Cognitive Rehabilitation Therapy – Companionship & Competition

Two Pronged Brain

Last month I talked of the two ways in which C.R.T. can be given – “Comprehensive” and “Modular”. My personal opinion is that a combination of both helps individuals most. This was following a conversation with someone wanting to help their family member directly.

I hope the link to Dr. Judd’s expertise was useful.

Nowthen, as it’s Christmas, I thought it might be an idea to look at some of the online resources available. There’s stuff out there, some even quite fun, that everyone can challenge each other at.

(“Restorative”)

It’s best to see this often used term as an intention, not a promise. It is used to describe exercises designed to improve precise areas of brain function. For an idea of the different options available online, click here for Phone Arena.Com’s view of their “Top 5” brain training sites. (Just under 4 minutes.) (As always, you may want to skip the ad’.)

(Neuronation)

Not saying it’s the best. Neuronation is the site I’ve most experience with. You can find your own favourite.

The first thing to do is register an email address and password to log on with. The first thing that will greet you will be three choices of subscription: 1. £11 for three months; 2. £5 for twelve months or 3. £299 for a lifetime access to all the games. But as with most things of this nature, you’ll get a free sample of tasters.

To gain access to these free samples, click the “Training” header at the top of the page. The next gives the options of “Daily Training” or “Exercises”.

On your first visit, I suggest you go straight to the exercises. These include a free exercise or two in the following catagories: “Numeracy”; “Language”; “Reasoning”; “Memory” and “Perception”.

Have a practice at each. You can time yourself, but I’d suggest building your confidence by having a go in “Learning Mode”. Pick a catagory; pick an exercise; choose the “Tutorial”; click the “Learning Mode”.

Neuronation monitors and charts your level of performance. At any time, when fatigue or boredom strike, you can come out of your chosen exercise.

Whether you’re wanting something to do yourself, or get to know and help your familiar-cum-new member of your family, these online products are a good way of doing it.

Wishing you progress throughout 2020. And a Christmas as best as best can be.

Sean

Xmas2020

Cognitive Rehabilitation Therapy – The Two Pronged Way

Two Pronged Brain

Here at last! I thought I was never going to get this uploaded. And still in November too.

Let’s turn our attention back to Cognitive Rehabilitation Therapy (C.R.T.)

Why?

  1. We haven’t talked about C.R.T. for a long time.
  2. Someone recently asked what they could do at home to help their loved-one themselves. (I’ve found a Youtube post that should help. See below.)
(Definition)

There are many. It seems every organisation the world over has its own description of what CRT is. Here’s my “in a nutshell” definition:-

Cognitive Rehabilitation Therapy is a collaborative series of tasks and discussions between therapist(s) and patient(s) / client(s) aimed at helping those patient(s) / client(s) cope with themselves and the wider world after a brain injury.

The implication for Cognitive Rehabilitation Therapists, be they grounded in classical Cognitive therapies or Person-centred therapies, is that C.R.T. involves both active listening and active thinking.

What do I mean by “active thinking”? I mean empathically thinking as the client thinks.

Art of cinversation

(Comprehensive)

Cognitive Rehab’ Therapy takes a two pronged approach. The Person-centred or “Multi-modal” (“Comprehensive”) prong takes account of emotions, behaviour and perceptions altogether.  Active listening flags up the patient’s / client’s motivation or lack of it – gauges what stimulates by whatever degree and how. A therapist can then intuit techniques and interventions to best aid the patient’s / client’s understanding and skills.

The relationship is one of observation – reflection or open question – reaction – observation – response. Such in-the-moment to-ing and fro’-ing between therapist and patient / client can result in unforeseen recognitions. I’m talking about immeasurable and surprising reconnections and new connections within the “neuro-person”, if I may call them that.

(Modular)

The Modular prong is more targeted. Its focus is on areas of damaged brain, not always the holistic person. Formulated exercises are aimed at improving attention, memory, visual and information processing, language or executive functions.

Single modules can be used for an isolated or overriding impairment. Selected modules can be used in group settings or tailored to individual patients / clients. Though less precise in delivery, modular, task orientated group therapy helps in the following ways:-

  • By facilitating peer support.
  • Problem solving by discussion gives greater chance to strengthen confidence, co-operation, as well as some empathy.
  • Less rigid, more flexible problem solving skills – “thinking sideways” also has greater chances to develop.
(Family Involvement)

How about that Youtube link? Clinical neuropsychologist, Tedd Judd, PhD. offers family members advice on how to approach helping a brain injured loved-one. (8.5 minutes.) Click here to watch. (Skip the advert.)

There is every reason to include family members in therapy when and where appropriate and possible.

When couple counselling I find it helps the couple best if we view their relationship as the client. Thinking sideways, it’s not difficult to shift this way of working to a wider family context. After all, it’s the relationship with and around a loved one with the acquired brain injury that needs to readjustment as much as A.B.I. survivor themselves.

More next month. Take care for now.

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.

Anchoring for New Memories

Common Problems

The biggest problem after brain injury is with short-term memory loss. Memories are the records of our experience. Lacking memory does not mean we stop experiencing things. But it can mean becoming unaware of our experience. We forget when and where we are and spend our energy on piecing things together and trying to keep track. And then we get tired out.

It’s a bit like being cast adrift on an uncharted sea.

NLP and brain injuty

Without a chart, how might we map our course to our next shore? How can we tell where to go to catch the biggest fish to eat? Not just that, who last had the captain’s log? Where is it supposed to be kept? And where is this captain character, anyway?

The good news is that the chart is not the sea. Though important and useful, it is only the representation of the sea.

What does that mean in the real world? It means that the good news is this: Memories are not experience. Though they give us a sense of space and time and “self” within spacetime, they only represent the past.

We are living in the present. Strengthening our attention on where we are and what’s happening around us improves our skills at making memories. The memory you make now is a memory to recall tomorrow.

Anchoring the N.L.P. Way

Before I talk about “anchoring”, it might help you to watch a short therapy session first.  It lasts 4 minutes. And of course you can go to it again and again, any time you like. Click here to watch the session.

Here is what the therapist does:-

  • Learns from the client the “state” / mood the client wants to be in. (It’s “happy”.)
  • Learns how the client looks when she’s happy.
  • Asks the client to remember a specific time when she felt very happy.

(Note: If she had a brain injury, this would most likely be a long-term memory from long ago. But you know that.)

Next the therapist:-

  • Gets the client to put her attention into her body and almost relive the original experience.
  • Asks the client to choose a knuckle the therapist can touch. (It is the knuckle she anchors the client’s happy feeling to.)
  • She keeps her finger on that knuckle. She encourages the client to relive the memory again – to see what she saw, hear what she heard, feel again her own laughter throughout every fibre of her body.
  • The therapist takes her finger from the client’s knuckle, asks the client to choose another happy memory.laughing

As soon as the client has choosen, the therapist:-

  • Holds her finger on the knuckle again and repeats the process with the client.
  • Brings the client’s attention back to the present.
  • Chats and, now and again, touches the client’s knuckle.

Each time the client feels her therapist touch that chosen knuckle, she laughs. Her happy state is anchored.

Tool Box

Okay, so how can anchoring help make new memories? By paying attention to your body’s sensations in what you’re doing now. Use the help of a friend, carer, coleague. If only one thing today makes you chuckle or want to scream, take note of how your whole body feels in that moment. Make sure you give that feeling a label.

That label is important. It’s job is to link you to the anchor you choose and to the experience that is tomorrow’s memory.

Anchoring might not be your thing. Then again, it might prove a big help. Feel free to share how well it goes after three or more practices.

Take care. More next month.