stop light which will be hung on her
refrigerator when she moves into her apartment and will help her to stay on track with the
meals she plans for. For this activity she will draw a stop light that contains the colors red,
yellow and green. Next to the red light she will identify signs or actions that well help her to
realize that she is back to her negative eating habits and not sticking to eating the balanced
meals that she is preparing. For example some of the signs that can be listed next to the red
light are signs or actions that she is currently displaying such as eating only her safe food of
chicken, purging, isolating herself, and not following a healthy meal plan. Next to the yellow
light she will identify signs or actions that can lead to her ending up in the red zone of falling
back in to her negative eating habits. For example some of the signs that can be listed are
anxiety and obsessive about food and gaining weight. Lastly next to the green light she will
identify signs or actions that display healthy eating habits. For example following the meal plans
she prepared, incorporating a balance of food into her diet and not obsessing over food.
Activity #2 For the second activity Daisy will be given a grocery list that contains examples of
different healthy foods that she can incorporate in to the meal plans. Using the grocery list
Daisy will put together 2 different balanced meals plans and snacks that she could prepare
when living on her own. Then she participate in planning and preparing the meal of a chicken
bowl. She will use the rotisserie chicken she enjoys eating and combine it with brown rice and
her choice of veggies.
 Session 2 of 3 Improving Self Image and Self Esteem
Goal: Daisy will work on improving her self-image and self-esteem which will help her to
overcome issues she encounters when living independently

Format:
10 minutes: Read to Daisy motivational quotes about being unique, discuss with her negative
words and actions that play in role in lowing self-esteem and discuss benefits of having a
positive self-esteem and how it helps with overcoming situations she could possible encounter
in life.
15 minutes: Create I am positive affirmation box
15 minutes: Practice a new hair style
10 minutes: Discuss with Daisy her feelings regarding activities that were completed, ask her to
describe how she will use the positive affirmation box.

Activity:
Activity #1 For this activity Daisy will be creating a positive affirmation box. She will first be
given a box and using coloring materials she will be asked to write on the box I AM DAISY.
Then she will be given magazines and she will be asked to select pictures or words that she
would like to use from the magazines to decorate the outside of the box. Once her box is
complete she will be given strips of paper and will be asked to write down positive qualities
about herself. Once she has finished writing down her positive qualities she will be asked to say
them out loud and place the strip into the box that she decorated. She will be encouraged to
read these qualities when she is feeling down and also be encouraged to update the box with
new qualities she loves about herself as she discovers them.
Activity #2 Since Daisy enjoys styling her hair which she often wears down and adds curls to
the tips of her hair she will learn how to style he hair in a new way. She will be taught how to
add a new curl to her hair by doing a simple braid to her hair. This will help her with feeling
good about her appearance, this could possible turn out to be a new favorite hairstyle for her.

Session 3 of 3 Social Building

Goal: Daisy will participate in social building activities that will help her develop meaning full
relationships so that she does not isolate herself when living independently
*This session will be scheduled during time when the exercise class takes place

Format:
10 Minutes: Discuss with Daisy habits/social cues that can interfere with individuals being able
to forming a relationships
15 Minutes: Activity #1 Roll the Dice
20 Minutes: Activity #2 Exercise class
5 Minutes: Have Daisy discuss what is something new she learned from a conversation she had
with another patient after the exercise class, have Daisy discuss any fears she had with starting
up a conversation.
Activity:
Activity #1 This activity will help Daisy to feel comfortable sharing information about herself.
For this activity there were be a set of dice and a page that lists multiple questions such as my
favorite movie is, my favorite hobby is, the most important item in my life is, my dream job is
ect Daisy will begin the game by rolling the dice, whatever number the dice rolls she will then
have to answer the question next to that number. I will them ask her another open ended
question to help her to elaborate on answers that are short in order to help her fell comfortable
having a conversation. I will then take a turn and roll the dice and answer a questions she will
be encouraged to ask me any additional questions pertaining to my answer.
Activity #2 For this activity Daisy will attend the last 20 minutes of the exercise class that she
enjoys going too, once the class has finished or during any water breaks she is given she will be
encouraged to initiate a conversation with an individual she does not usually interact with, the
intention of the conversation is to learn something new about this individual. Once the class is
over she will then share with me information she learned about the individual had a
conversation with as well as any fears she had during this social interaction.

Daisy will be encouraged to continue with 6 more treatment sessions, the sessions will
be structured around helping her to improve her meal preparation and planning skills, building
her self-esteem and improving her social skills. It is being recommended that she continue
treatment in order for her to feel confident in these areas when it is time for her to live on her
own. If by the end of the 3 sessions Daisy does not feel confident with the skills she have been
taught the chances of her returning to the psychiatric hospital are high therefore we want to
ensure she is feeling confident and this is why an additional 6 more treatment session are being
recommended. Education will be provided to her father in order for him to be a tool in helping
her to become more independent, while we will encourage them to keep a continued close
relationship we want to avoid her father handling situations that she is capable of handling.
 References

Porter, R. S., & Kaplan, J. L. (2011). The Merck Manuel. Whitehouse Station: Merck Sharp & Dohme Corp.

Wagenfeld , A. (2016). Foundations of Theory and Practice for the Occupational Therapy Assistant.
Philadelphia: Wolter Kluwer.