You, Me & The RC: Meet Ross

Welcome the first instalment of You, Me & The RC, a series in which I convince a very patient Rehabilitation Counsellor to let me buy them coffee and probe them about what it means to be an RC. Would you or someone you know like to be featured? Reach out here

Meet Ross Miller

Ross has been working in the disability sector for over 30 years. As a guy with a hearing and visual impairment (Ross is legally blind and affectionately refers to himself as a "blindie"), he brings a unique level of insight and personal experience to his work. 

How did you discover Rehabilitation Counselling?

I knew that I wanted to work with people. I actually found social sciences and Rehabilitation Counselling as I was looking through a university course guide... The course at Lidcome [University of Sydney] just looked like a good bet to me. I didn't know where I wanted to end up but it was exactly what I was looking for. 

Did having a visual and hearing impairment influence your choice to become an RC?

Well, no, not at all! But it does impact the way I work with people. I've had my fair share of experiences where people have had opinions about what I can and can't do. One of the great lessons is that you must take personal responsibility, even if you have been treated badly by the system, because you cannot rely on others to do so. And so I try to impart that onto my clients, too.
When you see opportunities or barriers, don't put the responsibility on others to follow them up or chase them down. Making your own decisions is the only way forward and assigning blame and abdicating your responsibility to others will never give you control over your health and livelihood. 

How do you help your clients figure out what their personal role in their recovery should look like?

This is the sort of thing that can take a couple of sessions - to really understand someone's situation and their perspective on what's happening for them. You can't go preaching to people right away if you don't fully understand their sense of what their role should be. It really is a matter of serious listening and trying to get a grip on how they see their place and where eventually they would like to be. 

I've created a few posters that I keep in my office which talk about this idea of taking back control. From the moment you get injured, your employer wants part of you and your time, your doctor wants part of you and your time, and so does your insurer and your physio and all the rehab people... and suddenly, you have lost of all your independence and power.
Because everyone else wants something from you, no one is going to give you that power. You have to take it for yourself and take control. It's not about being defiant but rather taking in advice and information and asking yourself how you want to apply it all so you can get your life back. 

Is there often a "lightbulb" moment for your clients?

A lot of them, yes. But we will all work with people who just don't want to take ownership. There's not a lot we can do about that. I can't make the change happen for someone else, but I can give the resources and support they need in order to make it happen if they choose to take ownership over their lives again.  

Ross, you're pretty well known to us as the King of Transferable Skills. 

What's the key to an excellent Transferable Skills Analysis?

You really, really need to take the time to break down each skill. I see people coming up with a list of only 5 or 6 transferable skills for a client and I think that's hilarious. 

Take something like "computer skills". I've seen people write something like "good computer skills" in a report and leave it at that. No. You have to break it down. 

Even if you break it down into "basic Excel skills" and "intermediate Word skills", what do you really mean by that? Get specific. What can they do in Excel? Can they enter in formulas, manipulate data or do they just know how to type numbers into cells? In what context are they using it - for banking, accounts, for marketing data? These small things add up to a much larger skill-set that can be transferred into a new role.

It's the same thing for communication skills. We use communication for so many different reasons in many different ways. What are the specific tasks? In what environment? Who are they communicating with? What outcome do those skills help a person achieve in each context? You have to delve into that stuff.  

That's how you end up with 5 pages of transferable skills for a client! And it's all legitimate stuff that they can use in a new role. 

What's your most memorable client story?

I remember one client where we really got to help someone turn their life around.
We worked with a gentleman who had been a labourer his whole life, totally illiterate. He was roughing it out in a park when we started working with him. We got him involved in a Work Action Group that we used to run, it was a club that covered what it took to get back into employment. 

Beyond just helping him find work, we helped him work on his relationships and day to day functioning. It was amazing when an employer called saying that they wanted to hire him - they were so impressed that he was the first person they thought of!

We still talk about him now, especially with my clients today, as an example of how people can turn their lives around when they're supported in taking back personal responsibility for their future. You can move forward even with barriers, if you make that choice.

Any advice for working with people who have a visual impairment? 

It's not that different to any other condition you work with, in that you need to know the research and what's available for each person's injury or condition. How can you help them if you don't have an idea of what the symptoms are like, what the supports are like and what could help? So yes, research.
Especially for blindies, there is so much great technology that we can use. On my iPhone and iPad, this stuff is there out of the box, and it's same with Samsung too. I have a hard time believing that blindies can't use the internet when I do it everyday - I've learned it. 

But I'm still waiting for my hearing aids to come with bluetooth built in!

