A tool to help me sleep

CBT-i Coach

I have been poking around on the Apple App Store, and I found a great little app for helping me deal with my sleep issues. It’s called CBT-i Coach, and it’s a mobile phone app for vets, service members, and others who are in Cognitive Behavioral Therapy for Insomnia.

I’m not in CBT, but I think this could really help me.

I’ve been filling in the details for my sleeping habits, and there’s nothing like having all the data right there in front of you, to tell you where you are.

They also have relaxation and mind-body exercises (although the audio doesn’t seem to work on mine unfortunately), and they have information on developing good sleep habits and getting rid of habits that interfere with sleep.

This looks promising to me. It’s another tool I can use – and it already feels like I have another helper in my corner, to assist with my sleep problems.

Just wanted to share that.

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A learning life is the best rehab for me

Tomorrow is Thanksgiving, and today I’m traveling to my extended family, several states away. I expect the traffic to be heavy, and I expect the trip to be long. I’ve spent the past week preparing myself for this mentally, emotionally, physically, and spiritually. I’ve consulted with my neuropsych, I’ve checked in with friends, I’ve been eating right and I’ve been working out and stretching regularly. Last night I actually got eight hours of sleep.

This year is very different from past years, in that I’m not pushing myself up to the very last minute when my spouse and I hit the road. I’ve been taking it easy, taking the different tasks in manageable pieces, not biting off more than I can chew, but keeping on task and on point. And I’ve been using my timer, to make sure I stay on schedule.

This year is also different, in that I called my parents ahead of time to find out what the plan was going to be for the next few days. I checked the weather, too, so I could be prepared to offer suggestions. I’ve requested that we just take Friday “off” and relax and do some light activity outside — the weather is going to be beautiful, and I would really like to spend time with my folks, just hanging out and talking.

I am also planning to share with them the findings of my neuropsych evaluations and work. I’ve made tremendous progress, over the past year, and I want to share the info with my parents in a positive and constructive way. I haven’t been able to do that, till lately, as I’ve had a lot of reservations about my progress (not helped by my psychotherapist, who has been trying to talk me into “accepting” (i.e., giving up on) my limitations and settling for less of an amazing life than I believe I can have.

I’m not sure how they got to be that cynical, but I’m not on the same page with them, and I am certainly not going to settle for less, just ’cause I’ve had some misfortunes along the way.

Anyway, I’ve been giving a lot of thought to how much progress I’ve made over the past year or so. My neuropsych says they are encouraged and inspired by my progress, which is great. I’m really happy I can return the favor of their assistance. I really have come a long way. A year ago, I was pretty turned around, I didn’t have much direction, and I was very muddled and confused by the ramifications of my issues. I had a long way to go, to figure things out.

My previous therapist wasn’t helping matters, by constantly focusing on what my mother did, as a source of my woes. I invested a lot of time with them, essentially being led down the wrong path — it wasn’t necessarily my mother (or my father) that was the root of my issues. It was more the neurological context in which I was living in my childhood — all those unidentified, misunderstood, pesky issues that complicated and intensified every experience I had, and had me “pegging” emotionally and behaviorally all over the map.

Now, I have to say, my current psychotherapist has helped me regain my balance from before. I think my previous therapist was trying to regress me, to find some deep, dark secret hidden in the innermost recesses of my psyche, so they could exorcise my demons or something like that. And my current therapist helped me regain my balance by helping me focus on the logistics of my day-to-day life, rather than floating around in the distant past. And I am very grateful for their help (tho’ I have to move on now).

Indeed, I think the thing that has helped me the most, over the past couple of years, has been the help I’ve gotten in dealing with my everyday life — keeping my issues in mind, understanding them and how they impact me, and getting to the bottom of the problems I can expect to have, given different situations. Being aware of patterns, like:

I get tired after a full day of intense activity, and when I get tired, I have a tendency to get turned around and agitated, which adds to my internal confusion and throws gasoline on the fire of my temper… and really contributes to me melting down over every little thing

helps me immensely, and it also helps the people around me to help manage and anticipate my issues before they get completely out of control.

