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Hallowsgate Hospital,
1507 Slaughters Creek,
Cabin Creek, WV



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 Moira Hanley

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Moira Hanley

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Posts : 60
RP Reward Points : 28
Join date : 2012-09-03
Age : 46

PostSubject: Moira Hanley   Mon Sep 03, 2012 1:53 am



HANLEY, MOIRA

Additional notes made by Dr. Eugene L. Hicks.


      D.O.B: 18/01/1971
      AGE: 41
      GENDER: F
      STREET ADDRESS: Appalachian Behavioral Healthcare 100 Hospital Drive
      TOWN/CITY: Athens
      STATE: Ohio
      HEIGHT: 5’7”
      WEIGHT: 130lbs
      ETHNICITY: Caucasian
      DISTINGUISHING MARKS: My ears are pierced although I haven’t been allowed jewelry for almost twenty years. I have scars on my wrists from repeatedly being strapped to the table and left for hours on end and the insides of my arms might as well belong to those of a junkie.


_____________________________________
Medical History

Do you have any ongoing medical issues for which you require treatment or medication?:

I have no ongoing medical issues.

Are you aware of any allergies? If so, please list allergy, age of onset and any medications or treatments you require or receive:

I have no allergies.

Have you had any surgeries or invasive procedures in the past? If yes, please list reason and approximate age of procedure:

I had a hysterectomy at forty after “complications” giving birth.

Ms. Hanley did have complications after giving birth to her son, Alistair. The procedure was medically necessary to prevent infection and to ensure that she suffered no further pain.

Do you take any medications or supplements daily? Do you follow any treatment plans? Please list medications or treatments, and reasons below:

I take a daily vitamin as well as the concoction of medications given to me by Dr. Eugene L. Hicks.

Ms. Hanley is on diazepam twice daily by mouth but we have repeatedly had to administer her medications intravenously.

Do you use tobacco, consume alcohol, or use any other drugs including street drugs and/or prescription medications not prescribed to you? If yes, please list number of packs a day, number of drinks a day, and/or drugs consumed below:

I smoke maybe half a pack a day if the doctors are feeling generous. Cigarettes aren’t only a commodity in prison. I haven’t touched a drop of alcohol since I was last released at twenty-nine.

_____________________________________
Psychiatric Screening

Please describe, to the best of your ability, your emotional and mental state of wellbeing:

Dr. Eugene L. Hicks will likely be filling in this section but I’ll save him the trouble and do it myself. I know both him and myself well enough to know exactly what he plans to say. He will write about how I’m incapable of guilt or remorse and that I feel no sympathy toward my fellow woman. Dr. Hicks will say that I can be “disruptive” when ignored and “violent” when challenged. He’ll go on to say that I am selfish, cruel, manipulative, cold, and an all around horrible human being. Any friendliness that I display toward others is false and a blatant attempt to gain favors. He’ll make sure the reader of this application is aware that I see people as toys or puppets to be used and disposed of once I am finished with them. At some point he will make mention of the fact that I use my sexuality to influence others and that I don’t see gender as a limitation. After that he’ll add that I have attempted to seduce him and will allude to the incident that happened late last year. Dr. Hicks will say that I am a compulsive liar and that nothing I say can be trusted.

While it is true that Ms. Hanley is a compulsive liar everything she has written above is true, even if incomplete. She shows no signs of genuine guilt or remorse for harming others and will use superficial charm to get other patients and staff to trust her. She has made attempts to seduce both male and female members of staff and this has lead to some skepticism among other professionals about her claims made earlier this year. She has history of violence toward those at the hospital, both patients and staff, and had repeatedly required us to use force and chemical restraints in order to subdue her.

What Ms. Hanley has left out of her self assessment were her tendencies toward hoarding. I use the term lightly for it is not quite the obsessive trait but she shows some similar characteristics. Ms. Hanley becomes extremely possessive of anything designated as “hers” no matter what value is placed on the object in question. She keeps her room meticulously organized and will become verbally abusive with the orderlies and nurses if they move any of her possessions. Should anyone take anything that belongs to her she becomes obsessive over the item and is restless until the item is returned. To give an example, Ms. Hanley had a roommate for a brief period of her stay with us. The young woman saw a book on her nightstand and picked it up to look through it. Ms. Hanley caught her with the book and assaulted her, causing her roommate to spend up several days in the medical ward for various injuries. Ms. Hanley repeatedly accused the woman of trying to steal her possessions and that if we would permit her to have a lock box she wouldn’t have to worry so much.

After review of Ms. Hanley’s files and history I feel that the possessiveness of objects and items comes directly from her childhood in the group home.


Have you been diagnosed with any psychiatric or psychological ailments? Please list any diagnoses below, and the treatments or medications prescribed to you. Please include name of medications, dosage, and number of doses per day:

On the books I have been diagnosed with Antisocial Personality Disorder and I take medicine twice a day to “manage me.”
Ms. Hanley has been diagnosed with Antisocial Personality Disorder and she takes 5mg of diazepam twice a day. I have been hesitant to diagnose her with Obsessive Compulsive Disorder so I leave that up to the discretion of her new doctor.

