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

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

 

Action for Brain Injury Week 2019

Hello, everyone.

20th -26th May 2019 is “Action for Brain Injury Week”. Activities aimed at raising public awareness of the effects of brain injury, and the dangers, will be held. Headway is the force behind it, and its branches will be holding Hats for Headway up, down and sideways across the UK. Find out more by clicking the poster.hats-for-headway-poster-2019

As this year’s theme spotlights fatigue, I may as well throw my hat into the proverbial ring and talk about fatigue in this month’s post. My neurologist once said to me: “Sean, you can do most of what people can do. It’s just that what they do on one Mars bar, you can do on two.” So here’s an example of how fatigue gets to me – what takes me from over-tiredness to being on top of things again.

This week I’ve taken a few days off from my day job. (I know we’ve just had Easter, but hey, I was doing Easter type things.) The day job often tires me out. There are times I return home and doze on the sofa before I’ve the energy to do anything else.

The house being a bit of a mess despite help, I’ve chosen to use the time to get a few outstanding chores done. To help myself, I’ve written a “to-do” list with reminders on my mobile for each day.

Today’s To-Do

7am to 8am = Emails; letters; catch up on yesterday’s journal (1 hour reminder)

8:29am 8:31am = Med’s (Daily 1 minute reminder)

9:30am to 10:50am = Trip to shops etc. (3 hour reminder)

11am to 11:15am = Make important phone (15 minute reminder)

11:15am to 11:30am = Coffee & Kit Kat (1 minute reminder)

11:35am to 12:35pm = Filing (10 minute reminder)

12:40pm to 1pm = Lunch (10 minute reminder)

1pm to 3pm = Blog (10 minute reminder)

3pm to 3:20pm = Break (10 minute reminder)

3:50pm to 5:30pm = Blog (10 minute reminder)Snoozing brain

5:40pm to  6pm = Snooze / read (15 minute reminder)

6:10pm to 6:30pm = Get ready for evening out with friends (1 minute reminder)

Thinking Behind It

Knowing what I’m like, I factored in some safeguards to help keep my cool, not get wound up if Life, if not my self did not keep to my time-plan. Let’s face it, the real world is filled with delays and “unforeseen circumstances”.

Note my reminders to myself. I’m not as good at waking up as I once was. My mobile actually bleeped my need to be at my computer at 6am – 1 hour before hand; I’d set myself a 1 hour “window” to psyche myself up to the reality of getting out of bed.

Be gentle with yourself when doing your own list.

I also planned breaks at times close to my daily routine at work. This has put me in a business-like frame of mind. (Parent ego state, to reference last month’s post.) Pacing is a must.

Here’s a presentation I Googled you might find helpful: “There is Nothing Lazy About Someone with A Brain Injury” by Adasm Anicich.

What Happened

I got up at 7:30, so already I was behind what I’d intended. Thankfully, a letter I needed to compose was a virtual repetition of what I’d written a year ago. I just needed to change the date and a couple of other things and print off an updated version. After the usual showering and breakfast toutine, I left home half an hour later than planned.

But what I needed to do took less time than I thought. And my return bus stood waiting for a driver at the stop. (Good luck happens too.)

My point is: Be SOFTLY regimental.

Today I got all I needed to do at my computer. When I made my phone call I did not get an answer, even though I tried twice. I got through a big bit of my filing and I’ve completed this post to you on time, on the 15th of May. I’m happy.

Until next month, take care.

 

 

 

Panic Buttons for A.B.I.

This month I’ve been asked to write about panic attacks. Wow! I thought. Why haven’t I covered it before? When any of us are unable to think straight, our biology, our emotions carry us along.

Where they carry us, we don’t know until we stop, draw breath and take in what we can of our situation. Up until that point, we don’t know which direction we’re taking ourselves. We become proverbial “headless chickens”.

Before any compensatory therapy or strategy can prove useful, Step One has to be a willingness to face fears. This is most true of clients whose cognitive functioning can be problematic, even on the happier days.

TV Static

The clouding of consciousness (brain fog) is for ABI clients / patients, physical. In a lot of cases it does not go away. Emotions determine the degree of cloud cover, but it’s always there to be lived with.

Another way to describe an injured brain might be as a faulty TV set. I am reminded of Sunday mornings I spent many, many years ago – playing around with the aerial of my parents’ gogglebox – trying to get an undistorted picture of the BBC test card before “Mr. Benn” started.

As therapists, the most we can do is reduce the amount of static and suggest positions the aerial might work better. The aerial’s actual positioning to stabilise their picture behind their static is our clients’ job.

There is no real, by the book, “how to…” with this. In my view, it has to be person-centred. Here‘s a link to Part One of a counselling session (not one of mine) with a head injured client. It lasts 9 or so minutes.

