Using the Open Chair Technique

Survivors with brain injuries push themselves to get better.  Staff members at TLC see this every day.  Survivors push themselves to walk better.  They push themselves to speak better.  They push themselves to improve their memory.  They push themselves in every aspect of the rehabilitation experience, but recovery from a serious brain injury can be quite slow.  It is almost always slower than the survivor would prefer it to be.  Unfortunately, this leads some survivors to speak poorly about themselves.  They say things such as “I am a failure because I am not 100% improved” or “I should be much better than I am now.  I am failing at therapy”.  This negative self-talk can lead to emotional difficulties such as stress, low mood and sometimes even to depression.

If looked at objectively, this negative self-talk is often due to unrealistic expectations that the survivors have regarding their recoveries.  The survivors may believe that the amount of time necessary to recover is in excess to that which they expected, even when the medical research shows that they are progressing at a normal rate.  By expecting faster or better results than are humanly possible, survivors can cause themselves unnecessary frustration.

Interestingly, these same survivors who hold unrealistic expectations of themselves generally do not hold these same expectations of others.  They are often more logical and understanding of other survivors than they are of themselves.  It is common at TLC for the same patients who have unrealistic personal expectations to support realistic expectations in other patients.  They will make supportive statements to other patients such as “Don’t worry and take it slow.  You will get better over time.  You are running a marathon not a sprint.”  When the patients with unrealistic expectations are asked if they believe the advice they are giving to others, they almost always answer in the affirmative.  They understand that the brain injury recovery process is a slow one which requires lots of work.  They understand it is a long-term process.  But they decide for whatever reason that their personal recoveries should take less time than those of others, holding themselves up to unfair (often impossible) standards.
One way to manage this negative self-talk is by using the “open chair” technique.  How this technique works is that patients are asked to imagine they are sitting next to themselves and that the person occupying their seat is someone else with the very same issues and deficits that they have.  The patients are then asked to give this “other person” honest feedback about how the “other person” is doing.  Often, patients find that this leads them to soften their tones and to make more supportive personal statements regarding their own progress.  Similarly to when they are actually talking to other patients, when they address themselves as that “other person”  patients demonstrate more realistic expectations and are less likely to attack themselves.  The “open chair” technique often helps patients treat themselves not only better, but also more fairly and honestly.  By being more fair and honest to themselves, survivors tend to have an improved mood.  And the better the mood that survivors can maintain, the easier it is to navigate the rehabilitation process.

Learn about brain injury treatment services at the Transitional Learning Center!  Visit us at: tlcrehab.org

Grounding Identity

Living through the brain injury experience can represent quite the assault on a survivor’s identity.  Previously athletic survivors may now struggle to walk.  Previously active and industrious survivors may now be unemployed.  Instead of being in charge at the workplace,  a survivor now is given a list of externally defined rules to follow essential to his or her rehabilitation.  All of this can cause notable emotional strain on a survivor.  Contending with the inevitable alterations wrought by such an injury to the perception of  one’s own identity is no small thing.  Sometimes rather than focusing on all of these changes, it is worthwhile to instead concentrate on those aspects of the survivor’s identity that have remained stable in spite of the injury.  It is often helpful to write down these stable aspects to help visualize and internalize the truth that many of the attributes that have always defined the survivor’s identity at core remain just as relevant post-injury.

Here are a few of these aspects with strong potential to remain stable following an injury:
1.  Family relationships – An injury does not change the fact that a survivor holds family roles as a parent, child or sibling.
2. Life Experiences/Memories – An injury does not negate the many life experiences that a survivor has accumulated.  These experiences can originate in work, school, family or any other facet of life.
3. Interests/Hobbies – An injury is unlikely to change a survivor’s interests and tastes in things like music, food and sports.
4. Knowledge – An injury will almost never fully erase a survivor’s knowledge acquired over years of life experiences.  As example, a survivor who is a truck driver will generally remember all of the quickest routes across town.
5. Personality – An injury may not change a survivor’s personality.  For instance, a survivor who was a hard worker prior to an injury will very likely be just as hard a worker after.
6. Physical Characteristics – An injury may not alter certain physical characteristics.  A brain injury will not change the color of a survivor’s eyes or hair.  For many survivors, overall facial appearance does not change at all (or sees only minor changes) following an injury.
7. Beliefs – An injury will generally have no effect at all upon a survivor’s belief system.  For example, a lifelong Democrat will almost never suddenly begin voting Republican post-injury.