I feel that it is important to note that while living at the children’s home Ms. Hanley was diagnosed with Conduct Disorder at age fourteen. Her files indicate that she was violent toward other children and animals, destroyed property, and remained disconnected from her peers. She would blame other children for incidents she caused, playing innocent with the adults who got involved.


Have you ever been hospitalized or referred to regular outpatient care due to these ailments or associated incidents? If so, please note where, and at roughly what age:

I have been in and out of hospitals around Ohio since I was nineteen but I’ve been a prisoner in some way my entire life. I started in Northwest Ohio Psychiatric Hospital and but was released at twenty-two. I was readmitted to Northwest at twenty-four but released at twenty-six after the doctor felt I would do well with outpatient therapy and if I stayed on medication. After too many ups and downs the doctor felt that I was too much of a serious case to be left on the streets and I was once again sent to Northwest. I was transferred to Appalachian Behavioral at thirty-four and have been there ever since.

Ms. Hanley was admitted at nineteen after a violent assault on her college roommate. She was charged with assault but after her lawyer got a hold of her Conduct Disorder diagnosis he used it to get her treatment rather than jail time. Ms. Hanley spent longer in the hospital than court ordered after her doctor diagnosed her with Antisocial Personality Disorder and was released when he felt that she had rehabilitated enough to live with therapy and medication. Ms. Hanley has reported that she never took the medication prescribed and made skipped much of her therapy. She was readmitted to Northwest after another assault on a coworker. This attack was brought on by the obsessive nature Ms. Hanley has with personal possessions. She was arrested and the hospital was contacted. With a new doctor they another attempt in outpatient car but with even less success. Ms. Hanley dropped off the map for a close to six months and her safety, as well as those she came in contact with, was a deep concern of ours. Ms. Hanley was once again picked up by the police at admitted full time to Northwest until her doctors were confident she was capable of functioning in society.

She was transferred to Appalachian Behavioral some years later when progress wasn’t being made. Her doctor, as well as myself, felt that she needed a change and that her case should be looked at with fresh eyes. She had remained with us since then but again little progress has been made. We feel that perhaps the complete change of location might be what Ms. Hanley needs.


How have these ailments affected you and your life? Are there any major life instances you feel have been directly affected by these ailments, such as suicide attempts, criminal activities, etc?:

I’m the sociopath that cries wolf. No one believes me when something is actually going wrong. Dr. Hicks and the staff don’t believe that I was raped by one of the nurses on the ward. They think I had consensual sex with him and that I got knocked up for sympathy points or get off meds for a while. But I didn’t and now I’m being transferred out of this place so I’ll stop talking about it and making them look bad in front of their board of directors.

There has been a full investigation into Ms. Hanley’s claims and the nurse in question was disciplined for misconduct with a patient. Ms. Hanley claimed that one night after lights out regular male nurses came in to her room and gave her a sedative. She woke up to him covering her back up and she felt as if she had been violated. We were not informed of this incident until after the second, where she claimed to have been physically restrained and sexually assaulted. We spoke to nurse and he admitted to them having consensual sex. He said that she had told him to come back to her room and that she was enjoyed being strapped down. Witnesses of their interactions during the day report Ms. Hanley flirting with him and some even have said that she tried to kiss him.

Ms. Hanley’s son was placed in foster care.


What is your social life like? Do you have many friends or relationships? How are your family relationships?:

I’ve made several friends at Appalachian, with both the staff and the patients. The guy who licks the walls is really sweet and the nymphomaniac and I get along very well.

It is true that Ms. Hanley does have several friends here with us although I do not believe that she actually feels any sort of connection to them. She has made friends with people she can exploit.

Do you believe your life circumstances have contributed to any ailments? If so, what circumstances, and why do you feel they have contributed?:

No.

I fully believe that Ms. Hanley’s life circumstances have contributed to her ailments. Having grown up in foster care before being sent to Windwood Farms Children’s Home at age eight has denied her the loving affection of parents and family, leaving her isolated and alone. I feel that she may have been a completely different woman if it weren’t for her upbringing.

If you could change one past event that has happened to you, what would it be, and why?:

I would have been smarter about attacking that girl in college. If I had, I might still be a free woman.

Do you wish to rehabilitate from your ailment(s)? If so, how do you feel this would best be accomplished?:

I never will so what’s the point of this question? I have never had my own home or even a bank account in my name. I’ve been in shelters, on the couches of people I met at the bar, and in hotels when I can afford it. I have never had a life outside of a cell so why start wishing for it now?

_____________________________________
Environmental History

Where did you grow up? Please list the location(s) and describe what it was like growing up there:

Ms. Hanley was born in Cleveland, Ohio to an teenage mother named Patricia Hanley. She gave Ms. Hanley up for adoption but after several couples changed their minds she was set to live in a children’s home. Ms. Hanley remained in the home until she was eighteen where she went on to attend college on a scholarship. Shortly into her freshman year she assaulted her roommate and it set her on the path to where she is now.

What was your family life like? Did you spend much time with your parents? Do you have any siblings? If so, what are your relationships like?:

Ms. Hanley has no relationship with her biological family.