And one of the big things that helps me identify my patterns is examining my life on a regular basis. I take a lot of notes, and I record a lot of my experiences. I look back on my days and weeks, and I watch for issues and patterns that emerge over time. I write down the times when I am having a really hard time of things, and I identify the contributing factors. And I draw pictures of my problems and the “flow” I use to deal with them. I work with my life — the failures and the successes — as my own individual recovery plan and practice. And I see results.

Real results. Like promotions at work. Like improved relationships with others. Like a more creative approach to my life, overall. If I can get past the old bad habit of being so hard on myself, and I can treat my difficulties as challenges (from the outside — from my faulty wiring — rather than from my inside character or personal worth) to be tackled creatively … challenges just waiting to be overcome… well, then, the ultimate results of my examined life are tangible improvements, the likes of which I never thought I’d see happen.

Truly, this is remarkable. I always thought — before I knew why things were always getting so screwed up with me — that I was flat-out doomed to failure. I had precious little expectation that things would ever turn around for me permanently… I figured it was always just a matter of time, till things got mucked up for no reason I could identify, and everything I’d worked so hard for just went away, swallowed up in the sinkhole of my life.

But now that I’m paying attention to the basics, and I’m following up to deliberately study the results of my actions and see how they can be improved… Now that I’m treating my life like the miracle that it is, and I’m studying my daily “playbook” with focus and intention, and I’m refining my approaches, based on what I know about my limitations, I no longer believe that I am stuck in endless cycles of attempt-failure-attempt-failure-attempt-failure.

My life is different now. Because I’m living it differently now.

And it’s good.

In case you’re wondering how I go about doing this, here’s the basic flow of my practical-life-recovery-plan:

  1. I figure out what I want to do. I understand why I want to do it, and how it fits in the overall picture of my life. For example, I figure out that I need to exercise first thing in the morning, and I need to really work up a sweat, because I have been feeling a little sluggish lately and I need to “pump up” my system a little more.
  2. I do it. And I track what I do. For example, I do my morning workout, but I don’t manage to work up much of a sweat.
  3. I figure out if I accomplished what I set out to do, and if I succeeded, I celebrate in some way. If not, I ask myself why that is. For example, I make note that I worked out — and I congratulate myself for doing that — but I didn’t work up a sweat, and I wonder why.
  4. I figure out why I didn’t accomplish exactly what I set out to do, and I ask myself what I can do differently to change that the next time. For example, while I’m having my breakfast, I look at how I’m doing, and I realize that I’m tired and distracted. I figure out that I didn’t get to bed at a decent hour the night before, and I also see that I let to many errands wait till later in the day, which pushed my schedule back farther into the evening, so I couldn’t relax and get to sleep at a decent hour.
  5. I think of alternative strategies I can follow to make changes in my daily life, that will help me accomplish what I set out to do better today. For example, I spend a little more time planning my day in a way that will let me get my busy-work done first thing, and give me more time in the afternoon to take it easy and wind down.
  6. I go about my day and check in with myself periodically, to see how I’m doing. I make a point of remembering the goals I did not accomplish, which I really, really wanted to accomplish, and I work a little harder to keep myself in line. For example, I check my daily work list periodically to make sure I’m staying on schedule and make sure I’m not overloading myself with extra stuff in the evening.
  7. Last but not least, I follow up. I do a check-in later to see how I’m doing, and if I’ve accomplished the goals I set for myself, I celebrate and reward myself. For example, if I get to the end of the day without wiping myself out, I treat myself to a little bit of television, watching a show on cable that I really like. Or better yet, I make an early night of it and I get in bed at a decent hour, which lets me sleep and sleep and sleep till I’m actually rested.
  8. And then I do it all again the next day.

