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COMMUNITY AND GLOBAL HEALTHIAPOP CONFERENCE 24-27.02.2010
WORKING WITH PATIENTS IN COMA AND THEIR FAMILIES
The Healing Role of Contact and Communication in Different States of Consciousness
Dr Bogna Szymkiewicz
The story unfolds...
2007/8 - Coma class at Process Work Academy- Individuals working with coma clients
2008/9 - „Friday’s Discussion Club” on coma and states of consciousness- Coma workshop in Warsaw – Gary Reiss- September 2009 – Conference „There is Life in Coma” organized
by Światło Foundation in Toruń
Internship for Process Work Students at „Caritas” Care Facility and Hospice
Project at Child Health Center with „Akogo” Foundation
Conference „There is Life in Coma” -September 2009
Toruń – „Światło” Foundation Care facility for people in
coma (24 beds)
Raising awareness around Coma:- publications- conferences- exhibitions- theatre performance
Conference „There is Life in Coma”
September 2009
Topics included: Brain and its potential Ethical aspects of life in
vegetative states Contact and consciousness in
coma Rehabilitation of people in
vegetative states Organization of care for
people in vegetative states Sleeping sexuality
Working with „Caritas”
PROJECT 1: We organize internship in „Caritas” Long-term Care Facility
and Hospice, with a special ward for people in vegetative states
Expectations from the organization:o To bring in new methods of work o To show the possibilities of contacto To help changing attitudes towards
people in coma o To spend time with the patientso To give support to the main caregivero To do some family work
Implicit: o To do some organizational worko To help finding the meaning and value of the work
„Caritas” Internship for Process Work
StudentsInternship program: Introductory workshop (preparation) Individual plan of the visits (one client for each students) Monthly supervisions Meetings and lectures for staff and families (medical
professionals being very open to learn new methods of communication)
Plans: to work with the organization
Students experience:o Deep contact and connection with patientso Finding place were it is possible to connect on the Essence
(Process-mind) levelo Questions: what am I really doing, what am I needed for
„Akogo” Foundation – Ewa Błaszczyk
PROJECT 2:
We work for „Akogo” Foundation, which is now building the first model clinic for children in coma in Poland:
- for children with severe brain injuries (15 beds)- up to 18 months after the accident- individualized program put together by physicians, therapists and parents
Activities of the Foundation: Web site that helps parents finding information (disorders,
therapies, specialists) Advertising new medical achievements and therapeutic methods Social and educational fields, calling the public's attention to the
problem
OUR PROJECT Polish Process Work Association & „Akogo” Foundation
Psychological support for the families with children after brain injuries
1. Psychotherapy2. Coma Work 3. Visiting families at homes4. Workshops and lectures 5. Free phone line (in progress)
The project is conducted at Pediatric Rehabilitation Ward in Child Health Center Hospital (the coma clinic will be connected to the
hospital)
Polish Process Work Association & „Akogo” Foundation 1. Psychotherapy
Our team in uniforms with the logo of Polish Process Work Association
Individual meetings in the hospital
Meetings with the families in the hospital
Consultations in our Psychotherapeutic Center
Conversation about future plans and organizational support
2. Coma Work
Introducing the basic elements of coma work to parents / caregivers
Working with the child (if the doctors and parents agree) making contact following the child adding the attitude of no expectations searching for the clues from the Dreaming looking for meaning: messagas from the Dreaming
in the context of the family family interventions
Supervisions and team meetings
3. Visiting families at homes
Teaching coma work at home (visiting families who take care of a person in coma at home once or twice – explaining and demonstrating the basics of coma work)
Family consultations after hospitalization: continuation of contact and support meeting with other family members (ex. siblings) interventions around special problems (ex. domestic
violence) family therapy
Plans: support group for parentsresidential workshops/ holidays
3. Workshops and lectures for medical staff Open lecture about Coma Work and stress (with Gary
Reiss) – November 2009
Workshops for physicians, nurses, rehabilitants creating opportunities to work with
organizational issues teaching basic psychological skills
Interpersonal communication Criticism-giving and taking Coping with stress Burnout Teamwork Non-verbal communication with clients Conflict resolution Rank and hierarchy in organization
4. Free Coma phone-line
Goal: to provide on-going support to the families with people in coma
data-base – information concerning local agencies, rehabilitations centers, medical professionals, possible financial and social support
