An interview with Suzanne Guest: Occupational Psychology

[00:00:00] Brooke Trotter:

Hiya, and welcome to Brain Injury Bites, where we provide help and advice for people after a brain injury. My name's Brooke, and I've lived with a traumatic brain injury since 2007.

[00:00:12] Ashwini Kamath:

Hi, I'm Ashwani, and I'm a Trustee at Headway Warrington. I'm also a Senior Associate Solicitor, focusing on catastrophic injury, including brain injury.

We're delighted to welcome Suzanne Guest. Suzanne is an Occupational Psychologist, working in the Greater Manchester area, and you run a company, Work in Mind. So thank you, Suzanne, for joining us today.

[00:00:35] Suzanne Guest:

Thank you for having me. I'm really excited.

[00:00:36] Ashwini Kamath:

So, Suzanne, it'd be really helpful for our listeners to understand a little bit more about who you are and what you do.

I don't think many of our listeners will have come across occupational psychologists in the normal scheme of things.

[00:00:49] Suzanne Guest:

Yeah, so I work mainly with people who've had acquired brain injuries and help them go back to work. So most people think I'm an occupational therapist, which I think is probably a cooler job than what I've got.

But my main work is looking at… the work I enjoy the most is working on job retention, which is helping somebody go back to the job that they would have had before. And what I do is I work with the person who's had the injury and find out what the difficulties are and more importantly, find out what their strengths are, and help to support them to go back to work. So that will mean looking at what the job involves, looking at how we can compensate for any difficulties, and also supporting the employer to support that person back to work.

[00:01:33] Ashwini Kamath:

And yeah, so you mentioned an emphasis on somebody's strengths in particular, because I'm guessing that often, maybe not always, people can't necessarily return to the job that they were doing before So I guess you're looking a lot at transferable skills and qualifications, interests, that sort of thing.

[00:01:51] Suzanne Guest:

Yeah, I think sometimes what happens is that when somebody's had an injury, we spend so much time talking about memory deficits and problem-solving deficits and social problems and physical problems but we do miss out that that person had skills before and they've... They still retain some of those skills, they still retain those interests. So it's looking at what that person's retained. Sometimes people develop new skills after they've had a brain injury, because they might find that actually they're a lot more empathic than they were before their injury, or they've developed different sorts of organisational skills because of all the strategies that they use. So it's then looking at transferring that back into a workplace.

[00:02:30] Ashwini Kamath:

And I'm just thinking about someone like Brooke, for example. So Brooke, as you may know, sustained his injury whilst she was still at university, so hadn't actually entered the job market. Do you work with people like Brooke?

[00:02:42] Suzanne Guest:

Yeah, so I work with people who have had an acquired injury and support with work or meaningful activity.

Most of my work is job retention, so people who are already in work. But I do work with people who, either can't go back to the work they've had or are at the very start of their career and look at finding work experience for people. So it could be that somebody's had no idea of what they wanted to do.

And I don't know if this was the case for you or not, Brooke, if you've got a clear path of where you was going or...

[00:03:16] Brooke Trotter:

No, I've never had a clear path of anything in my life and then stick a brain injury in there and it's, uh, the path gets a lot more…

[00:03:23] Suzanne Guest:

Yeah, but I think sometimes people can have really rigid ideas of what they want and either it's not realistic or it wasn't what they thought it was going to be and I think sometimes finding opportunities and being open to what comes into your path is actually really productive for some people.

So, you know, did you think when you had your brain injury, actually I'm going to be on a podcast?

[00:03:48] Brooke Trotter:

You have expectations for yourself, and you think you're going to go in some sort of direction. I didn't have the exact path planned out, but my, one of my friends, Graham, he's gone on to work in construction. He's working in London, lives in London. I felt like we lived together, went traveling together, went to uni together and I feel that I would have followed the same path. I think I would have gone down to London and actually, at the time went back to Scarborough which is exactly what I didn't want with my life.

I think it's important to… just to do something with your life is really important because I think if you have too much free time it really does eat at you and that's when the depression starts.

I think the first thing I ever did that was of any use was I did a 10k run. I raised some money for it and I think that was the start of, started me on the path that I'm on of raising money and um, you know, going back into helping people.

So you need to focus on something and you need to think that you're making a difference in this world because I just thought… that's one of the things that really got me. I just thought, sorry to be brutal, but if I died tomorrow, who would, apart from my parents, my family, my immediate family and friends, who would miss me.

[00:05:01] Ashwini Kamath:

I suppose, what have you done? What have you contributed?

[00:05:03] Brooke Trotter:

What have I contributed to this earth, yeah, and that's what started me off and, you know, raising some money. It might not seem like a lot to a lot of people, but it was, it made me feel better for, I've made a positive contribution to the world.

[00:05:15] Ashwini Kamath:

Yeah. I think the point that you're making and what you were saying is that it's got to be meaningful. So it's about finding something that will give your client a purpose, a reason to get up in the morning.

[00:05:28] Brooke Trotter:

That was something that, someone said that to me, a reason to get up in the morning. That's what… apart from watching Jeremy Kyle, of course!

[00:05:38] Ashwini Kamath:

That's not a reason to get up in the morning!

[00:05:40] Suzanne Guest:

No, and there is things about looking at what's right for that person. So as a fluffy psychologist, I always want to get somebody to a position that they really love their job and it's something that, you know, they wake up and they click the heels and it's what they want to do.

But there are people who their main motivation for working is about the finances for them. And, you know, I remember working with a guy who was a really high earner, and he was talking, he was very financially driven. But when you drill down into that, actually it was about security for him. So it wasn't just about putting a sharp suit on and, you know, putting more money into a savings account - it was about security for his family. So, even when there is the kind of things that are a bit less fluffy, often there are human reasons behind wanting more money. It's not just purely about wanting a bigger house or a bigger car for him.

