Returning to the Basics after Traumatic Brain Injury

“Traumatic Brain Injury is an important public health problem in the United States. Because the problems that result from Traumatic Brain Injury (TBI), such as those of thinking and memory, are often not visible, and because awareness about TBI among the general public is limited, it is frequently referred to as the ‘silent epidemic.’”

Marilynn Lash: The Essential Brain Injury Guide (4th Edition) The Brain Injury Alliance of America, 2007.

When I was new to the practice of chemical dependency counseling, I worked at Fairview Recovery Services. One morning a rushed counselor breezed past me and handed me something from the fax machine. It was a short article about client-centered counseling. The point of the article was to encourage being cognizant of that moment in a session with a client, when you’re not sure where to go next. The article urged the reader to go back to the basics, focusing on the simple (though not always easy) practice of being present and actively listening. Of course, this was a basic teaching within the field of counseling, which I understood intellectually.

I left Fairview many years ago and for the last 11 years have been working at Vinland National Center, which is a substance use disorder treatment program for adults with diagnosis of serious and persistent mental illness, traumatic brain injury and, of course, substance use disorders. All of these conditions result in impairments to cognitive control. Difficulties with motivation, planning, impulse control, inattentiveness, and anger are often coupled with physical difficulties such as balance problems or general states of physical deconditioning.

In 2011 I had the good fortune to attend a national conference in Washington D.C. that focused on traumatic brain injury. Most of the attendees worked in traumatic brain injury rehabilitation, either as direct care providers or as researchers. I was there as a member of Vinland Center to present on the effects that a Mindfulness practice had on the adults living in our semi-independent living facility; they had all been diagnosed with a brain injury and a substance use disorder. During the conference, I remember listening to two separate presenters describe how traumatic brain injury affected those they studied. Both presentations pointed out how the slow descent into isolation had a dramatic impact on the overall health of those that suffered from a traumatic brain injury. Try this little experiment sometime: Find a clear space of about 20 feet. Begin to walk heal to toe slowly, but not so slow that it makes balance difficult to maintain; just a slow but steady pace. After about six feet, bring your left hand up and close and cover your eyes, while continuing to walk heel to toe.

Did you feel that? Did you notice that balance became more difficult?

The ‘brain’ is just a word; a concept that attempts to collect a multitude of activity under one name. It is, in fact, a series of networks. When you complete the above activity, you are, in effect, disrupting a network. The brain relies on connected parts to function optimally. I realize I am oversimplifying this complicated neurological activity, but just imagine if you woke up in the hospital and large numbers of your ‘networks’ had changed. They had not only changed, but some of them would not change back with conscious control. Some changes would last a lifetime, such as short term memory deficits, inattentiveness, difficulties with planning and organizing, impulse control problems, shifts in personality and increases in irritation and anger.

You may ask yourself, “Who am I now?” Your loved ones may ask, “Who are you now?”

I once worked with a client who was a heavy drinker that sustained a brain injury after a serious fall. He was well educated and originated from the east coast. He was living and working in Minnesota at the time, but I suspect that when he spoke to his friends back east, he’d shake his head in disbelief that he was living in “flyover country.”

At some point after his fall, he was convicted of a DWI and was court ordered to complete treatment and follow all recom- mendations. He came to Vinland National Center’s substance use disorder program for high intensity, residential treatment. However, while he was interested in changing his drinking habits, but was not interested in engaging in treatment to make this change. He arrived at Vinland’s residential facility and proceeded to roll his eyes through much of the initial programming. Shortly after he arrived, I saw him in the hall having an animated conversation with a peer. When I asked him about it, he reported that the person he’d been talking with had similar brain injury symptoms and recoveries. When I asked him how many people he had previously had a conversation with about his brain injury, he said “………Zip……… zero…………” “Seriously?” I asked. “Nope, nobody,” was his response. He sustained a brain injury and basically didn’t engage with anyone for a year and a half. Loneliness is not good for anyone.

Much of the benefit he would receive from treatment would begin on that day. His ability to open up to someone else, even just a little, cultivated hope. In my experience, hope arises out of a sense of genuine connection with someone or something. Sometimes the emotional authenticity which is needed to connect is subtle. Sometimes it is in the simple act of listening to understand. People are more likely to listen to others when they feel they are being heard.

Working with people with brain injuries and substance use disorders can be hard. The more difficult the case, the greater the need to stick to the basics of active listening with presence. In preparing for a talk, I asked a group of brain injury survivors what they would want more of in the substance use disorder treatment industry. One group said they hoped for more education and more patience. This coincided with a story from one client about being involved in a program and being asked to submit to a drug test because he had an unsteady gait (a product of brain injury).

Most of the ideas about what to do next come from the clients, not me. Even with a brain injury, they are collaborators in their care. “Full lives for people with disabilities” is what is printed on the sign out in front of the campus of Vinland Center. “Full Lives” doesn’t mean that you will come here; go to a few groups and Voila’! – you’re back to your old self and ready to resume your life. To me, it means that people with brain injuries get to have full lives in which they are fully acknowledged, accepted and heard, despite any limitations they may have. It means that over and over again I can return to the simple, but not always easy, practice of being fully present with our clients.

That means being fully in my life, quiet, still, open to what is happening, not worrying about what comes next, no matter if it is pleasant or unpleasant. Of course, this is a basic teaching within the field of counseling, which I understand, experientially.

Tom Beckers, LADC, is the Program Services Manager at Vinland National Center in Loretto, MN. To receive further information about Vinland Center, contact Molly Gilbert, Director of Business Development at or 763.479.4525.

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