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

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Patient- signal workFamily - social/ financial

aspectsHospital – rules and

proceduresSociety – social awareness

Patterns: stories, images, metaphors, fairy tales, musicmovement, symbols

MeditationProcess mind

EMERGINGCONSCIOUSNESS----------------------

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CR Consciousness

Sentient awareness

LEVELS OF PERCEPTION

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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

Photo-pictures: Klaudia and Stanisław Winiarscy, „Sleeping Stories”