[00:06:36] Brooke Trotter:

The image as well, I think, of, you know, you want to look good to your peers, don’t you. There's people that you went to school with and you want to have, you know, appeared to, well, if you have that, that school reunion, you want to have done well, don't you? And you don't want to be someone that's not done well, so…

[00:06:54] Ashwini Kamath:

But I think it also comes back to what we discussed in the last series about self-esteem, the importance of self-esteem, and, you know, what you do for, I think, most adults in some sort of occupation, it largely defines who you are as a person, because you spend so much time of your week in work, so once something comes along, like a traumatic brain injury that takes that away or takes it away temporarily, it can have a huge impact on your self-esteem, your sort of sense of self. And particularly then if that person's not able to return to what they were doing before, that's going to have a huge, I imagine, um, psychological impact on them.

[00:07:31] Suzanne Guest:

Yeah because work provides so much for people, even if you're in a job that you don't like and you don't particularly value. So there's potentially ther’s, first of all, obviously there's an income. But then there's things like social context. So there's people who are in jobs that they don't particularly like, but they've got friends there.

It's often the way that somebody would identify themselves. It's a huge use of your time. So like Brooke was just saying about, you know, wondering who'd miss him or, you know, not having time to fill. Work actually does provide that so it's a huge, you know, 30, 40, 50, 60, however many hours people end up working - it's a huge hole in somebody's life when work’s taken away.

[00:08:11] Brooke Trotter:

It's one of the first questions as well, isn't it? Who are you? I’m Suzanne, and what do you do? If you stumble on the first hurdle, then it's a bad thing.

[00:08:20] Ashwini Kamath:

Yeah, yeah, we are, we are very much defined by what we do. It's very much a topic of conversation and it is that sense of purpose, as we were saying, to, to have something.

Before I just expand on that a little bit more, I just wanted to, out of curiosity, ask you if there was a difference between occupational psychology, which is what you do, and vocational rehabilitation.

[00:08:39] Suzanne Guest:

Well, occupational psychology actually covers a really broad area. So there's people who work in occupational psychology who do things like the assessment centres that graduates do, or you can work on recruitment, you could work within doing things like team building and things like that. Occupational psychology is basically the psychology of work. It doesn't necessarily need to involve somebody who's had an injury or anything like that. So vocational rehabilitation is basically using work as a form of rehabilitation, potentially after injury, but it could also be, um, after somebody's been in prison or somebody's had drug issues and things like that.

[00:09:26] Brooke Trotter:

Rejoining the world, isn't it?

[00:09:28] Suzanne Guest:

Yeah, yeah.

[00:09:29] Ashwini Kamath:

Okay, no, interesting. I didn't think about that, that occupational psychology is much more than working with people with injuries.

So you talk about working with the individual, looking at their strengths, working with employers as well. Can you talk to us a little bit more about that in terms of the liaison that you have with employers and presumably talking to managers, HR. What sort of discussions do you have, and do you come across any sort of challenges, barriers with that?

[00:09:57] Suzanne Guest:

Yeah, I think it's quite easy to paint the employer as being the bad guy and very rarely are they. So occasionally there's somebody they don't want back and they would be quite obstructive and they very rarely say ‘we don't want this person back’, so they will throw barriers in the way. But one of the things that I think we very often forget about in this whole process is that the employer, particularly the line manager or the colleague, will be somebody who maybe has worked with that person for many years and then suddenly, one morning, they will get a call to say that their colleague is in intensive care. And I don't think we think about how shocking that is for the employers. And I've had ones who've said, we just didn't know what to do. We didn't want to bother the family, but we didn't want them to think we weren't bothered either.

And I think sometimes there is that looking at sorting that communication out. So I've had survivors say to me, do you know, ‘I was off and they didn't ring up’, and the employees are saying ‘we didn't want to bother them’, and it wasn't that they didn't care, they didn't know what to do.

[00:11:05] Ashwini Kamath:

I suppose they didn't want to do something that might put them in a difficult position legally as well.

[00:11:11] Suzanne Guest:

Yeah. So I think the employers are often in a really, really difficult position. So we're looking at facilitating communication between the person who's off work and the employer, and it's often about just finding the right person. So we need to have contact with the line manager and usually HR.

I do often have people, and one of their concerns is how am I going to explain to people while I'm off? Because we know brain injury is the hidden disability. So I had a guy once who ran the London marathon before he went back to work. Not on the day, but, you know, sort of, um, yeah, just, just whip around London and then …

[00:11:53] Ashwini Kamath:

Sounds like the kind of thing Brooke would do!

[00:11:56] Suzanne Guest:

Yeah, me too!

So you have somebody who's coming back, maybe looking quite fit, but what we don't see is that a couple of hours of work in an office that might be brightly lit, staring at a screen, concentrated, is exhausting.

[00:12:12] Brooke Trotter:

There's all these new things, it's a really weird world to go into, because you go, you're into this world and there's all these things that you now find really fatiguing that you never did before.

Like, listening, like talking to people. And like there’s that element of employers not really understanding anything. Like, I remember when I moved back to my mum and dad’s for six months and I had this thing, I wanted to move back to Manchester. So I moved back in with my mates, obviously my mates were still either at uni or working, and working in bars. And I had this thing that I wanted to go back to work – well I think I wanted to be seen to be wanting to go back to work and not… I mean, at the time I had my injury there was a program on TV called Benefits Street, and it was very… people I knew anyway, they were very against people on benefits, and I didn't want to be seen as one of them.

So I had made an effort to go back to work, just for free, and I worked in a bar. I didn't think I could handle the till. I just thought sort of helped in on the day was moving stock about, and I was exhausted. And I remember him saying to me, ‘When are going to be alright to come back to work, and I'm like ‘I don't have a clue’.

[00:13:24] Ashwini Kamath:

I think it's cognitive overload. I mean, even working in a bar, it's like all the noise and, you know, people around and just having to sequence tasks and things, but in an office environment, I can totally see how, you know, when you've taken a period of time out, and I mean, any one of us who goes on a long holiday comes back and goes, how do I do my job?

But, you know, add on a brain injury and a prolonged period of time out and it's all of a sudden, it's getting used to the systems and the noise. And even things like, obviously, I imagine people, colleagues will want to talk to them, find out how they are and that can be fatiguing as well.

