1. The “Psychotherapy”-Part of Clinical Neuropsychology Tobias Gräßer Clinical Neuropsychologist (GNP) Systemic Therapist (IGST) Bonn, Germany Conference “Complex neurorehabilitation as the basis for reintegration into society and the labor market” „NEUROPSYCHOLOGY and SENSORS“ Praha, 27. - 28.9.2013

2. Neuropsychological Therapy in most cases is a combination of cognition-oriented therapy and psychotherapy concerning coping and adaption. Therapy aiming at improving or compensating changes in cognitive functioning necessarily influences the way a person views and lives his/her life. Basic assumptions on Therapy

3. Psychotherapeutic interventions have to be adapted to the needs and requirements of neurological patients. Basic assumptions on Therapy

4. Goals of Psychotherapy in Neurorehabilitation Coping with depression and anxiety Controlling emotions (crying) and/or behavioral impulses Adaption to impairments and related life changes Coping with Stress Awareness and motivation Coping with role changes Family coping

5. Psychotherapeutic Interventions in Neurorehabilitation Psychotherapy with neurological patients has to be adjusted to specific conditions a) cognitive functional – Memory deficits – Speech disorders – Executive dysfunctions –...

6. b) emotional – Self control – Control of emotions (aggression, crying) c) motivational – Awareness of deficit – Patient might not seek psychotherapeutic help intrinsically – Others (doctors, partners, relatives) consider psychotherapy more necessary than patient Psychotherapeutic Interventions in Neurorehabilitation

7. Cognitive-behavioral approaches, e.g. – Reinforcement strategies – Self observation of problem behavior – Activity Scheduling Milieu-Therapy Systemic Family Therapy...

8. Systemic Family Therapy Basic assumption: A severe neurological disease always affects not only the patient but his/her whole family system Partners / spouses Children Other significant persons Considering coping as a family task can offer psychotherapy options even if the patient does not see a need for individual psychotherapy.

9. Effects on Family Systems Changes in roles / functions the patient is holding (e.g. income, domains of power and influence, driving) Changes in roles / functions the partner / child / significant other is holding Changes in the way everyday life is designed Changes in future perspectives, plans, goals

10. Frequent Family Topics Support, protection, overprotection Power overthrow Excommunication of the patient Positive “side effects” of the disease (e.g. being spoiled, avoidance of uncomfortable activities) Ambivalent feelings towards disease and its consequences (that are not suitable, forbidden, cannot be expressed)

11. Frequent Family Topics Personality changes (being married to a stranger) Problem behavior (aggression, impulsiveness) Separation and divorce

12. Not every patient or family with a severe disorder does need psychotherapy or professional support. Aspects of time after acute phase: Importance of psychotherapeutic work frequently increases in later stages. Importance of contract: Any psychotherapeutic approach requires a demand by the patient or his/her family. Finally...

13. Thank you for your attention!