 

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Rethinking Mindfulness

Unless you've been hiding under a large rock (or perhaps meditating on one), you're probably a bit sick of hearing about mindfulness by now. From colouring books to apps to breathing exercises, we've reached mindfulness saturation.

Mindfulness has become the poster-child for our fight against the stresses of modern life. Hard day at work? You should try mindfulness. Kids testing your patience? Do some breathing exercises. Got anxiety or depression? Focus on the present and watch your worries melt away. 

Those are some mighty big promises. It's no wonder then that so many of us find mindfulness to be so underwhelming. 

"I just sat quietly for 10 minutes and I don't feel any better. What gives?!?" 
Rethinking Mindfulness: Control, Awareness and Choice.

Rethinking Mindfulness: Control, Awareness and Choice.

And how many of us have worked with clients, particularly people with a mental illness or longstanding pain, who have tried mindfulness or breathing exercises and think it's all a big crock? 

So... is mindfulness a sham? 

Do you see a trend in the way we've been using (and abusing) mindfulness? 

  • "I should try mindfulness to reduce my stress"
  • "Will these breathing exercises make me less anxious?"
  • "My [insert well-meaning person with an opinion here] said that meditation would help my pain"

We've been using mindfulness as a control strategy [1], which is not its intended purpose. 

Mindfulness is not about eliminating painful thoughts, feelings or sensations. It's not about "focusing on something else" (like your body parts, or your breathing) and it's not about positive thinking and willpower. 

It's actually the opposite. 

Mindfulness practice requires us to make room for the uncomfortable stuff instead of struggling against it.

In a nutshell, being mindful is about being present to all that's happening around (and within) ourselves. And the goal is to do this without judgement and without getting too attached to whatever thought, feeling or sensation we notice. 

This concept sounds simple enough but it's really, really hard

Our minds have evolved to tune into the thoughts and feelings that trouble us. The brain is like the ultimate threat detection device and it wants to hold tightly onto potential threats and do something about it because that's what used to keep us alive. 

By contrast, mindfulness asks us to hold stressful thoughts, feelings and sensations lightly.

Your brain does not want to let go of pain, or worry, or stress. So when we use mindfulness as a way to control, minimise or avoid those things, we're often left feeling disappointed because we're fighting against a biologically hard-wired response. Some people even feel more stressed after mindfulness meditation than before they started! [2]

So our approach to mindfulness might need to shift a little bit. Mindfulness, by definition, is not about dropping or letting go of the painful stuff. It's about holding it lightly and making room for it. 

So why bother making room?

Two reasons:

1. Control is kind of an illusion anyway:

Have you noticed how hard it is to not think about something? Seriously. Whatever you do, don't think about penguins right now. Don't think about their adorable little feet or their cute white bellies. 

How'd you do? 

Unless you have superhuman levels of control, you probably just thought about penguins. And even if you did manage to not think about them, imagine trying to keep up that level of control for the rest of the day without being totally consumed by not. thinking. about. penguins. which brings me to point #2...

2. Control comes at a cost. 

When we make "mindfulness" about gaining control or getting relief, whatever we're trying to avoid or minimise often gets louder. It consumes our field of vision and demands attention. In white-knuckling our way through painful experiences, we miss out on opportunities to engage in the stuff that matters to us. We become mindless. 

In being mindful, really mindful, we make room for the uncomfortable stuff so that we have the energy to notice and choose (if we wish) to do the things that we care about. 

Is there something you care about enough that you would choose it, even if the pain or discomfort came along for the ride as well?

Mindfulness does not promise control or relief. Mindfulness offers choice.

Could be a useful discussion to have with our clients who have said that breathing exercises don't work or that they just hate the idea of mindfulness. What are they hoping to get out of it in the first place?

Still not convinced that mindfulness can help us do more of what matters by creating room to move? Then give this resource a spin:

3 mindfulness exercises for people who hate mindfulness:

Struggle with Mindfulness?

No zen meditations here.

Try these 3 exercises to ease into mindfulness & being present.

I like spam less than I like meditating. None of that here. Powered by ConvertKit

References and further reading:

[1] Dr Russ Harris speaks extensively about the issue of acceptance vs control in mindfulness in his book, ACT Made Simple.

[2] Creswell, J. D., Pacilio, L. E., Lindsay, E. K., & Brown, K. W. (2014). Brief mindfulness meditation training alters psychological and neuroendocrine responses to social evaluative stress. Psychoneuroendocrinology, 44, 1-12.

Dr Sarah McKay @ Your Brain Health: Does Meditation Stress You Out?

And one last thing... 

Are you a mindfulness convert or still doubtful? How do you find calm in your life? 