What was school like? Did you have any problems? Did you enjoy school? What were your grades like?:

According to records Ms. Hanley’s grades were consistently average, not excelling in any one area specifically. After speaking with the home I found out that she didn’t much care for school.

Did you engage in any extracurricular activities, such as academic, artistic, or sporting clubs?:

Ms. Hanley was fond of music in school and played the piano in her spare time.

What was work like? Did you have any problems? Did you enjoy your work? What were your coworker relationships like?:

I had gone to school for business, although I didn’t finish, and once I got out of Northwest there was no way I was going back full time. I had almost nothing and took the first job I could get. I waitressed for a while at a diner in Cleveland but that didn’t last. From there I went to work for a guy I met answering the phone at his home business but just like before that fell through after a few disagreements. The best paying job I landed was in a department store but after a fight with a coworker I ended up back in the hospital. Work and I have never been the best bedfellows.

Have you ever been convicted of a crime or misdemeanour? If yes, please explain, list conviction, and list any sentences associated with convictions:

I’ve had a number of assault charges brought against me but have only been on trial for one. I was found guilty but instead of going to jail they had me committed.

Lastly, please tell us about yourself. How do you feel about yourself and what you have done with your life? If you have committed crimes, how do you feel about those now? What are your hopes for the future?:

I guess it’s impossible for me to be a victim. As the abuser I can’t be hurt by those around me. I was attacked and all the bastard got was a slap on the wrist and a few weeks cleaning bedpans. Thanks to him I went through nine months of hell and now there’s a kid crawling around out there with a rapist for a father and a sociopath for a mother. I’m not getting out of here any time soon. Simply trading one prison for another.

_____________________________________
Out of Character Section

What are they not telling us? What secrets do they have to hide? What back story are we not hearing? This is where you can tell us all the things your character wouldn't put on an application, or others don't know.:

Moira was actually raped by the orderly but the staff at the hospital refused to believe her.

Your Nickname: Nebby
Your Chatango Screen Name: TinyNebula
Your Character's Playby: Charlotte Gainsbourg
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Havoc
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Posts : 45
RP Reward Points : 18
Join date : 2012-07-19
Age : 27

PostSubject: Re: Moira Hanley   Wed Sep 05, 2012 3:40 am



________________________________________________________________________

HANLEY, MOIRA


    DIAGNOSIS(ES): Anti-Social Personality Disorder (Possible OCD)
    WARD: Female
    DORMITORY: 03
    BED: 01
    THERAPIST: Dr. Benjamin Graham


________________________________________________________________________

OOC - BEFORE YOU BEGIN PLAY

Before you begin play, you must complete the few steps listed below:

  • Sign up for the Hallowsgate Patient membergroup HERE.
  • Sign up for the who plays who list HERE.
  • Sign up your play-by on the face claim HERE.


Don't forget to familiarise yourself with the pertinent patient handbooks and other in character information that you'll need to reference for play, and have fun!
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Finn McAlister

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RP Reward Points : 79
Join date : 2012-06-25
Age : 39

PostSubject: Re: Moira Hanley   Mon Oct 22, 2012 10:58 pm

THERAPY NOTES
_____________________________________

    Date:October 20, 2012
    Attending: Dr. Benjamin Graham
    Session With: Dr. Finn McAlister
    Session: Group Therapy


Therapy Notes: The intention for this session was to introduce the idea of the subconscious and how our minds tend to cover up things we wish to repress from our memory. I instructed the group to introduce themselves and state one thing they enjoyed about Hallowsgate Hospital. I then lead into an imagination exercise:

Quote :
You are walking down a road.... As you are walking, you see a house. Look at it. Notice its details.... Walk towards it. What do you notice about it?.... You start to walk around the house, looking at it as you walk.... Now you are halfway around. Notice the details of the house as you continue to walk around it.... Now you come back to where you were when you started.... As you walked around the house, you noticed a way to get in. Now go into the house.... What do you see?.... Explore the house, what's inside?.... As you were exploring, you noticed a secret door leading to a secret room. Go inside that room. What do you see?.... Now leave the secret room and go back into the main part of the house.... Now leave the house. As you are walking away from it, you look back at it one more time....what do you see?"

I proceeded to ask each patient what they imagined. Moira Hanley spun a tale of simple house, and the inside of the secret room contained psychiatric treatment equipment home to a mad scientist. My interpretation was that she feared the treatment we were providing for her, and she stated that she was not fearful of this, that she is just meant to be crazy, in whatever way it comes out.

After the incident in the North Wing, I do believe she is fearful of psychiatric treatment.

Additional: I have a hard time believing the things Moira Hanley says, as she has been known to lie in the past.

Follow-Up: Monitor her actions, touch on the incident in the North Wing and the things that she states that happened and how this could feed into her fear.


_____________________________________________________

I'll never wear your broken crown.

