Brave New Who?

Bereavement

Hello all,

No, nothing to do with Doctor Who’s regeneration. This month I thought we’d cover bereavement. Not the kind of bereavement people usually talk about – after a death of a loved one. I mean the kind a brain injury brings.

The following is drawn from my experience, counselling clients with ABI and stroke.

Similar to the grieving process we all go through after a death, people finding themselves with a life-changing brain condition go through their own. This process has its own stages / periods. N.B: Theses stages / periods have no particular order.

Bereavement02

  • Denial
  • Anger
  • Loss of Focus / Identity
  • Depression
  • Reflection & Self Awareness
  • Acceptance & Adaptation

Let’s look at these in turn.

(Denial)

This can be either a willful or unconscious non-recognition that a brain injury has happened. This is different to a client not perceiving the difficulties they are having; some clients know they’ve for example, suffered a stroke but remain unaware of the true extent of adaptation they need.

However, sometimes the shock of a life-changing event and the initial fears that go with it are all too much. It seems easier to go with the idea that nothing’s wrong, or that others are making things up, or exaggerating.

When it’s obvious that short-term memory problems and/or “simple jobs” are no longer being done “properly”, both the brain injured person and those close to them can find it helpful at first to pin problems on another health condition. Or age.

(Anger)

Even before a brain injury, some people have short tempers. After a brain injury those tempers can change either way – become even shorter, or if not stay the same, become harder to tell. Some people hardly ever get angry. Some are good at hiding it.

As part of bereavement, anger is often aimed at the cause of the injury, the world for not understanding, life in general or God for what’s happened. Or the patient / client can target their anger towards themselves.

N.B: Anger can alternate with guilt, for example when a person labels themselves as a “burden”. (I like to balance this with a further note: That a good number of people also find comfort in being needed by others.)

One good thing about anger is that, in the right place, time and company, it can be a great motivatior.

(Loss of Focus / Identity)

The crux of the matter. The immense yearning to again be that person who was. Because all that’s left is, for this time being, a nobody. For one client it was like the voice saying: “I don’t know who I am anymore,” was coming from a faceless shadow, not the person himself.

(Depression)

No kidding, this is a difficult period to move on from. Because of the change in neurology, medications may be necessary to help. Being actively listened to and listening to one’s self can also help. Keeping as active as possible is important too, even when not feeling motivated.

For more on motivation and ABI, click here.

(Reflection & Self Awareness)

In Western society we are quick to confuse who we are with what we do; we identify ourselves with our job. Meeting a stranger the question most asked and answered is: “What is it you do?”

Reflection and growing aware of the person who the person was who appled for that job before they had it, asking: “How much of that person is still here?” and paying attention that remaining person is very much part of the brain injury journey. Especially for the patient / client themselves.

(Acceptance & Adaptation)

This is not the end result of the process. The process goes round and around like a wheel moving forward.

Recently, I also used this metaphor: Bereavement is like two feet walking – an emotional foot, and a managing foot. Some days emotion take over, some days practicalities can be done.

Living with a brain injury yourself, or indeed getting to know someone all over again can be rewarding too. Some people consider themselves a nicer, or stronger, or more confident person than they were before. Some discover talents that had never shown themselves before.

I’m going to end this month with a song.  It’s not about brain injury. But the words kinda fit. Alicia Keys: Brand New Me Skip the ad’.

Take care.

Sean

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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

 

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.

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.