[00:14:00] Brooke Trotter:

At the time I was in my early twenties and like the thing to do then was, you know, go out partying and then all of a sudden, you know, you stay up all night and maybe even going to work the next day and you know, just being a student generally. But I went… I found myself that the best environment for me would be like a well lit with natural light, like a coffee shop on a Tuesday afternoon or something - not the nightclub at three o'clock in the morning. So it's weird having to adjust to that as well and having your friends not…

[00:14:33] Suzanne Guest:

…not understanding.

[00:14:34] Brooke Trotter:

Having your friends not understanding that as well and trying to trying to help you along.

[00:14:38] Suzanne Guest:

Yeah, I think one of the things that is really important is doing brain injury education with the employers. So getting them to understand about memory problems. Sometimes you'll get people very well meaning saying, ‘You don't need those diaries, just, if you just focus and you just, you just think about it, you'll not need to keep writing things down’, when obviously the strategies and the writing things down helps take that demand off of your brain.

[00:15:08] Brooke Trotter:

And you want it to be, you want it to be like, to fit back in as well - you'll just say, yeah, yeah, I agree with you. And then you take them diaries away and then, yeah, you're in trouble.

[00:15:18] Suzanne Guest:

So one of the things that I give employers is the, one of the fact sheets that's produced by Headway UK, which is a guide for employers, and that talks about how some of the difficulties associated with brain injury and also some of the strategies. Because I think when we talk about reasonable adjustments, people always think that, well it's putting a ramp to the door and it's lowering things and it's all very expensive, and sometimes it's as simple as somebody learning to organise their emails into different folders or having a little meeting at the beginning of the day or the week to plan what somebody's going to do or structuring breaks differently. It's not necessarily anything that's massively expensive.

[00:16:07] Brooke Trotter:

It's bespoke to that person.

[00:16:09] Ashwini Kamath:

Yeah, a I suppose it's also then creating those habits and habit loading so that, you know, that becomes embedded and somebody gets used to having those meetings in the morning or organising their emails that way so that it makes it easier to get through the day.

[00:16:25] Suzanne Guest:

Yeah. One of the things that I think is really important to remember though is that people with brain injury, one of the things they often struggle most with is change and workplaces tend to be changing environments. So we don't always realise that the little changes that are creeping up, so it could be that a manager changes, IT changes all the time. So it's having somebody who will be aware that something different, that the person with a brain injury maybe would need a little bit of extra time.

[00:16:58] Brooke Trotter:

It's like if they've had one in the last few years and then all of a sudden you have to get used to QR codes.

[00:17:03] Suzanne Guest:

Yeah.

[00:17:04] Brooke Trotter:

Like, what are they?

[00:17:05] Suzanne Guest:

Yeah. And what do you do when its… I don't get why people put them on things that you would look at on your phone because you've…How do you scan it when it's on your phone?

[00:17:15] Brooke Trotter:

Yeah. Do you have to get, hold your phone up and scan it from another phone?

[00:17:19] Suzanne Guest:

I don’t know! Or you could selfie it in the mirror, maybe. Will it work back to front?

[00:17:23] Ashwini Kamath:

I've no idea.

[00:17:26] Brooke Trotter:

Well, you shouldn’t have to put that much effort into it, should you!

[00:17:27] Suzanne Guest:

Exactly. It's just… give me a link! I know what a link is, I can click on a link!

But an example I had several years ago - I don't think I ended up working with this person, but I can remember speaking to the employer who this person was in a kind of sheltered workplace, and they kept losing their temper and they would allow that because they've ‘got problems’. But they introduced a new signing in system that this person was forgetting because it was completely new. And they actually disciplined him for not signing in but they were not actually reining in the losing the temper because they've ‘got problems’. And it was interesting that the temper was seen as a brain injury thing, but the memory wasn't. And it is those little things of if you introduce a new system, that person with the brain injury maybe needs a few more prompts or needs it writing down or just a little bit of leeway to get used to it.

[00:18:25] Ashwini Kamath:

So in a situation like that, say, let's say you have a client and you know, you're liaising with the employer in the lead up to them going back to work and then person goes in but as you say, you know, workplaces change systems and processes a lot, but it's not always sort of, you know, it's not a case of it'll be every month.

So how... Do you sort of have ongoing contacts with your clients and how do you get involved if somebody's actually struggling with a change? Is it sort of on that person to come to you and say, I'm just really, you know, I just can't cope with this, I don't understand. Or would it be the employees that come to you and say, is there anything you can help us out with here?

[00:19:04] Suzanne Guest:

It's a mixture of both. So, while I'm working with somebody, I would still make contact with people regularly. That might just be dropping somebody a text saying, how are you getting on? Or it could be ringing somebody up or with the employer. Unfortunately, things do sometimes just hit crisis point rather than it being one of those situations where, oh, I'm just struggling with this a little bit.

But the big thing I do always try and stress with the employers is that change is difficult following a brain injury. So, you know, think about how you implement change after a brain injury.

[00:19:38] Ashwini Kamath:

And maybe look at whether that individual needs some additional support, I guess. Or, you know, can we do it slightly differently to… like with the signing in thing, I wonder whether actually, if somebody had thought about it, was there another way of helping that person to sign in or remembering to sign in, and that may, may not, I don't know, have alleviated some other problems.

[00:20:00] Suzanne Guest:

Yeah, absolutely.

[00:20:01] Ashwini Kamath:

Yeah, it's very interesting. I should say as well, we'll put the fact sheet that you referred to from Headway on the footnotes to the episode if anyone would like to see them.

I have worked with you in a litigation context, so…

[00:20:17] Suzanne Guest:

I know, I was a delight, wasn't I?

[00:20:18] Ashwini Kamath:

Yeah, yeah, you still are!

And so just to explain to our listeners. The context in which I've worked with Suzanne previously/currently is as part of a, what we call a multidisciplinary team where we have a team of different rehab professionals all supporting a client with traumatic brain injury. So there'll be typically a case manager, there'll be a neuropsychologist, yourself as an occupational psychologist, we'll have an occupational therapist because the two are different. There might be a speech and language therapist, there might be physiotherapists - whatever that particular client needs.

