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Effective workplace communication with employees with acquired brain injury

Chapters

Talking about futures

The employment planning process requires supported employees to think about the future. You may need to work with them to help them make the abstract concept 'future' something concrete they can understand.

The future is an abstract concept and, therefore, one that people with ABI will often find quite hard to understand. Take the Individual Employment Planning Process, for example.

When a service works with an employee to develop an Employment Plan, it can be hard getting the employee with ABI to make a meaningful contribution. The tactic of setting goals – What goals would you like to set for yourself for next year? – often becomes a rote-like process with little real contribution from the person supposedly setting the goals.

People with ABI often lack the orientation to the future that will help them understand:

Depression, fatigue and problems with motivation are common effects of brain injury and are factors that make future planning extremely difficult for the employee with ABI.

Depression is very common amongst people with ABI. Lives may be severely disrupted, work and relationships suffer, and people may go on grieving the losses they've experienced for a long time. In such circumstances, talking about a 'future' you may be unable to appreciate or understand may be quite beyond you.

The fatigue experienced by many people after a brain injury is very different from the normal tiredness you get from staying up too late at night or working too hard. It is an intense and long-lasting sense of exhaustion, a complete draining of energy, enjoyment or interest in what is going on around you.

Fatigue is frequently accompanied by a disorder of motivation, called adynamia, where there is a loss of drive and initiative to do anything. This is not laziness or lack of enthusiasm, though it can appear to be. Loss of motivation also leads to a loss of a sense of any purpose in life, and, in turn, to a sense of powerlessness. The person feels they have no control over anything.

Cleo

Cleo is a tall, beautiful woman of 30. She won her first modelling contract at the age of 15 and was soon earning an excellent living in high fashion. Her proud parents covered the walls with photographs of her and talked constantly about her accomplishments.

Today, eight years after the car accident that left her with severe brain damage, Cleo lives in a group home where she has to be supported for most activities. She works one day a week at Merrinvale. Cleo speaks in a slow, flat monotone. She rarely shows any facial expression.

At work, Cleo often falls asleep, and sometimes stays at her workbench during breaks, staring ahead, saying she is too tired to move. Support staff from her home report that Cleo sometimes wets her bed; although she recognises the impulse to urinate, at times she lacks the drive to get up and go to the toilet.

When asked about what she would like to plan or do, Cleo's usual response is to say, 'Oh, I'm too busy for anything here. I'm doing David Jones' Spring Show, and after that, I'm going to New Zealand for Fashion Week'.

When Em, her supervisor, tries to get Cleo to focus on what she can do at Merrinvale, she simply says, 'Oh I'm only here for a few days so there's no point in making any plans'.

Cleo rarely sees any of her family and has no friends left from her modelling days. Em and the others think this may be why she seems so depressed so often.


From Em's notebook

I have two employees with ABI in my section and I can't get over how different they are. It's strange, too, because both Trevor and Cleo have been very successful in the past and obviously had a great future before them. They've both lost heaps: Trevor his family and high powered job; Cleo all the celebrity she was gaining (she was on the cover of an old magazine I saw at the dentist last week). You can't blame them for being bitter. What I can't understand is why Trevor seems to have accepted that his life has changed, and Cleo just can't seem to do that.

I mean, Trevor's memory is far worse than Cleo's and he gets really confused and down when he can't do something, but he always comes back cheerful again. He's always willing to try things. He listens to what you say and thanks me for trying to help. He seems quite realistic about his future and shows interest in the activities he does outside work; he often shows me his diary with his appointments for the classes he does at TAFE and so on. He can't remember much about what he's done but he will tell you he enjoys having things to do. He is interested in others, and is happy to chat.

Cleo shows no enthusiasm for anything. She has no interest in anyone else at all. It makes it hard when you are trying to give her a chance to do something different, or learn something new, when she is just so totally apathetic.

Strategies

  1. Take things slowly. When you have no concept of a 'future' it is likely to be confusing and agitating to talk about plans for it. Remember that the thinking of an employee with ABI may be confined to what they remember prior to their injury, or what they are expecting now. Provide real examples and pin them to concrete experience to assist them to think about a future event.

You earned money when you were modelling and you earn money now, too. You could earn more if you wanted to work an extra day.

  1. One step at a time. Give step-by-step guides and instructions as to how a goal or task might be achieved. This approach will reduce confusion and lessen fatigue. It will also give the employee a sense of achievement as single steps are completed.

There are five steps involved to finish this. Let's try to do one each day this week.

  1. Do not talk down to the employee. Always show respect for the person's age, culture and level of understanding. Never be dismissive of their opinions or feelings.

I know you liked modelling a lot more than what you do here.

  1. Show optimism. Try always to present an air of 'quiet optimism'. This doesn't mean the slap-on-the-back, high-five waving, 'hey guys, let's get positive' routine. Try to reflect a low-key but consistent attitude that there is something to look forward to.

I know you liked modelling a lot more than what you do here … but there are good things you can do here too.

  1. Don't argue the point. People with ABI can become stressed very easily. Avoid arguments and stressful situations.

Instead of saying, No, you're not doing Fashion Week in Auckland, Cleo; that was ten years ago, try, Do you remember what you saw when you were in New Zealand that year?

  1. Allow time to respond. People with ABI often take longer to respond to a question – especially a question based around an abstract concept like the future.

I'm going to write down the question again in your communication book. You might like to think about it later, and we'll talk about it then.

  1. Provide information. Employees with ABI need to know they have a role in shaping their future, and they need to know what this may mean for them. Speak realistically and be future oriented. At the same time, use familiar and concrete language. Focus each discussion about the future on one main point.

Today let's talk about what new jobs you might like to learn.

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