12 minutes
Awareness, and how to talk about it Learn what impaired self-awareness is, why it is not denial, and how to plan with a person who does not perceive the changes you are planning for.
What you’ll be able to do Explain impaired self-awareness as a neurological effect, and describe a planning approach that neither confronts the person with their deficits nor colludes with an inaccurate picture. Compare the responses to this question and explain your choice: What is the most useful approach? Document a next step for Awareness, and how to talk about it: For one person whose self-assessment differs from others', find a goal they hold and plan one supported experience toward it. Not denial Denial is a psychological response: a person who could perceive something painful and does not let themselves. Impaired self-awareness after brain injury is different. The neurological system that monitors one's own functioning has itself been affected, and the person genuinely does not perceive the change. They are not refusing to see it. They cannot see it, in the same way a person with a visual field loss cannot see the left side of the room and is not lying when they say nothing is there.
This distinction changes practice completely. If it were denial, evidence and gentle confrontation might work. Because it is not, evidence produces disagreement and confrontation produces distress. The person concludes that the people around them are wrong, or hostile, and the relationship that any plan depends on is damaged. The workable approach starts somewhere else.
Three approaches, and what each produces Confrontation Presenting evidence of deficits until the person accepts them. Produces: Argument, distress, and a person who now believes the team is against them. Insight does not arrive, because the mechanism that would receive it is what is affected.
Collusion Accepting the person's picture and planning as though it were accurate. Produces: A plan that fails, sometimes dangerously, and a person who experiences the failure without a team alongside them.
Anchoring on goals, learning through experience Starting from what the person wants, which is usually accurate, and building supported experiences toward it in which the person can discover what works and what does not, with the team staying alongside. Produces: Slower progress, an intact relationship, and awareness that arrives through experience rather than argument, where it can arrive at all.
Impaired awareness is not a shortage of evidence. Giving the person more of it does not help, and it costs the relationship.
Start from the goal, not the deficit What you can change You control whether a planning conversation opens with what the person cannot do or with what they want. The second is usually accurate and is the only starting point that keeps them in the room.
What to watch for Do not let the team's frustration turn into a campaign to make the person see. The campaign will fail and the person will leave.
Your next step Take one plan built around a person's deficits and rewrite its first page around their goals.
Carry this forward After brain injury, the part of the brain that monitors one's own functioning may itself be affected, so the person genuinely does not perceive changes that are obvious to others.
Confronting the person with evidence tends to produce distress and disagreement, not insight; colluding with their picture produces a plan that fails.
The workable approach anchors on the person's own goals, builds in experiences that let them discover what works, and keeps the relationship intact through the discovery.
An accordion on three approaches, a quote, a scenario decision and a knowledge check.
For one person whose self-assessment differs from others', find a goal they hold and plan one supported experience toward it.
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