But in this twilight how dare you speak of grace?
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Finn McAlister

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Age : 39

PostSubject: Re: Moira Hanley   Mon Dec 03, 2012 3:11 am

THERAPY NOTES
_____________________________________

    Date:December 2, 2012
    Attending: Dr. Benjamin Graham
    Session With: Dr. Finn McAlister
    Session: Group Therapy


Therapy Notes: Today’s session was low key and involved helping Hallowsgate look more festive for the holidays. This involved setting up several Christmas trees in the dining room, decorating them and ending in Peppermint hot chocolate and gingerbread men. Each of the patients entered calmly, and I asked for each to introduce themselves starting with Moira who did not comply, however everyone else did state their name. I split the group into twos, with Janine Zeegar and Henry McAuliffe into putting up one tree near the door, Mallory Bates and Harlow Jacobs putting up the tree near the kitchen, and Moira Hanley and Myself separating garland to decorate the dining hall. Moira Hanley refused to get up from her seat to assist, and Dr. Benjamin Graham, Moira’s attending stepped in to assist. I then went about sorting ornaments for the group, as well as lights, divvying them up between the two groups setting up the tree. Janine and Henry worked well together, and Henry seemed in somewhat decent spirits. He stated that this activity was better than sitting in his room, or talking in a circle with a bunch of crazies. Janine also seemed in high spirits, especially when she realized we would be decorating for the holidays. During this discussion with Henry and Janine, an outburst occurred between Harlow Jacobs and Mallory Bates. As I did not see the altercation directly, I cannot place blame, however, Mallory did shove the lights at Harlow and into his chest. From my understanding, Harlow believed Mallory was attempting to take the lights from him, and expressed his frustration in a loud outburst. Harlow exclaimed that Mallory tried to take the lights, and then stated that Mallory threw the lights at him, and called him a name. However, because I did not witness the altercation face to face, I cannot back up or deny this. Due to Harlow's delivery and outburst, however, he did face punishment after a warning of calming down and working as a team, in which he refused to pick up the lights and help. Harlow also stated that he didn't like Christmas, and he didn't want to put together the stupid tree. He also stated that he told Mallory to leave him alone. Due to this, and his inability to calmly answer why he hollered and what happened,he was placed on dish duty for the afternoon in the kitchen for this outburst Mallory refused to tell his side of the story, however, he was not sent out. This will be discussed in a later individual therapy session, and I will check back up with Harlow again once he has calmed down. Towards the end of the session, I allowed the patients to enjoy gingerbread men and hot chocolate. Moira worked through the session with Dr. Graham and earned her hot chocolate and cookie, however, she did not take the cookie, and simply took a hot chocolate back to the table for Dr. Graham.


Additional: N/A

Follow-Up: One on One seems to help more with Moira than anything else. I suggest keep up with the one on one therapy, and the goals to work towards.


_____________________________________________________

I'll never wear your broken crown.

But in this twilight how dare you speak of grace?
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Dr. Benjamin Graham

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PostSubject: Re: Moira Hanley   Tue Dec 04, 2012 7:48 am

Dr. Benjamin Graham wrote:


Nov 29, 2012

    Group Participants:
    Thaddeus Salant - Schizophrenia (Catatonic Subtype)
    Moira Hanley - APD/(Suspected OCD)
    Quincy Randall - Sexual Paraphilia (Vampirism)/Obsessive Love
    Joleen MacMahon - Stockholm Syndrome/Hypersexuality
    Harlow Jacobs - GAD/MDD/Hypersomnia


Therapy Plan: Today's therapy will be an exercise in sharing and relationship building, utilising the light-hearted nature of a game to foster communication about the self with others. The aim of the game (a customised jenga block game) is to encourage patients to talk about themselves openly, build rapport with others, and foster trust with others. The game functions in such a way that each block has a therapeutic question pertaining to the self written upon it. Patients (and therapist) play the game of jenga as usual, only players must answer the questions on the blocks they pull. At the end of the game, whoever knocks over the tower will have to answer an (appropriate) question from each of the other members of the group.


Group Observations: New patient, Quincy Randall, was in attendance for today's session after a morning arrival. He was first into the group room and displayed appropriate greeting behaviour and vocalisation. He did appear a little dazed, as to be expected for new arrivals, but was otherwise pleasant. Next to arrive to our session today was Joleen MacMahon. Her face was still bruised from a recent fight with roommate Jamie Gibbs, but she seemed in relatively well spirits despite this. However, her body language and tone of voice bordered on the inappropriate. Harlow Jacobs arrived shortly afterwards, seeming a little anxious though he nodded in greeting and took a seat without prompting. Thaddeus Salant seemed much unnerved, as his behaviour might be best described as skittish and evasive upon entering the group therapy room. Regardless, he also took a seat without having to be prompted. Moira Hanley was the last patient to arrive to the session, with little enthusiasm, but also was seated without being prompted.

Before introductions could be made Joleen MacMahon and Quiny Randall struck up an introductory conversation between themselves. Given Joleen's injuries and diagnoses, and Quincy's condition, I intervened and disrupted this private conversation by encouraging Quincy to turn his attention to the rest of the group and introduce himself. He was polite and compliant with this request. Thaddeus Salant continued to exhibit distancing behaviour and anxious body language during the introductory part of our session, which remained throughout, though he was supplied with some note cards and a pen, in order to doodle. Clearly having some activity eases some of his anxiety, though I will be discussing paying more attention to group activities with him in future individual therapy sessions.

