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 themselmselves, 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.

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

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

Panic Buttons for A.B.I.

This month I’ve been asked to write about panic attacks. Wow! I thought. Why haven’t I covered it before? When any of us are unable to think straight, our biology, our emotions carry us along.

Where they carry us, we don’t know until we stop, draw breath and take in what we can of our situation. Up until that point, we don’t know which direction we’re taking ourselves. We become proverbial “headless chickens”.

Before any compensatory therapy or strategy can prove useful, Step One has to be a willingness to face fears. This is most true of clients whose cognitive functioning can be problematic, even on the happier days.

TV Static

The clouding of consciousness (brain fog) is for ABI clients / patients, physical. In a lot of cases it does not go away. Emotions determine the degree of cloud cover, but it’s always there to be lived with.

Another way to describe an injured brain might be as a faulty TV set. I am reminded of Sunday mornings I spent many, many years ago – playing around with the aerial of my parents’ gogglebox – trying to get an undistorted picture of the BBC test card before “Mr. Benn” started.

As therapists, the most we can do is reduce the amount of static and suggest positions the aerial might work better. The aerial’s actual positioning to stabilise their picture behind their static is our clients’ job.

There is no real, by the book, “how to…” with this. In my view, it has to be person-centred. Here‘s a link to Part One of a counselling session (not one of mine) with a head injured client. It lasts 9 or so minutes.

N.B. The client reports being “snappy”, NOT “panicky”.

Panic Button Controls
  • DON’T FIGHT, TAKE FLIGHT. Remove yourself from the environment / situation causing your panic.
  • Find somewhere you can be safe and quiet.
  • Begin listening to your own breathing, taking slow, deep breathsABI and Panic
  • Close your eyes and, if possible, imagine you’re in your favourite surroundings, doing a favourite thing.
  • If imagining you are somewhere else is impossible for you, hold an object in both hands and look at it. Keep listening to your breathing as you notice each of the object’s details – shape, colour, texture, markings…
  • Keep practicing. Set a special time andplace aside for yourself.

Reading what to do might be easy. Remembering and doing it, as we all know, is hard. It helps most to be with someone while you practice.

Click here for Part Two of the counselling session. Again, not a counselling session of mine. Part Two also lasts around 9 minutes.

Patchy Reception & Counselling

If you are perhaps wanting counselling, the following points may help you decide.

  1. It offers you a room clear of clutter and distraction – space to breathe and relax.
  2. Regular time slots (50-60 minutes) that can be used to off load – kind of scatter thoughts, feelings, experiences into and around that room.
  3. It provides someone who will support, not judge. Part of that support is in helping take control of the panic. Part is in helping you get organised.

If I was to counsel you, I’d combine listening with breathing techniques and other Mindfulness exercises. A new sense of self can grow. Because as your new self becomes less patchy, you could begin to identify your gut instincts – which situations cause panic more than others and how to deal with them yourself.

Take care for now.

Sean

 

Busy Doing Nothing

watering holeThere are many pictures used to describe problems around motivation. One that’s used a lot is this: A horse led to water, who refuses to drink. Close to this is the picture of the proverbial “stubborn mule”. Mixing these pictures together, automatically thinking that the horse isn’t drinking because it’s refusing to – that it’s just being a nuiscance for the sake of it, can be a mistake.

Applying “stubborness” to someone with an aquired brain injury can be unfair and misleading. Yes, the person may appear disinterested, may well be unmotivated. But there are two important questions to ask:-

1) Q: What is motivation?

A: “A reason or reasons for acting or behaving in a particular way”. (O.E.D.)

2) Q: What motivates reasoning?

A: Feeling unsafe. Due to hunger, lack of shelter or being cared for, or craving social status.

Fear

NOT being motivated (as some people might see it) might in truth be VERY motivated.

The person “not doing anything” may in truth be doing many things. Things liMotivationke:-

1) Regaining energy after doing what they did yesterday

2) Avoiding standing out from the crowd

3) Stopping themselves making mistakes

4) Avoiding making his or her self see they are unable to do the things they used to in the way they still want to.

