Keeping Things Together

IMPORTANT:

Until further notice, I am not taking new clients. I am continuing to counsel and mentor current clients. Current sessions are by telephone. Normal service will resume as soon as possible.

This may come as a surprise to some. All the anxiety and fear that is being passed around right now, you’d think this is the time when people will want counselling more than ever.

The thing is, it’s my responsibility to take care of myself as well you. I need to be “fit for purpose”. For the time being, I don’t feel it would be ethical of me to invite more work than I can manage right now. I hope you understand. As I say, normal service will resume as soon as possible.

Meantime, I can still provide help and support via this here blog. If anyone out there wants to comment, share your experiences, please do.

Sorry to write this off the cuff. There’s a lot I’ve had to get my head around in the last fortnight. And I’ve had to do it fast. Haven’t we all?

In the coming days and weeks we’re all going to cope as best we can. For those whose immune systems are less effective, it’s going to be harder. The advice to stay indoors should be taken seriously.

A lot of people are learning what it is living life in isolation. We are all having to take extra care of our wellbeing. Keeping active, keeping a sense of routine and purpose is more important than ever. Anything that takes your mind off things will help keep us calm.

Here are a few links back to some helpful posts I’ve given you before:-

pacingMaintaining achievable goals & a rouine: SMART pacing

Art Therapy

Being creative: Expressive Art & Brain Injury

Journal keeping: Writing Therapy (Part One)

Writing Therapy

Writing stories: Writing Therapy (Part Two)

Take good care, all of you.

Sean

 

The Timing of a Tide

I hope this month’s title isn’t too upsetting. I wanted something to convey the whole experience of personality loss. It can be harder to deal with than ordinary bereavement.

Those of you looking after your family member or life-long friend will know. Those of you tasked with caring for someone losing or who has already lost themselves, may find it hard occupying who you’re working with.

Recently, I was approached by a volunteer with a charity that supports Alzheimers patients. She wanted advice on coming up with activities. This month’s post is my response. For her and anyone coping with anyone with dementia symptoms, e.g. via Lewy Bodies (DLB) – a form of Parkinson’s. I hope it helps.

Colour Joy

(I used to know a lovely lady called Joy.)

 

5 Top Tips

1. Shape activities in the here-and-now in ways that match their long-ago.

Activities that mimic what a person used to enjoy physically. If someone used to work for the Post Office, ask them if they’d like to help you sort through paperwork that needs shredding and paper that can go straight into recycling.

Activities that draw on past knowledge. E.g. Maths quizzes using old money.

2. Make activities sensory.

If someone’s attention / perspective comes and goes, conversation is a challenge. Your own sense of engagement with who you care for needs support from them. Resources that stimulate memories or stories can help. E.g. listenning to old 45’s or 12-inch singles together. (I’m assuming you young’uns out there know what they are. Vinyl is back in fashion after all.)

Activities can also be about the look, feel and smell of something. (D’you know there are some people who still prefer the smell of a well thumbed novel to the feel of a Kindle.)

3. Encourage teamwork.

Maintain, or at least slow the loss of social skills. Anything requiring co-operation is good. Discussing methods for doing a jigsaw puzzle (“corners and sky first”, for example) is unnecessary. It is enough to let the picture emerge as you compare and contrast each piece together.

4. Make it physical first… (As far as possible.)

Gentle movement is enough to keep the circulation going; there’s no need for a sweaty workout down the gym’. How about kicking or throwing a giant sponge ball between two, three or four people? If someone is chairbound, they can still join in if they want.

5. Be present

Be prepared to connect with your patient or loved-one’s reality as they perceive it. N.B: I DO mean “as they perceive it”. And be prepared to be persuaded that their way to do something is the better way!

To better understand what an Alzheimer’s personality goes through, here’s another helpful link.

For more general information and assistance about Alzheimer’s and Parkinson’s, click on the logos below.

alzheimers-logo-desktop

ParkinsonsUK-1b

That’s it for February.

Take care.

More Than One Way

HAPPY NEW YEAR!

Hoping you all managed through the festive season. Now that we’re out and on the other side, I thought we’d take a look at a slightly different option when seeking help. Or wanting to help a client with A.B.I. / T.B.I.

Cognitive Analytic Therapy (C.A.T)

What It Is

illustration-im-lost-hiker-no-direction-frits-ahlefeldt

C.A.T. is a type of therapy based on Cognitive Behaviour Therapy and Psycho-analytic Therapy.

Typically, therapy is given with a collaborative, person-centred style. New names / labels are found to describe difficult patterns of events, stages in process and emotions and behaviours that link them.

This means that problems can be looked at more in depth. Patterns can be drawn out and joined up in relation with different areas of life; whole situations can be mapped out.

The number of sessions spent with a therapist is limited.

How it Can be Applied to Acquired Brain Injury

I’ve done a little diagram of my own. I think many of you will recognise the re-occuring cycle.

CAT Diagram

This is how I have seen it with different clients over the years. But it can never be a case of “one size fits all”. With help, the best person to draw the process you go through is YOU.