By spending time identifying and shifting focus upon the stable facets of survivors identities, survivors can better emotionally ground themselves as they navigate the brain injury experience.

Learn about brain injury treatment services at the Transitional Learning Center! Visit us at: http://tlcrehab.org/

 

 

 

Open Communication

The brain injury experience is a remarkably complex one.  Overnight, so many things change and so many adjustments need to be made.  Throughout this experience, brain injury survivors have goals, concerns and aspirations.  Survivors’ loved ones will have their own goals, concerns and aspirations as well as they come to terms with their own roles in this new and dauntingly complex experience.  These two sets of expectations may or may not fully match up with one another.  Survivors and their loved ones will all try their best to achieve desired outcomes.  Sometimes  differences in respective desired outcomes can lead to conflict.  One of the most common contributing factors to such conflict is poor communication.

Family members, injury or no injury, tend to make assumptions about one another.  In fact, we all engage in some form of attempted “mind reading” in which we guess at what another person is thinking.  For instance, if one person pauses to look at a second person prior to walking through a doorway that second person may “mind read” and think, “The other person is looking at me because he wants me to enter the doorway first.”  There are no actual words spoken in this momentary exchange, only valid assumptions made.  This method will generally work well enough in simple situations, but problems  arise when we engage in such “mind reading” in place of actual open communication regarding more substantial and  important issues.  A simple look or smile does not say “I am hoping that a month or two after discharging from therapy I can return back to working and driving” or “I am worried that my son will want to return to mountain climbing where he could fall and suffer further brain injury”.

A good place to start open communication is with a family meeting explicitly organized to talk through the goals, concerns and aspirations of all involved.  The meeting should be planned in advance and all parties informed of its purpose.  This gives each family member time to organize his or her thoughts about pertinent issues.  Many survivors benefit from writing down a list of topics they’d wish to discuss at this meeting in order to ensure that they don’t forget to raise a given subject.  A meeting of this sort need not necessarily determine the final word on any topic.  In fact, it can be a good idea to state from the start of such a meeting that participants are in no way required to (and may not even be expected to) agree with what others are saying.  Particularly at the first meeting of this sort, it is not important to make decisions regarding the future.  Instead it is more important to open the lines of communication so each person can know what all others are thinking and “mind reading” can be avoided.  Opening the lines of communication in such a formal manner may seem awkward to some, but it helps ensure that the goals, concerns and aspirations of each family member will actually be discussed and addressed rather than being lost in any number of side conversations.  Once these lines of communication are opened and everyone has a chance to freely discuss thoughts and sufficiently convey perspectives, it is much easier in the future to re-visit these topics in a constructive manner.  Open communication will ultimately allow family members to walk hand-in-hand into the future with less conflict.

 

Learn about brain injury treatment services at the Transitional Learning Center!  Visit us at: http://tlcrehab.org/

 

Life, Brain Injury and Repairing with Gold

There is a fascinating art form originating from Japan called “kintsugi” (a name formed from the Japanese root words meaning “golden” and “joining”).  In this form of art, broken pottery is repaired by using lacquer mixed with gold, silver or platinum.  Rather than being hidden, these cracks are instead highlighted, enhanced and made to reveal an entirely separate and distinct beauty.  Kintsugi is connected to the philosophy of “wabi-sabi” which means “finding beauty in broken or old things”.  This is not really a philosophy of items but a deeper spiritual concept informing a healthy approach to the world around us.

