You're Too Young To Be a Rehab Counsellor

I’ve often felt like I’m too young for this job.

What could a person in their twenties have to offer someone who’s two, three decades older?
Don’t you need life experience to be a decent Rehab Counsellor?
And seriously, what could a twenty-something possibly know that all the other experts haven’t already tried?

There’s that word… expert. 

Rehab and return to work management is like an expert’s playground.

You’ve got doctors, specialists, psychologists and stumpologists (OK - I made that one up), every other –ologist you could think of…. plus anybody else with an opinion. That means friends, families, benevolent co-workers, bosses, managers and that guy two doors down who slipped at work and got a massive payout. How’d he do that?

We put a lot of faith in experts. Our clients trust and hope that one day, some expert will finally find the missing piece of the puzzle that puts them back together again.

By the time they come to us, our clients are no strangers to the “expert opinion”.

And yet, none of those expert opinions have helped them get unstuck.

If expertise was all it took, your client wouldn’t be sitting in front of you, saying (or thinking) something along the lines of:

“Let’s see what you’ve got that I haven’t already tried yet.”

And I know the feeling of terror that comes with those clients who just make you want to throw your hands in the air and say, "yep – I seriously have no idea what to do now."

Aren’t you supposed to have a plan? Well…

Whose Expertise Is It Anyway?

I’ve worked myself into the ground trying to come up with The Answer  to my clients’ problems. I’d agonise over transferable skills, analyse possible job options and bang my head against a wall trying to discuss the benefits of work with my clients and their doctors.

Nothing moved forward. Nobody cared.

To my clients, I became just another person with an opinion who let them down because I couldn’t fix them, right the wrongs of the system and give them their old life back.

The last thing your client needs in their life is another expert. They have plenty. 

It’s all too easy to fall into the trap of feeling like you need to have all of the answers for your clients, and this feeling is especially pronounced when you’re a new graduate and you feel like you have none of the answers.

Experience is important, expertise is needed, but you already have the most important expert right there in the room.

It’s your client.

And you don’t need 28 years of experience plus a doctorate to start asking them some better questions.

Seriously, It’s Not About You

I often still catch myself feeling like an idiot because I don’t know what to do yet, what to recommend or what the plan should be. I get caught up in a trope I know all too well:

“You’re too inexperienced, you don’t know anything, you’re a big fraud and everybody knows it.”

It’s times like this when I thank my brain for that story (broken record that it is) and remind myself that seriously. it. is. not. about. you.

The experience that is crucial, and the experience that is mostly ignored, belongs to our clients.

Only they can answer questions like:

  • What’s missing here?
  • What’s working and what isn’t?
  • Where do you feel stuck?
  • What do you wish people knew about you?
  • What matters to you and how can we do more of that?

And those are just a couple.  You need exactly zero years of experience to be curious.  It doesn’t cost anything to listen, hear and seek understanding.

And you’ll be one of the few people who do.  Our clients are sick of being told what to do by experts who don’t get it and don’t listen.

Our real expertise lies in being able to help our clients draw on their own experience, their own expertise, to start making choices about where they want to go next.

I’ve been playing with this idea of shared expertise for a little while now.  And what’s an idea worth if you can’t turn it into a venn diagram?

Shared Expertise and The Sweet Spot

Shared Expertise in Rehabilitation Counselling. There's beauty in not having all the answers. Ⓒ Able-Minded 2016.

Shared Expertise in Rehabilitation Counselling. There's beauty in not having all the answers. Ⓒ Able-Minded 2016.

Thinking about sharing expertise has been a revelation for me. Our expertise as health professionals only becomes relevant and useful through the lens of our clients’ experience, their values and their unique insight into their own lives.

Asking big and powerful questions helps us find the sweet spot, where we can exchange expertise with our clients, back and forth, to move towards an outcome that is meaningful and valuable to them.

If we’re lucky, we might even stumble across a big, hairy audacious goal that catapults us and our clients forward.

Every meeting you have with your client in which you are the expert is a missed opportunity. 

Being the expert is boring.

The question-askers get to have some fun.  First of all, a question-asker doesn’t run themself ragged trying to solve someone else’s problems. They don’t have to shoulder the burden of having all the answers and engineering a plan for someone else’s recovery.

Question-askers get to be curious. They get to be humble. They aren’t plagued by the insecurity of not knowing it all because that means they get to work with their client to figure it out. Question-askers build partnerships and get out of the driver's seat so that their client can take back the wheel.

I think I’m OK with riding shotgun for now. Are you? 

 

Let's Celebrate the Beauty in Not Knowing It All:

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Further reading: Michelle Loch at Rewired Leadership has been instrumental in my learning around what it means to be a facilitator for my clients rather than expert. If you want to have more powerful conversations with your clients, please consider one of her programs.

Feature image by Melpomene/shutterstock.com

 

#SlowDownSunday: The Stress-Free Job

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? Lets talk about stress:

A post from the New York Times popped into my newsfeed this morning: In Desperate Pursuit of the Zero-Stress Job.

It got me thinking about how many of our clients (and their treating health professionals) believe that the only job they can succeed in is one without:

  • pressure
  • deadlines
  • anxiety-provoking situations
  • times of stress

I’m not sure that this job exists. 

And I’m not sure that a life without stress and anxiety exists either. 

I don’t say this to diminish the havoc that stress and anxiety can wreak on a person’s life. And I’m not suggesting that we encourage people to pursue unnecessary stress in their life or work.

But when we set a goal to completely avoid something that is a side effect of being, well, alive, I think we might be creating some problems. 

So why are we so afraid of stress?

It makes sense that stress is something we'd rather avoid. Stress sucks. And we've all read the articles and been told by our doctors about the health effects of prolonged stress. Our adrenal glands just weren't built to be on high-alert around the clock. 

But stress-free living has a dark-side.

The Yerkes-Dodson Law tells us that people need a baseline level of stress in order to perform effectively. Zero stress doesn't necessarily mean that we'll function better, or that we're able to navigate life more effectively. 

In the pursuit of the stress-free life, we also have to say no to the things in life that are innately difficult, yet rewarding and meaningful.

When we talk about a stress-free life, we are also talking about a life that is devoid of human connection.

We are talking about a life with no new experiences or environments, one without opportunities to learn and grow and develop ourselves, to pursue meaning and purpose and the things we really care about. 

The stress free life comes at a cost. 

This reminds me of something Russ Harris says often in his teachings: 

"Don't set goals that a dead person can do better than you."

I don't know about you, but a goal like "avoid being stressed or anxious" is something that a dead person would totally kick my butt at. 

So my question to people who feel that their lives, and their choices, are at the mercy of stress and anxiety is this: no one but you can decide your limit. But… 

Is there something valuable enough that you could make room for some anxiety and stress in order to have it? 

As Rehabilitation Counsellors we are in a unique position to ask this question of our clients. What if we could work with our clients to:

  • Minimise unnecessary stress through suitable job choices and accommodations;
  • Help people develop the resilience and strategies to effectively manage and respond to the stress that cannot be avoided;
  • Identify the things that are worth pursuing as part of a rich and multidimensional life, even if that means stress and anxiety come along for the ride;
  • Talk about whether working could help them achieve the things they value, and empower people to do more of what matters.

So what do you think: Is the stress-free life one worth living? 

Oh, and one last thing…. what was on your radar this week? 

Image credit: The images in this post by Bernard Goldbach and Franklin Ramos are licensed under CC by 2.0.

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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.