Psychotherapy Can Help Traumatic Brain Injury Patients. (Unconventional Wisdom)

By Mulcahy, Nicholas | Clinical Psychiatry News, March 2003 | Go to article overview

Psychotherapy Can Help Traumatic Brain Injury Patients. (Unconventional Wisdom)


Mulcahy, Nicholas, Clinical Psychiatry News


NEW YORK -- Psychotherapy can be effective in the treatment of patients with traumatic brain injury even in the case of substantial organic damage to the brain, Michael Harvey Psy.D., said at a symposium on traumatic brain injury sponsored by Fordham University.

"Rehabilitation of the [traumatic brain injury] patient can and should include psychotherapy because patients have a range of emotional reactions to trauma, which, if untreated, impair optimal recovery," he said.

This belief in the necessity and efficacy of counseling traumatic brain injury (TBI) patients is contrary to the conventional wisdom about TBI patients, Dr. Harvey said.

"Because TBI patients have brain damage and a diminishment of their intellectual capacities, their feelings are viewed as largely irrelevant," he said.

Nonetheless, the emotional and defensive reactions to TBI range from pain, anger, and frustration to loss, mourning, and depression, he added.

"In my experience, the ability of a patient to address their emotional reaction to TRI strongly correlates to their ability to make progress in rehabilitation," said Dr. Harvey, who is clinical director at Mountain Regional Services Inc., Cheyenne, Wyo.

Dr. Harvey told the story of "Kevin," a 24-year-old medical student who experienced a severe TBI in an automobile accident.

His TBI was complicated by a massive loss of blood from a ruptured spleen and intercranial pressure that exceeded 40 mm and required a drug-induced deepening of coma.

He was eventually declared brain dead, and his parents were asked to agree to organ donation, which they refused.

After a long course of hospitalization, Kevin stabilized, and MRI showed bilateral damage to temp oral-parietal areas and the orbital frontal cortex, and clear evidence of shearing, he said.

"When I first started counseling Kevin and his family 18 months after the accident, he had largely recovered physically from the accident but exhibited symptoms such as immature behavior, disinhibition, overfamiliarity with strangers, low frustration tolerance, grandiosity, and hypomania. …

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