This idea of making the cracks more beautiful rather than trying to hide the break is an amazing metaphor for post-injury growth.  Survivors should not feel the need to hide or be embarrassed by their injuries.  Survivors never asked to have brain injuries, the events simply happened.  But there is a great deal of opportunity to use an injury and the rehabilitation process to take beautiful steps forward in life.  Some TLC patients have taken their experiences and used them to educate others about brain injuries.  Rather than shying away, they put themselves out front and center so as to benefit others in a powerful way that typical rehabilitation professionals do not have access to.  These survivors can speak from the authority conferred by actually having lived through the injury experience, lending their words an innate credibility that similar statements from health care and rehabilitation professionals can sometimes lack.  Other TLC patients have used their injuries as impetus to reach out to family and rekindle strained relationships.  Relatives who had not spoken for years were able to be reunited through response to these injuries.  Still other TLC patients have used their injuries to take their lives in healthier directions, such as returning to school, getting better jobs or cultivating sobriety.  Each of these steps forward is a way of taking the breaks in life created by brain injuries and repairing them with a “golden joining”, so that the survivors engage the world in an undeniably changed but potentially more beautiful and impactful way than before those changes wrought by their injuries.

Learn about brain injury treatment services at the Transitional Learning Center!  Visit us at: http://tlcrehab.org/

 

Utilizing Music For Mood

Music has the amazing power to touch our hearts and souls.  The right song at the right time can move us in powerful ways, eliciting emotions ranging from brightest joy to deepest sorrow.  Harnessing the power of music can also help brain injury survivors (along with the rest of us) make it through their days more successfully.

It is a common sight at a gym to see the majority of participants working out with music in the background to help keep them motivated and driven.  This music tends to be upbeat and intense.  This workout music highlights the ability of music to boost our performance.  Survivors may want to consider using similar energetic background music while they are working out, whether in a gym or in therapy, to help them when they might be feeling low in energy.  However, it is important to ensure that the music does not distract the survivor.  An example of this pitfall to be avoided can be observed in a survivor suffering from substantial deficits in the arena of attention.  A catchy song could cause this survivor to sing along and devote a disastrous lack of attention to foot placement while practicing walking.  Finding the balance (whenever possible) between drive and distraction is important.  Energetic music may also help mitigate general fatigue that can occur at any part of the day.

Music has the ability to lift us when we feel down.  Following a brain injury, many survivors will display acute symptoms of depression or at the very least be significantly (if understandably) sad about their situations.  Survivors should identify songs that lift their moods and listen to that music when they find themselves feeling low.  These songs often tend to incorporate themes of hope and joy.  Religious music is also a very popular and effective source of this helpful form of mood modulation.

Many survivors also face serious difficulties with stress and anger.  Certain music can help individuals to relax and stay calm.  Soft, classical music tends to be popular to ease stress and anger though other types of music can do this as well.  Some individuals prefer listening to sounds of nature (such as waves lapping upon a beach) to reach a more calm state.  Meditation music is a hot market and there is a huge amount of excellent music available both in stores and online.

Not every song will help with every mood and sometimes the music that is most helpful may not be the survivor’s favorite song or from a favorite band.  What is most important is that the music in question leads to the emotional experience that the survivor would like to cultivate.  Technology has advanced exponentially over the last few years, and survivors should take full advantage.  A survivor can keep a playlist of songs to help influence his or her emotions on a smartphone, Ipod or other similar device that can then be accessed throughout the day.  Remember that music can be an important part of any recovery process!

Learn about brain injury treatment services at the Transitional Learning Center!  Visit us at: http://tlcrehab.org/

 

 

 

The Problem With the Word “Should”

The word “should” may be one of the most hazardous words in the life of a brain injury survivor.  It tends to appear in sentences such as “I should be walking already” or “I should have been back at my job by now.”  The word confers a tremendous degree of expectation on the survivor and implies that somehow the survivor is a failure if he or she has not achieved what he or she “should” have achieved.  Often, this word sparks a cascade of statements by which survivors verbally punish themselves.  “I should have been able to walk without a wheelchair but I instead I fell.  I should be doing better with my mobility.  I am letting down my whole family!”  These “should” statements can easily lead to depression, stress and damaged self-esteem.

