I’d like to propose something controversial here that probably won’t be well-received in psychotherapeutic circles. I’ve said it before, I believe, but I’m going to say it more emphatically now. Someone recently commented on another one of my posts, right when I’ve been thinking about it a lot, so I’ll say it again:
Therapists/mental health counselors (without a strong grounding in neurological information) are about the last people who are able to effectively deal with mTBI. And in the early stages of recovery, seeing a therapist to “figure things out” can do more harm than good. Much more harm than good.
It’s unfortunate, and I hate to say it, but I believe it to be true, based on personal experience with therapists and with friends/acquaintances who are therapists. What I’m about to say comes from years and years of observation, and no matter how seriously therapists may question my point of view (after all, I might be mentally impaired), I still believe it and I stand by it.
See, here’s the thing — TBI seriously screws with the functioning of your brain. Even a “minor” concussion and shear and shred axons and synapses and all those connectors that you’ve built up over the years to learn to live your life. Plus, it releases interesting chemicals into the brain that kill cells. Don’t be alarmed – the brain is a marvelously resilient organ that ingeniously figures out how to re-route connections, recruit other parts of the brain to do the jobs of parts that can’t do it anymore, and generally adapts to changing conditions in ways we are only beginning to recognize and understand.
The thing is, in the early stages of injury (and by early, I also mean the first couple of years after the incident — TBI is a gift that keeps on giving 😉 ) your brain is still trying to figure things out and it is organizing itself around a new way of needing to live your life. Generally folks with TBI don’t have a full and complete understanding of how they’ve been impacted and how it’s affecting their life – we just thing that the world has suddenly gotten all screwed up for no apparent reason. So, our brains are floundering and confused and not quite sure how to find their way out of the messes we’ve gotten into.
And the reorganization that normally takes place as a natural part of recovering from an injury — the reorganization of our brains along certain lines, so that we can resume some level of functionality — can be a bit haywire. The “plastic” brain is a lot like modeling clay. If you press it into a certain mold and leave it there, it will assume that shape and become like its environment. If you leave a lump of it lying on a table and walk away, when you come back a week later, it will be hardened into a chunk that may shatter if you drop it. If you stretch it into lots of thin, haphazard shapes and you leave it that way, it will harden into those thin and haphazard shapes.
So, when your brain is coming back from an injury and it’s looking for different ways to reshape itself, it can get all pulled in a gazillion different directions, because in the aftermath of TBI, things can be crazy and confusing, and we can come up with all sorts of skewed perceptions of ourselves. And if those perceptions are not questioned, challenged and corrected, they can harden into “truth” — which leads us even further down an erring path — into yet more trouble.
Hm. So, the crazier things get, the crazier you feel, and you wonder if you’re just plain losing your mind. You feel depressed and confused and out of sorts, and you don’t know why. So, you do the “logical” thing and you seek professional help. Your friends and family applaud you, because you’ve been getting harder and harder to deal with, and it seems like you have “emotional problems”. (Well, duh – emotional lability and impulse control are often “bundled” with TBI, as a neat little package of insult, injury, and humiliation for everyone involved.)
The only problem is, the therapist you start to see doesn’t know jack about TBI, and they come from the camp of “repressed memory” and how an unhappy childhood marked by long-forgotten/denied/overlooked abuse and neglect is to blame for adult issues. They believe with all their professional soul that most people are walking around in life cut off from their emotions, and that the true path to happiness is to connect with your inner hurt, name your pain, confront the things you are avoiding, and learn to love your demons.
There’s only one problem — none of what they say actually applies to you. The issues you have didn’t start until after your traumatic brain injury, and prior to that head injury, you were a reasonably happy and functional person with their share of troubles, but no “ticking time bomb” of forgotten abuse and neglect to throw you off course. They think that like certain childhood abuse survivors, you have been in denial most of your life, until you reached a certain point in your life when you had “advanced” enough to confront the challenges of resolving a difficult childhood… and they’re going to help you do just that — get in touch with your repressed memories, love the shadow, dance with your demons, and ultimately come to accept and love yourself, no matter what.
What they don’t realize, however, is that your brain is still recovering, still changing, still modifying itself to the world as it now is (rather than as it was before your injury). It’s volatile and highly subject to suggestion, and you’ve been wrestling for so long with not knowing for sure what’s going on with you or how best to deal with it, that your system is highly tweaked and on an emotional hair trigger. They think you’re in need of emotional “tough love” — but what you really need is some good regular exercise, a daily routine to take the guesswork out of your life, and extra patience and rest.
