The Power of Zen (Part One)

Spaceballs01Hello there. Welcome back for what I hope is another entertaining and helpful read.

Imagine you and me in a spaceship. Neither of us know exactly where we are going, but we’re happy to just head out into the galactic lanes and follow a scenic route to the closest picnic planet to lunchtime. Our  ship’s name is “Personality”.

“Who am I?” is one of the most difficult questions we ask ourselves. Here’s another, maybe an even more difficult one to answer: “Where am I coming from?”

Some of us human beings display no e-motion after a brain injury. Some of us even become unaware that we are unaware; we don’t know that we don’t know. (In the second case it’s unlikely we would have the curiosity to ask the “where from?” question at all. Importantly, we would not have the choice to not choose something.)

But let’s assume you and I are still curious. Having a brain injury, we’re blissfully looking out into the depths of Space in our passenger seats on the good ship, “Personality”. Sharing the piloting are Vilayanur Ramachandran and Rollo May.

Neurology

World famous neurologist, Dr. Vilayanur Ramachandran is one of my inspirations. He begins his Ted Talk (“3 Clues to Understanding Your Brain” (approx. 23 min’s) with the following…

He says: “Here is this mass of jelly – this three pound mass of jelly. You can hold it in the palm of your hand and it can contemplate the vastness of intersellar Space. It can contemplate the meaning of infinity. And it can contemplate itself contemplating the meaning of infinity. And there is this peculiar recursive quality that we call self awareness, which I think is the Holy Grail of neuroscience…”

(Already I hear in my mind’s ear, a chorus of 2 1/2 year-olds chanting “But why?!”)

Zen

Anyone remember “Blake’s 7”? Basically, it was kind of Robin Hood / Dirty Dozen in outer space.One of the seven outlaws was a computer expert called Avon. In a remake of the series, he gives an alien computer an “interface” called Zen which allows him and the computer to exchange information; Zen becomes the computer’s personality.

Personality is our awareness and voice in action.  It allows us the chance to know each other.

Existential Therapy

Okay, having stopped off for a bite, or dare I say “byte”, on planet Neurology, back on board our spaceship, psychologist, Rollo May decides to take us for afternoon tea on his homeworld – Existential.

But let’s not go there straight away. Let’s visit next month in Part Two. I’m pooped and I’m guessing you are too. For now, let’s have a quick flick through our metaphorical tour guide.

In it we see the goals of Existential Therapy are:-

  • To understand unconscious conflict
  • Identify unhelful defencive / coping mechanisms
  • Discover their destructive influence
  • Diminish secondary anxiety
  • Righten restrictive ways of dealing with self & others
  • Develop other ways of coping with primary anxiety

Bye for now,

Sean

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Brave New Who?

Bereavement

Hello all,

No, nothing to do with Doctor Who’s regeneration. This month I thought we’d cover bereavement. Not the kind of bereavement people usually talk about – after a death of a loved one. I mean the kind a brain injury brings.

The following is drawn from my experience, counselling clients with ABI and stroke.

Similar to the grieving process we all go through after a death, people finding themselves with a life-changing brain condition go through their own. This process has its own stages / periods. N.B: Theses stages / periods have no particular order.

Bereavement02

  • Denial
  • Anger
  • Loss of Focus / Identity
  • Depression
  • Reflection & Self Awareness
  • Acceptance & Adaptation

Let’s look at these in turn.

(Denial)

This can be either a willful or unconscious non-recognition that a brain injury has happened. This is different to a client not perceiving the difficulties they are having; some clients know they’ve for example, suffered a stroke but remain unaware of the true extent of adaptation they need.

However, sometimes the shock of a life-changing event and the initial fears that go with it are all too much. It seems easier to go with the idea that nothing’s wrong, or that others are making things up, or exaggerating.

When it’s obvious that short-term memory problems and/or “simple jobs” are no longer being done “properly”, both the brain injured person and those close to them can find it helpful at first to pin problems on another health condition. Or age.

(Anger)

Even before a brain injury, some people have short tempers. After a brain injury those tempers can change either way – become even shorter, or if not stay the same, become harder to tell. Some people hardly ever get angry. Some are good at hiding it.

As part of bereavement, anger is often aimed at the cause of the injury, the world for not understanding, life in general or God for what’s happened. Or the patient / client can target their anger towards themselves.

N.B: Anger can alternate with guilt, for example when a person labels themselves as a “burden”. (I like to balance this with a further note: That a good number of people also find comfort in being needed by others.)

