Sabrina B. Transcript

My name is Sabrina Batt, and I live in Newfoundland, Canada. I’m a certified Canadian counselor and a registered social worker. My private practice is called Guiding Light Counseling, and I also work with a rehab center, the Newfoundland Balance and Dizziness Center. That’s really how my story about why I care so much about concussion symptoms started. I was doing my Masters, and my supervisor was working with this population, and I’ll be really honest, I didn’t even know it was a thing until I started working with her, and I was blown away with the impact that concussion was having on people, and it just became an obsession for me to know more. I started, literally from zero. I can’t really even say I had many people, or any experiences with people who in my family, or anything growing up like with concussion, it was always just, if you had a concussion, you were okay in two or three weeks. And life went on. And I started to see these people sitting in front of me years after they were injured and not getting the validation or the care that they needed. So I started doing it from a research perspective, then my supervisor and I ran a post-concussion group, and we had, I think it was eight women all at different stages of recovery, and that was really where, you know, they were sharing their stories with one another, what worked, what didn’t work, what was most difficult about their recovery. A lot of it was around not being believed, and that was my goal. I wanted to create a space where the moment you walked in the door, you felt believed. So that’s always been the goal.

 I started working with the newfound Balance and Dizziness Center. My supervisor decided to take on a different role, and work with a different population. So I always say she kind of like handed me the torch, and from that moment on, was when I just started doing the individual counseling. So typically, I’ll see post-concussion clients fairly long after the initial injury. So if it’s a motor vehicle accident, it could be a year or two, and they’re coming in, you know, sunglasses on, earplugs in, asking me to turn my lamps off because the light sensitivity is still there, the headaches, and we really just dig into how that’s impacted a lot of the time, their identity, that’s a big part of what I do, and they just feel like they’re missing pieces of themselves that they they love so much, whether it’s the role of being a really active parent, someone who’s really involved in hobbies, someone who exercises a lot, those pieces of their identity are not accessible in the same way. So we have to really come up with a plan. And as much as I always say to my clients, you’re going to hate me when I say this word, but there’s a big piece of acceptance in this journey of, what can I do when I wake up today to honor what my body’s telling me? And that’s so hard, and there’s so much grief involved in that. 

So you know, when you think about post-concussion and mental health, you probably think about the anxiety, you know, depression, like those, those symptoms. But when we dig in, it really becomes about identity issues and feeling lost in themselves and the grief. There’s so much grief, so grief work is a huge part of it, and being able to process that and have space for it, to say, – it almost makes me a little bit emotional, because, you know, I think when I first started, I didn’t even realize that was going to be a piece of it. And now I spend most of my days doing it, but the validation to say, you are different, and I think everyone wants to gloss over that. There’s a lot of people that- they’re uncomfortable with big emotions. They’re uncomfortable with the hard stuff. So they’ll just say, Oh, you just need to relax. You just need to rest. And even from medical professionals, you know, oh, it’s just anxiety. You’re just, you need to just go for a walk or, you know, do some meditation. These are very real symptoms that are happening for very real reasons. And I just attended, actually, the World Congress for Brain Injury in Montreal, Canada, and there’s new research coming out all the time, like in 10 years, we’re going to know more about this, even more than we do now. So, when you sit in front of mental health professionals, or, you know, a physician or a neurologist for that matter, and they say, oh, it’s not possible that you have symptoms or it doesn’t last this long. I kind of just want to say they’re wrong. I want to validate that you absolutely can be experiencing symptoms for a very long time, and it takes more than going into a dark room and meditating to make you be able to function in the way that you want. 

So the grief and loss, the identity piece, all of that, is very real, big components of this. And I think that the mental health piece, when you’re dealing with persistent concussion symptoms, should almost be a non-negotiable for everyone to at least go to an intake. I’ve had, you know, referrals, where I’ve been referred someone who’s, you know, persistent concussion symptoms. They come in and they’re, they don’t really feel like they need a lot of counseling. They, you know, they’ve, they’ve got their life kind of in order. They’re managing like they want to be. And we don’t have a lot of work to do. But for the most part, there is an aspect of mental health that you can benefit from seeing a mental health professional, whether that be someone like myself, a psychologist, a psychiatrist, or all three, you know, depending on the need. 

