“Feeling part of things”: Personal construction of self after brain injury

Abstract

There is a growing body of literature on the nature of subjective changes experienced following brain injury. This study employs personal construct and qualitative research methods to address the question of how people make sense of, or construe, themselves after brain injury. Thirty-two individuals who had experienced acquired brain injury engaged in small group exercises based on a personal construct approach. Bipolar constructs were elicited through systematic comparison of pre-injury, current and ideal selves. The constructs elicited in this way were subjected to a thematic analysis. Nine themes were derived and an acceptable level of reliability of the definitions of these themes achieved. The highest proportion of constructs fell into the theme "experience of self in the world", followed by "basic skills" (cognitive, sensory, physical, social) and "experience of self in relation to self". It is concluded that following brain injury, people make sense of themselves in terms of the meanings and felt experiences of social and practical activity. This is consistent with social identity theory and stands in contrast to traditional neuropsychological sense making in terms of impairments and abilities alone, or activity or social participation alone. The implications of these findings for future research and rehabilitation are briefly considered.

“I’ve never been a yes person”: Decision-making participation and self-conceptualization after severe traumatic brain injury

“…[1,38,42] An individual's experiences of decision-making participation were deeply embedded in this process as decision-making participation and self-conceptualization interacted in a recursive manner. This finding aligns with Gracey et al's [39] contention that one of the central ways in which people understand themselves after TBI is via their subjective experience of activity. Through an ongoing process of engaging in decision making and evaluating the outcomes of those decisions, participants fashioned their self-concept.…”

“…[7,49,50] This experience may be directly related to injury-related impairments, including experience of "loss of connection between one's mind and body", [51] which negatively impact on an individual's sense of agency. [8,39,42,46] These findings point to the potential role of decision-making participation in providing a means to overcome the loss of autonomy described by adults with TBI.…”

“…[35] Self-conceptualization after TBI There is a growing body of literature investigating the self after TBI. [1,6,[36][37][38][39][40][41] Researchers have noted a lack of agreement relating to how the self is defined and conceptualized, including imprecise distinctions between a number of related terms and concepts (such as sense of self, self-identity, self-knowledge, and self-concept). [42] Despite this, literature within psychological and sociological fields generally describes two separate characterizations of self.…”

“…[1,38,46] A person's social environment and their interactions with others plays a crucial role within this context. [1,36,39] In particular, those in the person's support network may both provide feedback about injury-related impairments, and offer support and opportunities to manage these impairments.…”

The Case of "Judith": Reflections on Combining a Psychoneurological Perspective Within a Client-Centered and Pluralistic Therapy Framework

“…Although King suggests that the cognitive rehabilitation was the more significant ingredient, he does acknowledge that there is a role for client centered-therapy in helping people after head injury ask and adapt to fundamental questions about themselves (Gracey et al, 2008). However, he concludes that such an approach cannot be sufficient, and that neuro-psychotherapy (Prigatano, 1986) will generally be required.…”