To some, it might sound arduous and like a lot of work, and it is. But it’s good work, and it’s really more of an orientation to my life, a kind of spiritual practice, if you will. In the Give Back Orlando material, they talk about how TBI survivors need to be more mindful of their lives, and I have found that to be very true. But even more importantly, I’ve found that I want to be more mindful of my life. Yes, it’s work, but I don’t mind the work. Yes, it’s different from how most people live. But I’ve never been like other people, so why start now — and why feel badly that I can’t be like them? I’m just fine, the way I am.

In the end, yes, it does take more work to live this way. In the end, yes, it is more time-consuming to do things that a lot of people do quickly and easily without a second thought. In the end, no, I don’t have as much time to fritter away on non-essential activities.

But in the end, the payoff is huge. I get to have a life.

Better yet, I get to have the life that I want to live.

MTBI and mental health

I’ve been thinking a lot about how TBI (especially MBTI) can either masquerade as mental illness… or lead to it. Not being a psychotherapist, I can’t speak to the intimate details of what makes a person mentally ill, but being a multiple MTBI survivor, I can speak to my own experiences.

In my recent post The Disordered Life and the Need for Psychotherapy, I talked a bit about how my past therapy experience was perhaps not the most effective for me — or the most appropriate. And now I’m starting to think that maybe it did me more harm than good, in some respects. That constant plumbing the depths of my soul, looking for things to explore… well, that frankly wasn’t often a very productive experience. I’d end up in tears, 24 hours later, and I’d be turned around for days, confused about things and off-balance in my life.

Here are some more thoughts regarding the mention over at Get Real Results. Their text is in bold, mine is plain.

Many people who enter traditional psychodynamic psychotherapy do so because they are dissatisfied with their lives.

I got into therapy, because I was having an incredibly difficult time dealing with being a caregiver for a family member who had developed disabling health problems. They had been going slowly but steadily downhill for a while, their health problems worsening without being really addressed. They frankly refused to see a doctor for their problems. They wouldn’t even admit that there was a problem. I had tried to soldier through with them, stick with them, no matter what, and be loyal and helpful and stabilizing. But ultimately, they ended up in the hospital, where they were properly diagnosed and put on a recovery regimen. They were unable to do much of anything for themself, so I took time off from work and helped them get back on their feet. During that time, I was the only caregiver for them, and due to circumstances that are way too complicated to go into here, I couldn’t ask friends of family for help. Only a few were available to me, and then in a very limited capacity. Basically, I was holding the fort down for the two of us, and I was getting increasingly frayed… and incapable of dealing with the situation in a productive manner. My temper got shorter and shorter and increasingly explosive, I was melting down (in private), occassionally self-injuring to relieve the internal pressure, and becoming more and more PTSD-y. It was just not good. I was getting worse by the week, and it was starting to get dicey for the person I was supposed to be caring for. I knew I was supposed to be doing better than I was, and I couldn’t figure out why I was so fragile and inept and having such a terrible time of things. A friend pushed for me to get into therapy, and they found me a seasoned therapist they thought would be a good match. I decided to give it a try.

Their dissatisfaction may be due to being unsure of themselves, goals that are not clear, inability to accomplish what they want, unsatisfying relationships, anger or fear, or they are depressed.

I really didn’t know what was going on with me. I was having a hell of a time understanding what the doctors were telling me, remembering the info I was getting, and if I hadn’t had us all on a very strict schedule each day, with extra attention paid to nutrition and exercise and the most  basic of needs, we all probably would have spun wildly out of control. Friends who knew about what was  going on would would ask me what I needed, but I had no idea. They would try to talk to me about the situation and give me some support, but I coudn’t seem to access anything useful to tell them. I could discuss high-level things like medical research. I could talk about basic stuff like eating plans. But when it came to regular human interaction and talking about what was going on with me, I was at a complete and total loss. People would ask me what I needed from them, and I couldn’t answer. I literally didn’t know. All I knew was, I was locked on target to keep everyone in the household going, and keep my care-take-ee on the road to recovery.