Another big component of the post-concussion stuff is the trauma. So the majority of my clients are motor vehicle accidents, whether they’re in a multi-vehicle car accident, or perhaps they’re a pedestrian who was hit by a vehicle. And you can imagine there’s a lot of trauma to come with that. So another component of it is the layers of sometimes we have post-traumatic stress disorder, and they’re really struggling with that. Sleep is typically almost always an issue. So we’re working on sleep hygiene. We might be doing some, I do a trauma therapy called Eye Movement Desensitization and Reprocessing Therapy EMDR, and we kind of do that in different ways to help the clients process their trauma. And you know, it’s just a very, it requires a multi-faceted approach. So you might be seeing someone like myself, seeing OT, you know, you’re seeing Chiro, you’re seeing your family doctor, acupuncture, you know, it becomes healing, becomes a part-time. 

Yeah, one of, one of the things I’ve noticed with my concussion clients is the acceptance piece. You know, that’s a big word, and I don’t mean that to accept it from like just an umbrella term, just accept it and move on. I mean, you know, acceptance is a tricky word, and it’s a tricky feeling, and it kind of ebbs and flows. Some days, you’ll wake up and there’s an acceptance of, I’m just going to do what I can today, and if the dishes are in the sink, I’m going to leave them, and it’s okay. And the next day, you wake up and the dishes are in the sink, and it might be soul destroying that you can’t just do the dishes, and you’re angry about it, and you’re sad about it, and the roles in your life have changed, and your family is upset and they don’t understand. One thing I always say about concussion is everyone else has the luxury of forgetting, except you. You’re living it in your brain, 24/7, in your body, and your family members, even the people who are closest to you. It almost gets tiresome to have to navigate it, and I hear that from my clients all the time, you know, I feel like my friends are just sick of hearing me say I have a headache. I feel like my family is just sick of me having to take breaks. I feel like, you know, I can’t travel like I used to, and I need help with those things, and people are just getting tired of it. So it’s unfortunate, because it kind of becomes the concussion patient’s job to be the teacher and to ask for what they need and to constantly be advocating for themselves. And that, in and of itself, is exhausting, and it actually lends itself. A lot of my clients struggle with isolation because they figure, well, it’s too hard to navigate. I don’t want to have to go to the party and go to the bedroom in a dark room, to lie down for 15 minutes every half an hour, because I need a brain break, so I just won’t go. And then that leads to so much loneliness, so much isolation, and a lot of the times, the people you know, they don’t know that they need to reach out, or they don’t know what to ask. They don’t understand what the person is going through. So the level, that’s another layer, kind of the mental health piece. It’s, you know, Where are all my friends? Where are my family members that I’m not hearing from them? They’re not checking in. And as bad as it might sound, I’ve had so many clients sit in front of me and say, I wish that I had maybe, been injured in a way that was more visible, because this is invisible, and I don’t know how to explain it, and the cognitive stuff makes it even harder to explain. I can’t find the words, I can’t get that train of thought. I’m not quick on my feet anymore, so I just don’t say anything. So when someone says, How are you doing, the answer is usually fine, and I’m not. I’m not okay. 

So that whole narrative piece sometimes is something that we work on in mental health field too. Is that we kind of do what I say is like the elevator speech of let’s, how can you be honest, and maybe as vulnerable is as safe in given the environment that you’re in, and come up with a few sentences so that it’s it’s more actual, authentic to how you’re feeling, as opposed to saying, fine, because if people don’t know how to help us, they can’t, and that’s one thing. The vulnerability piece is difficult to say, especially, you know, you’ve got so many people who they’re, you know, they’re the ones that make the Christmas happen. They’re the ones that work, you know, 80 hours a week. They’re the ones that do all these things, and then all of a sudden they can’t, and they’re just not used to asking for help or needing help. So that becomes a whole goal, in and of itself, is to say, How can I ask for help and feel okay about myself and give myself permission to need, right? Because, yeah, I don’t know if there’s a correlation there, but I feel like a lot of my concussion clients are that more type A personalities, you know, they’ve got the house figured out and the parenting and the job and the hobbies and the friends, and then something like this happens, and it is such a blow in so many ways. So that would be definitely some advice in terms of making sure that you have a care team that is hitting on all of the facets. So it’s, you know, the trauma piece, the identity piece, physical issues, obviously, you know, depending on what type of concussion you’re dealing with, you’re doing physio, you’re doing different, different types of care that are going to be specific to what you’re dealing with, and that can be hard to find. You know, especially in Newfoundland, sometimes our resources aren’t necessarily readily available, but I think that’s probably everywhere in different ways. 

