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

 

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

 

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.

Suicide Prevention

Hello everyone.

Monday, 10th Sept. 2018 was Worldwide Suicide Prevention Day. It’s a bit of a touchy subject for most people. It’s easier to give into the fear of giving people ideas andBlack hole of the soul not talk about it. Yet all too often it is the unheard voice that causes surprise. And pain.

With this in mind, let’s look at suicide in relation to acquired brain injury survivors.

Ordinarilly I address subjects with an even handedness: serious reflection on one hand, a bit of entertainment on the other. I cannot do it this month.

Instead, if you are questioning yourself in this way I urge you to reach out to someone you trust – someone who will neither discourage you nor encourage you, but will give you their caring attention.

Two helplines to turn to are Headway UK and The Samaritans.

HeadwayHelp
Samaritans

For one-to-one, face-to-face help in and around Norwich, Norfolk, my counselling sessions are available at these times:

Monday to Wednesday = 5pm to 8pm. Thursdays = 9am to 8pm.

Contact: sean@seanhindle.co.uk or on 0777 552 0302. If you cannot reach me immediately, please leave a message. I will get back to you after 4pm.

Spot the Signs

These are the most common signs. But let’s look again at them in respect of someone living with a brain injury. In this case, it’s helpful to keep in mind their new personality as you’ve come to recognise it.

  • Sudden calmness: Is this out of character? Following an ABI, some people’s body language becomes hard to interpret. Some people are left with a lack of emotion.
  • Excessive sadness or moodiness: Again, is this the new norm? With little or no short-term memory, there’s no dwelling on things for long; emotions change in stoccarto fashion. Social inhibition and emotional control may be a manifestation of brain injury alone.
  • Withdrawal: Choosing to be alone and avoiding friends or social activities are possible symptoms of depression. Though just as true of brain injury sufferers, I’d weigh this with their motivation – as discussed last month.
  • Changes in personality and/or appearance: The “new” personality, that is. A person considering suicide might exhibit a change in attitude or behavior. Has (s)he become less bothered about their own safety and/or personal appearance?
  • Threatening suicide: For some people, “I wish I was dead” is as much a casual expression as “Sometimes I could…”; they say it without meaning it. Even so, every threat of suicide should be taken seriosly.
  • Dangerous or self-harmful behavior: A sensitive time for those with a brain injury (especially if recent) is when he or she begins to realise for themselves the extent of their cognitive difficulties. Bereavement, anger, addiction, recklessness or intentional self-harm – any can be triggered around this time. Another key time is when depression reduces and motivation increases.
  • Making preparations: Often, able people deeply considering suicide will begin to plan. The plan may include “For after I’m gone” behaviours – to take care of loved ones “left behind”, for example. Even if such organisation is impossible for an individual they may, over time, learn where and when oportunities present themselves.

It’s easy to get alarmed reading these kind of lists. Has the list prompted a memory of something you found odd at the time? Has something someone’s said struck you as odd? Talking openly as possible to those that matter about any of the above can reduce the intensity of such discomfort.

Okay. I’ve rambled again. I’m a bit late with my posting this month too. Sorry.

I shall be quicker next month..

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.