Providing Psychotherapy to People with Neuropsychological Impairment: Complexities and Issues Raised by the Case of "Judith"

Abstract

Ward and Hogan (2015) present a case study of ''Judith'' where a combination of client-centered psychotherapy, cognitive rehabilitation and social support result in very positive outcomes despite neuropsychological impairments being present and these posing challenges to the intervention. The case study highlights a number of very important issues when providing psychotherapy to clients with cognitive impairments. These include: 1) the common requirement that issues of self identity are explored; 2) the common need for adaptations to be made to the delivery of psychotherapy to mitigate against the effects of cognitive impairments on psychological interventions; 3) the need for specialist neuropsychological rehabilitation services to be available to such clients in the long-term and for specialist neuropsychological supervision to be available to clinicians working psychotherapeutically in this area; and 4) the demonstration that emotional growth and positive psychotherapeutic results are possible even when neuropsychological challenges are present. The extent to which these important issues are fully demonstrated by the case of Judith is limited in three main ways: a) there being some lack of clarity regarding the severity of the head injury sustained; b) there being a lack of psychometric data to confirm the type and severity of the cognitive impairments present; and c) there being some ambiguity regarding the relative contribution of organic and psychological factors to Judith's neuropsychological problems.

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

“…Finally, we consider what the overall contribution of Judith's case study might be. We conclude by agreeing with King (2015) that, because cases like Judith's can derive great benefit from therapy, considerably more resources should be available for clients like her. …”

“…This leads King (2015) to question whether Judith should be considered as similar to an earlier case report (King, 2002). In relation to this, we would put forward the following observations.…”

“…In relation to this, we would put forward the following observations. First of all, as noted by King (2015), it appears there was a considerable period of anterograde amnesia. This suggests a moderate-to-severe injury.…”

“…We appreciate the interesting, wide-ranging, and thoughtful commentaries on our case of Judith by King (2015), Hyer and Brandon (2015), and Webb (2015), and we welcome the opportunity to respond. As a start, we note that all three commentaries identify positive features of the work with Judith.…”

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ABSTRACTIn this article, we respond to three commentaries by King (2015), Hyer and Brandon (2015), and Webb (2015) concerning our case study of Judith (Ward and Hogan, 2015). We organize our response in terms of five themes.

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