Ask Kathy M. Archives
A Collection of Questions and Answers from TBI Advice Expert - Kathy Moeller

Topic: Social-Emotional - Self Esteem

Question:

Dear Kathy M.,

I used to be an executive with a major corporation. I worked hard to get ahead and after my accident, I worked hard too, but it didn't seem to get me very far. I got a little therapy, but probably not enough (insurance ran out). I've tried to get back to work. There was no way I could do my old job. I got some low-level jobs through Vocational Rehabilitation, ended up doing some volunteer work, but it seems like no matter what I try there's always a "deal breaker" someone down the line (did you know you can get fired from volunteer jobs if you forget important deadlines?). Most of the problems were related to memory or organization or frustration. I look OK, so that seems to be a problem too!

It's been three years and I still have to depend on wife or my children for nearly everything. They handle the house, the bills, the doctors, even school schedules. I'm bored, feel useless and am starting to get very depressed. I think I'm on the verge of giving up! What do people in my situation do? I still feel I could be useful -- to a company, to my family, to myself -- and sometimes when I get up in the morning I am determined to get it together. I end up feeling even more worthless when I get lost or stuck in the middle of the day (or get too tired to think). My doctor thinks I have a self-esteem problem and need a therapist who can help me adjust to having more realistic expectations out of life. He also suggests anti-depressants. I'm not optimistic that will help. I'm also not optimistic that you can help, but thought I'd write anyway.

Jim


Kathy's Response:

Dear Jim,

I think "looking OK" is another barrier those of us with so-called invisible disabilities need to understand and deal with. It can make our families and co-workers think everything is OK when we know it isn't. The invisibility factor is something I deal with every day, and it isn't easy. I've also been down the path of trying (and failing) at work, stepping on what I call the "mine fields,"and feeling depressed and worthless. So have others with brain injury. First off, know you are not alone!

Let me try to address the questions you asked, one at a time:

Working Hard

I'm curious what you "worked hard" to do after your injury? Perhaps you are not aware of this, but brain injury is not something a person can out-muscle. It's something we need to OUTSMART! For example trying hard to remember seldom works. Trying hard to learn effective strategies for retrieving information does. Effort applied to the latter helps us outsmart the injury. Effort applied to the former can frustrate and discourage us.

What I'm trying to point out here is that "working hard" is not necessarily effective, as a stand-alone effort. It needs to be applied in the right way. Imagine asking a person with hearing impairment to work harder at hearing. Ridiculous you say? Yet, this kind of "effort" is often what is expected of us (by others and by ourselves) after a brain injury. Have you ever heard, "If it had been important to you, you would have remembered it"? Implying that effort or care about something is linked to our ability to remember it? This may have been true prior to the injury, but after an injury, memory doesn't work that way any longer.

Hard work (at a job, at therapy, at having a so-called positive attitude), may not necessarily be the key to having a positive functional recovery. Think about someone trying to drain a swimming pool with an eyedropper. Imagine they are working very hard and end up discouraged. That's what I see a lot of folks with brain injury doing -- they are working their hearts out -- but the effort alone is not helping them recover.

A little therapy

What type of therapy, may I ask? Of course, "a little therapy" is seldom enough following a brain injury, no matter what kind -- even after a so-called "mild" or "minor" injury. Know that "a little" cognitive therapy, "a little" memory book training, "a little" adjustment counseling, or a little bit of anything else, probably was not adequate, and may not have even been appropriate! If you were in a situation where you received whatever therapy your insurance plan paid for, it's almost a sure bet you did not get either enough treatment or it may have been structured to fit what was covered. I'm told that these days, some insurance companies do not pay for cognitive rehabilitation because they consider it experimental. If they pay for adjustment counseling, that's often what their customers get -- even if cognitive rehab. would have been more helpful. I'm not saying this is what happened to you because I don't know. I'm saying that this is sometimes what happens to people.

Trying to go back to work

Congratulations on trying to work again! What did you learn during these experiences? You did make notes, I assume, so you could learn from each experience. If not, the next time you try to work (and I would encourage you to not give up), keep a journal so you know what the issues are -- your problem areas and your strengths!