One good thing about anger is that, in the right place, time and company, it can be a great motivatior.

(Loss of Focus / Identity)

The crux of the matter. The immense yearning to again be that person who was. Because all that’s left is, for this time being, a nobody. For one client it was like the voice saying: “I don’t know who I am anymore,” was coming from a faceless shadow, not the person himself.

(Depression)

No kidding, this is a difficult period to move on from. Because of the change in neurology, medications may be necessary to help. Being actively listened to and listening to one’s self can also help. Keeping as active as possible is important too, even when not feeling motivated.

For more on motivation and ABI, click here.

(Reflection & Self Awareness)

In Western society we are quick to confuse who we are with what we do; we identify ourselves with our job. Meeting a stranger the question most asked and answered is: “What is it you do?”

Reflection and growing aware of the person who the person was who appled for that job before they had it, asking: “How much of that person is still here?” and paying attention that remaining person is very much part of the brain injury journey. Especially for the patient / client themselves.

(Acceptance & Adaptation)

This is not the end result of the process. The process goes round and around like a wheel moving forward.

Recently, I also used this metaphor: Bereavement is like two feet walking – an emotional foot, and a managing foot. Some days emotion take over, some days practicalities can be done.

Living with a brain injury yourself, or indeed getting to know someone all over again can be rewarding too. Some people consider themselves a nicer, or stronger, or more confident person than they were before. Some discover talents that had never shown themselves before.

I’m going to end this month with a song.  It’s not about brain injury. But the words kinda fit. Alicia Keys: Brand New Me Skip the ad’.

Take care.

Sean

More Than Words – Expressive Art Therapy and Brain Injury

Art Therapy

Hello, all. Hoping you’re okay.

A few months back, I posted a piece about Writing Therapy. But writing is not the only creative form to be used as therapy. Drama, dance, drawing and painting, all can come under the title of Expressive Art Therapy.

I was introduced to it in my third year of training via Natalie Rogers. She’s the daughter of Carl Rogers, and a pioneer in her own right. If you’d like to see her explain her contribution to the Person-Centred approach to counselling, click here.

But the  U.K’s so-called “Father of Art Therapy” was Edward Adamson. Between 1946 and 1981 he worked at Netherne Hospital in Surrey.  It was there he encouraged patients to paint, draw and even sculpt.  He also extended his work througjh the British Red Cross.

Watching Paint Dry

Very academic readers and viewers might like to watch a conference presentation published on Youtube by the Edward Adamson Collection. (Or some of it.) It’s in two parts and called: “Art in the Assylum – Edward Adamson’s Life & Work”. Part 1 (Approx. 30 minutes long) and Part 2 (Just over 30 minutes long.) Those of you less academic WON’T.

General Principles of Expressive Art Therapy
  • Therapy is process focused, rather than systematic
  • The therapist, though qualified and professional, offers support, not authority
  • The client is their own expert
  • Creativity, expression and reflection can lead to positive wellbeing

What do these principles mean?

One, that therapy looks to the client’s experience more than goals and strategies. Two, the therapist does not believe their opinion is more important than the client’s. Three, the therapist trusts the client’s motivation, openness and self realisation. Four, the client’s own way forward is shown through their art.

Art Therapy2

How Expressive Art Therapy Works with Brain Injury

Thinking of the symptoms of brain injury – poor short-term memory, lack of concentration, aphasia or dysphasia, difficulties specifying goals, how can Expressive Art Therapy help?

  1. As the saying goes, “one picture can paint a thousand words” – there is no pressure to mean things with words
  2. The focus is on what’s going on for the client in the moment, so that there is less reliance on memory
  3. Both therapist and client have something tangible to refer to as therapy takes place
  4. The activity of being creative has the potential to increase concentration, planning and other cognitive skills.

But don’t just take my word for it, here are a couple of shorter links:

“Art Therapy Helps Patients with Traumatic Brain Injury” published by NJTV News (3 minutes long)

“Art Therapy Activities: Art Therapy and Brain Injury” published by eHowArtsAndCrafts (2 minutes long)

This is it for July. Take care for now.

 

Someone Walks into a Bank – Brain Injury, Modern Technology and Isolation

This month I’d like to highlight isolation. To help, I’ve the story of Mike. Mike is not a real person, but he is inspired by several real people – people living with the social effects of brain injury as well as cognitive.

What is Isolation?

The state of being separated from someone and/or something else. A “something” might be our community, which means being separated from lots of people. “Community” also implies, by its own definition, that those lots of people are helpful to each other.

So isolation can also mean ending up without help.

