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 clients2008/9 - Fridays Discussion Club on coma and states of consciousness- Coma workshop in Warsaw Gary Reiss- September 2009 Conference There is Life in Coma organized by wiato Foundation in Toru

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 2009Toru wiato Foundation Care facility for people in coma (24 beds)Raising awareness around Coma:- publications- conferences- exhibitions- theatre performance

Conference There is Life in ComaSeptember 2009

Topics included:Brain and its potentialEthical aspects of life in vegetative statesContact and consciousness in comaRehabilitation of people in vegetative states Organization of care for people in vegetative states Sleeping sexuality

Working with CaritasPROJECT 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:To bring in new methods of work To show the possibilities of contactTo help changing attitudes towards people in coma To spend time with the patientsTo give support to the main caregiverTo do some family work Implicit: To do some organizational workTo 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 supervisionsMeetings 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:Deep contact and connection with patientsFinding place were it is possible to connect on the Essence (Process-mind) levelQuestions: what am I really doing, what am I needed for

Akogo Foundation Ewa BaszczykPROJECT 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 FoundationPsychological support for the families with children after brain injuries

PsychotherapyComa Work Visiting families at homesWorkshops and lectures 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 CenterConversation about future plans and organizational support

2. Coma WorkIntroducing the basic elements of coma work to parents / caregivers Working with the child (if the doctors and parents agree)making contactfollowing the childadding the attitude of no expectationssearching for the clues from the Dreaminglooking for meaning: messagas from the Dreaming in the context of the family family interventionsSupervisions and team meetings

3. Visiting families at homesTeaching 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 supportmeeting with other family members (ex. siblings)interventions around special problems (ex. domestic violence)family therapyPlans: 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, rehabilitantscreating opportunities to work with organizational issues teaching basic psychological skills Interpersonal communication Criticism-giving and takingCoping with stressBurnoutTeamworkNon-verbal communication with clientsConflict resolutionRank and hierarchy in organization

4. Free Coma phone-lineGoal: to provide on-going support to the families with people in comadata-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 visitpossibility 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 ConsciousnessAwareFrom a-ware - wary cautious, alert, attentiveHuman's or an animal's perception and cognitive reaction to an event Informed; alert

Arnold Mindell -automatic process of perceptiontendency before self-reflection or consciousness noticing, reacting, perceiving base for all the experienceConsciousFrom Latin conscius 1. having joint or common knowledge with another; 2. conscious to oneselfConscientia - knowledge-with; shared knowledge Awareness of being aware

Arnold Mindell - deals with parts and with their connection to one anotherawareness 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 IWhen two people relate to each other authentically and humanly, God is the electricity that surges between them.

Jzef 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:

Helping out a person who is stuck in loneliness in the formless realm of experienceSupporting the I to emerge from the Essence level through the Dreamland to Consensus Reality (helping the I to find way home) acknowledging subjectivity and autonomyhelping 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 CRAcknowledging the value of NCR experience

EssenceWaking up to the mystery of life, human being, consciousnessMeditation and other forms of contact through Process mindUnfolding the Mystery: what is happening down (or up) there? Elaborating the Essence language, description of the non-local experiences (science, media, art)

DreamlandWorking with client on symbolic aspects of what is happening

Discovering patterns by connecting the signals from the client, our own experience and information from the family

Whos 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 attitudesacknowledging the responsibility and leading role of a physicianmaking 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 brainThe idea, that consciousness is reflective and we are serving as an external awarenessExplaining 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 futureMain role in creating the model ofpsychological support in the Alarm Clock Clinic

Developing cooperation with Caritas on-going internshipworkshops 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 Stanisaw Winiarscy, Sleeping Stories