So, they push you. They challenge you. They test your limits. They try to get you to open up to them… pushing and pushing to get you to “admit” what’s going on inside of you, when internally, you’re in storm of emotion that’s neurologically based and totally inexplicable from a purely psychological point of view. They think you’re in denial and resisting necessary change, and you’re sitting there, week after week, looking at them like they’re from another planet, wondering “What’s wrong with me?!” and getting more and more confused and depressed by the week. You take it out on your friends and family, who have really had it with you, by now, and pull even farther away from you than before, thinking you’re just not trying hard enough.
Your therapist thinks you’re making great progress, getting in touch with your feelings and emotions, letting them come up and processing them. But you’re sinking farther and farther into a morass of emotional confusion, volatility, self-doubt, even desperation. Of course, this is all helping to create repeat business for the therapist who is “helping” you, and they can add even more diagnoses to the insurance bill, so what do they care? (Okay, in fairness, I’m sure that not all therapists are interested in creating repeat business, but any time you combine “care” with making a living, you get into gray areas and tricky territory.)
You’re increasingly worried about your emotional and mental health, and that’s keeping you stressed. You’re not sleeping well, which is taking a toll on your ability to self-regulate — your ability to do, well, everything. You’ve got all of the following TBI after-effects in abundance:
emotions, moods, agitated, can’t settle down, anger, anxiety, feeling vague fear, worry, anticipation of doom, depression, feeling down, excitability, everything feels like an effort, feeling unsure of yourself, feelings of dread, feeling like you’re observing yourself from afar, feelings of well-being, feeling guilty, feeling hostile towards others, impatience, irritability, no desire to talk or move, feeling lonely, nervousness, feelings of panic, rapid mood swings, restlessness, tearfulness, crying spells, feeling tense, feeling vague longing/yearning, etc…
And according to your therapist, it’s all due to mental health issues. Not brain issues. Emotional ones. It’s not your body that’s the problem. It’s your soul. You’re screwed.
Your brain is getting a steady stream of messages from your therapist and from yourself about “the way things are” — which is that you’re screwed up and in need of some serious intervention — and it’s causing your very plastic brain to re-form itself along the lines they’re suggesting. You feel like you’re getting worse, so your therapist dials up the intensity … and tells you all the drama is good — you’re “feeling things for the first time” (which is total, utter crap) and you’re acknowledging the difficult-to-handle aspects of your life (which really only emerged after your TBI). It throws you into even more of a tailspin, and before you know it, you’re planning on breaking up with your partner/spouse/lover, you’re riding the roller-coaster of withdrawal on one hand and aggression on the other, and you’re more and more convinced that you can’t live without your therapist, who is the one person who will sit in a room with you for more than a few minutes, as you’ve effectively chased everyone else away.
Anybody else have this happen to them? It happened to me, and looking back, all the advice from my friends and family about getting professional help from a licensed psychotherapist, was about the worst I could have gotten — and followed. It almost cost me my marriage, it turned my life into an extended experience in chaos, and the only reason I managed to escape the bogus-psychotherapy merry go round, was that I ended up seeing a truly well-meaning but neurologically clueless psychotherapist who scared the crap out of me because they had connections at a local mental hospital who could have me committed (against my will) at their say-so. A narrow escape, but an escape no less.
In fairness, I do believe that a lot of therapists are well-meaning and they are acting on the information and the training they have. But too often that training does NOT include a neurological element, and/or they decide that the awful ills of the world have psychological roots.
Another thing that makes it difficult is that a lot of therapists have mental health issues of their own. A lot of my therapist friends got into therapy because they were helped by counselors, themselves. While I applaud their eagerness to help others, it puts up a huge red flag for me. Because the nature of their mental health issues — incest or eating disorders or some other awful trauma — caused them to distance themselves from their bodies at a fairly early age, and they have grown up living outside their bodies. My therapist friends are by and large antagonistic towards their own bodies. They don’t really exercise, and if they do, it’s “gentle stretching” or yoga or something really non-challenging. They are not on friendly terms with their own physical selves, which closes their minds when I suggest that exercise and taking care of your body (as if your life depends on it, which it does) is key to mental health.
It’s all “mind over matter” for them — and I’ve witnessed the same mindset in other psychologists and therapists I’ve met. Not physically vigorous. Not physically healthy. Sitting all day in small rooms, gaining weight, losing muscle tone, planning on knee and shoulder replacements to repair the damage that their sedentary lifestyles have done to their bodies. And complaining all the while about stupid little things that a little exercise would make seem inconsequential.
Anyway, I’ll quit ranting, now. It’s a beautiful day, and thank heaven I remembered I need to move money into my bank account to cover a monthly autobill. Just to wrap up, when it comes to deciding whether or not you really need therapy, consider your neuropsychological state, and make sure you don’t get stuck with someone who doesn’t have a clue about how neurology can make you a little crazy… but that passes with time, and with the proper training and reinforcement for what your life can really be like.
‘Cuz if you aren’t crazy when you start seeing them, regular visits can make sure you really get there.