Chains of Isolation
  • Invisible cognitive problems
  • Communication difficulties
  • Emotional difficulties
  • Poor access to work
  • Reduced daily living skills
  • Relationship strains
  • Feeling sidelined
Modern Life

On the theme of computers and social skills, here‘s a “Little Britain” sketch I thought you might like before reading about “Mike”. Enjoy!

(Mike’s Story)

One Saturday morning, Mike decided to visit his bank. He had to cancel a direct debit. Not feeling confident, he had it in his head that a staff member would help from across the counter or in one of the side offices.

A reminder on his mobile three hours before the bank closed prompted him why he needed to get up in good time. (Being a Saturday Mike’s bank closed early.)

He arrived at the bank and stood in line to be seen. As he waited, a member of staff approached him. She had an ipad in one hand and a cheerful greeting for him. Before he could answer she asked if Mike banked on line. She told him that if he did, he need not have made the journey into town.

Mike felt awkward. He heard himself say: “I’m not interested. I’m just here to cancel a direct debit. Sorry.”Bank2

She carried on regardless. Mike tried to concentrate, but panic rose and her words began to wash over his mind. Anger began to take over from panic. The level of his voice matched the level of his emotion. “Stop!” Embarrassed he apologised. He tried humouring her. “I’m a dinosaur. I don’t get on with technology. I prefer to speak face to face with someone.”

Eventually, Mike felt telling her he had a brain injury was the lesser of evils. He coped better when not having to think about PIN and customer reference numbers, and yet another password. Telling her was his only way out of this situation. He did not like doing it; he worried who else might be listening.

The lady accompanied him to a desk and another member of staff. And even though that member of staff tried to help, her computer would not allow her to authorise the cancellation. In the end, Mike was led into a cubicle with a phone and given a number to ring.

Eventually Mike and the voice at the other end cancelled the direct debit. It had taken the voice several ways to answer Mike’s one last question, but the voice did not mind. The voice belonged to a human whose relative had had a stroke.

Mike was grateful but eager to get home. He felt drained and in no hurry to talk to anyone else that day.

As the “Little Britain” sketch shows, you don’t need to have a brain injury to be frustrated with modern technology. But for those with ABI, the problems can double.

Take care for now.

Sean

 

Action for Brain Injury Week 2019

Hello, everyone.

20th -26th May 2019 is “Action for Brain Injury Week”. Activities aimed at raising public awareness of the effects of brain injury, and the dangers, will be held. Headway is the force behind it, and its branches will be holding Hats for Headway up, down and sideways across the UK. Find out more by clicking the poster.hats-for-headway-poster-2019

As this year’s theme spotlights fatigue, I may as well throw my hat into the proverbial ring and talk about fatigue in this month’s post. My neurologist once said to me: “Sean, you can do most of what people can do. It’s just that what they do on one Mars bar, you can do on two.” So here’s an example of how fatigue gets to me – what takes me from over-tiredness to being on top of things again.

This week I’ve taken a few days off from my day job. (I know we’ve just had Easter, but hey, I was doing Easter type things.) The day job often tires me out. There are times I return home and doze on the sofa before I’ve the energy to do anything else.

The house being a bit of a mess despite help, I’ve chosen to use the time to get a few outstanding chores done. To help myself, I’ve written a “to-do” list with reminders on my mobile for each day.

Today’s To-Do

7am to 8am = Emails; letters; catch up on yesterday’s journal (1 hour reminder)

8:29am 8:31am = Med’s (Daily 1 minute reminder)

9:30am to 10:50am = Trip to shops etc. (3 hour reminder)

11am to 11:15am = Make important phone (15 minute reminder)

11:15am to 11:30am = Coffee & Kit Kat (1 minute reminder)

11:35am to 12:35pm = Filing (10 minute reminder)

12:40pm to 1pm = Lunch (10 minute reminder)

1pm to 3pm = Blog (10 minute reminder)

3pm to 3:20pm = Break (10 minute reminder)

3:50pm to 5:30pm = Blog (10 minute reminder)Snoozing brain

5:40pm to  6pm = Snooze / read (15 minute reminder)

6:10pm to 6:30pm = Get ready for evening out with friends (1 minute reminder)

Thinking Behind It

Knowing what I’m like, I factored in some safeguards to help keep my cool, not get wound up if Life, if not my self did not keep to my time-plan. Let’s face it, the real world is filled with delays and “unforeseen circumstances”.