Yes, there are deal-breakers at work. Lots of them! That's why I see returning to work like navigating a mine field. If you miss one, it's likely there's another one waiting for you. This is one area where I will strongly encourage you to seek out the support of your working peers. Those of us who have made it back to work again are in a good position to support and encourage you during your journey. Together, we can help you make your way back.

Don't give up on the idea just because you have had two or three (or 20 or 30) so-called failures. Now, I don't want to suggest that you keep making the same mistakes, either. Instead, keep a journal, network with your working brain-injured peers, and try again! Heck, I know people who worked on getting back to work or finishing school for ten or more years -- they just kept learning from each experience! Now, if you don't want to wait that long, or do it ALL by trial and error, please feel free to join an e-mail discussion and support list I facilitate for persons with brain injury who are working again. Click on the following URL for more information: www.brainbook.com/brainbook/email_lists_ws.shtml#tbiworking

Memory, organization and frustration

Good news! There are strategies you can learn to compensate for all of these things! Trying harder to have a better memory is not one of them. Trying harder to "be organized" also doesn't work very well. And trying harder to NOT be frustrated is almost impossible. BUT, know that you can learn how to successfully deal with all these things from others with brain injury! Again, networking with your peers will help. If you don't already go to a local support group, you might want to check one out. If you are not yet in touch with your state's brain injury association, get in touch with them so you can go to state conferences or regional meetings and meet others with brain injury. See the following URL at the national association's web site (www.biausa.org) for state listings: www.biausa.org/States.htm

Dependency, boredom and feeling useless

Yes, it sounds like your self esteem has taken a beating! This happens to most all of us who have this injury. I've started to network with professionals with brain injury lately (doctors, lawyers and executives), and I think for people with high-powered careers, the issues we must deal with following brain injury are particularly difficult to cope with. I'll never forget the way I felt when I looked in my closet and felt confused by all my clothes! I mean, I had a Masters-level education; I had been a New York executive; I had managed a national sales force -- and I was confused by MY CLOTHING? Yes! And no amount of effort could reduce the confusion. Learning some strategies could, but that came later.

Adjustment counseling

I am not a fan of so-called "adjustment counseling." I know it's awfully popular. From an outsider's perspective it make sense. Our doctors or therapists probably see us struggle and fail, and feel the kindest thing they can do is help us "adjust" (also known as "having realistic expectations"). The premise is that if a person can redirect their thinking about the source of their self esteem, and also adjust their life expectations, this will help them feel better about their life. Yes, there is truth in this. But it's also not that simple

My preference is to encourage a person to regain as much functional recovery as is possible, and then encourage them to figure out for themselves what is realistic or not. This may be more complicated and may take longer, but I think it's a more satisfying path than starting out with a focus on adjustment. I think adjustment counseling can be particularly cruel if the person has not had an opportunity to learn compensatory skills. In this case, it's analogous to telling someone who has lost the use of their legs to stay at home in bed (and get used to it), but not offer them the option of learning to use a wheelchair or lift van or cab to get around. Make sense?

Initiation and follow-through

When we get up in the morning determined to do things differently and it doesn't work out, that could be rooted in not having work-able strategies and also problems related to things known as "initiation" and "follow-through." Initiation and follow-through problems are often issues that follow a brain injury. Again, the good news is that you can probably learn strategies for overcoming these problems. You will benefit by talking to your peers, many of whom have learned to deal with these things!

Optimism I don't blame you for losing some of your optimism. I hope you haven't lost hope, though. I absolutely do not fault you for being skeptical. On the other hand, I hope you are willing to be open to new alternatives.

You know the old saying, "Whether you think you can or you think you can't, you're probably right"! Give your peers a shot at it. It makes sense to look for guides from among people who have traveling the path you're on, don't you think?

Now, if you so depressed you feel you can't cope, by all means, DO GET PROFESSIONAL HELP! But also network with others so you don't feel so alone! Hope it helps to know that many of us know how you feel and want to help in whatever way we can!

Kathy M.

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