basic clues about coma work maintaining contact with families met at the hospital or
during family visit possibility to talk to someone who understands issues of
coma and long-term care
Format: 2 hours 2 x week Psychotherapists from Polish Process Work Society
Contact and communication on three levels of reality
FORMS AND CONTENT OF CONTACT AND COMMUNICATION
-----------------------------------------
Patient- signal workFamily - social/ financial
aspectsHospital – rules and
proceduresSociety – social awareness
Patterns: stories, images, metaphors, fairy tales, musicmovement, symbols
MeditationProcess mind
EMERGINGCONSCIOUSNESS----------------------
---
CR Consciousness
Sentient awareness
LEVELS OF PERCEPTION
--------------------------
Awareness and Consciousness
Aware• From a-ware - „wary” –
cautious, alert, attentive• Human's or an animal's perception
and cognitive reaction to an event • Informed; alert
Arnold Mindell - automatic process of
perception tendency before self-
reflection or consciousness noticing, reacting, perceiving base for all the experience
Conscious• From Latin conscius 1. having
joint or common knowledge with another; 2. conscious to oneself
• Conscientia - knowledge-with; shared knowledge
• Awareness of being aware
Arnold Mindell - „deals with parts and with
their connection to one another”
„awareness of consensual signals, rooted in dreaming and quantum flirts and created through the self-reflection of these NCR experiences”
Helping the „I” to emerge
Martin Buber : „Through the Thou a person becomes I”„When two people relate to each other authentically and
humanly, God is the electricity that surges between them.”
Józef Tischner: „...encounter with another person is at the beginning of any experience of the world”
Ronald D. Laing: „I” emerges during the process of being corroborated /acknowledged by others
Contact and communication with people in Coma
Contact in itself is healing:
o Helping out a person who is stuck in loneliness in the formless realm of experience
o Supporting the „I” to emerge from the Essence level through the Dreamland to Consensus Reality (helping the „I” to find way home) acknowledging subjectivity and autonomy helping to create a new coherent personal history, including
experiences that were outside the previous identity helping to the integrate parts, past/present/future and other
aspects closer to CRo Acknowledging the value of NCR experience
Essence
o Waking up to the mystery of life, human being, consciousness
o Meditation and other forms of contact through Process mind
o Unfolding the Mystery: what is happening „down (or up) there”?
o Elaborating the „Essence language”, description of the non-local experiences (science, media, art)
Dreamlando Working with client on
symbolic aspects of what is happening
o Discovering patterns by connecting the signals from the client, our own experience and information from the family
o Who’s helping whom: therapists, clients and non-local experiences
Consensus Reality
a. Organizational and legal level: institutions, rules and regulations, procedures, rights of the patients
b. Social consciousness:how to introduce the value of different states of consciousness in society?
c. Communication with professionals and families
- Billboard by „Akogo Foundation”
- „50% people in coma are conscious - BUT WHO CARES?”
Communication with families and professionals – some ideas
Helpful attitudes acknowledging the responsibility and leading role of a physician making sure there will be no harm (in a medical language) differentiating between „observable evidence” and „subjective
experience” (taking the role of an authority when talking about subjective experience)
How to explain what we are doing? Referring to the brain and using „objective” language: ex. we
help to create or activate new connections in the brain The idea, that consciousness is reflective and we are serving as
an external awareness Explaining that we are helping the person to feel more in
control by following his/her signals (rather than giving orders)
Questions
How to talk about other levels of reality? ( concepts of „soul”, „states of consciousness”, how people react to it ; the need for stories, evidence, art )
How to help the main helpers to redefine their role? (often mothers give all the attention to a child in coma, they are demanding and pushing ; ex. shifting focus from the child in coma to the family as a whole)
How to help to elaborate a new narrative for medical professionals, especially doctors (the meaning of medical help in long-term vegetative states, the definition of success)
Polish Process Work Association: Plans for the future Main role in creating the model of
psychological support in the „Alarm Clock Clinic”
Developing cooperation with „Caritas” on-going internship workshops and seminars for staff members
Publishing anthology „Mysteries of communication”
Making a short movie about coma practice (signal and family work)
Creating a certificate program for Coma workers