Note my reminders to myself. I’m not as good at waking up as I once was. My mobile actually bleeped my need to be at my computer at 6am – 1 hour before hand; I’d set myself a 1 hour “window” to psyche myself up to the reality of getting out of bed.

Be gentle with yourself when doing your own list.

I also planned breaks at times close to my daily routine at work. This has put me in a business-like frame of mind. (Parent ego state, to reference last month’s post.) Pacing is a must.

Here’s a presentation I Googled you might find helpful: “There is Nothing Lazy About Someone with A Brain Injury” by Adasm Anicich.

What Happened

I got up at 7:30, so already I was behind what I’d intended. Thankfully, a letter I needed to compose was a virtual repetition of what I’d written a year ago. I just needed to change the date and a couple of other things and print off an updated version. After the usual showering and breakfast toutine, I left home half an hour later than planned.

But what I needed to do took less time than I thought. And my return bus stood waiting for a driver at the stop. (Good luck happens too.)

My point is: Be SOFTLY regimental.

Today I got all I needed to do at my computer. When I made my phone call I did not get an answer, even though I tried twice. I got through a big bit of my filing and I’ve completed this post to you on time, on the 15th of May. I’m happy.

Until next month, take care.

 

 

 

Transactional Analysis & A.B.I. (Part Two)

Easter may have gone but we’re not yet donning jingle bells around our knees nor skipping around May poles. Hoping you had your fill of buns and chocolate be it milk, dark, diabetic or any other alergen free treat.

I promised last month to look at how Transactional Analysis might add extra insight into relationships with a loved one or client with an A.B.I. – how T.A. might help.

Ever tried to see the point of view of someone else? Maybe you end up saying: “I don’t know where you’re coming from.” Or when someone said something hurtful, as if out of nowhere, you’ve said: “Where did that come from?” Perhaps someone else has said this to you and you’ve not known yourself.

Transaction01

Where That Came From

We looked at the three “ego states”last month – Parent; Adult; Child. These are three simpler way of viewing our frame of mind – especially the networks of feelings, thoughts and behaviour during our interactions with others.

When our words and attitude towards another lay the law down, having decided that person is in the wrong, those words are as if from a Parent.

When our words are factual and fair so that compromise by everyone is most likely, we are “behaving like Adults”.

Our Child is viewed as taking control if our feelings are so strong, we go back into old ways that were helpful before, but not now.

In everyday life, we don’t just say one word or sentence to someone and then walk away from them; we ask them to respond, or look for their reaction. We have conversations. Each back-and-forth statement is a “transaction”.

Ordinarilly, our frame of mind is changing as fast as we react and respond to the Parent, Adult and Child of others. But what when one of us has a brain injury? It depends on the type of person and extent of their brain injury.

For example,  some time ago, I worked with someone presenting with expressive aphasia. Let’s call her Daisy. Paraphrasing, I learnt quickly, was a no-no. Making sure I understood Daisy correctly was doubly difficult. If I didn’t repeat back to her precisely the same words she’d used, and in the same order, Daisy believed me stupid; even though to my mind my sentence meant the same as hers, she would get very impatient with me.

Daisy’s default ego state was Parent. (This also had been reflected in her choice of job prior to her injury.) It’s possible her injury caused her ego state to be less flexible.

How did I cope? Honesty. I apologised, said I was slow to learn, and maintained a judgemental tone as I kind of told myself off. My words (one of which was often used by Daisy) were Adult, my tone with myself (as she listened) was Parental.

Puppy love

Types of Transactions

(Complementary)

These are transactions that parallel one another.  Ideally, they are realistic and factual, from person to person – both as Adults. Parent to Parent is also parallel. Child to Child too. But Adult to Adult works best. Both people want to have a mutually good outcome.

(Crossed)

Crossed transactions can happen when one person misreads the other person’s ego state. Even when one person talks from an Adult stance, the other person might respond from vulnerable feelings (Child) or believing the speaker is being insubordinate (Parent). Not helpful.

(Ulterior)

Here we are into gameplay. There’s a more complex transaction on two levels at once –  social and psychological. And it is important that both people understand what game is being played! Ulterior transactions happen when someone says something but means something else.

N.B: As family, friends, carers, therapists or other supporting professionals, the onus is on us to pay attention and respond in the appropriate way. If and when possible, our goal must be to bring out and engage with the other person’s own Adult self. The best way to do that is with our own.

Until next month, take care. I’ll leave you with a useful presentation by the Latimer Group called The Recipe for Great Communication

Source: Berne, E: “Transactional Analysis in Psychotherapy”

 Grove Press; NEW YORK; 1961