Training the Brain-Injured Client in Behavioral Self-Management Skills

Abstract

Treatments based on clinical experience are often developed initially from theoretical assumptions exemplifying the state of the art in related scientific fields. In an area where clinical treatment of behavioral disorders following brain injury may occur without reference to the incompletely understood complex of relationships among behavioral/affective, neurological, and neuropsychological processes involved, a clear statement of assumptions on which behavioral treatments of the brain-injured are based is important. A behavior therapist, for instance, may recommend treatment for a brain-injured client based on the assumption that deviant behavior is learned and can be unlearned, but may fail to assess the effects of brain injury on the client’s learning abilities. A psychiatrist may recommend psychopharmacotherapy indicated by the presence of psychoticlike symptoms while failing to appreciate the way in which brain injury may have altered the neurochemical substrate on which therapeutic chemicals are layered. A rehabilitation counselor may fail to recognize a brain-injured client’s inability to perceive body schema and to function accurately and may thus incorrectly assume that, as for a spinal cord-injured person or an amputee, the brain-injured patient’s emotional lability is in reaction to perceived loss of physical abilities.