By L. Pedar. Southern University, New Orleans.

Thus cheap minocin 50mg amex virus and antibiotics, I encouraged them to see the pot of gold as the prestige generic minocin 50mg on-line antibiotics that cover pseudomonas, re- spect, and freedom that money affords. The processing questions in this session revolved around the issue "how does it feel to daydream about un- limited admiration, self-esteem, and independence? In this session I placed importance on the opposition of autonomy and dependency reactions, or what Yalom described this way: "To attain what I really want, I must change" (1985, p. In this phase of the group process we explored the dependency of institutionalized living, discussed the group members’ com- monalities and differences, and managed the maladaptive interactions. In the end, I used the verbiage of the drawing as the question about change: "What is a new outlook on life that you have adopted? For this session the group was offered copious amounts of plasticene clay and a single piece of white cardboard and instructed to "create a group 248 Group Therapy Illustrated 6. As with all here-and-now interactions, the primary focus is the imme- diate relationships and interactions of the group members. In combining this approach with art therapy, one creates a visual experience that has the ability to break through the well-honed verbal defenses acquired over a lifetime. In this way, each individual’s three-dimensional work revealed his or her internal concerns, issues, and needs before feedback and discussion even began. One male with significant organic deficits metaphorically illustrated his need for structure and support as he spent the majority of the group session forming a foundation out of his clay. When his peers pointed out to him that the cardboard paper would be the base, he abandoned the underpin- ning he had so carefully worked on and created the walls for the house. Another member, a chronic schizophrenic, formed the fencing that runs the length of the project, symbolizing his need for boundaries that function to contain as well as protect. A regressive schizophrenic fashioned three bears and placed them in front of the home, while a developmentally de- layed young adult superfluously fantasized about living with Goldilocks and cooking meals together. The leader of the group produced the items meant for transportation, while the coleader anxiously instructed others in the finishing of the de- 249 The Practice of Art Therapy tails. Ultimately, he focused his attention on the house’s roof and the pro- fuse smoke that metaphorically symbolized his inner tension. I took these observations into consideration and wove them into the di- alogue to foster illumination of the process. Consequently, my questions revolved around how the group made decisions ("who were the leaders of the group project today? In a case in which I worked with female preteens and adolescents the initial project began as individual pursuits (simplistic cooperative tasks) and ended one and one half months later with my directing them to take all of their two- and three-dimensional items and create "a group sculp- ture. For ease of interpretation I have chosen to focus on one child’s verbal and nonverbal productions. This 13-year-old client (whom I will call Sarah) has a tendency to express herself through fantasy production and obsessional rumination. When frustrated, she exhibits aggressive outbursts that are accompanied by infantile traits such as baby talk and tantrums. Sarah’s social relationships are marred by her passive-dependency: She dis- regards the personal boundaries of others in her childlike self-absorption. Sarah had been a frequent participant in my art therapy groups and thus was familiar with the framework of task introduction, completion, and feedback. However, the processing of the here-and-now interactions was relatively new to all of the girls; therefore, I made a conscious effort to ease their anxiety about the intensified communications. One of the first directives I gave was a pass-around assignment (refer to Chapter 4 for specific information). The group members were inherently familiar with this exercise, and it was one they enjoyed. Although others freely copied her technique of crumpling the tissue paper before applying it, they singled Sarah out for ridicule when her title mimicked another’s. This form of communication was one that Sarah was ultimately comfortable with, as the scenario pro- 250 Group Therapy Illustrated 6. However, as Sarah drew a self-portrait and added her dream boyfriend, Harry Potter, these internal fantasy produc- tions became overwhelming, and she began to mutter her desires aloud. When her peers derided her verbalizations, she began to furiously add items to her drawing.

