138 Chapter 6 more casual positive interactions with care professionals, family or friends. The subtheme general positivity included any mention of positive affect. This could be sense of humor, making a relaxed impression, having a good day, or positive dialogue with care professional. For example the mention “client played boardgames after the barbecue and visibly enjoyed herself” indicates that positivity occurred during descriptions of the issue of the day, which are subdivided under two themes: received care and daily schedule. The latter involved her daily schedule unrelated to medical or psychological treatment, which could be either at the facility (e.g., doing the household or taking a walk) or social activities away from the facility (e.g., board games at activity center). Received care related to any actions from care professionals, which could be either in the form of security measures (e.g., checking her room for potential objects used for self-injury or secluding the participant), dialogue with care professionals (e.g., talking about what is on her mind, complimenting the participant), medical care (e.g., treatment of wounds at care facility or hospitalization), or psychological therapy sessions (dialectical behavior therapy and psychomotor therapy). Challenging behavior was a theme with three subthemes: verbal aggression, physical aggression, and self-injury. The latter two were also self-reported on a daily basis by the participant. Daily record accounts of challenging behavior related to emotional and/or physical discomfort, for example “client cut herself with a broken piece of plate, she says she wanted to experience different pain than the pain in her stomach”. The theme physical complaints related to either feeling sick (e.g., nauseated) or mentions of the participant communicating experiencing physical pain. Both could be a cause and consequence of challenging behavior. For example, self-injury caused wounds, which lead to inflammation, which naturally come with pain or sickness such as fever. Self-injury through reopening existing wounds was the most frequently reported self-injurious form, which exacerbated physical complaints. That required her receiving (extra) care. Related to both challenging behaviors and physical complaints were emotional tensions – a broad theme that comprised of three subthemes. Records describing extraordinary negative events (e.g., losing her pet), social tensions (e.g., quarrels with staff or family) and general descriptions of negative affect (e.g., feeling irritated, fearful, frustrated, or insecure). Emotional tensions could be triggered during any daily activity and could be both cause and consequence of physical complaints. For example “client is working on a painting. When we adjust schedule to playing a boardgame she becomes angry”. Moreover, it could result in receiving extra care (e.g., support from staff when in distress) or was the consequence of dissatisfaction with received
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