Focus Cards Help Students Regulate Emotions, Solve Problems

By Leslie Davis

The students at Bromley Brook boarding school for girls are struggling with normal teenage concerns at the same time as they are dealing with one of several behavioral issues. This can prove to be very overwhelming for the girls who attend boarding school, despite the supportive environment they are in.

To help its students enhance their emotional regulation, improve their problem-solving skills and create stronger relationships, Bromley Brook boarding school for girls created Focus Cards for its residents. The cards focus on five skills, and contain 26 coping mechanisms that girls can use to manage what they're struggling with.

The cards help students focus on the following five skills:

  • Increase emotional regulation skills and decrease emotional liability
  • Increase distress tolerance and decrease impulsive behaviors, suicidal threats and para-suicidal actions
  • Increase mindfulness skills and decrease identity confusion, emptiness and cognitive dysregulation
  • Increase interpersonal skills and decrease interpersonal chaos and fears of abandonment
  • Increase self-management and decrease poor health by improving good personal hygiene, healthy food habits, healthy exercise, following community rules, filling in focus cards and learning how to self-reflect
If a girl is struggling with mindfulness, for example, the cards recommend she do any of the following, which she can easily recall through the mnemonic OPENS:
  • Observe: just notice
  • Put it into words: describe verbally
  • Enter into the experience: participate
  • No judgment: don't jump to conclusions
  • Stay in the present: keep her mind current
"The cards can help the girls be more mindful rather than just react in the moment," said Sharon Hartunian, LICSW, LADC 1, CADAC, Bromley Brook's clinical director. "The cards can help them look at what they're struggling with and the process of how they handle problems."

Time to Reflect

The Focus Cards were introduced to students at the beginning of the 2010 spring semester as a way to help girls label their feelings, thoughts and the behavioral issues they need to work on. The cards also provide them with specific skills to help them solve problems during difficult situations.

The girls receive one Focus Card each week, which is added to a binder of collected cards that the girls and their treating staff can refer back to. Three times each day, students are given time to reflect on their behaviors and fill in the cards, rating their experiences with using the coping techniques and the helpfulness of the chosen skill.

"The girls will be given moments throughout the day to slow down and label what's going on with them," Hartunian said. "They can sit down and assess their behaviors, and they may be able to figure out what makes more sense when handling a situation."

Using the cards, the girls can test out what coping techniques really work for them, and experiment with different ways to manage their self and their emotions.

"So many of our girls struggle with distress tolerance and emotional regulation," said Mary Jo DeGrandi, MS, coordinator of Special Therapeutic Programs at Bromley Brook. "We want to create opportunities throughout the day for the girls to reflect on what's going on with them and what strategies they used to help themselves."

The staff at Bromley Brook hopes to create a structure and community at the school that encourages students to reflect on their behaviors and strengthen their coping strategies. This is partially done through training the school's clinical staff and therapists on how to help girls use the cards and process their observations. The cards also create a common language among therapists and students, which can make it easier to discuss issues and help identify what the girls are struggling with.

A Unique Method

The Focus Cards were created by Bromley Brook staff in collaboration with the Stone Center at Wellesley College to foster a unique way of working with adolescent girls. The cards integrate the theoretical foundations of women's psychology and relational-cultural theory in a way that can help girls foster healthy relationships and connections, and encourage girls to have power with each other as opposed to power over each other.

Using the relational-cultural theory, the cards can also provide girls help and support to make connections, create stronger relationships, have empathy for others and improve relationships with their peers and their families.

"It's the only theoretical model that has been researched as specifically effective with women and how they relate to the world around them," DeGrandi said. "It's naturally the perspective of the girls."

This model works with how women already think and relate to others, so integrating it into the school was a logical decision.

"We want to work with it, not fight against it," DeGrandi said. "We want to help the girls develop strong support networks."

The Focus Cards are simplified versions of the Dialectical Behavior Therapy (DBT) diary cards that have been successfully used in therapy since the 1990s. Bromley Brook has run a DBT group for students for years, but only a small group of girls participated. The cards allow all students to benefit from DBT.

"We were already doing DBT work and realized that every girl would benefit from it," Hartunian explained. "It provides a concrete way for students to measure and keep track of their emotions."

The Focus Cards are just one of many steps the staff of Bromley Brook is taking to integrate the teachings of women's psychology and relational-cultural therapy into the school as a way to better support the girls who attend.

"We want to help girls look at what their struggles are and the process of how they problem solve," Hartunian said. "It can help them realize that there is no absolute way of thinking and feeling, and they can see if there are certain skills that can help them."