Here’s the thing:-

  • Once expressed and put on paper, the process is not reliant on memory. How a situation is now can be seen and read.
  • Attention can be focussed more easily and areas identified that need tweaking. (For example, with support, the above “Former Self / Current Self” box can be gone into more in depth. A list of former, helpful skills that are still current might be revealed.)
  • A sense of direction could also become clear. (E.g: A still present, helpful skill could be discussed to see how it might be used to effect another box – maybe even re-write what’s in it.)

I shan’t go on. You’ve got the picture.

Research

Some of you out there might like further research on this subject. Here’s a very interesting online publication I came across. (Click the title.) It’s a paper by Caroline Rice-Varian. It’s called:

“The Effectiveness of Standard Cognitive Analytic Therapy (CAT) with people with mild and moderate acquired brain injury (ABI): an outcome evaluation”.

Referrence: Rice-Varian, C., 2011. The Effectiveness of Standard Cognitive Analytic Therapy (CAT) with people with mild and moderate acquired brain injury (ABI): an outcome evaluation.. Reformulation, Summer, pp.49-54.

Signing Off

Thanks for reading. Your questions, requests and comments throughout 2020 will be appreciated as always .

And now, in true “Monty Python” style, here’s something completely different: A cartoon called “The Cat Came Back”. (Approx. 8 minutes.)

Enjoy!

Cognitive Rehabilitation Therapy – Companionship & Competition

Two Pronged Brain

Last month I talked of the two ways in which C.R.T. can be given – “Comprehensive” and “Modular”. My personal opinion is that a combination of both helps individuals most. This was following a conversation with someone wanting to help their family member directly.

I hope the link to Dr. Judd’s expertise was useful.

Nowthen, as it’s Christmas, I thought it might be an idea to look at some of the online resources available. There’s stuff out there, some even quite fun, that everyone can challenge each other at.

(“Restorative”)

It’s best to see this often used term as an intention, not a promise. It is used to describe exercises designed to improve precise areas of brain function. For an idea of the different options available online, click here for Phone Arena.Com’s view of their “Top 5” brain training sites. (Just under 4 minutes.) (As always, you may want to skip the ad’.)

(Neuronation)

Not saying it’s the best. Neuronation is the site I’ve most experience with. You can find your own favourite.

The first thing to do is register an email address and password to log on with. The first thing that will greet you will be three choices of subscription: 1. £11 for three months; 2. £5 for twelve months or 3. £299 for a lifetime access to all the games. But as with most things of this nature, you’ll get a free sample of tasters.

To gain access to these free samples, click the “Training” header at the top of the page. The next gives the options of “Daily Training” or “Exercises”.

On your first visit, I suggest you go straight to the exercises. These include a free exercise or two in the following catagories: “Numeracy”; “Language”; “Reasoning”; “Memory” and “Perception”.

Have a practice at each. You can time yourself, but I’d suggest building your confidence by having a go in “Learning Mode”. Pick a catagory; pick an exercise; choose the “Tutorial”; click the “Learning Mode”.

Neuronation monitors and charts your level of performance. At any time, when fatigue or boredom strike, you can come out of your chosen exercise.

Whether you’re wanting something to do yourself, or get to know and help your familiar-cum-new member of your family, these online products are a good way of doing it.

Wishing you progress throughout 2020. And a Christmas as best as best can be.

Sean

Xmas2020

Cognitive Rehabilitation Therapy – The Two Pronged Way

Two Pronged Brain

Here at last! I thought I was never going to get this uploaded. And still in November too.

Let’s turn our attention back to Cognitive Rehabilitation Therapy (C.R.T.)

Why?

  1. We haven’t talked about C.R.T. for a long time.
  2. Someone recently asked what they could do at home to help their loved-one themselves. (I’ve found a Youtube post that should help. See below.)
(Definition)

There are many. It seems every organisation the world over has its own description of what CRT is. Here’s my “in a nutshell” definition:-

Cognitive Rehabilitation Therapy is a collaborative series of tasks and discussions between therapist(s) and patient(s) / client(s) aimed at helping those patient(s) / client(s) cope with themselves and the wider world after a brain injury.

The implication for Cognitive Rehabilitation Therapists, be they grounded in classical Cognitive therapies or Person-centred therapies, is that C.R.T. involves both active listening and active thinking.

What do I mean by “active thinking”? I mean empathically thinking as the client thinks.

Art of cinversation

(Comprehensive)

Cognitive Rehab’ Therapy takes a two pronged approach. The Person-centred or “Multi-modal” (“Comprehensive”) prong takes account of emotions, behaviour and perceptions altogether.  Active listening flags up the patient’s / client’s motivation or lack of it – gauges what stimulates by whatever degree and how. A therapist can then intuit techniques and interventions to best aid the patient’s / client’s understanding and skills.

The relationship is one of observation – reflection or open question – reaction – observation – response. Such in-the-moment to-ing and fro’-ing between therapist and patient / client can result in unforeseen recognitions. I’m talking about immeasurable and surprising reconnections and new connections within the “neuro-person”, if I may call them that.

