traumatic brain injury disability counseling janey b. mosier

Traumatic Brain InjuryTraumatic Brain InjuryDisability CounselingDisability Counseling

Janey B. MosierJaney B. Mosier

The terms disability and handicap The terms disability and handicap are often misused and confused.are often misused and confused.

DisabilityDisability

This refers to the limitation of This refers to the limitation of function that results directly from an function that results directly from an impairment at the level of a specific impairment at the level of a specific organ or body system.organ or body system.

HandicapHandicap

This is an actual obstacle or This is an actual obstacle or obstacles the person encounters in obstacles the person encounters in the pursuit of goals in real life, no the pursuit of goals in real life, no matter what their service.matter what their service.

It is important to remember that It is important to remember that people can have either just one, or people can have either just one, or both. (disability or handicap)both. (disability or handicap)

VERY IMPORTANTVERY IMPORTANT

The brain controls The brain controls EVERYTHINGEVERYTHING we we do. It controls do. It controls ALLALL of our actions. of our actions. This is serious. When damaged, the This is serious. When damaged, the counselor, has their work cut out! Be counselor, has their work cut out! Be prepared for the prepared for the unexpectedunexpected!!

A Traumatic Brain Injury can happen A Traumatic Brain Injury can happen because of a fall, vehicle accident, because of a fall, vehicle accident, assault, or any other blunt force assault, or any other blunt force trauma to the head. This may cause trauma to the head. This may cause people to become handicapped or people to become handicapped or physically/mentally disabled.physically/mentally disabled.

Human BrainHuman Brain

Frontal Lobe

Parietal Lobe

Occipital Lobe

Temporal Lobe

Frontal LobesFrontal Lobes

““commanding officer of the brain” commanding officer of the brain” controls impulse motivation, social controls impulse motivation, social abilities, expressive language, and abilities, expressive language, and voluntary movements. This part voluntary movements. This part controls the ability to retrieve controls the ability to retrieve memory from storage and helps with memory from storage and helps with organization. It also controls our organization. It also controls our emotions/emotional regulation.emotions/emotional regulation.

Temporal LobesTemporal Lobes

Holds the bulk of memories (recent Holds the bulk of memories (recent and distant past), controls emotional and distant past), controls emotional thoughts, holds the ability to thoughts, holds the ability to understand language and appreciate understand language and appreciate music. It also controls perceptions.music. It also controls perceptions.

Parietal LobesParietal Lobes

This controls the sense of touch. It This controls the sense of touch. It plays a major role in academic plays a major role in academic abilities. Victims may be unable to abilities. Victims may be unable to feel or recognize objects.feel or recognize objects.

Occipital LobesOccipital Lobes

Controls sight, victims may become Controls sight, victims may become blindblind

On your mind???On your mind???

50 First Dates50 First Dates

Drew BarrymoreDrew Barrymore Adam SandlerAdam Sandler

Effects of a TBIEffects of a TBI

PhysicalPhysical CognitiveCognitive BehavioralBehavioral CommunicationCommunication EmotionEmotion PsychologicalPsychological

Each person suffering from a TBI will Each person suffering from a TBI will have dramatically different recovery have dramatically different recovery results. The hospital length will vary. results. The hospital length will vary. The length of outpatient therapy will The length of outpatient therapy will vary. Finally, the time before vary. Finally, the time before beginning counseling will vary.beginning counseling will vary.

Counseling is Counseling is the the KEYKEY of the of the rehabilitation rehabilitation process.process.

As counselors of patients with a TBI, As counselors of patients with a TBI, we must be prepared for a variety of we must be prepared for a variety of challenges. Let’s dive into what lies challenges. Let’s dive into what lies ahead!ahead!

If a client has a severe memory If a client has a severe memory impairment because of a TBI the impairment because of a TBI the counselor may need to teach them to counselor may need to teach them to use tools such asuse tools such as

tape recordertape recorder plannerplanner notebooknotebook journaljournal

Counselors cannot be alarmed. The Counselors cannot be alarmed. The client may perceive them as client may perceive them as negative or antagonistic because of negative or antagonistic because of their attempts to address their new their attempts to address their new deficits.deficits.

There are steps that a client with a There are steps that a client with a TBI will go through and steps the TBI will go through and steps the counselor will take to work with counselor will take to work with them. It is important to know, these them. It is important to know, these steps are the same for any disability, steps are the same for any disability, beyond a TBI.beyond a TBI.

SHOCKSHOCK

This is psychic numbness resulting This is psychic numbness resulting from an overwhelming physical from an overwhelming physical trauma.trauma.