So can you just talk to us about your role within a multidisciplinary team and how you work with other professionals in terms of goal setting and, you know, moving a client towards that sort of the magical self actualisation on the pyramid, the Maslow's hierarchy pyramid?

[00:21:14] Suzanne Guest:

It's really important to keep communication with the whole team.

So, the neuropsychologist will often be working with people to develop strategies. So if somebody is using a particular type of diary system at home, then it makes sense to try and transfer that to the workplace rather than have one system at home and one system at work. So that bit is, is important.

I think one of the things as well is to… We often look at, ‘Oh, somebody's only working three days a week’, but we're missing out that they're seeing an occupational therapist, a physiotherapist, a neuropsychologist, which are all really cognitively demanding. So potentially when you add up the hours that they're working and the therapy time, you're at a full-time job.

So, there's looking at carrying over the strategies to the workplace and also the other members of the team, sometimes, say for example, if somebody's doing shopping with the occupational therapist, they might mention that something's not quite right at work because I think when you're doing things, things just come out as opposed to just sitting in a session.

So it's important then that they would feedback to me so I can address those issues. So we do all tend to work really closely with each other because work impacts home and home impacts work. So we sort of, you know, we all hopefully communicate well.

[00:22:40] Ashwini Kamath:

Yeah, I think that's the importance of building a really solid therapeutic relationship with the clients as well. So those nuggets of information that can be really quite key can come out in a more natural setting rather than, as you say, in a clinical, sort of face to face ‘tell me about what's going on at work’ kind of a situation. So, yeah, no, I think communication is key and we've discussed that in many sort of previous episodes as well.

Thinking about some of the challenges then, because you talked before about how, you know, a lot of people's drivers are sort of around financial security. It's not necessarily about the prestige of the employment, it's about being able to provide and, you know, if you take, and I'm going to horribly stereotype here, but let's say you take a, I don't know, a man in his 40s, you know, married, kids, the main breadwinner. And I must stress, that's not always the makeup of this, but take somebody like that who suddenly can't work and, you know, was previously earning well, had a nice life. And as you say, their concern will be that financial security - being able to provide for the family and so on. But whilst they might be able to get into something that, as you said Brooke, you know, fills their day, gives them purpose, it might not necessarily give them the same financial reward.

And that must, in itself, impact on somebody's self-esteem. How do you manage those sorts of challenges?

[00:24:03] Suzanne Guest:

Those type of things are so difficult. It is about somebody adjusting. So if there isn't any grounds for litigation, then somebody's standard of living will end up massively reduced. So we can look at trying to access benefits for people, but contrary to what certain newspapers would have you believe, you know, people on benefits don't have a lot of money.

So there, there is looking at somebody - it might be that they need to downsize the house and make sort of quite difficult decisions. And again, that's where working with a team where the neuropsychologist or sometimes we get counsellors involved to work with someone emotionally adjusting to what is a very different type of life. And that can also include the family. So if somebody's married and they've had very different roles and suddenly that dynamic’s changed. And potentially at some point the partner becomes a carer and we know that children can find it difficult if their parent’s had a brain injury and suddenly things are very different for them and they take on a bit of a caring role for, or potentially they might be a bit embarrassed by the parent.

All kids are embarrassed by their parents at some point. That's a given, isn't it? But I think there's a point that, you know, you, um, if somebody is a bit disinhibited and they're at school, then, you know, we can work with children on getting them to understand why their parents are a bit different.

[00:25:31] Ashwini Kamath:

And what about, say, somebody who is able to return to work, but not doing what they previously did. Can that have an impact? Or rather, I suppose what you'd do is you'd do a lot of groundwork beforehand to help manage that transition. But what kind of things would you do?

[00:25:48] Suzanne Guest:

Well, first of all, it's looking at… we would initially try and get somebody back to their original job. If that isn't possible it could be that we would look at, are there different jobs within that employers and that's a bit of a double edged sword so that the positives are things like they're with people who potentially would be quite supportive and they're in a familiar environment.

The downside could be if somebody's taking a lower grade than they had before. So I worked with a man who he ended up working under people who he'd previously supervised, so he found that really difficult

[00:26:27] Brooke Trotter:

Were they kind to him? Depends on whether he was kind to him in the first place or not.

[00:26:32] Suzanne Guest:

Yeah. I think he actually was a really hard working guy but he had quite difficult social problems after his brain injury. So I think a lot saw that his issues were around his brain injury, but he was very focused at work.

And for some people it is just intolerable working in a lower grade in the same employer. So that's when, you know, you look at finding something very different, it could be, and it's about adjustment and starting a new life for them.

[00:27:04] Ashwini Kamath:

And I guess that's where, again, the importance of the multidisciplinary team comes in because you'd also have the psychologists working alongside, you know, and counselling and that sort of thing, and I suppose it's finding, as you say, purpose and meaning in the activity that they're engaged in as well so… but it's a big adjustment, no doubt.

[00:27:25] Suzanne Guest:

Yeah and I do think one of the things that can really help with that is Headway groups. So somebody meeting other people who are maybe a bit further on in their injury. I think like the work that Brooke does - I first saw you speaking at a conference about your journey, you know, this is where I was, this is where I am now, is an important factor in somebodies’ adjustment.

[00:27:49] Ashwini Kamath:

Yeah. And realising that you're not alone.

[00:27:52] Brooke Trotter:

Don't remember that! That's a symptom, isn't it?!

[00:27:56] Suzanne Guest:

It was, it was many years ago.

[00:27:58] Ashwini Kamath:

I was going to say, I first saw you at a similar sort of conference, but yeah, that would have been many years ago. I think you've just done so many of them as well, haven't you, Brooke? But, you know, don't underestimate the importance of that telling your story. That's your purpose, I guess, coming back to what we were saying before.