Our group session went largely according to plan today, though I encountered some oppositional and defiant behaviour from Moira Hanley whenever it was her turn to select a block from the tower. Moira Hanley and Joleen MacMahon also engaged in a short-lived verbal altercation towards the end of our session, the precursor of which came towards the beginning, when Joleen seemed to attempt to defend me from one of Moira's outbursts.

In the middle of our group session, Joleen made inappropriate sexual contact with myself underneath the table, my reaction to which disrupted the game momentarily as I put distance between us. I did not verbally raise the issue during the group, in the interest of not derailing our activity, but this behaviour is entirely inappropriate and should be made special note of, with Miss MacMahon's primary therapist.


Session Report: I started our session today by choosing the first block, and answering the question upon it in very impersonal and general terms.

Moira Hanley was next, drawing a block which asked her to say what motivates her. She disputed that she had any motivations. When I questioned why she got out of bed in the morning, she eventually answered that going out to smoke a cigarette was her motivation for getting up. More on this in later individual therapy notes. It is my belief that Moira witnessed Miss MacMahon's inappropriate contact, and she attempted to bait me with suggestive questions after the fact, before she was derailed by the continuation of the game. Moira's second block was one that she refused to answer, and which I kept for a later session. It asked her to talk about a time when someone made her uncomfortable. She refused to answer and put the block back on the tower. Moira was kept after the session for an impromptu individual session, following her poor behaviour throughout the group. During this individual session, her cigarettes and personal affects were confiscated, only to be earned back by cooperation with her therapist and the other staff, and evidence of her behaviour and self control improving towards others.

Quincy Randall was relatively calm and polite in our session today. he did not make trouble, though I am cautious of allowing him to associate with Joleen MacMahon, given her diagnoses and Randall's susceptibility to romantic and inappropriate advances. he answered both of his questions from the game eloquently, beginning with being asked: How often do you incorporate what people think into what you do?[ He admitted that he didn't often give much thought to what other people thought, but that it did matter to him on some level. Though he admitted trying to give consideration to it, he also noted that sometimes the things that he wanted overrode this consideration. Individual therapy could focus on impulse control, and on healthy outlets for thoughts and frustrations, as well as healthy relationship constructs and interpersonal communication and listening skills. Mr. Randall's second block from the game asked: What are your plans for the future, and how do you hope to achieve them? He admitted to wanting to go back to Paris, and acknowledged that it would only be possible if he got out of Hallowsgate, further conceding that his discharge depended upon honestly and a willingness to cooperate. Efforts should be made to reinforce these thoughts for Mr. Randall, but also to build upon other things that will have to be addressed in therapy.

Joleen MacMahon was willing and compliant with the group activity throughout our session, despite her obvious inappropriate conduct towards myself. She was upset by Moira Hanley's outbursts towards me, but responded favourably to attention during the group. Given her conduct towards me, I can assume that she harbours a sexual attraction towards me, which influenced her behaviour during our session. Regardless, she answered the questions she received from the game, beginning with being asked to list five things that made her happy. While largely inappropriate, she answered with the following, and was allowed to let it rest at that for the first round: "Well you make me happy Ben. Very happy. [...] And I like bright colors, like purple and pink and aqua. Singing makes me happy too. I liked going to the movies that was always fun...and sex. Sex makes me very happy." Joleens second block asked her If you were an animal, what would you be and why?' She answered that she would be a unicorn, because then she would be so special that everyone would have to care about her. Obviously, given her history and diagnoses, attachment issues can be guessed at throughout. I would recommend that therapy focus on creating appropriate and reliable relationships with others, and on boosting real self confidence and responsibility. Her sexual promiscuity may be compensating for a lack of real attachment in her interpersonal relationships. I would recommend exploring the possibility of a buddy system, with another female patient unlikely to give in to sexual advances, or even a female member of staff.

Harlow Jacobs was quite withdrawn and appeared anxious for a lot of our session. He seemed perturbed that he would have to answer questions at random from the jenga tower block, but he did manage to put forth some effort to do so, for the most part. He started off with a block which asked: Where do you want to be? How do you think you can get there? He struggled with this question, and answered that he didn't want to be anywhere, his tone unsure and anxious. Looking to me for a prompt, I asked Harlow if he would like to be outside of Hallowsgate one day. He conceded that he did want to, but that he didn't have any clear goals as to where he wanted to be so long as he was useful. Future therapies should focus on realistic goal building and self confidence, encouraging small steps towards small goals at first, and then building up to larger ones, as I expect he may be easily overwhelmed. Perhaps some activities involving personal responsibility and rewards for effort may help. Harlow did not have a chance to answer a second question, after Moira Hanley's conduct and Joleen MacMahon's reaction to her meant that our session needed to be cut short to avoid more conflict.

