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.

 

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.

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

Tying Things Together Pt 2

Did you watch the clips of the real life Helen Keller and the dramatised version? You’ll have noted Helen’s learning through touch. In fact the clip with the water pump underlines this by showing her throwing away the pale to feel the wet stuff flowing. Only then can she make the connection. It’s also obvious to us that it’s her frustration with herself and/or loss of patience with her teacher, Anne (most likely a bit of both) that throws the pale away.

All emotions serve their purpose.

Let’s look some more at Cognitive Rehabilitation Therapy.

Part 2: Development

CRT is a coming together of four professions. Let’s treat them as threads – look at them separately, then see how they’re knotted.

(Neuropsychology)

This is the study of how different areas of the brain work to make us do what we do, learn what we learn, know what we know, share what we share.  The grand-daddy of this science is Alexander Luria. (Click on his name if you want to know more about him.)

(Physiotherapy)

Most of us understand this. Exercises for the body – having limbs and muscles yanked about for us and/or stretching, bending, lifting and moving our bits as much as we can by ourselves. How does this help rehabilitate our brains? Well, take my brain, for example.

I have a daily routine of eight exercises I try to stick to help improve the thickness of my right leg. (If I do them every day from Sunday to Saturday without fail I reward myself with a flapjack and a beer. I especially enjoy them as I watch the latest crime thriller on BBC4.)

Anyway, my point is: co-ordination. For me, it’s not a matter of automatically stretching the tendons behind my right knee. Oh no. I have to think about how my left leg straightens so I can tell my right leg to have a go at matching it. So far, this means telling my right knee to pay attention to where my right heel and my right hip are, so it then learns for itself where it is and tells me if it’s ready to play along. To persuade my right knee,  I get my head to kind of speak kindly to it. If it is happy to listen, it allows the back of itself to get closer to the floor.

In this way my brain and right leg are teaching each other.

(Occupational Therapy)

Occupational Therapy is more than physiotherapy. It specialises in the physical, environmental and social needs of the individual. This way of looking after patients actually has its beginnings in the 1700s and what was called “The Moral Treatment Movement”.

To learn more about it and the advancement of OT, click here.

These days some Occupational Therapists are interested in how specific occupations benefit communities too, not just individuals. They look at what we are most happy doing, how and where we can do it, and who else we make happy by doing it.

(Psychotherapy / Counselling)

The treatment of troubled, injured or disabled minds by talking, has a long history. Sigmund Freud looms large in both neuropsychology and psychotherapy. (Click his name if you want to know more.)

What’s the difference between psychotherapy and counselling?

To my mind the two are so closely entwined, like the two threaded twist in DNA, it’s hardly worth asking.  When the trained professional employs congruence, empathy, unconditional positive regard and listens, (s)he is a counsellor. When (s)he considers what they’re hearing and the suitability of an intervention or coping strategy, and suggests it, (s)he is a psychotherapist.

So, there we go – the four professions that interweave and knit together into this thing called Cognitive Rehabilitation Therapy.

How?

  1. Luria and Freud often corresponded, sharing their ideas and inspirations regarding how brain sections, personality and society are linked. In this way they tied neuropsychology and psychotherapy together. Changes to the brain = changes to the person. So, talking to the person = talking to the brain.
  2. Physiotherapy is, effectively, body-talk. People talk about the brain and body as though they’re separate, or at least revere the brain as if it’s somehow superior to our other organs. This IS NOT the case! Yes, our brains influence our movement, muscle tone and general physique and give us a sense of “being behind our eyes”. But here is the bigger truth: All body parts together, brain included, depend on each other.
  3. Occupational Therapy, puts 1 and 2 together. Like psychotherapasists, occupational therapists treat the whole person because thinking, doing and emotional wellbeing depend on each other.

Enough for now. Next month we’ll see how Cognitive Rehabilitation Therapy is practiced. Take care one and all.