11 thoughts on “Therapy + TBI = Disaster”
separating out your body, your emotions, your brain, your physical self from your emotional safe are false dichotomies, at least that’s what i’ve learned in my time in therapy. i agree you need someone who specializes. it’s a bad therapist who doesn’t recognize how they are all connected. sounds like you have seen some bad, and lazy, therapists.
Yes, bad and lazy and not willing to look at all sides of the issue. I’m sure there are some good folks out there, but I just haven’t found that many who have open minds and a commitment to challenging what they think they know.
its amazing to me how similar “WE” all are… its also very challenging considering all the brain does and how everyone near and dear wants to give YOU information on whats best for YOUR brain.
the information you provide is absolutely inspiring , thanks so much for always keeping it real!
I am seeking someone that is qualified to analyze my brain, as well as a doctor who has a neurological background, coupled with some experience dealing psycho dynamic issues. Are there any doctors or hospitals that anyone can recommend in the Philadelphia, Bucks, or Montgomery Counties. Suggestions please….
As a caregiver I agree. I also think that therapist should proceed with extreme caution in the rehab setting. I’m not convinced that when someone is emerging from a coma, severe injury that therapy is helpful. I observed a therapist asking someone with Aphasia questions early on that only seem to frustrate, confuse and annoy. I believe that family and friends support goes a long way in recovery and coping skills. Family knows the person they used to be and can help a person with TBI just by not treating them different. When an outsider comes in and tries to “treat” someone they hardly know for a perceived “problem” I can see this pushing the person over the edge. I advocated for my son when the original therapist was not a good fit, I feel sorry for people exposed to personalities that are not consistent with needs and have no one to speak up for them. I wish you all continued success moving forward.
Thanks – You bring up an excellent point – family not treating the individual different after the injury. So many times, we’ve just “forgotten” how to be the way we wish to be, we have lost the familiarity with how we are, and we just need some time and regular reminders of the persons we were, are, and can be again.
There is so much room for confusion about the source of issues after TBI, that if someone with a psychotherapeutic background tries to approach it from that point of view, they will not only find the results inconsistent, but it can also really harm the survivor and set them back.
It doesn’t work for anyone in the “mix”.
First, My TBI mind allowed me to read right through the words that spell check won’t pick up but an editor will. My writing group helps with that proofreading.
Second – Great post. I work in healthcare and am surrounded by lots of docs and therapists. Their total knowledge about TBI is minimal at best (save for the neuropsychologist and a few neurologists.) The six years since my TBI and the four years before that dealing with MS were largely years of constant education. I’ve been analyzed and told I’m this way or that and I listen to only the neuropsychologists. Even they don’t have a full understanding. Nobody really gets brain injury until they get a brain injury. Besides, the whole field of neuroscience is still in a fledgling stage. WE are the teachers. The best doctors listen closely and ask questions. Even then, our knowledge is slowly growing brain by brain. Only time will let the gaps in knowledge be filled in.
Continue to advocate for yourself and the BI community. WE are the real educators!
Mark, you have a great point. We do need to be the educators. It gets frustrating at times, because with all their education, as well as their power and influence, one tends to think that doctors and professional experts are capable of knowing more and doing better. But ultimately, we’re all people. The main thing, I guess, is to remember that and always stay open to the possibility that there may be something more to consider, something more to learn, something more to develop and evolve.
Best of luck with everything.
You raise some excellent points.
I work in mental health and it is frightening how many workers are ignorant about some of the very fundamental facts about TBI. Sometimes I feel like I should go and knock on their heads and ask if there is anybody home and then ask if they realise that they do have a responsibility to maintain a certain level of core information about areas that may not be their specialty (besides – there are enough people with TBI that are misdiagnosed on presentation to hospitals and sent to mental health units that mental health clinicians should know how to (a) tell the difference and (b) know what to expect & how to help people manage it anyway). It is embarrassing to think how many intelligent people seek to use known counter-therapeutic techniques.
Your point about health workers who aren’t healthy is a challenge. When the worker who clearly shows no evidence of engaging in healthy lifestyle practices tries to convince you how essential they are to your health then wonders why you don’t follow through with their advice … it does place a certain level of acceptability on ignoring the advice.
Self-advocacy is a great skill. You are doing a great job here. Educating those you interact with is an ongoing process. At times endless and tiresome – yet at times it can empower and make a difference, if not for you then for the next person. It is valuable.
Congratulations on determination. Keep it up.
It is remarkable, isn’t it. I believe that the “territorialism” of mental health fields has a certain amount to do with it. People want to lay claim to certain conditions, so they can treat (and bill for) them. I think the system is designed to promote this sort of ignorance. If someone cannot bill the insurance companies for a certain condition, then I believe they won’t invest the time and energy in learning about it. It’s madness. That produces yet more madness. And makes insanity out of things that are actually manageable.