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Other approaches to the problem have been more limited and functional: the use of cold or frozen gel packs held in special vests discount minocin 50 mg otc antibiotics for pink eye, so that working or undertaking other activities in hot conditions does not raise your body temperature to any great degree purchase minocin 50mg visa antibiotics livestock. Unfortunately, there is no easy solution, as the loss of balance is basically a problem caused by damage to part of the brain – the ‘cerebellum’ (or its pathways in the brain stem). Other factors can compound the problem, such as spasticity or weakness in the legs. After a while you will probably adjust to some of your problems and, although you may wish to keep going for as long as possible, the most obvious way of helping yourself is by using walking aids (perhaps a stick or crutches); at least these will help you avoid some painful falls and also signal to others that you are not drunk, but that you have some physical problems with movement. Sometimes other sensations, like feeling sick (‘nausea’), are associated with vertigo. Dizziness from loss of balance is also related to damage to the cerebellum (or brain stem), the nerve connections to it from the middle ear, or within what is called the ‘vestibular system of the inner ear’. In almost all cases in MS, the dizziness goes away of its own accord after a few hours or days. Dizziness can be helped by some drugs: • Steroids (particularly intravenous methylprednisolone) can help when the dizziness is both acute and persistent. There is one other apparently strange method that people use: when the vertigo feels worse on moving, exaggerating those movements can sometimes help. Deliberately falling on to a bed (or other very soft surface) on your left and right side, and backwards, three times each way, may ‘rebalance’ the vestibular system, at least temporarily. You may also find that there is a particular position that lessens the vertigo, such as lying on one side rather than another. Pain For many years MS was considered, medically, to be a painless disease, probably because the process of demyelination was thought in itself not to be painful. However, people with MS themselves have known for many years that specific symptoms could cause considerable pain, and this is now being recognized. Although pain is more common amongst people with severe MS, and SENSATIONS AND PAIN 73 amongst older people with the disease, almost everyone will experience some kind of pain at some point. Trigeminal neuralgia Trigeminal neuralgia is a very acute knife-like pain, usually in one cheek, and sometimes over one eye, but it rarely affects both sides of the face. Drug treatment usually includes carbamazepine (Tegretol), although this drug does produce side effects, which may be a problem. The primary side effect is sleepiness, so the drug may be started in low doses and then given in higher doses until the pain is controlled. It is also possible that phenytoin, which has a milder action than that of carbamazepine, may be used, or less commonly, baclofen, which is usually given for spasticity. Another approach is to try and block the inflammation; if this is associated with a relapse, steroid therapy is given. If there is a continual problem of trigeminal neuralgia linked to several relapses, then a prostaglandin analogue called misoprostal (Cytotec) can bring relief. In some cases, various surgical operations, including the ‘gamma knife’, can destroy the relevant nerve pathways. Even if the trigeminal neuralgia reappears, as it can do, then the treatment can be started again, and it will almost certainly reduce the pain. Jaw pain There are other types of pain that may affect the facial area, which may not be linked to particular forms of myelin damage: temporomandibular joint (TMJ) pain affects the jaw area, or you may get more general migraine or tension headaches. Drug therapy can help counteract this pain, but in each case will be dependent on a careful investigation of the cause of the pain, and particularly the extent to which it appears to be linked to the MS, or to something else. Pain from unusual posture and walking patterns Pain from poor posture when sitting or lying, and from unusual walking patterns, is quite common. In most cases the pain does not result from the neurological damage of MS, but from its effects on movement. In fact one of the most common kinds of pain treated by neurologists in relation to MS is low back pain, often arising from an abnormal sitting posture or from a way of walking that has developed as a result of damage to the control of leg muscles. This may result in a pinched 74 MANAGING YOUR MULTIPLE SCLEROSIS nerve from ‘slipped discs’, or other back problems, which can also be caused by unusual turning or bending motions. So it is important to pay careful attention to how you sit and how you move in order to lessen such difficulties. You may need to seek advice from a physiotherapist in relation to both posture and movement.

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However cheap minocin 50 mg amex antibiotics for uti types, as Sarah drew a self-portrait and added her dream boyfriend minocin 50mg amex bacteria quotes, Harry Potter, these internal fantasy produc- tions became overwhelming, and she began to mutter her desires aloud. When her peers derided her verbalizations, she began to furiously add items to her drawing. She began by adding a series of five clouds, and then to the left of the self-portrait she drew two more suns. Her invented realities (whether fantastical, behaviorally isolative, or verbally affected) provided an escape from her ineffective attempts to cope with social interaction, pressures, and conflicts. When we began to process the here-and-now interactions (with ques- tions like, "can you think of an example when you judged someone in group today? Discussions on their immediate communication had not been managed with such depth, and the group began to grow restless. As a way to integrate what they had ex- perienced and to offer support for the group’s effort, I asked the members to complete the following sentence: "Today I was proud of __________. Kramer describes this regressive use of the art mate- rials as "spilling, splashing, pounding; destructive behavior leading to loss of control" (p. Prior to the completion of these boxes, Sarah had entered the group ses- sion in a restless mood. It took her many moments to settle into her seat and even longer to begin the project. She initially chose the box on the left and painted it in the brightest pink available. After she swept the color across the box, immersed in the process, she added green polka dots, which 252 Group Therapy Illustrated 6. It sloshed out and around her project as her excitement spiraled upward until she abandoned the paint brush and began to smear the colors into one mass of brownish black. The only thing to return her to a state of calm would be the removal of the paint supplies. This tangible intervention served to calm Sarah’s frenzied behavior, and I offered her markers and the choice of a sec- ond box. As her motions gained momen- tum, she again reverted into a chaotic loss of control, and since the marker ink would not dry on the plastic surface of her box, she touched the box to the tip of her nose (leaving a dot) and placed her fingertips on strategic parts of her face and arms. Some of the girls stared in dismay; others laughed, which served as encouragement; and oth- ers berated her for her immaturity. These reactions did little to contain Sarah’s anxiety and instead provided reinforcement for her continued re- gression. I removed the second box and instructed her to clean up her area and wash her hands and face. This shift from self-absorption to performing concrete and tangible tasks offered Sarah the time she needed to coalesce, return to the group, and join the discussion phase. However, rather than focusing the discussion on Sarah’s metaphorical communication—something she would have no doubt enjoyed, as any at- tention is good attention—I elected to ameliorate the anxiety by focusing 253 The Practice of Art Therapy on relationship goals. Consequently, I asked each group member to re- spond to a closure directive in an orderly fashion. The directives were "Name one thing you are going to work on so that you can improve your relationships in future groups" and "Name one thing that you accom- plished in group that was good. Through the im- plementation of structured directives and media, I intentionally provided boundaries that I hoped would contain any residual anxiety. Additionally, before beginning group I asked each member to repeat her relationship goal of the previous week and charged each with working toward that ob- jective in this group. In this session the directive was to draw three lines on the cardboard tube (Figure 6. In the feedback stage of the group Sarah’s peers praised, and thus reinforced, behavior that was not regressive. Through the groups verbal statements Sarah was able to find a measure of self-esteem and regard through belonging to a larger group.

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