Psychotherapy of the Brain-Injured Patient: Reclaiming the Shattered Self (Norton Professional Book)

A brain injury attacks not only one's functioning but also one's very sense of self. The individual may be unable to remember familiar faces or the names of common objects; attempting to perform simple tasks may result in frustration and angry outbursts. Even trying to read a few printed words or to "get" the humor in a television sitcom will lead to a painful awareness of lost abilities. Quite literally, the brain-injured patient's self has been shattered. In this book, Laurence Miller presents a comprehensive and compassionate approach to working with people suffering from brain injuries. Seeing brain injury as a devastating blow to the self, he proposes that the function of a rehabilitation program is to facilitate recovery of this "shattered self" through an individually tailored treatment plan, which may include physical and cognitive therapy, individual psychotherapy, alcohol counseling, or marital and family therapy. This book gives psychotherapists whose practices may include patients with traumatic brain injury and related neurobehavioral syndromes (such as strokes or brain tumors) both a theoretical rationale and a practical clinical guide to doing psychotherapy. Here, practitioners will find an integration and summary of the diverse literatures, tying together neuropsychology, personality, and psychotherapy. Each chapter comprehensively reviews the complex neuropsychodynamic and biopsychosocial factors surrounding a particular clinical issue before recommending guidelines for effective therapeutic change. Miller deals with such traditional aspects of individual psychotherapy as support, interpretation, insight, behavioral change, and the therapeutic relationship. But he goesfurther to provide in-depth coverage of the special problems and issues that may arise in treating brain-injured patients, including aggression and impulsivity, alcohol and drug abuse, chronic pain and somatization, sex and relationships, vocational and forensic issues, and the role of the family and significant others. Perhaps the most important message that a practitioner can take from this book is the advice to educate patients about their injuries. Brain-injured patients are often cognitively and emotionally overwhelmed; in many cases, their anxiety will be ameliorated by information about the nature of their injury and what they can expect, cognitively, emotionally, and physically. Treating brain injury is a difficult specialty, where progress and improvement are often slow. This book balances a realistic view of recovery potential with a respect for patients' dignity and an optimistic outlook regarding future advances in brain injury treatment.

Laurence Miller, Ph.D., is in a private practice in neuropsychology, behavioral medicine, and psychotherapy in Boca Raton, Florida. He is Clinical Director of the Palm Beach County Critical Incident Stress Debriefing Team, and a member of the National Brain Injury Foundation, the International Critical Incident Stress Foundation, and the Florida Network of Victim Witness Services. He is on the adjunct faculty of Florida Atlantic University and is a frequent commentator on radio and television programs around the country.