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.

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.

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.