Behavioral correlatesBehavioral correlates

Immobilization, cognitive Immobilization, cognitive disorganization ex. Incoherent disorganization ex. Incoherent speech, blank starespeech, blank stare

Counselor StrategiesCounselor Strategies

Comforting-verbally and physically, Comforting-verbally and physically, listening and attending, offering listening and attending, offering support and reassurance, allowing support and reassurance, allowing ventilation of feelings, referring ventilation of feelings, referring person institutional care (when person institutional care (when appropriate)appropriate)

AnxietyAnxiety

Panic-stricken reaction upon initial Panic-stricken reaction upon initial recognition of traumatic event. recognition of traumatic event. Remember, it may take a person Remember, it may take a person with a TBI a long time to realize what with a TBI a long time to realize what has happened.has happened.

Behavioral CorrelatesBehavioral Correlates

Restlessness, purposeless activities, Restlessness, purposeless activities, rapid speech, sweaty palms, panic rapid speech, sweaty palms, panic attacks, hyperventilation, fast pulseattacks, hyperventilation, fast pulse


Listening and attending Listening and attending empathetically, offering support and empathetically, offering support and reassurance, reflecting and reassurance, reflecting and clarifying, applying muscle relaxation clarifying, applying muscle relaxation procedure, medication may be procedure, medication may be necessary because the part of the necessary because the part of the brain that is damaged may be brain that is damaged may be causing the depressioncausing the depression

BargainingBargaining

Expectancy of recovery from Expectancy of recovery from disabling condition through protest disabling condition through protest and deal makingand deal making


Information seeking, continuous Information seeking, continuous consultation of physicians, contract consultation of physicians, contract proposals with God, obsessive-proposals with God, obsessive-compulsive activitiescompulsive activities


Providing accurate information, Providing accurate information, supplying medical facts (when back supplying medical facts (when back round permits and client can round permits and client can cognitively comprehend), confronting cognitively comprehend), confronting reality (when appropriate)reality (when appropriate)

Denial or AnosognosiaDenial or Anosognosia

Denial is defensive retreat from Denial is defensive retreat from painful realization of disabled painful realization of disabled condition implicationscondition implications

Anosognosia is when clients with a Anosognosia is when clients with a TBI deny the severity of the injuryTBI deny the severity of the injury


Lack of awareness of problems, Lack of awareness of problems, unrealistic goal-plan setting, unrealistic goal-plan setting, avoidance of “failure-prone” avoidance of “failure-prone” situations, ignoring or forgetting situations, ignoring or forgetting physicians orders, attempts at physicians orders, attempts at maintenance of predisability daily maintenance of predisability daily routines, overcompensation for routines, overcompensation for deficiencies (when shielding by deficiencies (when shielding by denial is threatened)denial is threatened)

Counselor StrategiesCounselor Strategies Provide accurate information, Provide accurate information,

accepting denial as self-protection accepting denial as self-protection (only at the beginning), clarifying, (only at the beginning), clarifying, interpreting inconsistencies, interpreting inconsistencies, confronting discrepancies (between confronting discrepancies (between verbal and nonverbal messages, verbal and nonverbal messages, cognitive and affective components, cognitive and affective components, etc.), heightening self-awareness etc.), heightening self-awareness (Gestalt Therapy techniques). (Gestalt Therapy techniques). Remember: these things may not Remember: these things may not work with Anosognosia.work with Anosognosia.

MourningMourning

Relatively short grief response upon Relatively short grief response upon realizations of personal implications realizations of personal implications stemming from disability. People stemming from disability. People with TBI mourn over the life they with TBI mourn over the life they lost. They may also mourn too, over lost. They may also mourn too, over all of the memories that are unable all of the memories that are unable to be retrieved. to be retrieved.


Loss of appetite, sleep disturbances,Loss of appetite, sleep disturbances,

slouched posture, sobbing, crying slouched posture, sobbing, crying episodes, slow body movements, low episodes, slow body movements, low energy levelenergy level


Listening and attending, supporting Listening and attending, supporting and reassuring, allow client to vent and reassuring, allow client to vent feelings, reflect and clarify, heighten feelings, reflect and clarify, heighten their self awareness, guide the client their self awareness, guide the client to recognition of inner resources and to recognition of inner resources and strengthsstrengths

DepressionDepression

Relatively extended and generalized Relatively extended and generalized bereavement of lost body part or bereavement of lost body part or functionfunction

Some clients with TBI are dealing Some clients with TBI are dealing with loss of former life and dealing with loss of former life and dealing with their new personalitywith their new personality


Loss of appetite, sleep disturbances, Loss of appetite, sleep disturbances, sobbing, crying episodes, slow body sobbing, crying episodes, slow body movements, lethargy, silence, movements, lethargy, silence, unkempt personal habits, slow and unkempt personal habits, slow and monotonous tone of voice, suicidal monotonous tone of voice, suicidal ideationideation