The reality is that each brain injury heals at its own rate and as a result each survivor is left with his or her own unique set of challenges.  After a serious brain injury, it often takes a survivor considerably longer than he or she may expect to reach goals due to the severity of the injury suffered.  An injured brain is not like a broken arm.  You cannot put a brain in a cast as you would put an arm, expecting that in a relatively brief period of time the brain will be healed.  Brain injury rehabilitation is a process that takes time and patience.  The only applicable “should” enters into consideration in emphasizing that the survivor should dedicate full effort to his or her therapies.  That is all anyone, including the survivor, can reasonably ask for.  As long as the survivor is giving his or her best effort, the survivor is doing everything in his or her power to get better.  The rest of the process will depend on time, the practicing and learning of new skills and how the survivor’s individul brain heals following a specific injury.  Recovery cannot be rushed or forced.  “Should” statements that imply that somehow recovery ought to have gone differently are thus plainly revealed as emotional snares best avoided.

 

Learn about brain injury treatment services at the Transitional Learning Center: http://tlcrehab.org/

 

Just Be Grateful

“Just be grateful you are alive”

“Just be thankful you didn’t die”

“You should just focus on the fact you survived”

Brain injury survivors hear these types of well-meaning lines all the time.  They are used by family members and friends to help survivors see the “brighter side” during their recovery periods.  There is undeniable truth in each one of these statements; traumatic brain injuries, strokes and other forms of acquired brain injuries lead to death for millions of people worldwide every year.  It is worthwhile to be thankful for life.  But these well-intentioned statements can all too often serve as double-edged swords.

Taking a step back for a moment, most survivors are truly thankful to be alive following their near-death experiences.  But that does not mean that they have not suffered real, painful losses.  While one may feel the commendable impulse to encourage and support survivors, it is also important to allow them to mourn these losses.  There is nothing inherently wrong with lamenting loss of arm function or fluid speech, as long as this does not lead to a serious decline in mood or performance.  For instance, wouldn’t any person be upset if, after decades of normal walking, he or she would have to suddenly learn how to walk all over again because of a stroke?  A balance has to be struck between fostering positive mood and allowing for reasonable mourning of loss.  “Just be grateful you are alive” is clearly not an inherently harmful statement, but it can still nonetheless be overused and thus inhibit healthy adjustment to change.  Excessive  repetition of such a statement can often cause survivors to be frustrated and feel as if they are being discouraged from expressing their feelings.  Though it may be difficult for family members or friends to witness as survivors experience sadness or anger, this is often one of the steps necessary while making a successful transition into post-injury life.

 

Learn about brain injury treatment services at the Transitional Learning Center: http://tlcrehab.org/

 

Give Yourself Permission

Brain injury survivors and their loved ones often try to approach life after an injury as if it is a fight.  Battle hard, stay strong and never let your enemy see your weaknesses.  But in truth, though there are some similarities in this analogy that are appropriate, life after an injury is not an actual fight.  In fact, by treating it as a real fight survivors and their loved ones can sometimes hurt themselves by not allowing themselves to feel and process certain emotions in a healthy manner.  By not processing emotions, individuals may allow these emotions to fester inside and come out at the wrong time or in the wrong situation.  Not processing emotions can lead to difficulties such as depression, anxiety and relationship stress.  I would like to encourage you to give yourself permission to feel these emotions.

Give yourself permission to get angry at the injury.  It truly is a frustrating and unpleasant experience.

Give yourself permission to cry.  There is no weakness in crying.  This is an appropriate reaction to a painful situation.

Give yourself permission to mourn.  There may be parts of you from the past that will no longer be part of your post-injury future.  It is okay to mourn their passing.

Give yourself permission to laugh.  Laugh at the moments of oddity.  Laughter, in measured amounts, is a reasonable coping technique during times of distress.

Most of all, give yourself permission to experience and value the full range of your emotions.  After all, our emotions are important aspects of who we are as people.  They are a central part of simply being human.  So please give yourself permission to be the complete person that you are, despite your injury.

Learn about brain injury treatment services at the Transitional Learning Center: http://tlcrehab.org/