5) “Torpor”. Torpor is a tough one. I’m using the word to describe a state of disconnection between something that in the past would have been acted upon but which after their brain injury, there is a present indifference to.

Here’s a link to a vlog entry by a young woman talking through her own problems with motivation: Click here to hear what she has to say.

What’s important to note is her linking stamina to motivation. Her ongoing research is, I think, proof of her personal motivation. She is positive that she WILL achieve what she wants.

Just to end this month’s post, here’s a little story for rescuers and readers finding yourselves stuck. I found it a big help. I hope you do too.

Cocoon

Along a dusty road in India there sat a beggar who sold cocoons.  A young boy watched him day by day.  After some time, the beggar finally beckoned to him.

“Do you know what beauty lies within this chrysalis?  I will give you one so you might see for yourself.  But you must be careful not to handle the cocoon until the butterfly comes out.”

The boy was enchanted with the gift and hurried home to await the butterfly.  He laid the cocoon on the floor and became aware of a curious thing.  The butterfly was beating its fragile wings against the hard wall of the chrysalis until it appeared it would surely perish, before it could break the unyielding prison.  Wanting only to help, the boy swiftly pried the cocoon open.

Out flopped a wet, brown, ugly thing which quickly died.  When the beggar discovered what had happened, he explained to the boy: “In order for the butterfly wings to grow strong enough to support him, it is necessary that he beat them against the walls of his cocoon.  Only by this struggle can his wings become beautiful and durable.  When you denied him that struggle you took away from him his only chance of survival.”

butterfly

May the walls of your cocoon be just thick enough to allow you to struggle just long enough to emerge strong enough.

Baring Things in Mind (Part Three)

Hello all.

Thank you to those of you who’ve got in touch. It was especially nice to get an email from a fellow counsellor with cerebral palsy. Yes, I agree we should chat more about its impact and on us as practicing therapists. I’d be very happy for this here blog to be a place to come and share.

If you find Neurolations interesting, entertaining, dare I say useful, please do spread the word. How many of us brain injured therapists are there across the U.K? It’d be great to learn how you connect your chosen form of therapy to your brain injury.

That said, I will restate my blog’s other purpose.

You may not be a professional; you may have short-term memory problems, difficulties keeping track of days, appointments, budgeting, knowing who’s who, controlling your reactions and times when strangers think you’re drunk or just plain wierd. Neuronations is also about helping you.

With all of the above in mind, I thought I’d share an idea with you this month. A work-in-progress, really.

I am always interested by close similarities and cross pollinations of psychotherapy approaches. Psychodynamic therapists and analysts talk  of “personas”; cognitive behavioural therapists refer to “schemas” and “models of behaviour”; transactional analysists speak of “ego states”. The list could go on. But let’s keep things interesting.

Can the triune brain  (lizzard, limbic system and neo-cortex together) form the basis of a new way of looking at Cognitive Rehabilitation Therapy?

I think it can. But my thinking is only based on my experience. I’m wondering how much of your own experience and concepts you can attach to the triune brain. Today I found a thought provoking video about it on Youtube: “Therapy in a Nutshell”. (Don’t you just love it when Serendipity comes along?) N.B: The video does NOT represent the hard science of how the brain works. It is a SIMPLE WAY OF EXPLAINING the brain and personality working together.

triune triangle

The world already has loads of pyschological ways of dealing with what it is to be human. Does it need another one?

The thing is, I’m not sure if any counselling approach takes physical, neurological injury into account. A whole range of books have been written about emotional and psychological disorders. Entire training sessions are given to learning about depression, eating disorders, addiction, anger management and so on. But much less so the interelatedness of brain injury and personality changes, for example.

Anything that does deal with A.B.I, as far as I’ve found so far, is just concerned with the neurological function of lobes and the effects of damage to them – almost in isolation from the rest of the brain. Useful knowledge in an operating theatre. Not so helpful when someone describes to you the loss of balance caused by loud noise but you cannot sense that with them.

Until next month, take care for now.