One thing I often talk to clients about, and I will share this story because it was in the group that I ran, and it was a few years ago, and the client, um, liked playing piano before she had the concussion. And I think, if my memory serves me right, she might have had multiple concussions, but playing the piano became nearly impossible just, you know, with moving, having to move her eyes, having to remember the songs, the sound, all of those things were just really hard on her system as she was recovering, and she started playing 10 or 15 seconds at a time, and she would sit down, and it was, it was literally 10 seconds, not just – a couple keys. And in the group, she shared a lot of that wisdom, because she had been going through it for quite some time in encouraging people, no matter how small and no matter how little time you can spend engaged in something that’s valuable to you, do it anyway. So, you know, we often fall into that black-and-white thinking, well, if I’m someone who used to run, if I can’t do my hour and a half run around the pond without being symptomatic and without, you know, really having to pay for it, then it’s not worth doing at all. So, breaking that cycle of black-and-white thinking in comparison to the person you were before it happened, is massive. And when people really take on, okay, I can still have a part of that identity in my life. It doesn’t look like I want and I’m allowed to be pissed off about that, like that’s the other thing. We’re not going to only do things when it feels good, sometimes you’re going to be angry, you’re going to be frustrated, you’re going to be grieving. But going for the eight-minute walk to the mailbox instead of the hour-and-a-half run is going to get you closer to the hour-and-a-half run. And I truly do believe that the hour-and-a-half run would happen. I don’t say that just to kind of blow smoke like I have a lot of hope when it comes to recovery and concussion, and I see it every day. And when you can engage in the activities, the pieces that matter to you, that add value to your life, the recovery happens sometimes a little faster, and it’s it just hits so many levels, because that eight-minute walk becomes a 10-minute walk becomes a 30-minute walk, and you’re like, I’m starting to feel like me again. And that’s really what concussion patients want. They want to feel like themselves. So we can only do that by starting small, for most people, right? And of course, like concussion care is a spectrum. You’ve got some people where this is going to happen, that hour and a half run, you know, might be possible in two months, but you’ve got someone else where it might be, it might be years where they’re building that up, or some days they can do it, and some days they can’t. That’s also very frustrating about concussion, it’s not linear. And you know, if I often encourage my patients to when they wake up in the morning, take a couple of deep breaths, do a little inventory of how you’re feeling, and based on that, start thinking about what your day needs to look like, and then the next day, do the same thing, and, but again, not pushing themselves. And, I mean, that’s a whole other area of the treatment, is the planning and the pacing. I really like the spoon theory. I don’t know if people are familiar with that, but there was a woman who was struggling with a chronic illness and was trying to explain to her friend what it was like to always have to manage her energy and not just have the ability to add things on at the end of the day, like there was only a certain amount of energy that she had. So she was at a cafe, she took a little container of spoons and kind of showed her friend, like, when I get off, I have 12 spoons, and every spoon is a unit of energy, so I use that a lot with my clients, and sometimes I’ll just take my pencil cup and say, let’s just pretend these are spoons, and you have 12, and that’s what you get for today. You don’t get to take from tomorrow. You don’t get to take from yesterday. You need to use them and allocate them so that at the end of the day, you’re not suffering in the red zone of symptoms. So, you know, if a shower is really hard because the temperature causes your nervous system to be dysregulated, it’s, you know, I have clients who shower in the dark because the light is difficult. Maybe that’s three spoons. Okay, so now you’ve got nine left, if you have to go to Costco or a grocery store that day, that might be five spoons, and then you have a physio appointment. So you want to look at that in terms of units of energy. How am I planning and pacing my day so I’m not utterly exhausted at the end of it, and I’ve even had clients who will get two cups, and every day on their kitchen counter, they’ll have their 12 spoons, and they move it over throughout the day so that their family can get a visual of, oh, How’s mom doing? So when mom says, I can’t be the one to take you to your soccer practice tonight, and the family’s kind of learned to look at the spoons and to pay attention to how mom’s feeling, they’ll say, Oh, I get it. It isn’t about me and she doesn’t want to be there. It’s that she’s run out of spoons. She has one left, and the kitchen still needs to be cleaned. So sometimes, for the family members and friends to be able to say, Listen, you can just add spoons, take spoons. You don’t have a chronic illness, but I actually need to be really careful on how I navigate my day, can be a good visual. So I’ve got lots of clients talking about spoons to their family and friends. 

