The Timing of a Tide

I hope this month’s title isn’t too upsetting. I wanted something to convey the whole experience of personality loss. It can be harder to deal with than ordinary bereavement.

Those of you looking after your family member or life-long friend will know. Those of you tasked with caring for someone losing or who has already lost themselmselves, may find it hard occupying who you’re working with.

Recently, I was approached by a volunteer with a charity that supports Alzheimers patients. She wanted advice on coming up with activities. This month’s post is my response. For her and anyone coping with anyone with dementia symptoms, e.g. via Lewy Bodies (DLB) – a form of Parkinson’s. I hope it helps.

Colour Joy

(I used to know a lovely lady called Joy.)

 

5 Top Tips

1. Shape activities in the here-and-now in ways that match their long-ago.

Activities that mimic what a person used to enjoy physically. If someone used to work for the Post Office, ask them if they’d like to help you sort through paperwork that needs shredding and paper that can go straight into recycling.

Activities that draw on past knowledge. E.g. Maths quizzes using old money.

2. Make activities sensory.

If someone’s attention / perspective comes and goes, conversation is a challenge. Your own sense of engagement with who you care for needs support from them. Resources that stimulate memories or stories can help. E.g. listenning to old 45’s or 12-inch singles together. (I’m assuming you young’uns out there know what they are. Vinyl is back in fashion after all.)

Activities can also be about the look, feel and smell of something. (D’you know there are some people who still prefer the smell of a well thumbed novel to the feel of a Kindle.)

3. Encourage teamwork.

Maintain, or at least slow the loss of social skills. Anything requiring co-operation is good. Discussing methods for doing a jigsaw puzzle (“corners and sky first”, for example) is unnecessary. It is enough to let the picture emerge as you compare and contrast each piece together.

4. Make it physical first… (As far as possible.)

Gentle movement is enough to keep the circulation going; there’s no need for a sweaty workout down the gym’. How about kicking or throwing a giant sponge ball between two, three or four people? If someone is chairbound, they can still join in if they want.

5. Be present

Be prepared to connect with your patient or loved-one’s reality as they perceive it. N.B: I DO mean “as they perceive it”. And be prepared to be persuaded that their way to do something is the better way!

To better understand what an Alzheimer’s personality goes through, here’s another helpful link.

For more general information and assistance about Alzheimer’s and Parkinson’s, click on the logos below.

alzheimers-logo-desktop

ParkinsonsUK-1b

That’s it for February.

Take care.

More Than One Way

HAPPY NEW YEAR!

Hoping you all managed through the festive season. Now that we’re out and on the other side, I thought we’d take a look at a slightly different option when seeking help. Or wanting to help a client with A.B.I. / T.B.I.

Cognitive Analytic Therapy (C.A.T)

What It Is

illustration-im-lost-hiker-no-direction-frits-ahlefeldt

C.A.T. is a type of therapy based on Cognitive Behaviour Therapy and Psycho-analytic Therapy.

Typically, therapy is given with a collaborative, person-centred style. New names / labels are found to describe difficult patterns of events, stages in process and emotions and behaviours that link them.

This means that problems can be looked at more in depth. Patterns can be drawn out and joined up in relation with different areas of life; whole situations can be mapped out.

The number of sessions spent with a therapist is limited.

How it Can be Applied to Acquired Brain Injury

I’ve done a little diagram of my own. I think many of you will recognise the re-occuring cycle.

CAT Diagram

This is how I have seen it with different clients over the years. But it can never be a case of “one size fits all”. With help, the best person to draw the process you go through is YOU.

Here’s the thing:-

  • Once expressed and put on paper, the process is not reliant on memory. How a situation is now can be seen and read.
  • Attention can be focussed more easily and areas identified that need tweaking. (For example, with support, the above “Former Self / Current Self” box can be gone into more in depth. A list of former, helpful skills that are still current might be revealed.)
  • A sense of direction could also become clear. (E.g: A still present, helpful skill could be discussed to see how it might be used to effect another box – maybe even re-write what’s in it.)

I shan’t go on. You’ve got the picture.

Research

Some of you out there might like further research on this subject. Here’s a very interesting online publication I came across. (Click the title.) It’s a paper by Caroline Rice-Varian. It’s called:

“The Effectiveness of Standard Cognitive Analytic Therapy (CAT) with people with mild and moderate acquired brain injury (ABI): an outcome evaluation”.

Referrence: Rice-Varian, C., 2011. The Effectiveness of Standard Cognitive Analytic Therapy (CAT) with people with mild and moderate acquired brain injury (ABI): an outcome evaluation.. Reformulation, Summer, pp.49-54.

Signing Off

Thanks for reading. Your questions, requests and comments throughout 2020 will be appreciated as always .

And now, in true “Monty Python” style, here’s something completely different: A cartoon called “The Cat Came Back”. (Approx. 8 minutes.)

Enjoy!

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