Dodging raindrops and finding my feet...

I know I've gone quiet lately.  The past several months have been tumultuous -- I've effectively shut down a business and a chapter of my life, moved country and started a new challenging job, and I guess it is hard to find your voice when you are busy trying to find your feet.  And no, this is not the first time I've jumped from one life chapter to the next, but for many reasons it has been the hardest.  I realise now that part of why this transition has been so challenging is that I underestimated how tenacious the personal and conductive roots that connect me to Sydney have become.

It was heart wrenching closing down Transformations.  It is always hard to say goodbye, and even though I know that friends and clients who over the last decade have become mentors and friends will stay in touch as many from other chapter have done, the nature and consistency of relationships must change.  We always talk about how two way conductive relationships are, and it was very hard to step away from people who have supported me and everything I've done personally and professionally over the last decade.

To add insult to injury, I spent the better part of the last three months in Sydney desperately looking for appropriate people in the rehabilitation and fitness industry to hand my regular clients over to.  I brought carefully considered hand selected trusted colleagues and professionals I respected to meet my clients, hoping they would carry on my work, and many of them balked.  I found myself having those conversations, the ones where people tell you that they could never do what I do, with trusted friends and colleagues and I felt like they were rejecting a part of me when they said they didn't think they could take on one of my clients for an hour a week.  I was reminded of a challenging discussion that Andrew Sutton, back in my student days in Birmingham, lead us as first year students through about understanding that in a profession like the one we had chosen, we were choosing to have disability in our lives, but that we had to have compassion and awareness that it was not something our clients and their families actively chose.  I guess I forgot that the world that is so normal to me, filled with people I value and hold so dear, is such a strange and scary world to so many other people, and I took it really personally that even as a favour to me, let alone the gift of regular client into someone's business, respected professionals would not choose to be involved in my world.

In Conductive Education we have always heard about families who have travelled halfway around the world and disrupted their lives and families so that they would access Conductive Education for their child.  We also need to talk about the wildness of being a part of a profession where the only opportunities for employment in your field often necessitates disrupting your life and family and moving to another corner of the world.  I love, and am grateful for the opportunities and adventures that  a career in Conductive Education has afforded me - but this time I didn't just follow my whim and do what suited me in the moment.  I uprooted a wonderful husband, a person whose happiness and well-being I feel inherently responsible for, a person willing to leave a life that he loved to support me on a journey that I wanted to take, and have watched him struggle to settle in and find his feet and his happiness.  I romanticised the adventure we were going to have together, and actually assumed it would be easier to jump chapters with him instead of on my own and didn't prepare either of us for the roller-coaster ride and bumps along the way.

I also romanticised the job I was coming into, an established adult CE centre, working with two conductors I liked and respected, in a place that I have always wanted the opportunity to explore.  I didn't allow myself to think about things like the subtle but very relevant distinctions between Kiwi and Aussie culture, let alone the culture shock of jumping into established groups that have been running very well without me for years thank you very much, or about having clients who have had years of conductive experience that hasn't included me.  Some of the adults here have been around CE longer than I have - in my professional experience, every group I've run, every client I've had since my student days and other than during my hiatus in Norway, has been a person I've introduced to CE and a group that I have set up and run (with mentorship and guidance) my way.  I have had to learn, adjust, adapt - as have my new clients and colleagues and it has not been an easy ride.

I've also come into an organisation going through change - in fact I am part of that change and the associated discomfort, and worse yet I'm causing some of that discomfort.  I now understand that part of my roll is actually going to be conducting this organisation through change and I am going to have to work hard to learn how to do that.  In other jobs and in other organisations where there has been change, I've had to learn to roll with the punches and have had to learn to fight back where necessary.  I've learned that if change is a wave crashing over you it is hard, so you have to either learn to ride the wave or to choose to get out of the water, but now I'm part of the wave instead of the surfer and to be honest it is really hard to learn how to be a more gentle wave -- it has never been my style and it will have to be my style if I'm going to be any good at my job here.  And that, in itself, is overwhelming, and I hope I am mature and ready enough to change myself.

So three months in to this new chapter I'm still settling in.  But I notice myself composing blog posts in my head, on the train as I head home from work, on my notepad and emailed to myself as reminders of things I want to think about and write about.  I'm trying to keep my head up, to be excited instead of overwhelmed, to count gratitudes instead of raindrops, and to find my feet -- and hopefully my voice too.

When conducting is Trying...

I have been working with Miss M for almost two years now; she is a young adult who had a terrible fall while overseas a few years ago, and she has been left with a rather nasty brain injury.  Miss M is one of the most personally and professionally challenging people I have had the privilege to conduct, and even in a month where we have had some ridiculously incredible functional breakthroughs I find myself unsure of where I am with her and having internal conflict after virtually every session.

Miss M has an incredible full-time carer, L, who Miss M and I are extremely lucky with.  L is fantastic with Miss M - she has a very close and loving relationship with her that I am able to work through, yet is able to be objective, firm, and work with 'tough love' where Miss M's parents can't.  L problem-solves with me and and reinforces the work done in CE sessions -- and when things don't go well, we help pull each other through the muck.