Hoping to find out what was going on, I went into therapy. I really didn’t know what to expect. I had tried therapy years before, and it ended badly. What I did know was that I was wearing thin, I was melting down, I was not holding up well, and I didn’t know why. I needed someone to help me figure it out — and hopefully address it.

Psychotherapy offers them a chance to explore their feelings and past, uncover and resolve the conflicts that interfere with their lives, vent their frustrations, and get on with their lives.

Oh, yes… the exploration of the past… My therapist was really into that. They wanted to know what my parents were like, what they’d done that was awful, what my childhood environment was like, etc. Granted, my early childhood was not easy — I didn’t see much of my parents in my early years, I was in childcare during most of my waking hours, and when I did see my parents in the evenings or on the weekends, they were busy working around the house or they were occupied with concerns other than me. And the times when I did interact with them, I often had troubles. We would start out pretty good, then eventually things would go south, and I’d end up melting down or being disciplined for something I’d done. I had a lot of sensory issues when I was a kid — touch felt like pain a lot of times, and I had a hard time hearing and understanding what people were saying to me — so the “easy” times were a bit more complicated than one might expect.

Anyway, my therapist apparently had a lot of interesting material to work with, ’cause my childhood as I reported it was such a tangled mess. And my teen years and early adulthood weren’t much more straightforward.  Let’s just say I’ve had an eventful life. A non-standard life. A unique experience. I often got the feeling, during our sessions, that they were trying to uncover something really awful that would explain why I was such a wreck.

I have to say, I wasn’t always comfortable with that dynamic. It seemed to me that they were making some assumptions that just didn’t “sit right” with me. Looking back honestly and truthfully — and I’m not afraid to look at bad things that have happened, to me (even though I’m not usually comfortable talking about them with others) — I just couldn’t find any evidence of the kinds of abuse that are usually associated with intense PTSD. Sure, there’s that whole “repressed memory” thing, but I’m sorry, I just wasn’t feeling it. My diagnostic neuropsychologist concurred (on their own steam) that the difficulties I face are not psychological in origin, rather TBI-related, and even before I started the neuropsych testing, I had a strong, undeniable sense that the problems I was having with keeping up with everything around me were NOT just about stress, were not just about an unhappy childhood, were NOT based in psychological problems, but had some other origin. And I had to figure out what that was.

I suspect that hard-core psychiatric/psychological “team members” are going to turn their noses up at this, but you have to understand — I have spent 30-some years specializing in exploring the innermost recesses of my psyche. I’ve got countless journals filled with self-exploration to prove it. I’ve peered into dark corners on a daily basis for decades, and I’m not afraid to confront my demons. Seriously. I’m not. And when I took a long, hard look at the chronology of my childhood and teen years and early adulthood… and up to the present time… and I compared it with the chronology of my regular-functioning siblings… and I compared how I wanted (and tried) to  behave and experience life against how things actually turned out, well it was pretty damned clear to me that there was more than psychology at work.

There had to be a logistical, systemic issue at hand that hadn’t been identified or dealt with. My difficulties stemmed — it was pretty clear to me — NOT from things that were “done to me” but rather how I interpreted and experienced the events of my life. My siblings had gone through many of the same things I had — some of them had gone through much worse — and yet they presented as (and were/are) perfectly normal. Ironically, my siblings are — in the estimation of people who know both me and them — a lot less “together” than I am. But they are/were a whole lot more functional in the most basic ways — particularly socially. They knew how to identify and communicate to others what was going on with them and what they needed in tight spots.