Thaddeus Salant was anxious and evasive throughout the group. She shows fear of his peers and hospital staff, and prefers distraction by way of drawing. I think that art therapy could be very good for him so long as it is fully monitored and the art work is actually guided and discussed. he should not just be left to his own devices, but should be eased into more social contact and communication instead. Though he struggled with comfort levels throughout the group, he was coaxed into participating in the game, wherein he drew a block which asked: What realistic alternatives are there to your current lifestyle? Thaddeus answered that he didn't know, and that he believes that being 'in here' [Hallowsgate] is better than being 'out there' sometimes. He lack any real self confidence, and is easily startled. Outside of guided art therapy, his treatment plan should focus heavily on safe socialisation and on self confidence building, as well as learning coping skills for his emotions, and working with medications more closely to find the best treatment for him.

Additional Notes: Socialising activities should be pursued for Thaddeus Salant, after individual sessions discussing social and life goals and considering medication options to control the symptoms of anxiety he is subject to. Guided art therapy should also be explored, as well as confidence boosting activities and communication skills, executive managing, and personal nutrition and hygeine skills.

Moira Hanley was kept behind after our session for an individual meeting which will be documented further in supplemental notes.

I will be filing an incident report concerning Joleen MacMahon's conduct and feelings towards me, in order to assure that this matter is entirely transparent and handled accordingly.




_____________________________________________________



Forty-Nine | Divorced & Single | Smoker | Psychiatrist | Stubborn | Damaged Goods
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Dr. Benjamin Graham

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PostSubject: Re: Moira Hanley   Tue Dec 04, 2012 9:00 am

Dr. Benjamin Graham wrote:


Nov 29, 2012

    Individual Therapy:
    Moira Hanley, APD/OCD


Therapy Plan: Today's session was an unscheduled response to Moira Hanley's oppositional an aggressive conduct in group therapy. She was asked to stay behind after the group session, having been verbally inappropriate towards myself and patient JM.

Therapy Observations: Moira was visibly angry and aggressive in body language. She was closed off and later attempted to intimidate me with aggressive posturing. Part way through our session, Moira attempted to physically attack me and was restrained physically on the floor until the danger to others and herself had passed.

Session Report: Initially, I kept Moira behind with an aim to attempt to foster communication over a question she was asked in the group therapy session, which she refused to answer. Communication on this subject was not possible, and Moira continued to be verbally abusive and aggressive. I made a clinical decision to begin therapy with Moira immediately, based on her behaviour, the danger she poses to others, and her admitted lack of any sort of goals or motivation here at Hallowsgate. This therapy will likely be difficult for Moira, but I feel an aggressive approach to breaking down communication barriers and distancing is the best way to begin actual rehabilitation.

During the session, I told Moira that her personal affects were being removed from her room, to be kept in storage, and that her cigarettes were now to be controlled by myself. She was made to understand that any return of her possessions and any smoking privileges would have to be earned through cooperation with staff. I further added a library cart ban. After Moira's violent outburst, she eventually conceded that she understood the term, after some aggressive language and a reinforcement of boundaries and staff-patient roles from myself. I will give Moira a few days to come to my of her own volition. If she does not return, or she causes more trouble, her hospital scrubs will also be confiscated, and she will be supplied only with hospital gowns, until she learns to understand that she cannot be fully in control of all situations, and to accept the requests of authority figures.

Additional Notes: Moira is not to receive books from the library cart without my specific say so. She is not to smoke cigarettes, and all staff should be vigilant that she does not receive cigarettes from other patients. Cooperation with her therapist should be encouraged, any time she may ask for a book, a cigarette, or her personal affects, by directing to her my office to discuss return of items and privileges.



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Dr. Benjamin Graham

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PostSubject: Re: Moira Hanley   Tue Dec 04, 2012 9:01 am

Dr. Benjamin Graham wrote:


Dec 01, 2012

    Individual Therapy:
    Moira Hanley, APD/OCD/PTSD?


Therapy Plan: Today's session was unscheduled, and a result of Moira Hanley's smoking privileges being revoked. She arrived to my office in an angry and oppositional manner, demanding a cigarette and using vulgar language. We commenced an unscheduled individual therapy session.

Therapy Observations: Moira was visibly angry upon arrival, and continued to display aggressive behaviour and language, attempting intimidation again. After her initial behaviour was addressed and we were able to go outside for a cigarette, Moira continued to display oppositional behaviour, and engaged in attempted deception in an effort to placate me.

Session Report: When Moira arrived, she burst into my office, slamming the door back, and exclaimed "I want a fucking cigarette." it was explained to Moira that her aggressive entrance and language would no earn her a cigarette, and she was given the option to try asking for one again, in an acceptable fashion. Moira replied as aggressively as before, attempting to warn me that if I did not acquiesce, she would leave my office and physically assault the first person she came across. Not giving in to the negative behaviour, I informed Moira that given her statement, if she left my office she would be escorted straight to seclusion for the rest of the evening. Her options were explained to her that she could either cooperate in an acceptable manner, or spend the evening in seclusion with no cigarette, and that it was her choice which was more important to her. This approach worked, and Moira paused before politely requesting a cigarette. I agreed to her request under the proviso that we would go outside together and she would need to talk to me during our cigarette break.

