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

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 and place 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.

Empathy v Sympathy

Hello everyone. This month’s post is in response to another recent email. A counsellor who, unlike myself, prefers to keep her brain injury under wraps from clients unless they ask.

There is no hard rule about it. I had my own discussions over it in supervision. For me too, how I share my experience was and is important. My most important question was: “Who really benefits from my openess?”

Answer: My therapeutic relationship with whoever my client is at the time.

Empathy
Seeing through the eyes and walking in the shoes of someone else

On the back of my business card, and on my website, I highlight that there is more to my work / life experience and skills than brain injury. It’s just that I have a more instantaneous empathy when it comes to the issues around having a brain injury than a non-brain injured counsellor.

Of course, not all clients arrive having read my website. My limp and poor co-ordination make themselves casually obvious. Together they make a warm, but brief ice-breaker. The briefer, the better. If brain injury is the issue, it is as unique for that client as mine is to me.

(Mirroring)

Speaking of “instantaneous empathy”, I feel inclined to share a conversation I had with my neurologist about it. But before I do, here’s something to whet your appetite. Click here for a cartoon on empathy. It is narrated by Brene Brown, a reasearcher-cum-storyteller.

Here’s my own story: During one of my regular appointmets with my neurologist a few years back, he did his usual thing of asking how life was going, how well I was managing my everyday work, and if I’d yet finished my training.

“Not yet,” I told him. “But I am doing some voluntary counselling on placement. In fact, the funniest thing happened last month and I wonder if you can shed some scentific light on what happened.”

I then went into a bit of a ramble about listening to and observing my client – and myself. I realised whenever my body mirrored his way of sitting. Or copied one of his gesticulations. Anyway, in the middle of doing all this, I began to get a deep sense of my client’s wider world. By that I meant my client’s hidden emotions and his unspoken distractions. It all felt so tangible, it was as if I was being him.

“Read this!” said my consultant excitedly. He quickly scribbled me a yellow post-it note. It read: “Mirror neurons”. My neurologist told me some studies had been carried out on elephants and had discovered that they too may very well have empathy. It was all down to mirror neurons located in the frontal lobe.empathic elephant

I could go on about how sympathy is often unhelpful. But I’m sure that’s a given to a lot of you out there. Above all you want people to understand what it is like to see through your eyes, walk in your shoes. Or not get up from a wheelchair for the most part of the day.

I’ll leave you with a hero of mine, Dr. Vilayanur Ramachandran, and his Ted Talk on “The Neurons that Shaped Civilisation”. Be warned, though. It runs over 7 mins.

No yawning at the back!

Enjoy.

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.

Baring Things in Mind (Part Two)

One of my followers asked last month if I’d used the correct spelling in the post’s tbrain in handitle. Most people say: “Bearing things in mind” – with an “e” – meaning holding things in mind.

True, but I just cannot resist putting a twist on things. I love a good pun. Besides, where my brain is concerned I am overwhelmed with multiple goings-on and meanings all in the one instance. I’m  at once expressing  I’m  wanting to uncover the mind, put it on show AND let readers behold it.

As last month was all about our so-called lizard brain – that part of us that processes what we sense, this month, I thought I’d give a case study of a client unaware of his bodily senses. With his permission, I have changed his name to protect his confidentiality.

 (James)

James was caught in a mix of family feuding, physical and emotional abuse. Though he requested anger management he came across as quite nervous.

James had no problem retelling all the incidents and background facts leading to his present situation. He had no problem getting excited about his ambitions. But when it came to recognising his excitement as he lived it, or what he was thinking in real time, he was speechless. He simply agreed with my tentative observations.

It was only after some silence in his second session he fixed eye-contact. He asked what thinking was. My description of what thinking is to me, satisfied him. He decided to give guided Focusing a go as something to do other than talk.

Guided Focusing is a series of directions that lead the focuser into and around their body starting at the toes. Sharing their experience is optional.

The idea seemed strange to James. To him, people existed in their head; their bodies just carried them around. So it was enough for him to at first do no more than note for himself his body’s physicality. And even this came hard to him. When not Focusing I introduced him to Stephen Karpman’s Drama Triangle.Karpmans-Drama-TriangleStudying it on my whiteboard was easier for him, with its systematic take on relationships. He saw himself in it.

James used his third session to separate out negatives in his past and positives in his present life.

He was happy to try Guided Focusing again. This time we combined it with the head-held, theory based, Drama Triangle. Focusing became more instrumental in this when he reported feeling ‘composed’. This was his label for his embodied experience and abstract understanding joined together. I re-worded my ‘guiding in’ script to suit.

‘Composure’ became the theme over the following weeks. James grew able to acknowledge and identify his changing emotions in relation to the different roles on the Triangle he felt himself to be as he told me about his week.

When I asked how his smirk was making him feel while he relayed what he’d like to do to get his own back on a particular person, his perception of himself switched from Victim to Persecutor. He called taking himself to his room and listening to music whenever ‘things invaded [his] head’ his Rescuer.

James struggled throughout with very hypothetical stuff. The whiteboard helped us both. Session 10 came. James decided he no longer needed to visit. He felt more confident at work (something also remarked on by his boss) less angry at home and more in control of his life.

Summary

That’s it for another month. But just before I go, to sum the Drama Triangle up, click here for a bit of “Penelope Pitstop”.

‘Who?’ some of you may ask. Don’t worry. I’m just showing my age. Best wishes to you all.