I, on the other hand, had my act together in many ways that they never have, and was a super achiever with a good head on my shoulders in many respects, but in others, I was just a train wreck. I had always had a hell of a time figuring out where I stood in relation to the world around me, what I was feeling, what I was thinking, and what I needed from others. And while the experiences I’d had as a kid were not unlike what others went through, I took everything incredibly hard and couldn’t deal with much of anything. Change was all but impossible for me to stomach. I took any alteration — expected or unexpected — very, very hard. Some changes I took so hard, I apparently blocked them out from my memory, and I only know about them from my parents. Social interactions were pretty much a lost cause with me. Indeed,tending to the most basic things in life were next to impossible… like following conversations, being able to follow through with the easiest of tasks, playing simple schoolyard games like kickball and four-square, interacting with others, and keeping my act together without melting down or going off on wild hyperactive sprees. I was alternately aggressive and emotionally hypersensitive, and I spent a whole lot of my childhood and youth being extremely angry and bitter, and acting out in various ways.

Now, plenty of mental health professionals could probably come up with some workable explanations for all of this, and they’d probably be right. I’m sure plenty of people would have difficulty with what I experienced. My siblings still struggle with the aftermath of similar experiences. But not to the degree that I did/do. In fact, it was the degree of my difficulties that tipped me off that there was something more going on with me. When I took an honest, truthful look at my life experiences, and I compared the outcomes with other comparable individuals, I could very plainly detect a significant difference in degree that — I’m sorry — can’t be explained as trauma or post traumatic stress or even the changing times I grew up in. There was something more going on, which complicated things then. And it was continuing to complicate things for me in the present.

Unfortunately, although many head injured persons fit the above description and thus get sent into traditional analytic or psychodynamic therapy — they often get worse, not better, to everyone’s dismay.

OMG – I wish to hell I’d read this a year ago. It explains so much. Lemme tell you, it’s no friggin’ fun sitting there, week after week, sometimes twice a week, trying “like crazy” to figure out what’s amiss, and why… to be following the standard protocol of plumbing the depths, trying to come up with examples of past distress, trying to identify what’s going on with you… doing what you think (and are told) is the right thing to do, therapeutically… only to be an emotional wreck for days afterwards. And be getting worse, not better.

That’s what happened to me. I wasn’t becoming more centered and together.  I wasn’t better able to cope with the stresses of my life. I was actually having a harder and harder time of it. And I was starting to doubt myself at every turn. I was starting to doubt my judgment, my ability to cope, my sanity. I would sit there for that 50 minutes or so, trying to come up with some examples of what I was feeling or what I had experienced, only to come up empty-handed — and feeling pretty stupid in the process.  I would try to figure out what I was feeling, how I was impacted by such-and-such an experience, what others and said or done that upset me… and try to feel my feelings in general.

Therapy was supposed to help me make sense of things, and in some ways, it did help to have someone to talk to. But it helped me most when I was just talking about my life and not processing it all in a psychotherapeutic context. When I tried to “therapize” my experience, I just ended up feeling stupid and incompetent and beset by all sorts of self-doubt. I often couldn’t follow what my therapist was saying to me, and I could react quickly enough to get them to slow down. I would rush through my sessions with them, just saying out loud what I thought should be said, rather than letting on that I wasn’t following and I wasn’t  articulating what I wanted to articulate. I was so embarrassed that I couldn’t put into words what was going on with me — and in fact, I couldn’t figure out what was going on with me — that I spent an awful lot of time spewing stuff that wasn’t necessarily accurate or reflective of where I was coming from. I had always had such a hard time interacting with people — especially in spoken conversation — I just couldn’t deal with the talk-therapy scene in a really authentic way.

I knew this on some level, though I couldn’t yet put my finger on it, and it made feel like a total fraud and a loser — both because I couldn’t seem to do better in our interactions, and because I didn’t know how to ‘fess up … and do something about it.

As a result, a lot of the problems I was having became even worse, and I started to blow up and melt down and make really stupid choices over and over and over again. I went through three or four jobs in the time I was in traditional talk-therapy, and I was stressing to the point of having spells/episodes that looked a whole lot like seizures of some sort.