(Modular)

The Modular prong is more targeted. Its focus is on areas of damaged brain, not always the holistic person. Formulated exercises are aimed at improving attention, memory, visual and information processing, language or executive functions.

Single modules can be used for an isolated or overriding impairment. Selected modules can be used in group settings or tailored to individual patients / clients. Though less precise in delivery, modular, task orientated group therapy helps in the following ways:-

  • By facilitating peer support.
  • Problem solving by discussion gives greater chance to strengthen confidence, co-operation, as well as some empathy.
  • Less rigid, more flexible problem solving skills – “thinking sideways” also has greater chances to develop.
(Family Involvement)

How about that Youtube link? Clinical neuropsychologist, Tedd Judd, PhD. offers family members advice on how to approach helping a brain injured loved-one. (8.5 minutes.) Click here to watch. (Skip the advert.)

There is every reason to include family members in therapy when and where appropriate and possible.

When couple counselling I find it helps the couple best if we view their relationship as the client. Thinking sideways, it’s not difficult to shift this way of working to a wider family context. After all, it’s the relationship with and around a loved one with the acquired brain injury that needs to readjustment as much as A.B.I. survivor themselves.

More next month. Take care for now.

The Power of Zen (Part Two)

Spaceballs02

Hello all. I hope you’re as well as can be.

Thank you to the couple of you who’ve emailed and commented on last month’s post.

To answer the question posed by one of you (What is “The Power of Zen” about?) it is about that thing we have that says: “I am”. It’s about that sense we have of being ourselves whatever the state of our brain.

In Part One I explain Zen is an interface – not the whole computer. Those of you who clicked on Zen’s picture may have noted that it gives a running commentry for its / the ship’s systems as they happen. And it is in this way, the ship acquires an ego-like quality.

Here’s a favourite “Blake’s 7” quote:-

BlakeBlake:  Seven of us can run this ship properly.Vila

Vila:  Six, surely.

Blake:  You forgot Zen.

Avon:  You’re not counting that machine as a member of the crew.Avon

Blake:  Oh, what do you say to that, Zen?

Zen:  Please state course and speed.

Blake:  Very diplomatic. Set a course for Centero, speed standard by two.

Zen:  Confirmed.

We have our identity and we know we exist. But how much power over our brain injury does our identity give us if our identity is influenced by that injury?

When we actively own our personality as something more than our brain injury,  to whatever measure possible, we can increase the likelihood of change. Zen’s power is will power.

Existing with a Brain Injury

Another thing I did in Part One of this article is put us in the passenger seat of our spaceship. Why? I’m going to answer with a case example. The clent is fictional. The circumstances are real. Some of you might relate to this example straight-away.

(Justine)

Justine takes medication for her epilepsy. She often needs reminding to drink fluids because when she forgets, she gets really bad headaches. She easilly gets fatigued and doesn’t show much emotion. Although she can hold a conversation much of the time, she gets frustrated when her voice doesn’t produce the words she tells it to. Also, she has difficulty reading and writing.

She says: “I know what I want to write but it’s frustrating. I know where I want to put my pencil’s lines – how to do them – but my brain changes them while I’m writing.”

She goes on to describe both sides of her brain arguing. Justine finds it “fascinating”, “scary…” and “…not really scary… more frustrating”. She is eager to improve.

The extent to which this is possible for Justine is unknown. Coping with the unknown is hard. What Justine is showing us for sure is that she is able to make real-time observations of what she perceieves her brain to be doing. She is frustrated by her lack of control over how her writing looks.

In other words, getting back to the good ship Personality, she is eager to move from her passenger seat to her pilot seat.

How Existential Therapy (E.T.) Might Help

How about we look at Justine’s case in light of the E.T. goals I ended with last month?

(Understand Unconscious Conflict)

Justine has a sense of one half of her brain arguing with the other half. Given the opportunity via therapy, her strength of personality – that bit of her that’s feeling frustrated might get to the bottom of what it is those halves are arguing about.

(Identify Unhelful Defensive / Coping Mechanisms & Discover their Destructive Influence)

I’m unsure how this goal applies to Justine. Perhaps a more applicable goal would be to focus on something practical. With her therapist’s support, she could experiment with aids and techniques to improve letter and word recognition and hand-eye co-ordination for writing.

(Diminish Secondary Anxiety)

If and as her communication skills improve – more and more of her intended words coming out right, her confidence might grow. Getting anxious about being anxious (panicking) could happen less often.

(Righten Restrictive Ways of Dealing with Self & Others)

With better communication and her own creative ways of getting around problems, Justine might help others wanting to help her improve.

(Develop other ways of coping with primary anxiety)

Always, each new achievement raises new unknowns, new possibilities. Fearing the unknown is healthy. Quality “me time” helps. Justine might later develop a new passtime that helps her chill out when she needs to. Who knows?

 

Now for a demonstration. For a quarter hour example of an E.T. session with an ABI client, click here. N.B: You’ll probably want to turn the volume up a tad; the sound quality is rubbish.

That’s all for now. Cheery-oh.

Sean