Brain Injury 2018 Services
Providing services for Portland and Central Oregon
Psychotherapy: Continuity starting from injury, connecting various treatment modalities, and on to reintegration into the community/ work (life beyond therapy program goals).
Frequent presenting concerns:
| Posttraumatic Stress
| Emotionally Labile
|| Chronic pain
| Return to Work
|| Impulse Control
| Poor Self Awareness
|| Poor Concentration
| Rebuilding a Meaningful Life
|| Memory Problems
Consultation (1 hour or 1/2 hour): often used to find community services or for a brief concern that usually has an educational component.
Assessment: Measurement of Cognitive and Communicative Function (percentage scores and graphic plot used to represent the degree of impairment). Designed to allow for subsequent testing to assess progress.
Brief TBI screen: For use with the TBI survivor and best with family/ friend present. Recommendations, referrals/ resources offered following screen.
Training/ Workshops: For individuals or organizations on TBI related topics/ skills: Biofeedback (Temporarily Unavailable); Sklar Process TM Visual Tools for Executive Functioning Success; DBT (Dialectical Behavior Therapy) skills adapted for TBI survivors; TBI screening in the health care or mental health setting.
• Independent living program participation is encouraged
• If appropriate, family are encouraged to participate with the survivor
• Support/ education group participation is encouraged
• High functioning survivors tell their story and give support
1) Independent Living Resources, Portland, OR, 503 232-7411, www.ilr.org.
2) Brain Injury alliance of Oregon, 1 800 544-5243, www.biaoregon.org;
3) Abilitree (growing abilities for independence), Bend, OR , 541 388-8103 ex 214, www.abilitree.org
Case Examples of Traumatic Brain Injury Treatment
When someone comes to my office with a brain injury, I go through several steps to determine how I can help them in the moment as I want to use our time well. I find out how the brain injury happened and listen to their story. Then we discuss how to adapt a variety of approaches and skills to their needs. Finally, we follow up with the plan. I have three cases created from different stories with identifying features changed as examples of this process.
Lets begin with George who fell and hit his head on a rock. He was diagnosed with a Mild Brain Injury, by his doctor and following the injury he began to struggle in his work and marriage. His symptoms included memory problems, difficulty with managing his feelings and he was not able act as a father, husband or employee. His wife (Jane) requested he have an assessment. She was very angry at him. He looked OK from the outside, making it difficult to believe he had a real problem. She was sure he could do better if he tried harder. She considered getting a divorce. Jane needed to observe George perform in a range of skills (memory, insight, thinking ability, etc) before she could understand the severity of his injury and that he was doing his best. The approach used was to invite Jane to sit in the assessment with George as an observer (and with George's consent). The outcome was that despite good effort, George performed poorly (as expected due to the injury). June realized: 1) that he was doing his best, 2) he was seriously injured, 3) the injury included thinking, emotions, behaviors and an inability to be aware of his deficits. Jane also was able to see the fear in his face as he was being assessed. She appeared to be very surprised and deeply shook.
In other settings, families may be more aware and able to support the Brain Injury survivor and it is the survivor who is in need. For example Pete, 22 years old was recently struck by a hit and run driver while riding his bike. His brain was injured. Symptoms included headaches, difficulty reading, balance difficulties, fatigue and memory problems. Five family members accompanied Pete to the office (to support, observe and take notes). Pete looked sad and worried. Pete needed help in finding himself again with all of the loss. In the visit Pete was: 1) listened to, 2) we discussed his fear that he was not the same person inside as he was before the injury. He understood that he was the same in his heart and his brain was less efficient, not less smart . 3) he could learn to work with his brain to help the cells rewire and learn how to work with his brain allow it to bring up information and work with new approaches, and 4) that he would be taught skills to reduce his headaches, fatigue and dizziness, and finally, 5) we discussed his gathering a treatment team and how teams work together. (Also noted that a support group would assist with other needs that the providers could not meet.) Pete was given a variety of referrals for providers and support groups from his community. Pete's eyes started 'beaming' and he talked more as the visit continued. I often see a survivor's eyes get clearer and brighter as they begin to feel hope.
Our last case is with Penny, a 24 old graduate student who was involved in a Kayaking accident. She was under water for an unknown period of time when the rescue team brought her back. She suffered from anoxia. Penny was referred to my practice two years following the injury. She was unable to control her anger and the speed at which it arose. Penny needed skills to teach her brain to begin being aware of early indications of anger. In the office she was taught belly breathing (using biofeedback to let her know when she was practicing it correctly or not). She also practiced checking inside several times a day to be aware of her feelings. This was like nudging her brain nerves to wake up and notice what if any feelings were there. Penny was very motivated and her excellent attitude enhanced her success. Shortly after she began to master these skills she joined a support group which quickly became very important to her as she had contact with others with shared experiences.
We discussed what occurs when someone with a brain injury comes into my office. The cases considered are typical concerns. I was not however able to present Post-traumatic Stress Disorder (PTSD) which is also prevalent . As you can see every case is very different as are the treatment choices.