Listening and attending, supporting Listening and attending, supporting and reassuring, reflecting and and reassuring, reflecting and clarifying, guiding client to clarifying, guiding client to recognition of inner resources-recognition of inner resources-strengths, reinforcing positive self strengths, reinforcing positive self statements, confronting and statements, confronting and restructuring unrealistic beliefs and restructuring unrealistic beliefs and expectations, engaging client in expectations, engaging client in physical activitiesphysical activities

WithdrawalWithdrawal

Resignation from social-interpersonal Resignation from social-interpersonal interactionsinteractions


Apathy, passivity, avoidance of Apathy, passivity, avoidance of human contacts, excessive sleep, human contacts, excessive sleep, deterioration of personal habits, deterioration of personal habits, silence, disrupted eating habitssilence, disrupted eating habits


Reinforcing social interpersonal Reinforcing social interpersonal contacts, teaching assertiveness contacts, teaching assertiveness skills (assisted by role playing), bring skills (assisted by role playing), bring client into contact with support client into contact with support (socialization, self-help) groups(socialization, self-help) groups

An excellent group for local survivors An excellent group for local survivors of a TBI is PABIA (Pittsburgh Area of a TBI is PABIA (Pittsburgh Area Brain Injury Alliance).Brain Injury Alliance).

Internalized AngerInternalized Anger

Self-directed bitterness and Self-directed bitterness and resentment often associated with resentment often associated with guilt feelingsguilt feelings


Self-blame, self-abuse, self-injuries, Self-blame, self-abuse, self-injuries, incidents, suicidal ideation, passive incidents, suicidal ideation, passive aggressiveness, argumentativeness,aggressiveness, argumentativeness,

lip biting, facial twitchinglip biting, facial twitching

Caution: There is a high link between Caution: There is a high link between TBI and alcoholism.TBI and alcoholism.

Counselor StrategiesCounselor Strategies Teaching expression of anger in socially-Teaching expression of anger in socially-

approved manner, teaching relaxation approved manner, teaching relaxation techniques, heighten self awareness, techniques, heighten self awareness, contracting (for decrease in acting out contracting (for decrease in acting out behaviors), confronting, teaching behaviors), confronting, teaching responsibility taking for one’s on behaviors responsibility taking for one’s on behaviors (reality therapy), Assisting in choosing (reality therapy), Assisting in choosing from alternative and more socially from alternative and more socially appropriate responses, apply behavioral appropriate responses, apply behavioral modification techniques to client’s modification techniques to client’s maladaptive aggressive responses, maladaptive aggressive responses, identify real cause of anger, provide drug/ identify real cause of anger, provide drug/ alcohol rehab (when necessary)alcohol rehab (when necessary)

AcknowledgementAcknowledgement

Intellectual recognition of future Intellectual recognition of future implications stemming from disability implications stemming from disability and their integration into one’s and their integration into one’s changing self conceptchanging self concept

Some clients’ with a TBI will NEVER Some clients’ with a TBI will NEVER reach this point.reach this point.


Intellectualization of specific areas of Intellectualization of specific areas of disability and their daily impact, disability and their daily impact, discussion of disability and the discussion of disability and the obstacles it creates, uses of sarcasm, obstacles it creates, uses of sarcasm, initiation of social contacts, initiation initiation of social contacts, initiation of future plansof future plans

Counselor StrategiesCounselor Strategies Planning and developing goals, reinforcing Planning and developing goals, reinforcing

positive self-statements, reflecting and positive self-statements, reflecting and clarifying frustrations, encouraging use of clarifying frustrations, encouraging use of humor, discussing and modeling new humor, discussing and modeling new behaviors, teaching assertiveness behaviors, teaching assertiveness techniques, giving feedback on progress techniques, giving feedback on progress and adaptation, teaching problem-solving and adaptation, teaching problem-solving skills, changing and restructuring the skills, changing and restructuring the environment, shaping behaviors (operant environment, shaping behaviors (operant conditioning), rewarding appropriate newly conditioning), rewarding appropriate newly learned behaviors, teaching self learned behaviors, teaching self responsibilityresponsibility

AcceptanceAcceptance

Affective, in addition to intellectual Affective, in addition to intellectual internalization of future implications internalization of future implications from disability and their integration from disability and their integration into one’s changing self-conceptinto one’s changing self-concept


