Tying Things Together

Hello everyone. I hope you had a chance to click the links last month. If not all of them, do have a look at the Occupational Therapy video. It’s fun to watch.

Group Holding Together

How do you like this month’s title picture? Looks a bit like a brain cell, I thought. Not just that, all the coloured threads come together as the background professions come together.

Part 3: In Practice

The bare bones of CRT is a set of activities. Activities designed to help injured brains practice finding their own way from one point to another: A) answer / solution unknown, to B) answer / solution known.

Here is an example – one you can do at home:

  • Take a pack of playing cards.Tying Things Together Pt 3a
  • Look at each card in turn.
  • See or feel what it is.
  • If it has an “N” in its name, like “Queen” or “Nine of Diamonds”, or any other name with an “N”, place it face up on your left.
  • Place cards without an “N” face down on your right.

You might think playing this game is enough to re-knit connections. It isn’t.

The flesh around CRT’s bare bones is the therapeutic relationship between therapist and patient / client.

Activities + Relationship = Knowing.

We practitioners have this term, “Metacognitive skills”. There’s an old saying that goes: “Wisest is he who knows he does not know.” Metacognition is basically the neural knitting that gives us this self awareness.

Did you do the card game? Scroll up and have another read if it’s helpful.

If you’re with someone wanting to have the first go, they might be happy having you say things as they have their turn. Things like: “I see you’re hesitating”; “you seem to be asking yourself something”; “I’m curious that you went straight to that pile”; “I don’t mind stopping if you’ve changed yours”.

If you’re on your own, no one will hear you describe out loud to yourself what you are doing as you do it. I’ve had clients help themselves – one card in their hand, spelling its name out loud, telling their hand which pile to put the card on.

Therapy is mostly done in groups. Sessions are run at clinics or organisations like Headway. Like-minded group members can share experiences. Worksheets can be worked on by the group together. Some find working alone better. And that’s okay too.

Some excellent self help books have been published. For example, Speechmark Books have published exercise books and workbooks for use by therapists, support workers, carers, family members or the injured person themselves.

Having someone as a so-called “soundboard” is good – someone to review your solutions with and discuss your experience that went into making them.

I’ve a view – nothing clinically proven – just my own picture of fibre optic brainways and personality illuminations. What I’m about to say to you, whether you’re the one with or without a brain injury, is important.

It’s this: NEVER push; ALWAYS nudge. Go with your flow more and mind how you go.

Be like Olivia Newton-John playing Goldilocks. Settle for the challenge that’s just right. Experience how well you feel while doing what you’re doing. Get physical by listening to your body talk.

Seriously. Your brain’s personality, and your personality’s brain need to get on together to go on together.

Next month, a few paragraphs on Neuro-Linguistic Programming. (“Hurrah!”) Until then the Society for Cognitive Rehabilitation website is worth a visit.

Tying Things Together

Thank you to all of you who encouraged me to join the Bloggersphere – all you who said I should carry on from where Cogs, Strings and Other Things (my article in BACP‘s Therapy Today, July 2017) left off.

I ended with a brief description of Cognitive Rehabilitation Therapy (CRT). I wasn’t entirely happy about that, so it’s nice to have the opportunity to explain a bit more at length. But I want to keep things as brief as possible, without need for a caffeine fix. I’m going to do it bite-size. So, to begin at the beginning.

Part One: Origins

CRT is generally accepted as having its beginnings in World War I. Veterans returning to their countries severely injured were mostly seen as heroes. Yet their disabilities, whether due to the loss of limbs and/or brain damage, prompted a need for care and whatever rehabilitation was possible for them at that time.

There was no single therapy to look to. (Hardly surprising. As is often said: “When you’ve seen one brain injury, you’ve seen one brain injury”.) Neither does CRT have a godhead figure such as Freud, Jung, Rogers, Beck, Yallom, Perls. et alia. Those of you out there studying and practicing neuropsychology may well be thinking of Alexander Luria, Alexei Leontiev and Lev Vygotsky.

It’s true these three began tying together psychology, sociology, physiology and behaviour in the 1920s into what became known as “Soviet Psychology” and worked with brain injured patients. But their interest strikes me as more to do with the organism of the mind than an intent to enhance the quality of lives, which is what CRT is about.

No. My nominations are Prof Anne Sullivan Macy and Helen Keller.

Okay, yes I know we’re mainly talking Speech and Language Therapy (SLT) here, and they would not have consciously linked what they were doing to an academic thing called “brain plasticity” (the brain’s ability to rejig itself). That had yet to be noted, analysed and played around with rather than merely witnessed. But watch and listen to Macy here as she explains her method by which she taught Keller to first learn to produce the sounds of our alphabet, and later string them into words and thereby communicate more and more with her expanding world.

It all comes down to environment and sensory learning. And what makes sense of the senses and tells us there’s a world, a universe around us? Our brain.

I’m also putting their work in the context of Keller’s championing disabled people’s right to as much of an active and independent life as is possible. Working with the American Foundation for the Blind, she helped set up rehabilitation centres and at the end of World War II visited hospitals to counsel soldiers.

That’s it for now. Part Two is to follow in which I’ll go into CRT’s development. For now I leave you with Hollywood’s dramatisation (and I mean DRAMATISATION – you won’t know whether to laugh or cry)  of Helen Keller’s eureka moment at the water pump in The Miracle Worker.