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

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

Hello all. I hope last month’s post help answer concerns you may have had about panicking. Feel free to give me your feedback. It’s always welcomed.

I thought this month I’d invite you to look with me at another type of talking therapy. Tranactional Analysis  (T.A.) created by Eric Berne, came to mind.

Why? Because after a traumatic brain injury, it can be even harder to see where a client’s thouughts are coming from as they talk to me. Also, to understand sudden changes in mood, in their whole being.

A person has a fair recall of the moments before their trauma. They’ve no memory at all of the time during the actual injury. Afterwards, there’s what I call “iffy” memory – recall of real-life sights, sounds, smells, tastes – but ones that seem to float around with no time pinned to them.

It seems to me that if this disorder is true of memory, it could be true of personality too. And if that’s true, Tranactional Analysis might help a client make better sense of the people around them.

First, if you’d like to, click here for a quick cartoon presentation I’ve found. It gives a brief explanation of the basics.Transaction01

To clarify, Eric Berne speeks of “ego states”. He names them “Parent”, “Adult” and “Child” to make his model more easily understood. It’s where the phrase: “Inner-child” comes from.

All well and good. But what does he mean by them? What do they describe? What’s the point of them? How can knowing the answers to these questions help someone with or supporting someone else with an A.B.I?

Berne’s “Structure of Personality”

Berne means the ways we draw on internal and external resources and information to give ourselves a sense of our own presence. The idea is that we all see ourselves in the context of our own continuing story. The older we get, the more our memories make us who we are.

Imagine an injured brain, and consequently all of a person coming out of a coma. Let’s call this person Liz. Liz might remember her old job, where she lived five years before. Let’s say Liz doesn’t remember what happened before their ambulance came, nor of arriving at hospital. She doesn’t know which hospital she’s woken up in, nor what day it is.

What’s going on?

(Child)

The Child is the state of our ego when organising itself  out of stuff from long ago. The personality regresses to a pre-logical pattern of feelings and behaviours. Whatever thinking takes place does not matter to the Child as much as comfort and discomfort.

So, there in our above example, is Liz –  confused, with a missing month’s worth of empty spaces her waking self expects to be filled with experiences. She cannot form a “here-and-now” for herself. All she has for certain is her emotions and the need to take flight, to fight, or freeze – the need to be comforted.

(Adult)

Our ego state when taking in and processing information from all around. That bit of the personality which weighs the evidence – rationalises.

Let’s say the nurses who come in to check on Liz manage to reassure her that she is safe. Comforted, and after a bit more rest, she might be ready to learn why she’s in a hospital bed.

N.B: The fact that she’ll most likely forget details of what she’s told by nurses and doctors is not important to her Adult state; Liz is aware of being treated with respect NOW.

(Parent)

The Parent ego state is the boundary setter, the rule-maker. It’s made from long remembered stuff – “shoulds”, examples of wrongs and rights, goods and bads as learnt from authority figures and experiences from yester-year.

As Liz begins her rehabilitation, her growing realisation of lost skills, know-how, of her inability to recall conversations, she begins to get more and more critical of herself.

(All Together)

N.B: At any one time, even after brain injury, all ego states co-exist together. All three of them. It is just that, depending on the situation of the moment, the personality is most influenced by one, a little less influenced by one of the other two, and least influenced by whichever comes third at the time.

Transaction02

That’s it for now. Sorry I’ve gone on a bit longer this month. I hope Part One was as interesting to read as it was to research. In Part Two I’ll be giving my perspective on the insights Transactional Analysis offers in regard to brain injuries and relationships with others.

Take care for now.

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

Grove Press; NEW YORK; 1961

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

 

SMART Pacing

 

pacingHappy New Year Everyone!

Here we are at the start of another twelve month cycle. If you’re anyone like me, this thought will have crossed your mind: “Is making a New Year resolution good for me?”

The Problem With Me

My neurologist once told me: “Sean, you can do most things most people can do. The difference is that they only need fuel themselves on one Mars bar. You need two.”

I’ve come to the conclusion, having a brain injury myself, that eagerness and enthusiasm to achieve works against me. I set myself too many ambitions. And those ambitions have been too big. I try to run before I can walk. I get fatigued and burn myself out.

I also set myself one year in which to achieve my goals. I’ve already said: “Here we are at the start of another twelve month cycle.” BIG mistake! Next Christmas becomes a Finishing Line. A Finishing Line that’s only half way down my imaginary racecourseeaster bunny.