We headed outside to the pavilion, for a cigarette, after I loaned Moira my spare coat, since her personal clothing has been confiscated. Once outside, we returned to the topic Moira had avoided in group therapy and our prior individual session, and I asked her to talk about a time when someone had made her uncomfortable. Moira engaged in deception at this point, with standard microexpression tells, and fabricated a story about a staff member at her group home molesting young girls. I did not permit Moira to get away with her deception. I asked her to try again and tell me something truthful. She attempted to continue with her deceptive behaviour until I informed her that I did not believe she was telling the truth, and again encouraged her to answer appropriately. With prompting and irritation, Moira eventually answered that I was making her uncomfortable trying to force her to talk about something she did not want to talk about. Since she had told the truth and expressed her own feelings and thoughts in a semi-acceptable fashion, I gave Moira a cigarette.

I went on to discuss with Moira a goal of having her words listened to and understood, but she continues to be oppositional to attempts to foster communication and reinforce the importance of her being able to express her thoughts and feeling appropriately to clinical staff and others. I left Moira to continue her cigarette alone, as progress for the session had plateaued.

Additional Notes: After returning to my office, I was called to seclusion, where Moira Hanley had been remanded for physically assaulting an orderly when they attempted to retrieve my spare coat from her, once indoors. Given the weather and the coolness of some of Hallowsgate's wards and corridors, I brought Moira a cardigan, which she should be allowed to keep. She was calm by the time I arrived, and thanked me for the cardigan. I informed her that she could return to her room for lights out, but that our previous arrangement on smoking privileges and personal items remained. Before I could leave, Moira asked me what she would have to share in order to be able to read a book. I returned again to the topic from our group therapy and two prior individual sessions. Moira referred to the allegations she made about being raped in her last hospital setting, and expressed belief that I would think that she was lying. She showed no indications of deception, and I am inclined to believe that she fully believes her allegations against the prior hospital staff member, and likely suffers from trauma as a result of the incident. I reassured her that I believed her, and granted her a two week library cart pass. She continued to express that she did not believe that I believed her allegations, and was allowed to return to her dormitory for lights out. Before Moira could leave, I asked her to think about what she would have to lose by not cooperating with the clinical staff, for our next meeting.



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Nevaeh Valentine

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PostSubject: Re: Moira Hanley   Mon Dec 17, 2012 7:30 am

SESSION NOTES
_____________________________________

    Date: 17/12/2012
    Attending: Dr. Benjamin Graham
    Session With: Nurse Neveah Valentine
    Session: Group Activity - Truth or Dare
    In Attendance
    Moria Hanley
    Wren Cantrell
    Luce Wagner
    Jonah Gallagher


Session Notes: The entire session was centered around a game of Truth or Dare. An oversight on my part was that I did not place any rules down for what dares or truths were and were not allowed. The session started with Jonah [Mr. Gallagher] daring Luce [Mr. Wagner] to remove my shoes and socks without using his hands. Which he did with his teeth. It was Luce turn and he asked Wren [Mr. Cantrell] who choose truth, “Would you rather gain 100 lbs or leap from the clocktower?” Wren choose the leap and Luce tried to probe Wren into a deeper explanation. I had the session move along to Moria’s [Ms. Hanley] Dare which was to do the Macarena for a round, she did so and then she asked if I was afraid of anything, to which I answered bees (Not true) and asked Jonah, who had managed not to be dared to do the chicken dance for 15 seconds, in an attempt for everyone to stop making such emotionally high-stakes dares. During this time Jonah and Luce engaged in some mean spirited side chatter at Wren’s expense which I stopped quickly. Jonah dared Wren, "In a seductive voice, tell everyone in the group a turn on and a turn off", Seeing how nervous Wren became at the dare I offered to take two and allow Wren to skip the turn, which wasn't accepted. Wren did answered the he did not have any and asked Luce who chose Dare, and he dared Luce to "Give Nurse Valentine your best lap dance." To which Luce did, Wren was clearly mortified at the situation and Moria was dared by Luce to lick her own foot or Wren’s, she refused and I pointed out it was unsanitary, the dare was amended a kiss. Wren complied but became very upset and started to cry. I ended the session immediately and the group dispersed, with Wren leaving first.

Additional: Despite her initial reaction to the session which was sarcastic, Moria was extremely participatory and relatively patient with the entire session. She did also join in some of the heckling of Dares or Truths she didn’t believe were a stretch for all involved, but by contrast to previous group sessions she managed her temper and occasional displeasure very well.