A lot of things surprised me, because I was just learning as I go. And you know, in brain injury, we say if you’ve seen one brain injury, you’ve seen one brain injury, because no two are exactly alike. And there’s so many layers to why someone is going to have the outcome that they have, whether that be who’s in their life, supporting them, financial issues, that’s a huge one for people. I’ve got a lot of workplace like worker’s compensation is kind of what we call it in Newfoundland. You know, they’re injured in the workplace, and they’re not getting even close to what their salary was. Maybe they were the breadwinner of the family. And it’s, it’s a really difficult part of recovery. So I think the surprising part was just there’s nothing that doesn’t touch like there’s not one area. And again, I was getting emotional – The work place incidents. Um, I kind of have a personal connection to that. Um, my my father was killed on a workplace site, and sometimes when you have a personal connection to things as a therapist, you choose to not engage with that type of client, right? Because it can be triggering. And I’ve actually found kind of the opposite. I. Think I get fired up and I want to advocate for people who sometimes can’t advocate for themselves. So I have a bit of a soft spot for the workplace stuff. And, you know, I’ll be the one to attend the meeting with the workers and to advocate and to cry in front of you know, the CEOs of the company, you know, it’s just one of those things where, again, it’s surprising how much it can impact someone’s life. So if you have someone who, you know, I value my career so much, and I put a lot of, you know, effort into it, and spend a lot of time kind of honing my skills and trying to be able to be as helpful as possible. And when you see someone in that stage of life who is enjoying their job, and, you know, feeling a lot of pride in what they’re able to do, and they’ve invested so much time and money and resources into schooling and education, and, you know, just traveling and trying to do the best they can, and then they get injured, and they can’t go back to that, because the reality is, sometimes that happens too. If you have an electrician who is climbing up ladders and having to read really intricate blueprints and do all of these very, you know, cognitively taxing things, plus physically taxing. I have, I’ve had clients where that is not an option anymore, that if they can get back to work, it needs to be maybe some different type of training, go back to school, do something different. But there’s a grief associated with that that they never get to go back to what they really want to do. And that’s that part of we can just be with people and listen to them. 

I think one of the issues with concussion is that everyone tries to make, not everyone, I shouldn’t speak in absolutes, but a lot of people try to make it all better. We just want to say, like, that’s okay, or at least you can work, or at least you can and we gloss over, like, the actual human impact of what this does to people. And if we’re being honest, I think as a society, we kind of suck at grief in general. And we wanted to say these very–it can be dismissive, right? It can be dismissive when we say things like, Oh, well, at least, and, well, you didn’t, at least you didn’t get killed, or at least you can still work, or at least whatever, or, or, you know, some people who are on workers or getting insurance money, oh, you got it made because you don’t have to go to work. And every client that’s ever sat in front of me with a concussion has said, like, there’s nothing enjoyable about this. And people on the outside will look in and say, Oh, that’s amazing. You never have to work again. And it’s, it’s angering, and it’s frustrating to hear those types of narratives. But again, it’s just more kind of evidence that people don’t get it. So when it comes to who’s on your team and who’s around you, like, you really do need people who get it. You need to have that, those people surrounding you and helping you, but also validating what you’re going through, that’s more of like, of course, again, like there’s a spectrum, I don’t want anyone listening to think, like, Oh, I’m never going to be able to work again, and stuff like that. That is that’s not necessarily what happens. Like I said, there’s a lot of hope and recovery, and we’re learning more and more every day, even just around like the vestibular system and the eye, therapies and things that we can do to rehab, whatever system is kind of struggling. But you know, I think it’s important that we do talk about the people that really their life is turned upside down.