[00:28:13] Brooke Trotter:

That was something my mum said to me, actually, that when she was in Salford Royal Hospital, and um, she said that if she could have, if she could have seen somebody like, like me, you know, further down the line, that would have given us so much hope then and I've always kind of endeavoured to do something like that, just to, to be an example to people. Because it is rubbish, and it is rubbish for a long time. Well, you know, every, everyone's got a different experience, haven't they? But it does get better, and I think it does, you've got to work hard at it, you know, there is light at the end of the tunnel.

[00:28:48] Ashwini Kamath:

Thank you for listening to part one. We hope you can join us for part two. Please don't forget to follow, subscribe and share our content. If you do have any suggestions for topics that you'd like us to cover, why not drop us a line at hi@braininjurybites.co.uk

[00:00:00] Brooke Trotter:

Hiya and welcome to Brain Injury Bites, where we provide help and advice for people after a brain injury. My name's Brooke and I've lived with a traumatic brain injury since 2007.

[00:00:12] Ashwini Kamath:

Hi, I'm Ashwani and I'm a Trustee at Headway Warrington. I'm also a Senior Associate Solicitor focusing on catastrophic injury, including brain injury.

Thank you for returning to listen to part two of this interview.

[00:00:26] Suzanne Guest:

And I think it is still a real shame that most people who don't work in brain injury don't really know what a brain injury looks like. Though, there is the statistic that every 90 seconds somebody is admitted to hospital with a brain injury.

[00:00:43] Brooke Trotter:

Is that worldwide?

[00:00:44] Suzanne Guest:

In the UK.

[00:00:45] Ashwini Kamath:

Wow.

[00:00:46] Suzanne Guest:

Yeah. So that could be concussions and this, but you know, there is a lot of people out there who've got brain injuries to varying degrees and I think we still don't really know as a society what that looks like.

[00:01:00] Ashwini Kamath:

I suppose though as well and we've discussed this previously that you see a brain injury, you see a brain injury and everyone presents differently. So there's that element. It's the hidden disability element. And, you know, it's not as obvious, you know, as opposed to somebody who say is missing a limb, but it's a, it… the impact is huge, absolutely.

[00:01:19] Suzanne Guest:

Yeah. I mean, the number of people who I've met with brain injuries who’ve said it would have been easier to lose a limb because people would have understood that. Or, you know, if I was in a wheelchair, people would understand that. People can't see how exhausted I am.

[00:01:33] Brooke Trotter:

There's also, you don't understand it as well.

[00:01:35] Ashwini Kamath:

Yeah. Yeah.

[00:01:36] Brooke Trotter:

You're trying to explain something that you don't fully understand yourself.

[00:01:39] Ashwini Kamath:

The amount of times I've dealt with family members or other people associated to clients where it's like, well, you know, but they're out of hospital, they're better. Why aren't they better now? And it's kind of trying to explain that it doesn't work that way. It's a brain injury. It affects the brain permanently.

[00:01:56] Suzanne Guest:

There's a really interesting video with Richard Hammond and Sterling Moss, and Sterling Moss also had a brain injury from racing. And Richard Hammond was talking about, he was saying, I look back and I thought I was okay then, but I realised there was still problems, but I'm okay now. And then six months later, he would look back and say, oh, do you know, I thought it was okay then. But, and that kind of…

[00:02:22] Brooke Trotter:

I can really relate to that. Someone bought me… that's a similar time as Richard Hammond had his injury in 2006 and then mine was in 2007 and I think he’d got the book out when I was in hospital or very soon after, and somebody bought me it to read in hospital.

I remember trying to read it, like, I had double vision and I was reading it through one eye. And, um, you know, you read five lines, you forget what you've just read and stuff. It was, um, I think I got through it, but yeah, I don't remember any of it.

[00:02:54] Ashwini Kamath:

We'll see if we can find a link for that video that you mentioned. If we can find it, we can certainly put it on the footnotes. Because I think that would be quite interesting to see, especially as you say, if it's sort of every six months, how that insight changes, but yeah, actually things are still not, um…

[00:03:09] Brooke Trotter:

You don't see yourself every day though, do you? I mean, sorry, you do see yourself every day, so you don't…

[00:03:14] Ashwini Kamath:

But you don't see the progress.

[00:03:16] Suzanne Guest:

Yeah. Because I think Richard Hammond was initially saying everything's the same. Is it, I like celery now or I don't like celery, there's something about celery and that was his only issue. But obviously, you know, he very publicly went on his journey, you know, which I think sometimes we don't give celebrities the confidentiality they need around their injuries.

[00:03:38] Ashwini Kamath:

No, I mean, I suppose it's double edged sword in a way in the sense that, yeah, he should be allowed to have that privacy, but then if he's chosen to and actually, it can sometimes help to put that spotlight on for the reason that we were saying before that people don't understand brain injuries. So having somebody in the celebrity sphere who says, actually I've had a brain injury and this is how it's affecting me, might then help other people to go, oh yeah, okay, I understand that, you know, you might find it harder to do this or to remember that.

[00:04:08] Suzanne Guest:

Yeah, I've got a lot of respect for the celebrities that do sort of share their difficulties. I suspect maybe earlier on we should be a little bit more protective is my thoughts.

[00:04:17] Ashwini Kamath:

Yeah, but I suppose he made that decision, so...

[00:04:22] Suzanne Guest:

But had he got capacity?

[00:04:23] Ashwini Kamath:

Well, oh, oh, let's not get into that minefield!

Another thing that I wanted us to cover it, and I think this has been covered with you, Brooke, I think in season one about, you know, the importance of pacing yourself and not trying to run before you can walk.

[00:04:40] Brooke Trotter:

Which I still mess up on.

[00:04:42] Ashwini Kamath:

I think, yeah, and it's natural as human beings, I think, that we want to, we want to get somewhere, you know. But I think particularly following a brain injury and, you know, someone… I see it time and time again with clients where they just want to get back to work and more often not that is a primary driver, I just want to get back to work as if you can just walk into work tomorrow and pick up, you know, from where you left off, log in and get on with it. And, you'll know that that's not necessarily the case. And I'm sure when you hear that, there's probably a bit of a wry smile going on, going, okay, let's see.

But just talk to us about how you manage your clients and employers through that in terms of the pacing, the phased return element of it.