Follow-Up: I leave that to Dr. Graham


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Dr. Rose Lewis

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PostSubject: Re: Moira Hanley   Tue Dec 18, 2012 12:31 am

THERAPY NOTES
_____________________________________

    Date: 12/13/12
    Attending: Dr. Benjamin Graham
    Session With: Dr. Rose Lewis
    Session: Group Therapy


Therapy Notes: As we began the session, it was obvious that some people were not keen on participating. I explained that we would be listening to different songs in effort to elicit responses and measure our emotions. I wanted to make a connection between the types of memories that could be triggered and the emotions that they feel in an effort to help them understand their control. Some were nonplussed, though Luce stated that he would give it a chance. With “Make someone happy” Joey explained she thought of her father. Moira interjected that it “explained a lot” and we discussed why the song made Joey feel this way. Upon playing “Home”, I asked Elijah about his response. He resisted and then had an emotional outburst, commenting on the death of his wife. He then refused to participate and left the room. “Shake it out” was played next, and I chose Adriana to answer. She had a positive memory of the song, thinking of when she was first promoted. “Last Night I heard Everything in Slow Motion” was the song for Luce, and he explained that it reminded him of “Well, there was this lovely young lady I knew in Tampa who liked music like that. One of the more pleasant times in my life. A real woman, that one - never hit me for trying to be decent.” This elicited a negative response from Eva, as the two had come to blows outside of the session. “Glory Days” was for Eva, and she stated she did not “dwell on the past” and that she didn’t have any such glory days. Moira was last, but refused to participate stating “Because I think this is pretty fucking stupid.” I dismissed the rest of the group and spoke with her one-on-one.

Additional: When we had our private discussion, Moira continued to be rude. She was abrasive and told me to “"Go fuck” myself before giving me the middle finger. She was also insubordinate both in the group therapy session and afterward. As her actions must have consequences and because she was completely unruly during our session, I asked she do dish detail to help work out some of her aggression. I also stated that she should could not have any cigarettes, specifically noting that Benjamin had previously been using them as a tool to control her behaviors. I decided it would be up for Dr. Graham to decide when it would be appropriate for her to have them again.
Follow-Up: It is my recommendation that Moira Hanley be barred from attending any Christmas Events. She is aggressive, insubordinate, and continuously fussy in regards to participating in group led activities. Her mean spirited behavior and consistently negative attitude show no signs of improvement. In comparison with those that present a danger to themselves and others, I would recommend against Moira being allowed outside of Hallowsgate.

[edited] While I have received a letter from Moira in apology, I would hesitate to allow her off groups before a successful group therapy session.

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PostSubject: Re: Moira Hanley   Tue Dec 18, 2012 7:52 pm

This letter was mailed to me by Dr. Rose Lewis, and has been placed in the patient's file.

Dr. Rose Lewis wrote:
Subject: Moira Hanley
To: Anita Forrester
CC: Dr. Virgil Hennessey

Anita,

I hope this email finds you well. I am writing to inform you about an incident that occurred on 12/13/12 in the early evening with Moira Hanley.

This incident occurred during our previous Group Therapy, in which I had a number of problems with Ms. Hanley. As you know, she is one of Dr. Graham’s patients. In a request made prior to me after a disagreement over Tally Tansy’s casefile, I obliged in following techniques set out by Dr. Graham when it came to his patients. He noted in Moira’s record that he used a technique involving what was important to her—offering her the choice between her cigarettes or seclusion—and that this technique had in fact worked to produce a positive result.

As Ms. Hanley was incredibly rude during the session and non-participatory (a fact that has also been noted in her file before that she has problems with the clinical staff) I engaged Ms. Hanley in conversation. She continued to be resistant and stated that I had no control over her behaviors. While I am not her attending therapist, her continued insubordination and lack of will to participate in group settings strikes me as an indicator of her lack of progress.

I write because I would like to caution against her going on any group outing in the future. I found her insubordination threatening and her visible anger—including a graphic hand gesture while leaving—to be alarming. As deception was noted in her file, I do not believe I can trust the apology that she has sent to me.

Also, after thinking over her situation, I would recommend against allowing her cigarettes. This is an unhealthy attachment that she has developed—recommending an object that is incredibly unhealthy in exchange for good behavior does not seem sound. This is also a wonderful opportunity for Ms. Hanley to escape from an addition and future health issues. I am reminded of Dr. Hennessey’s notes that we are promoting a professional and healthy atmosphere, and therefore believe that we must also be promoting healthy behaviors. While Dr. Graham’s attempts were well intentioned, I am also reminded of his familiarity with Moira, and know that Dr. Hennessey has warned of not becoming too familiar with our patients as this may cloud our judgement in issuing appropriate treatments.

I send this hoping that you will become aware and take note of Moira’s behavior. I am a firm believer that actions have consequences, and that we must do our best to promote an environment that achieves progress in our patients.

Regards,

Dr. Rose Lewis
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PostSubject: Re: Moira Hanley   Tue Jan 15, 2013 1:32 am


INCIDENT REPORT
_____________________________________

    Attending: Dr. Benjamin Graham
    Incident: I ran into Moira Hanley while out in the Gazebo/Pavillion area. As it was rather cold and dreary, I offered her my coat in which she refused. I also offered a cigarette to her, however, she has stated that she was going to quit smoking, with reasons being that it is "bad for [her] health." I believe this is not the reason she is quitting smoking. I did not push the matter, nor did I push my coat upon her. After a few moments out in the cold and rain, I was able to convince her to re-enter the hospital and return to her dormitory.

    Additional: I believe something is bothering Ms. Hanley, however, she refuses to open up to me past the snark and wit. Therefore, I do not have further information on the matter, but I do suggest trying to get to the bottom of what seems to be eating at her.




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