When I get to Christmas, I feel a failure. My ambitious project still has a lot of time to be spent on it. In any case, the truth is I’d be out of puff before I’d got to Easter.

SMART Eggs

Specific   Measurable   Actionable   Relevant   Time-boundaried

That’s what S.M.A.R.T. stands for. It’s a way of working out the best goals to set. No one needs to be an egghead to use it, either… (Sorry. I couldn’t resist.)

Rather than have a New Year resolution, why not start smartly at Easter? Easter’s about new beginnings too. Better prepare yourself. Give yourself the best step forward. Consider your current experience and go on from where you are.

For example, the need for memory aids etc. Knowing who to talk through your hopes and wishes with might be your first step. Collaboration can help everyone involved be more aware and focused.

(Specific)

Be clear and certain. Set your sight on something simple. Very often, brain injury lets in all sorts of clutter – too much info’ from too many places – facts, opinions, advice. The more specific your target, the greater your chance of staying on track.

Let’s use the example of changing weight. “Changing weight” is an unclear statement. “I’d like to be 10 stone” leaves no-one uncertain about what’s wanted.

(Measurable)

For the purpose of demonstration here, let’s say “One pound difference a fortnight”. Weight can be measured every two weeks and a record kept.

(Actionable)

Again, stay specific. What treat can you not do without? Are medication and special dietary needs important factors? What is realistically achievable?

Memory and organisational problems can be reduced by dicussing meals for each day of the week. If need be, ask someone to add them to your diary, or tablet, or on something stuck to your fridge’s door.

It doesn’t have to be as strict as keeping count of how many calories per plate. Once a sensible menu has been agreed, just keep to that day’s meal.

Exercise, however possible is also something to be discussed.

(Relevant)

How relevant is weighing 10 stone to health and happiness? Maybe our existing weights are already ideal for us. Maybe something else is in more urgent need of attention.

(Time-boundaried)

Let’s say the difference between our start weight and the desired 10 stone is 3 stone. There are 14 pounds in 1 stone. 14 (pounds) x 3 (stone) = 42 (pounds). Pacing, targeting and measuring one pound difference every two weeks sets the target time 84 weeks… So we may as well, allowing a bit of leaway for celebrations and lapses, set a time boundary of two years.

And hey, if the 10 stone weight is arrived at sooner, what the heck?

Take care. I’ll be back in February.

The Art of Conversation

Art of cinversationChristmas is nearly upon us again. Straight-away my heart goes out to lonely and isolated people. Those out of touch with their loved ones. Those who struggle with the cold, maybe a reduced immune system.

And let’s face it, not everyone enjoys Christmas anyway.

It can all get just that bit too noisy. Crowded shopping malls and streets with nowhere quiet to go. Even staying put indoors, the likelihood is the loud arrival of noisy visitors – all expecting you to be as caught up in the magic of the festivities as they are.

For those with an acquired brain injury, Christmas can equally spell feelings of entrapment, anxiety, confusion, irritation, dizziness, extra fatigue, anger. And then comes the fallout.

So in light of all that, I thought I’d share something of a book recommendation with you from a client. For the sake of confidentiality, let’s call our book reviewer Adam. Up until his brain injury, Adam dealt with negotiations and contracts as part of his job. Now he admits to being rigid in his thinking and unable to handle group conversations.

“How to Control a Conversation” (by Peter W. Murphy)

How to converse

Adam said to me: “I’m only up to page 14. I keep re-reading the same pages, and I am getting the idea. The book is making me stop and ask myself questions. I ask myself: ‘Am I communicating on the right level with the right person?'”

I was unsure what he meant by this. In my mind I had a picture of his mind’s eye stepping away from himself to watch his scene and hear what he himself was saying in it. Did this image make any sense to him? I asked. He told me it did.

He continued: “It gets complicated sometimes. There are words I know exist but they won’t come. It’s helpful to be able to predict what’s coming out of your mouth. This book is helping me to ask the right questions inwardly before I say anything.”

Something else that became more apparent as I listened to Adam (I don’t think he’ll mind me saying so) was an increasing empathy within him, or at least an attempt to imagine how he sounded to others. And a sense that somehow writer, Peter Murphy’s guidance was a mind opener Adam is finding exciting.

I haven’t read the book myself. But I’m thinking I might buy it as a Christmas present to myself. Thank you, Adam.

MERRY CHRISTMAS EVERYONE! All my best for 2019.

Sean