Traumatic Brain Injury Disability Counseling Janey B. Mosier

1. Traumatic Brain InjuryDisability CounselingJaney B. Mosier

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

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

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

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

6. VERY IMPORTANT • The brain controls EVERYTHING we do. It controls ALL of our actions. This is serious. When damaged, the counselor, has their work cut out! Be prepared for the unexpected!

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

8. Human Brain FrontalLobe Parietal Lobe Occipital Lobe Temporal Lobe

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

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

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

12. Occipital Lobes • Controls sight, victims may become blind

13. On your mind??? • 50 First Dates • Drew Barrymore • Adam Sandler

14. Effects of a TBI • Physical • Cognitive • Behavioral • Communication • Emotion • Psychological

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

16. Counseling is the KEY of the rehabilitation process.

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

18. If a client has a severe memory impairment because of a TBI the counselor may need to teach them to use tools such as • tape recorder • planner • notebook • journal

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

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

21. SHOCK • This is psychic numbness resulting from an overwhelming physical trauma.

22. Behavioral correlates • Immobilization, cognitive disorganization ex. Incoherent speech, blank stare

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

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

25. Behavioral Correlates • Restlessness, purposeless activities, rapid speech, sweaty palms, panic attacks, hyperventilation, fast pulse

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

27. Bargaining • Expectancy of recovery from disabling condition through protest and deal making

28. Behavioral correlates • Information seeking, continuous consultation of physicians, contract proposals with God, obsessive-compulsive activities

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

30. Denial or Anosognosia • Denial is defensive retreat from painful realization of disabled condition implications • Anosognosia is when clients with a TBI deny the severity of the injury

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

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

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

34. Behavioral correlates • Loss of appetite, sleep disturbances, slouched posture, sobbing, crying episodes, slow body movements, low energy level

35. Counselor Strategies • Listening and attending, supporting and reassuring, allow client to vent feelings, reflect and clarify, heighten their self awareness, guide the client to recognition of inner resources and strengths

36. Depression • Relatively extended and generalized bereavement of lost body part or function • Some clients with TBI are dealing with loss of former life and dealing with their new personality

37. Behavioral Correlates • Loss of appetite, sleep disturbances, sobbing, crying episodes, slow body movements, lethargy, silence, unkempt personal habits, slow and monotonous tone of voice, suicidal ideation

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

39. Withdrawal • Resignation from social-interpersonal interactions

40. Behavioral correlates • Apathy, passivity, avoidance of human contacts, excessive sleep, deterioration of personal habits, silence, disrupted eating habits

41. Counselor Strategies • Reinforcing social interpersonal contacts, teaching assertiveness skills (assisted by role playing), bring client into contact with support (socialization, self-help) groups • An excellent group for local survivors of a TBI is PABIA (Pittsburgh Area Brain Injury Alliance).

42. Internalized Anger • Self-directed bitterness and resentment often associated with guilt feelings

43. Behavioral correlates • Self-blame, self-abuse, self-injuries, incidents, suicidal ideation, passive aggressiveness, argumentativeness, lip biting, facial twitching Caution: There is a high link between TBI and alcoholism.

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

45. Acknowledgement • Intellectual recognition of future implications stemming from disability and their integration into one’s changing self concept • Some clients’ with a TBI will NEVER reach this point.

46. Behavioral Correlates • Intellectualization of specific areas of disability and their daily impact, discussion of disability and the obstacles it creates, uses of sarcasm, initiation of social contacts, initiation of future plans

47. Counselor Strategies • Planning and developing goals, reinforcing positive self-statements, reflecting and clarifying frustrations, encouraging use of humor, discussing and modeling new behaviors, teaching assertiveness techniques, giving feedback on progress and adaptation, teaching problem-solving skills, changing and restructuring the environment, shaping behaviors (operant conditioning), rewarding appropriate newly learned behaviors, teaching self responsibility

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

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

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