N.B. The client reports being “snappy”, NOT “panicky”.

Panic Button Controls
  • DON’T FIGHT, TAKE FLIGHT. Remove yourself from the environment / situation causing your panic.
  • Find somewhere you can be safe and quiet.
  • Begin listening to your own breathing, taking slow, deep breathsABI and Panic
  • Close your eyes and, if possible, imagine you’re in your favourite surroundings, doing a favourite thing.
  • If imagining you are somewhere else is impossible for you, hold an object in both hands and look at it. Keep listening to your breathing as you notice each of the object’s details – shape, colour, texture, markings…
  • Keep practicing. Set a special time andplace aside for yourself.

Reading what to do might be easy. Remembering and doing it, as we all know, is hard. It helps most to be with someone while you practice.

Click here for Part Two of the counselling session. Again, not a counselling session of mine. Part Two also lasts around 9 minutes.

Patchy Reception & Counselling

If you are perhaps wanting counselling, the following points may help you decide.

  1. It offers you a room clear of clutter and distraction – space to breathe and relax.
  2. Regular time slots (50-60 minutes) that can be used to off load – kind of scatter thoughts, feelings, experiences into and around that room.
  3. It provides someone who will support, not judge. Part of that support is in helping take control of the panic. Part is in helping you get organised.

If I was to counsel you, I’d combine listening with breathing techniques and other Mindfulness exercises. A new sense of self can grow. Because as your new self becomes less patchy, you could begin to identify your gut instincts – which situations cause panic more than others and how to deal with them yourself.

Take care for now.

Sean

 

SMART Pacing

 

pacingHappy New Year Everyone!

Here we are at the start of another twelve month cycle. If you’re anyone like me, this thought will have crossed your mind: “Is making a New Year resolution good for me?”

The Problem With Me

My neurologist once told me: “Sean, you can do most things most people can do. The difference is that they only need fuel themselves on one Mars bar. You need two.”

I’ve come to the conclusion, having a brain injury myself, that eagerness and enthusiasm to achieve works against me. I set myself too many ambitions. And those ambitions have been too big. I try to run before I can walk. I get fatigued and burn myself out.

I also set myself one year in which to achieve my goals. I’ve already said: “Here we are at the start of another twelve month cycle.” BIG mistake! Next Christmas becomes a Finishing Line. A Finishing Line that’s only half way down my imaginary racecourseeaster bunny.

When I get to Christmas, I feel a failure. My ambitious project still has a lot of time to be spent on it. In any case, the truth is I’d be out of puff before I’d got to Easter.

SMART Eggs

Specific   Measurable   Actionable   Relevant   Time-boundaried

That’s what S.M.A.R.T. stands for. It’s a way of working out the best goals to set. No one needs to be an egghead to use it, either… (Sorry. I couldn’t resist.)

Rather than have a New Year resolution, why not start smartly at Easter? Easter’s about new beginnings too. Better prepare yourself. Give yourself the best step forward. Consider your current experience and go on from where you are.

For example, the need for memory aids etc. Knowing who to talk through your hopes and wishes with might be your first step. Collaboration can help everyone involved be more aware and focused.

(Specific)

Be clear and certain. Set your sight on something simple. Very often, brain injury lets in all sorts of clutter – too much info’ from too many places – facts, opinions, advice. The more specific your target, the greater your chance of staying on track.

Let’s use the example of changing weight. “Changing weight” is an unclear statement. “I’d like to be 10 stone” leaves no-one uncertain about what’s wanted.

(Measurable)

For the purpose of demonstration here, let’s say “One pound difference a fortnight”. Weight can be measured every two weeks and a record kept.

(Actionable)

Again, stay specific. What treat can you not do without? Are medication and special dietary needs important factors? What is realistically achievable?

Memory and organisational problems can be reduced by dicussing meals for each day of the week. If need be, ask someone to add them to your diary, or tablet, or on something stuck to your fridge’s door.

It doesn’t have to be as strict as keeping count of how many calories per plate. Once a sensible menu has been agreed, just keep to that day’s meal.

Exercise, however possible is also something to be discussed.

(Relevant)

How relevant is weighing 10 stone to health and happiness? Maybe our existing weights are already ideal for us. Maybe something else is in more urgent need of attention.

(Time-boundaried)

Let’s say the difference between our start weight and the desired 10 stone is 3 stone. There are 14 pounds in 1 stone. 14 (pounds) x 3 (stone) = 42 (pounds). Pacing, targeting and measuring one pound difference every two weeks sets the target time 84 weeks… So we may as well, allowing a bit of leaway for celebrations and lapses, set a time boundary of two years.

And hey, if the 10 stone weight is arrived at sooner, what the heck?

Take care. I’ll be back in February.