[00:05:25] Suzanne Guest:

Yeah. So I would do a phased return to work, which would be… I'm more of a fan of little and often rather than trying to do longer days. Some companies already have phased return to work plans, but they're the same, whether you've broken your leg or had a severe brain injury. So somebody who's been off work a long time would need a much slower return to work, but that's not just looking at hours. I think sometimes we look at, oh, well, you do this number of hours and you increase to this number of hours.

There's also looking at the tasks that are involved. So it could be that you're working with supervision. It could be that there's certain tasks you know you can do really well and others are a bit of a challenge. So we have to increase the tasks as well as the the hours. Sometimes there'll be people who can work a lot of hours, but actually they're only doing half the job because they're not doing, doing the full job.

So it's important to get that graded return in terms of A, hours, but B, the tasks and potentially C, the amount of supervision and support that goes along with that.

[00:06:34] Ashwini Kamath:

Do you meet resistance from employees when you said that your preference is little and often, but you might have employees with set plans? Do you meet resistance? Because presumably it does also take a lot for employers in the sense that, you know, that at the end of the day, they're missing somebody's service, their employment, and I imagine there'll be extra resource involved in terms of having a buddy, a mentor, a supervisor working with that person to phase them back in, so it's additional resource on the employers side. Do you find that employers can be resistant or are they helpful in that regard?

[00:07:06] Suzanne Guest:

There's a mixed bag. I've never done any proper research on this, but my gut reaction often is that the people who were really well liked before they had their brain injury are the ones who get support when they go, they go back.

So I have had ones where the employees have been a little bit resistant maybe, and then one of them say, you know, he wasn't particularly well liked before he had the injury, so when somebody's coming back before they, you know, coming back maybe with social problems and a bit disinhibited as well, um, there is resistance to that.

But you know, some employers have been absolutely amazing. And I've had ones that they've already kind of thought about how they can do it and made their plans and really want to support that person. And again, I think it does go back to what I was saying earlier around, they did get that phone call out of the blue to say their colleague was in intensive care and they're shocked by that and they do want to help.

[00:08:01] Brooke Trotter:

It comes down to individuals, doesn't it? What's that boss like as a person, is he caring, is he willing to put the effort in to understand, or is he just, you know, want the person back.

[00:08:10] Ashwini Kamath:

Yeah. I mean, I suppose at the end of the day, it's humans, isn't it? But you're right. And it's interesting what you're saying there about, you know, I appreciate it's not official research, but I suppose there is that human inclination to help those that we like, that's one of us or whatever and question whether that's actually fair, but you know, human behaviour is what it is.

Can you sort of think of any particular success stories that resonate for you and with all the clients that you've worked with over the years?

[00:08:41] Suzanne Guest:

There have been, people who, you know, gone back to the original job. So the guy who ran the London Marathon, he ended up going back part time, but actually worked really closely with his employers, found a job within, a slightly modified job. It worked for him, it worked for his family. And, you know, he contacts me every now and then and just sort of lets me know. I discharged him years ago, but, you know, sort of keeps up to date with how things are going.

There was a man that I worked with a long time ago who got him, it was a new job and he's still in that role. And every now and then there is little hiccups and it's usually around work changing and sometimes I go back and offer a little bit of support, but he's been able to maintain that role.

[00:09:32] Ashwini Kamath:

That's good. And I suppose success doesn't have to be defined by going back to the same job, does it? It can be, as you, as we started off by saying at the beginning of the discussion about finding something meaningful.

[00:09:45] Suzanne Guest:

Yeah, I do also think sometimes the sort of the sadder part of my job is supporting somebody to leave a situation with dignity.

So, you know, sometimes it isn't working and I do think that is really important to support that person potentially to make a decision to leave and to support through that decision. And it's something that I hate doing and I normally go home and cry a bit, but it is one of those situations that again, we often paint the employer as being the bad guy and often in those situations, they're gutted too. So we would normally have some sort of final meeting that they have to have for their legal situation, but, you know, they've wanted it to work as well. Sometimes somebody is too injured and it just, it isn't the right environment for them, but I think there is sometimes trying to give that person the feeling that they've had some choice and some control over leaving the work.

So on paper that might not feel like a good outcome, but if somebody has been able to leave a situation in a way that's a bit more dignified, I think that is still a success because it cuts ties and allows them to then move forward. And that could be looking for different work or it could be filling time with hobbies and voluntary work or other things like that, that are positive for that person.

[00:11:08] Ashwini Kamath:

And I guess the benefit of your input there as well is that that exit wouldn't come as a shock, it would be very much a managed process again with potentially the input of other therapists in the mix to help support that person with those decisions. But, um, yeah, as you say, if it's the right outcome overall, then it's not a failure, it's just, it's a different direction.

[00:11:32] Suzanne Guest:

Yeah, I think this is one of the things that we often look at the cognitive side around brain injury but we sometimes miss out on the social issues that potentially, and I think people, employers are actually really happy to support around diaries, but if somebody is quite disinhibited, that can be really quite problematic within a workplace.

So one of the things that I often use if I'm doing any sort of training with people is a clip from the film Imitation Game. And I think this is how you know that your life is just got really, really sad, when you sit in the cinema and you're watching a film, and you think that's going to be great for training.

And it's a bit in, in fact, it is on YouTube, so you'll be able to link it in the description, but there is a bit where Alan Turing, who, you know, amazing guy who helped develop the Enigma machine, but was, you know, socially quite awkward. And one of his colleagues says, ‘Oh, we're going for lunch’, and he carries on working and they say, ‘Alan, we're going for lunch’. He carries on working and they say, ‘Alan, do you want any lunch?’ And he's then this conversation just descends where he's saying, ‘Oh, what you're having for lunch?’ ‘Oh, I don't like sandwiches.’ And it's this whole conversation that they're just almost having two different conversations. And he said, ‘Look, you know, we've just asked you three times, do you want to come for lunch?’ And Alan Turing says, ‘No, you didn't. You said, I'm going for lunch.’