Chronic Pain: When Giving In is Good

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I attended a workshop back in March that has changed the way I practice forever. I wrote briefly about it here, but I've been trying for the past couple of weeks to wrap my head around the message and say something useful about it here on the blog.

Then I realised that I was being an annoying perfectionist and I should just write the damn post.

So here are my partially-digested learnings (it's less gross than it sounds... really) from that day. I'll be talking a lot about pain rehabilitation, but the applications are much broader.

We're doing it wrong...

In the land of vocational rehabilitation, our path forward is dictated by medical certification. A lot of our time is spent clarifying expert medical opinion on what our clients can and can't do.

All of this makes sense when we're working with a person who is on a normal path to recovery and is keeping up with the expected timeframe of when they will get better. The reality is that so few of these clients ever get referred to us - because they got better and went on their way.

Most of our clients are dealing with protracted injuries and chronic illness.

Beyond that, they have a cacophony of social, environmental and psychological "stuff" happening in their lives as well. Timeframes and rigid capacity upgrades just don't work here because there is so much more going on.

In rehab, you might feel like you're banging your head against a brick wall in these situations.

And maybe you keep getting stuck in circular discussions that never. go. anywhere.

Me: So Mr. Doctor, when can Mr Peabody start thinking about work again?

Frustrated doctor: When he is in less pain.

Me: We've been trying to fix Mr Peabody's pain for a while now. What else can we try?

Slightly more frustrated Doctor: He is in too much pain for us to do anything. Let's not do any more activity until the pain is better.

Me: So what do we do in the meantime?

Very frustrated doctor: ¯\_(ツ)_/¯

That was a real discussion I've had. And it's not an uncommon one.

I can get mad at the medical model all I want, but I was making a mistake here too. We all were.

We were all focusing on fixing the problem instead of helping a person live their life, now.

An Un-winnable War

If you have 45 minutes to spare, you really (really) need watch this video from Professor Kevin Vowles.

Then, you have to come back and tell me whether you agree with this statement:

Helping people live better lives is not about fixing their injury, their illness or their pain when experience (and research) tells us that this may not be possible. Our job is to help people do what matters, with or without the pain.

And in the case of chronic pain... treatment attempts have proven to be futile.

So this calls into question whether our obsession with improving "capacity" is of any use if our definition of capacity relies on pain reduction.

Will any of this actually help our clients live better lives, or re-engage with their community and work again? 

Nope.

Research tells us that:

  • Opioids do a terrible job at long term pain reduction.
  • Ongoing pain and disability after surgery is the norm.
  • Treatments and surgeries that do produce a reduction in pain tend to have no meaningful impact on disability or function.

What does this mean?

When people with chronic pain pursue conventional (and not so conventional) approaches to a cure, the longterm gain is negligible.

People are a little more comfortable, but they continue to miss out on life.

Giving up the "good" fight for something better

When our clients come to us, they are fighting the fight of their lives against their pain. Their pain has taken so much away from them: their vitality, their relationships, and their work (just for starters).

This makes perfect sense: as humans we're wired to avoid pain because pain means danger.

Pain demands attention.

But for people with chronic pain, those pain signals don't necessarily mean danger anymore. But anyone with chronic pain will tell you that the experience of pain can be unbearable. So often, people stop doing anything that might rouse the pain monster once more. They halt the activities that might aggravate their pain. 

The cruelest part of all is that these attempts to stop the pain don't actually work in the long term. Perhaps even crueler yet is that these perfectly normal attempts to avoid pain also mean that a person becomes isolated from the activities and people they once felt connected to.

You may be anticipating my next point...

What if we gave up the struggle against pain to make room for something else?

I know - how trite. How could anyone like the idea of giving into pain?

But "giving in" is the opposite of what I mean. Here's an example that Prof. Vowles gave in the workshop:

Living with pain is like walking around with your finger in front of your face. All you focus on is that finger - what it means, what it's done to you, and how you can get rid of it. As you walk around, your attention is directed only at the finger, so you miss out on potential opportunities to engage with something else - something you value.

Our current approach to treating pain is like trying to chop off that finger. But again, research tells us that this is easier said than done. And the costs of this approach result in long term disability, pain and loss of function.

The alternative:

Noticing what else is there.

Try walking around again with that finger in front of your face, but look beyond it. Can you see what's around you again? Are you making better decisions about where to turn and what to do next? Are you noticing more?

What we can help people be on the lookout for are opportunities to engage with the things that matter to them even when the pain is there.