Positive self-statements and Positive self-statements and optimistic future outlook, relaxed optimistic future outlook, relaxed posture, use of humor, self-posture, use of humor, self-assertiveness, perusal of specific assertiveness, perusal of specific future plans, discussion of disability, future plans, discussion of disability, its emotional aspects, and ways to its emotional aspects, and ways to overcome obstacles createdovercome obstacles created


Refining assertiveness skills, give Refining assertiveness skills, give client feedback on progress, upgrade client feedback on progress, upgrade problem-solving and decision making problem-solving and decision making skills, shaping behaviors, setting skills, shaping behaviors, setting priorities, specifying and refining priorities, specifying and refining goals, encouraging further goals, encouraging further interpersonal relationship-building, interpersonal relationship-building, assisting client in joining and assisting client in joining and participating in support groupsparticipating in support groups

Adjustment-adaptationAdjustment-adaptation

The final phase in the coping The final phase in the coping process. Behavioral adaptation and process. Behavioral adaptation and social integration into a newly social integration into a newly perceived world.perceived world.

Even in a Brain Injured client doesn’t Even in a Brain Injured client doesn’t or cannot acknowledge their or cannot acknowledge their disability they will still eventually disability they will still eventually adjust with time.adjust with time.


Risking of new situations, Risking of new situations, accomplishment of plans and goals, accomplishment of plans and goals, self-assertiveness, purposeful self-assertiveness, purposeful activities, attempts at functioning activities, attempts at functioning independently, persistence in the independently, persistence in the face of (possible) failures, successful face of (possible) failures, successful overcoming of disability-related overcoming of disability-related obstaclesobstacles


Giving positive reinforcement for efforts Giving positive reinforcement for efforts made, providing information and periodic made, providing information and periodic feedback on psychological social, and feedback on psychological social, and vocational adjustment, refining problem-vocational adjustment, refining problem-solving skills, encouraging person to solving skills, encouraging person to maintain independence, reviewing maintain independence, reviewing periodically client’s functional level in periodically client’s functional level in community-based support system(s), community-based support system(s), proving occasional follow-up sessions proving occasional follow-up sessions (when requested)(when requested)

Family members may also go Family members may also go through many of these stages. There through many of these stages. There may be group family counseling or may be group family counseling or individual counseling for a family individual counseling for a family member as they deal with all of the member as they deal with all of the changes.changes.

REMEMBERREMEMBER

These are the educated guidelines These are the educated guidelines and suggestions for dealing with a and suggestions for dealing with a client that has a Traumatic Brain client that has a Traumatic Brain Injury. You are also, hearing it from Injury. You are also, hearing it from a real a real SURVIVORSURVIVOR!!! Depending on !!! Depending on the individual and their limitations the individual and their limitations counselors may have to be creative counselors may have to be creative when coming up with ideas and when coming up with ideas and techniques to help the client techniques to help the client maximize their potential.maximize their potential.

ReferencesReferences1.Guth,M. (1996) Brain Injury 1.Guth,M. (1996) Brain Injury

Rehabilitation: The Role in the Family in Rehabilitation: The Role in the Family in TBI TBI Rehab. Texas :HDI Publishers.Rehab. Texas :HDI Publishers.

2.Livneh,H. & Evan, J. (1984) Adjusting to 2.Livneh,H. & Evan, J. (1984) Adjusting to Disability: Disability: Behavioral Correlates and Behavioral Correlates and Intervention Strategies. Intervention Strategies. Personnel and Personnel and Guidance Journal, 62, 363-366.Guidance Journal, 62, 363-366.

3.Marinelli, R.P. & Orto A.E.D. (1991) the 3.Marinelli, R.P. & Orto A.E.D. (1991) the Psychological and Social Impact of Psychological and Social Impact of Disability Disability (3(3rdrd ed.). New York: Springer.ed.). New York: Springer.

4.McAlaster, R., Lundgren, G, & Higa, C. (1996). 4.McAlaster, R., Lundgren, G, & Higa, C. (1996). Teaching Persons with Brain Injury :What Teaching Persons with Brain Injury :What to to Expect. Tampa :HDI Publishers.Expect. Tampa :HDI Publishers.

5.Senelick,R.C. & Ryan C.E. (1998) Living with Brain 5.Senelick,R.C. & Ryan C.E. (1998) Living with Brain Injury. Alabama : Health South Press.Injury. Alabama : Health South Press.

6.Wright, B.A. (1993). Physical Disability-A 6.Wright, B.A. (1993). Physical Disability-A Psychosocial Approach (2Psychosocial Approach (2ndnd ed.). New York : ed.). New York : Harper and Row.Harper and Row.

traumatic brain injury disability counseling janey b. mosier

Documents

handicap slide

mosier slide

blind slide

blank stare slide

brain controls

occipital lobes controls

frontal lobes

temporal lobes