Self-Identity after Brain Injury by Tamara Ownsworth

Author:Tamara Ownsworth
Language: eng
Format: epub
ISBN: 9781317820185
Publisher: Psychology Press

A case illustration: Craig

Craig was a 37-year-old man who sustained a right thalamic stroke four years prior. His main goals in community-based rehabilitation were to return to full-time work in his former vocation as an accountant and to increase his independence from his parents’ support. Craig displayed a lack of awareness of his cognitive deficits (e.g., reduced processing speed, visuo-spatial and executive function impairments) and experienced regular periods of depression. Psychoeducation and feedback were identified as important components of a 12-session vocational rehabilitation intervention to increase his self-awareness, self-monitoring and use of compensatory strategies in daily living. Due to concerns about his emotional state and the possible negative impact of feedback, a bi-directional feedback approach was employed throughout the intervention. Specifically, the therapist provided feedback on Craig’s performance during the session, while Craig’s perspective on the value of different therapy exercises was sought during a 10–15 minute post-session debriefing (see Ownsworth, Turpin et al., 2008). This debriefing supported Craig to process the meaning of feedback he received and also helped the therapist to monitor the psychological impact of the intervention.

Craig’s feedback indicated that he found psychoeducation about brain functioning and stroke ‘very interesting’. However, asking him questions about the long-term effects of his stroke was not beneficial because this focus on his problems made him feel like ‘a second class citizen’. In a self-estimation task he found it difficult to rate his cognitive abilities, because there was no ‘benchmark’ to compare himself against. During a role-reversal exercise the therapist overestimated her performance on cognitive tasks (e.g., list learning and line bisection) and Craig provided feedback on the accuracy of her self-estimation. After switching roles, Craig recognised the benefits of receiving immediate feedback on his performance, as follows: ‘I think it’s important to get it [feedback] early because you’ve got to know how you are measuring up against their standard … but it needs to be accurate feedback’ (Ownsworth, Turpin et al., 2008, p. 703).

Craig received audiovisual and verbal feedback on his performance on real-life tasks (i.e., cooking, planning weekly activities and a work trial), and became increasingly more accurate at predicting and evaluating his own performance. Later sessions focused on Craig identifying both easy and difficult components of tasks and developing management strategies. He also received counselling to enhance his understanding of how cognitive deficits influenced the type of work he could achieve. After the final session, a work trial observation, Craig identified that the programme helped him to better understand his ‘strengths and downfalls’ and become ‘realistic about the type of work you want to do’ (p. 705). His modified goal was to work 2–3 days a week, 6 hours per day in one of a number of possible employment areas. Three weeks after the intervention Craig achieved part-time work (15 hours per week) as a retail assistant and maintained this position at long-term follow-up (6 and 9 months).

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