Not good.

This happens because the disorder in their lives reflects not primarily underlying psychological conflicts, but the damage to their brains that has resulted in cognitive and executive dysfunctions.

Amen to that. I couldn’t for the life of me figure out why I was screwing up, left and right. I was getting in touch with my feelings, I was feeling them. I was talking about my difficulties. I was releasing old hurts. I was doing what was supposed to be done — or so I thought — but my life was still on a collision course with… well, me. I was making all sorts of bad decisions, and my therapist gave me room to “explore” them as I wished. The only thing was, the decisions put me on a really bad path to some serious professional peril — and I wish they’d spoken up and corrected some of the shitty thought processes that were in play. I wish they’d challenged my thinking on a bunch of subjects. I might not have made the choices I did, and done the stupid-ass things I thought were such good ideas at the time, if they’d just questioned me more closely … with the understanding that my brain tends to misfire at critical times. I was cognitively and executively dysfunctional in some pretty significant ways, but they approached my difficulties from an emotional point of view, rather than a logistical one. They seemed to think that if I just had a better sense of self, and if I overcame my low self-esteem, I would be able to get my life back on track.

Uh…. NOT. Self-esteem has nothing to do with any of it. Nor lacking sense of self. It’s basic system issues that plague me. If anything, my sense of self is my strongest suit, and my self-esteem is for the most part quite intact. But all of my self-regard is useless, if my brain is misfiring and giving me wrong bits of information about what I should do with all that self-esteem and identity stuff.

This has gotten me in trouble more times than I care to think about. I swear… I’ll be feeling really strong and good about how I can do anything I put my mind to… but I won’t realize that fatigue is getting the best of me, and I’m missing cues and clues about what’s going on in the world around me. And I’ll screw up the job I’ve started — like a spreadsheet of numbers I’ve collected, or a piece of programming code I’ve written. I won’t muck up because I don’t feel good about myself, but because I didn’t take the time to walk through the steps of the job I’m doing… and I’ll screw it all up, miscalculating and end up with the wrong answer entirely. Broken program. Wrong numbers. Messed-up results — not because I lack self-esteem, but because my form was crappy.

Low self-esteem wasn’t the source of so many of my problems. MTBI was. Low self-esteem was an effect of the underlying problems — not a cause.

My old therapist also seemed to think that if I looked too closely at the ways in which I was deficient, it would take a toll on my self-esteem. If I explored the details of my screw-ups, I’d get down on myself and lose ground, psychologically. Untrue, untrue, untrue. It was in NOT looking at how I was screwing up, that I got into trouble, because I could never correct my mistakes so I’d do better the next time.  They spent a whole lot of time trying to reassure me that “I could do it”, without empowering me to actually do it in the way I needed to. Actually, I couldn’t do it — at least, not without help. There’s no shame in that, but the way they went about things, they actually made me feel as though there was.

Their lives are disordered because their brains are disordered.

Uh, yah. And acting like I was cognitively and excutively intact, was a huge mistake. For them, and for me. I guess I just didn’t grasp the extent of my difficulties, nor did they. They seemed to think that my lack of initiative stemmed from emotionally based depression, rather than a physical slowing of the brain processes… that my difficulties socially came from low self-esteem, rather than a long history of mucked-up relationships that stemmed from behavioral issues that began around the time of my first TBI and got worse with every successive one. My life, while full and whole and complete and highly functional in some ways, was in a total shambles in others.  It seems to me that that should have raised a flag of some sort — why does someone who is such a top performer and peak achiever in significant ways, also show such profound deficits in others? It’s not emotional in nature and origin. It’s neurological.

“Talking things out” does not solve the problem and may worsen it.

Which it did for me. Talking just made everything worse — it was all talk, no action, and if I talked about my difficulties, their main approach was to reassure me that I was an okay person (which I already knew!) rather than encourage me to deal with the logistics.

