Psychotherapy in Acquired Brain Injury (ABI) – part 2
We continue with the second part of the article on acquired brain injury. Although it can be read independently, this is the second part of the article Psychotherapy in Acquired Brain Injury (ABI) – part 1.
Each case of acquired brain injury is unique
In the first part of this previously published article, we discussed the importance of intervening not only at a neuropsychological level but also at a psychological level in cases of people with Acquired Brain Injury (ABI), since the usual symptomatology of sudden neurological lesions often includes certain psychological and behavioral symptoms that significantly interfere with the person’s well-being.
We also saw that, although often necessary due to the symptomatology, it is not always possible to carry out this type of intervention directly with the person, since cognitive deficits and a total or partial lack of awareness of the problem often significantly reduce the real possibilities of applying this type of intervention or at least of obtaining real and functional benefits without causing other types of problems in its place or in addition to those already present.
Therefore, we talked about the importance of taking into account the person’s most direct social environment, which in these cases – when the person has left the hospital environment and is in the “back home” phase – are usually caregivers (close family members or professional support assistants).
However, it is necessary to carry out a precise assessment of the case, considering it unique and, therefore, addressing both the psychological needs of the person with brain injury and the demands and needs of their environment. In summary, the psychological intervention process in neuropsychosocial rehabilitation must contemplate these two lines of intervention in its most basic scheme: patient and family or professional caregivers, if any.
Basic intervention scheme for people with ABI
Following this basic scheme, first, we must define the possibilities of intervening directly with the person with acquired brain injury. Here we must decide if it is possible to initiate a psychotherapeutic process that offers them the possibility of emotional release and readaptation to the abrupt change that acquired brain injury entails in their daily life. If the person cannot benefit from such a space (for reasons we already discussed in the first part of this article), it might be more interesting to direct our efforts to analyze with their environment what actions can be taken to reduce the emotional symptoms they present, how they can be helped to increase and reinforce positive experiences in their daily life if the person is immersed in a low mood. Similarly, if we want to reduce or try to eliminate certain problematic behaviors but the person has low or no awareness of their problems, or presents cognitive deficits in reasoning, memory, comprehension (…) that do not allow direct therapy with them, it would also be interesting to concentrate efforts on performing a good functional analysis of said problem behavior with their environment, teaching family members or caregivers to do it on their own as part of the psychoeducation process in which we must offer resources so that the direct social environment is capable of solving certain problematic situations that occur or may occur in the future on their own. By identifying the stimulus or sequence of actions that causes a problem, it is easier to establish guidelines and strategies to prevent it. In some cases, for example, redirecting the person’s attention may be enough to immediately eliminate a specific problem; however, in other cases, it may be necessary to modify the physical environment by eliminating specific stimuli or correcting certain behaviors of their close people in specific situations that could be maintaining or exacerbating a problem.
When we propose psychological care in the context of a rehabilitation process, it may be interesting to distinguish between carrying out a continuous therapeutic process, such as addressing a grieving process aimed at helping the person accept their situation and adopt an active role in their rehabilitation process, or carrying out specific interventions to provide emotional support at certain times or in certain situations, or trying to eliminate certain dysfunctional behaviors. Once again, the individualized study of the case, addressing the demands not only of the person but also of their family system, must guide us to take one path or another, always in a flexible manner.
Facilitating readaptation to the new reality
Ultimately, the techniques and approaches of clinical psychology are many and varied, and we can use many of them to carry out an intervention in the field of neuropsychology, but adapting them to the needs and characteristics of the neuropsychosocial profile of each case. What is important, more than the method or the approach itself, is its potential clinical utility in that specific case. The objective: to facilitate the process of readaptation and social and community reintegration.
When ABI evolves favorably
In cases where the person evolves favorably and gradually gains functional capacity and autonomy in their daily life, it is necessary to offer support and guidance, especially focused on establishing realistic life goals that serve as motivation to continue evolving and to feel useful and self-fulfilled. In these cases, accompaniment, not only at the moment of setting goals but also during the process of achieving them, becomes a fundamental pillar for overcoming emerging difficulties, readapting goals if necessary, establishing different problem-solving and coping strategies, or anticipating difficulties.