From Prof. Vowles again:

Thus, the issue is not to just “accept it”, but to determine if there are areas in life worth the experience of pain. In my clinical experience, people with pain can readily identify these areas, desperately want to return to them, and agree that these areas matter even when pain is present. Such patient sentiments can allow further conversations about whether treatment might usefully include valued activities and progress towards them as a marker of treatment success.
To summarize, from one perspective, the purpose of treatment is to allow patients to engage in activities that allow for a quality of life sufficient for their needs. It is within this purpose that acceptance of pain can be relevant – sometimes greater acceptance of, and consequently less time and energy spent struggling and avoiding, pain may free up behavior to allow for the pursuit of what is valued. [1]

Preliminary evidence from this approach is promising: people with chronic pain who are supported in re-engaging with activities that align with their values experience better functioning and quality of life. [2]

What could this do to reduce the amount of suffering that comes with ongoing pain?

What could this mean for our clients who have put their lives on hold, waiting for a promised cure that may never come?

What does this mean for the way we currently approach rehab?

Your thoughts?

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Image credit: feature image by Rodger Evans is licensed under ND by 2.0.

References and further reading:

[1] Professor Kevin Vowles @ NeuRA: What is acceptance of pain and why would anyone want it?

[2] Scott, W., & McCracken, L. M. (2015). Psychological flexibility, acceptance and commitment therapy, and chronic pain. Current Opinion in Psychology, 2, 91-96.

Manage Your Pain: Practical and Positive Ways of Adapting to Chronic Pain.

McCracken, L. M., Vowles, K. E., & Eccleston, C. (2005). Acceptance-based treatment for persons with complex, long standing chronic pain: a preliminary analysis of treatment outcome in comparison to a waiting phase. Behaviour research and therapy, 43(10), 1335-1346.

#SlowDownSunday: Embracing The Near Win

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Welcome back to #SlowDownSunday! As we wrap up the weekend and move into a new week, I want to use this time to slow down and reflect on what made it onto our radars in the last 7 days.

This week? It's all about the near wins...

(For the skimmers, here's the link to an interactive transcript.)

Embracing the Near Win (Kinda)

I'll say it: I hate not winning. I hate the idea of anything that resembles "losing" or not being the best at what I do.

I'm your stereotypical "all or nothing" person - but I'm working on it, I promise.

Anyway, because I know the effects of this hopeless pursuit of perfection, it's really easy for me to recognise the same plight in my clients.

Progress vs. Perfection

For some of our clients, this plight might look like a cycle of boom and bust - overdoing it and then having to take a week of down-time to recover.

For others, it might look like avoidance. Maybe you've had a client who loathes the idea of walking 10 minutes a day as a path to better function when they used to be able to run half marathons before they got sick. Anything less feels a lot like losing - so why bother?

And success?

To that client, success might only look like that moment when they're able to finish a half marathon again.

All that annoying stuff in the middle (the hurdles, the stumbles)... it's just fluff, right?

Nothing worthwhile there.

Well...

Mastery vs. Success

In the TED talk above, Sarah Lewis explores the idea of a near-win and the potential it has to build mastery.

Why might it be valuable (for us and our clients) to pursue mastery over success? I'll let Sarah field that one:

"I realized that success is a moment,but what we're always celebratingis creativity and mastery.But this is the thing: What gets us to convert successinto mastery?This is a question I've long asked myself.I think it comes when we start to value the gift of a near win...

...Success is hitting that ten ring,but mastery is knowing that it means nothingif you can't do it again and again.Mastery is not just the same as excellence, though.It's not the same as success,which I see as an event,a moment in time,and a label that the world confers upon you.Mastery is not a commitment to a goalbut to a constant pursuit."

Requires quite a shift from our current idea of what success looks like, don't you think?

And particularly when it comes to goal setting, it makes me wonder why we value the end point so much more than the process of getting there.

What could a conversation about near wins with our clients look like?

Maybe it involves reframing a missed goal as something that could get us closer to where we want to be in the long run.

Maybe it requires us to explore the value in the annoying "middle stuff" - the stumbles and the hurdles, the times where we don't do so well - and their ability to help us build mastery and skills that will last much longer than that feeling of success when (and if) we reach that goal.

Oh, and one last thing:

What was on your radar this week?

*Feature image from Ben Rodford.

 

Disruption and The Slow March of Progress

Disruption and The Slow March of Progress

If you’ve been around at Able-Minded for a little while, you know that I talk a lot here about being brave enough to ask different questions and approach problems from new points of view.

I think this is what our industry sorely needs in order to stay afloat, I think it is what our profession needs in order to stay relevant and I think it is what our clients need from us if we’re going to help them re-engage with life, community and work.

So why is it so hard?