And it's that one of those things of just understanding that somebody with a brain injury might find those little subtle bits of conversation really challenging.

In my first job, I used to work in a brain injury rehab unit and Howard Jackson, who was my boss, used to say, say what you mean, mean what you say, and that is those silly little things of saying, I'm going for lunch rather than do you want to come for lunch is really important. And that's often where difficulties occur at work rather than just being the pure cognitive problems, which, you know, is around cognitive inflexibility, isn't it? That somebody wouldn't understand those things.

[00:13:46] Ashwini Kamath:

Yeah. And I think, yeah, it's interesting because I think the English language is full of examples, not that I can come up with another one to mind but we've got so many examples of things where you say one thing, but it has a completely different social meaning and by and large, people understand that. But when you take somebody who is now thinking in a very black and white, rigid way. I totally see that and that can then cause friction between people – unintentionally so. But, um, yeah, it becomes harder to manage and potentially I wonder whether that could then lead to isolation within the workplace as well.

[00:14:26] Suzanne Guest:

Yeah. So I think that, you know, you can see people will say, ‘Oh, we don't want to say things to him, he'll take it the wrong way.’

I always think the word fine is one of those things. Because fine can mean, yeah, fine. Or it can be fine. They mean very different things. You know, the second one, things aren't fine, but yeah, so those are, I think often the bigger problems and the cognitive problems that happen within, workplaces.

And it is just about getting somebody who, um, I worked with a woman, she was volunteering in a cafe and it was around… we called it ‘sandwichgate’, but there was issues because she'd learned how to make a sandwich and when you're working in a professional environment, they have their, they want their sandwiches to be consistent. So they were, the way they made sandwiches was quite, was slightly different to how she made a sandwich. And that created a big row because nobody'd actually talked to her about, okay, that's your sandwich and that's fine. But in this workplace, this is how we, you make our sandwiches and she felt like she was being attacked and they felt like she was being awkward and… so it can often be the tiniest of things, but if somebody doesn't understand that that person thinks in a really black and white way then, you know, it appears to be awkward and it's actually often anything but.

[00:15:50] Ashwini Kamath:

Yeah, yeah, and again, I suppose it's the importance of brain injury communication, brain injury education, sorry, but also someone just perhaps almost objective coming in and just taking that overarching view of, What's the process here? What's the missing link? Where is it falling down?

And it can be as simple as that sort of tiny chunk of communication that's missing. That's, yeah, it's very interesting and it makes you think how many situations could have been handled differently, how outcomes could have been very different if actually communication was improved. So I guess you are a communication facilitator as well.

[00:16:29] Suzanne Guest:

Yes, guru, I think maybe.

[00:16:32] Ashwini Kamath:

So thinking about, um, meaningful employment, meaningful activity, and also the idea that, you know, we've talked about how if you see a brain injury, you see a brain injury and people are impacted in different ways. So I think, Brooke’s mentioned in the past that, you know, there are certain hours of the day when he's more awake or, you know, and I also see this as well with certain clients, you know, that you just wouldn't do anything with them in the afternoon or if they've had, um, you know, if they've had a particularly gruelling psychology session or whatever it is, you know, something that might've taken a cognitive toll.

And then I suppose you look at that with what somebody's work expectations are or what, um, their employment requires of them. I guess you'd try and work out when is somebody functioning optimally and perhaps Brooke, you can talk to us about some of your experiences.

[00:17:25] Brooke Trotter:

First of all, something that I've discovered recently is cold showers. As brutal as it is on the morning, three minutes in the cold water really really does wonders for you.

[00:17:34] Suzanne Guest:

Wow, Wim Hof!

[00:17:35] Ashwini Kamath:

I know!

[00:17:37] Brooke Trotter:

That's what I tell myself I am when I'm shivering under the cold shower!

[00:17:43] Suzanne Guest:

You're tougher than me, Brooke!

[00:17:43] Brooke Trotter:

Generally, on the morning, um is the best time and I tend to fade towards the end of the day. But, um, you know to do anything in the late afternoon is generally, you're not getting much out of me.

So it's, I guess, trying to find the best ways you can be employed because I found that sometimes I can be good and I can be quite creative, but then other times I can be terrible and really affected by my brain injury and it's finding those best times and they're not always going to be like in, to fit in a work schedule.

So I think what I did this to start with, because I was just bored at home and I wasn't doing anything was I started writing and I taught myself to type. I had this, my dad bought me ages ago. It was a Mavis Beacon Teaches Typing. And I remembered that, and I downloaded it on the computer and I did that and I taught myself to touch type. And then I started writing silly things. I'm writing blogs down and putting them online and then people started liking them, and that was what I did for the start.

But I mean like, I’d do some writing then I'd just be exhausted and you know, come back to it finish it later, you know, it's like a couple of pages of work would take me, you know, a couple of days to do. And you just think you'd constantly be comparing yourself to people in like the professional you know, professional sphere, like, you know, how easy it must be for somebody to just sit and write, you know, professional person to sit and write that down – maybe half an hour, and it's taking me two days. And that of course has an impact on your self-esteem.

Then I guess I found this idea that I wanted to do public speaking. And the first thing I did was to Headway at Scarborough and I got, I think I, well, I don't know how many people came, like 30 people came or something like that, but it was… I remember when I'd done it, it was, it just felt really good that I'd actually done something and like the, it's the first time in years I'd actually contributed something and it felt really good and that's something I'd continued to do and I found that was suiting because at home there wasn't a rigid schedule that I had to stick to a plan this. I could plan it when I wanted. And then, you know, the delivery of the talk itself was only like… Well I did used to waffle on… It used to go for an hour and a half sometimes but it was about, you know, less than an hour. And I remember just, you know, coming back from that.

And I used to do it with the emergency services in North Yorkshire at the start. And coming away from that was… it just felt, it was really good that I'd contributed something and, um, you know, I hadn't put the amount of hours in, but I just thought, you know, I've, you know, I really have contributed something.

I've spoken to kids about the potential dangers of, you know, the potential consequences of driving without due care and attention. So, um, yeah, I did feel good about that.