This is because traditional therapy removes structure and encourages the spontaneous expression of whatever thoughts and feelings seem most important.

Yet another contributing factor. OMG — can I tell you how many sessions I just rambled on and on without any particular direction? It may have seemed like giving my emotions free rein was a good idea, but they clearly didn’t know how capricious my brain can be around thoughts and feelings. Without structure and purpose, all that cognitive energy just went flying all over the place, leaving me even more confused than before, in many ways. Which did not support my mental health.

Such a process is guaranteed to lead to further disorganization and confusion in a person whose major problem is structuring and organizing the thinking processes, while trying to keep surges of emotion from washing everything away entirely.

Amen to that. Now I can see why my present therapist, who is a neuropsych by training, is constantly steering me away from the emotional exploration I became accustomed to. This new therapist (NT) takes a totally different approach from my Old Therapist (OT), and I have to admit it confused me at first and made me angry and disoriented. I was accustomed to therapy being about venting and “releasing”, but NT was focusing on logistics. And steering me away from overly emotional responses to every little thing (which had been encouraged by OT before).

When individual “therapy” is a successful adjunct to a rehabilitation program, it is a structuring, supportive, problem-solving approach.

And so it is — this new approach with NT is so much more helpful to me. And to everyone around me. My family members have commented that I’m doing a whole lot better, now that I’m seeing NT, and I can tell a huge difference. NT is very supportive, but they don’t let me get away with crappy cognitive processes, and they make me stop and think things through before I take action I’m talking about. They’ve already “talked me back from the edge” of doing something really stupid, a number of times. And this in only a few months. Plus, they’ve talked me through some wrong assumptions and bad information I was working off of, for nearly 20 years. They are talking me through thought processes that have been deeply flawed — yet rote — for decades, now. And I’m revising my perceptions in the process.

That’s just huge. And it’s something that I, as an MTBI survivor, need desperately. I need to be stopped and questioned and challenged. Even if it makes me uncomfortable and mad. I need to be forced to think things through in a careful and deliberate way, not just fly into situations thinking I can do everything on reflex. I can’t. I’m not sure I ever could. But this is the first I’m realizing it fully.

But at least I’m realizing it now. So I can actually do something about it. And make some real progress!

This does not mean that head injured persons cannot have mild or severe psychological problems that either result directly from, or exist (usually existed) separately from the results of their injury.

In my case, I would say that a fair number of my psych issues have stemmed from my long history of screwing up due to MTBI problems. There’s only so many false starts and cock-ups you can commit, until you start to be convinced you’re an idiot and don’t deserve a full and fulfilling life. There’s only so many relationships you can blow away, before you start to think you’re unfit for society. And having people make fun of you and bully you and ostrasize you and tell you you’re lazy and stupid and slow and whatnot also takes a toll.

I’m not complaining and I’m not crying boo-hoo.

I’m just saying…

They can, and often do. It does mean, however, that the traditional psychodynamic approach seldom offers the head-injured person relief from their disordered life.

Yes to this. To get relief from my disordered life, I need specific coping strategies and tools in my “toolbox”. After I’ve stopped making a mess of everything I touch, I can start to rebuild my self-esteem. But not before then.

The psychotherapist who specializes in brain injury must have an appreciation of the impact of brain damage on the patient’s capacity to benefit from the process of therapy.

Which my OT didn’t, I don’t think. At least, I don’t think they understood just how deeply I’d been impacted by a lifetime of injuries and the resulting effects.

Rehabilitation professionals should seek out such specialists if their clients require psychotherapy.

And clients should do the same.

I’m really hoping that this post has offered some food for thought to therapists and clients alike. It’s just so important, and there are so many critical considerations to go into this.

If TBI isn’t considered fully in therapy, the process itself can wreak havoc in an already disordered life… making things worse in the process. Folks may disagree with what I’ve said above, but that’s just my own experience and perception.

Therapy should be helpful. I think we can all agree on that.