There is no getting around it; acquired brain injury is complicated -- especially when physical disability is accompanied by impairment to behaviour, personality, memory and other cognitive functions.  When I first started working with Miss M, I saw so much potential for regaining functional mobility but was not sure if I was going to be able to work around her behavioural and cognitive impairment.  I was not sure to what extent the behaviour was a result of the brain injury or was something that she had learned to use manipulate and control her circumstances and the people around her since the brain injury.  The behaviour drastically impacted the presentation of the disability, so much that the physical impairment and the physical disability were incredibly mismatched.  She yodelled and shouted jibberish as her main source of communication; otherwise she just parroted what was said.  She cried and shrieked with 'pain' when anyone even mentioned touching or moving her hands, feet, or legs, so no therapy or splinting happened, and as a result her hands and feet are amazingly contracted and deformed.  She had a very violent and aggressive streak that had required no provocation.  She was not interested in actively participating in CE or therapy; not motivated, and refused to take part.

And yet she knew every word to every song, including recent pop music from after her brain injury, and we could sing together.  Once I got over my own hang ups about what is appropriate when working with adults I found that through children's song and play I could interact with her and sometimes get her to do things with me; I frantically went through my notes from my student years in nursery and school groups looking for appropriate songs, added in 'camp songs' and pop songs and other movement games and suddenly there was a relationship.  And with that relationship came my expectations around behaviour - not just with Miss M, but with her amazing family and wonderful carer as well - and with expectations and goals around behaviour came change - both good and bad -- think of a full strength adult hitting the 'terrible twos'.

We are working teach Miss M that being violent and aggressive is not acceptable -- she is strong, has good motor control, and is unpredictable and dangerous.  At first this behaviour seemed random - no provocation required.  A previous therapist had in fact capitalized on it early on -- rough play and play fighting was the only activity she would take part in and that was how he helped her find her body and movement after the accident.  Now, by holding her down, restricting her movement, repeatedly telling her that she was hurting me (and yes I have had my share of bruises and scratches and bites and hair pulling and pinching courtesy of Miss M) I've started to see that she can stop being agressive if there is consistency around this.  But more, I saw that she could learn - when I intercepted her aggression she would burst into apology and tears.  I also confirmed that she could be manipulative - while she was apologetic and teary I would drop my guard and she would attack again.  I also started to see that the violent behaviour was not random - frustration, confusion, pain, being frightened, being over something, needing some physical space were all triggers.  Miss M has a very short fuse; and when she loses control she can't yet reel it in.

Now we are working to teach her that saying sorry and crying isn't enough, she has to choose not to repeat the behaviour -- and we are making progress.  However, in some ways these improvements have made the behaviour harder to manage.  We have seen intention and purpose in her rage -- this is incredibly hard to work with because we know that it is not just random brain injury lability, but directed violent anger -- very different.  There are good days, days when we work well and have no fighting.  I know that once Miss M loses her temper she is out of control, but because I feel that Miss M understands what she is doing and that she knows she is not behaving nicely, I feel my own anger rise when dealing with hers.  It is very hard to physically restrain somebody who is attacking you when you are also managing your own anger and trying to be professional and appropriate.  If she is on the floor or in her wheelchair I can move away; if we are in the pool or balanced on the edge of a plinth, my duty of care doesn't allow me to step away and I have to restrain her to protect myself while keeping her safe and managing my own temper.  And I'll be honest -- I sit in the car and cry after these days.

When I say we have seen ridiculously incredible functional breakthroughs I am not exaggerating; in the last few months we have seen exponential improvements in spontaneous communication and vocabulary; we see memory and refection where previously there was none; we see the beginning of an ability to understand that there was an accident, that there has been a brain injury, that we are trying to help her get better.  Miss M has gone from from swimming only with floaties and someone right beside her to independent swimming on her front and back.  She has learned to roll onto her stomach (or more precisely to tolerate being there) and from rolling onto her stomach in a matter of a week has learned to get up onto her knees and to crawl, and from there to pull herself up into high kneeling and onto a plinth or the lounge.  The other day she was in high kneeling and tried to put her foot on the floor as if to stand (if only her feet and ankles weren't so terribly contracted!!!).  Her body is remembering what she used to be able to do and latent abilities are presenting gob-smackingly rapidly and spontaneously -- it is like watching normal deelopment in fast foward.  And when these things happen we celebrate  - Miss M's parents, L, and I all shocked and amazed, ecstatic to the point of tears, and Miss M caught up in the excitement of the moment.

And then I show up the next day, expecting to reinforce and repeat what we have achieved and Miss M will be in a mood, refusing to participate, crying, being aggressive.  When this was what I arrived expecting it was hard, but I was prepared, and it was what was expected.  But now I don't know what to expect, and I excitedly arrive, still on yesterday's high; we review videos so Miss M remembers and we get excited watching them. Then we try to do something and I get behaviour and refusal to try.  And I am heartbroken and disappointed even though I know that this is the nature of this brain injury and that this is a part of the process for Miss M.  And even though I know that any confusion, disappointment, frustration I feel is minute in comparison to the complex emotions that Miss M feels and has no real way of expressing.  My disappointment and frustration sometimes clouds my thinking, it feels personal -- we have a relationship that has allowed her to develop and exceed everyone's expectations; I'm putting everything I have into these sessions, and she can't be bothered to try.  And only hours later while debriefing with L, am I able to appreciate and understand and deconstruct what is happening, and to remember how far we have come, and to find energy to keep trying.

You've got to try...

Or perhaps this is more inspiring...  Try, just a little bit harder