[00:20:36] Suzanne Guest:

Yeah. And I just think, I'm listening to you talking, thinking, well, actually public speaking is one of the biggest fears that people have, so you’ve smashed that.

[00:20:44] Brooke Trotter:

That was, that was a reason for it really. It was just like, what can I do with my life? And I had this limited energy to work with. So what can I do with it?

[00:20:52] Suzanne Guest:

Yeah. And you know, you say, I know, it was only about an hour, but actually an hour of public speaking… That's actually really, and I noticed you were going only this, only that, but actually doing really…

[00:21:03] Ashwini Kamath:

Yeah, give yourself more credit and stuff.

[00:21:04] Suzanne Guest:

Yeah, I think sometimes listen to the way you talk to yourself.

[00:21:07] Brooke Trotter:

Which is something my psychologist has continually said to me.

[00:21:11] Suzanne Guest:

Be kinder to yourself. Yeah. But I think also interestingly, when you're saying about, you know, you're better in the morning than maybe the evening, that's when it is good to look at if people are going back to work, looking at the graded return.

So for some people, if they've got a lot of pain and maybe need to take painkillers and things like that, then an afternoon start or a bit of a later start might be better. If somebody has got a lot of anxiety, then if they start in the afternoon, they just spend all their morning dreading going to work.

So there is that actually trying to look at the times.

[00:21:45] Brooke Trotter:

And that itself can be exhausting, anxiety.

[00:21:50] Suzanne Guest:

And then, you know, sometimes work isn't, or paid work isn't always the right thing for somebody. So it could be that, you know you've got skills, you know you want to make a difference, but it could be that you do something… I mean, I have to say, Brooke, you've shown amazing initiative. The fact that you started a blog is really good and, you know, I think I just want to go and do some public speaking and then go carry it out.

[00:22:12] Ashwini Kamath:

And then I'll just run a marathon or two.

[00:22:14] Suzanne Guest:

Yeah, yeah.

But, you know, it could be that you find an outlet for yourself, or it could be that you join an organization. So some people would join different classes. It could be that they go salsa dancing or join choirs - I know you're very into choirs, aren't you, Ashwini?

Or it could be that some people go and find groups associated with their disability, like their local Headway group. Often, or most of the Headway, I think if not all of them have survivors of brain injury on the committee, so they can help run the group.

So there is different ways of contributing that isn't just paid employment. It's volunteering, it's going, having hobbies and interests, doing different things with family.

[00:22:54] Brooke Trotter:

On that salsa dancing thing, I've been recently trying, #trying, to learn Argentinian tango. No, no, no, you see me dancing Argentinian tango and you would not say wow!

But I've been going. Obviously, my girlfriend is from Ecuador, she speaks Spanish, so I'm trying to, you know, she was, we were at the Spanish Cervantes in, um, the Spanish Institute on Deansgate in Manchester, and there was like an open day. And there was a guy there doing, um, like tango demonstrations and I've been learning Spanish, but I just found it was, I got to a point where it was, I'd had like, I'd missed four lessons. I had two lessons a week, went on holiday and missed two. And then I come back, and I had COVID so I had to have another week off. So I missed four lessons and I just really struggled to get back to the class after that.

So I made a decision to have a bit of a break, but in that time, we decided to go to tango lessons. They were at half six at night and it was just, you know, people, I suppose people without brain injury, it was, you know, they were finishing work and it was a nice thing to do on an evening. But to me, there was like, my brain was exhausted trying to learn these steps and then you're like, you come the next week and you've forgotten it all, you know, going back to what we did last week. And it was just, yeah, I really sort of struggled with it.

So I wasn't quite strictly come dancing, but the guy did actually say to me, it was, um, he'd had some experience with brain injury and he said, uh, two of the best things to do for a brain injury is to A, learn a language and B, learn... well, he said tango, but I guess it's learn dances, learning the steps or something that's keeping your brain active. But I suppose it would be better if you had the lessons in the morning. Yeah.

[00:24:46] Ashwini Kamath:

How are the Spanish lessons going, incidentally?

[00:24:47] Brooke Trotter:

It was, um, because of that, I was struggling with it so I took a break. So I'm on a bit of a cycle from it, but I'll go back to it, yeah, I was enjoying it. It was just, I just missed too much out of the lessons and then you go back and then these people have learned things that you haven't learned, and it was yeah… I'm going to go back to it because I did enjoy it.

[00:25:06] Suzanne Guest:

Yeah, and I think that does go back to little and often whereas trying to pick up something on a weekly basis is really difficult. Whereas if you do shorter periods of regular activity it helps.

[00:25:18] Brooke Trotter:

Which is why I did the two lessons a week. So I was learning Tuesdays and Thursdays and it was, I was enjoying it until I got behind.

[00:25:25] Ashwini Kamath:

But I suppose it's also finding the balance between little and often to get that habit loading, but also not cognitively overload as well because yeah, it can be, I suppose it's trial and error in some ways, isn't it? Just finding what the right balance is for somebody.

Well, thank you, Suzanne, that's been really interesting. I think both of us have, uh, really got a lot out of that discussion, and I'm sure our listeners will have done too. And of course, we will put the links to the resources that we mentioned in the footnotes to the episode.

Suzanne, if you've got your social media contact details, by all means, please do…

[00:26:00] Suzanne Guest:

So I'm on the Twitter or X as it is these days, so it is Sue's guest, which is S-U-Z-G-U-E-S-T, and I'm also on Instagram, and TikTok and YouTube as ‘Have I got Suz for you’. So at the moment, my TikTok is full of my sourdough. I've made a sourdough starter and it is my entire personality right now!

[00:26:26] Ashwini Kamath:

I love the handle though – ‘Have I got Suz for you’. I think that's genius.

[00:26:33] Suzanne Guest:

And my website is workingmind.co.uk

[00:26:37] Ashwini Kamath:

Thank you. Thank you very much again for coming in and talking to us today.

Please don't forget to follow, subscribe and share our content. If you do have any suggestions for topics that you'd like us to cover, why not drop us a line at hi@braininjurybites.co.uk