Psychotherapy for Families After Brain Injury

In Psychotherapy for Families after Brain Injury, Dr. Klonoff takes her readers on a journey from the acute, immediate post-injury phase all the way to end-of-life. This approach sounds comprehensive, and indeed the text itself is an impressive reference. The initial introduction and overview in Chapter 1 presents readers with a foundation of the various theoretical frameworks and format that may be applied to survivors of brain injury and their families. Using the author’s own Family Experiential Model allows a great deal of insight into the family’s experience (from both individual and collective viewpoints) throughout the recovery process and beyond. Chapter 2 highlights important content to be covered during the initial therapeutic consultation and ensuing early sessions. Pertinent emotional and social themes of which providers should be aware and/or address are also included, such as caregiver burden, identity and social role adjustments, demoralization, expectations, loss/grief, guilt, anger, and others. This is also a practically important chapter, as it includes not only sample verbiage (i.e., an explanation of the role of family in holistic treatment, family mantras) but also template materials (i.e., deficit rating scale, welcome letter to explain a treatment program). Chapter 3 carefully reviews the social network from a multi-tier and developmental perspective, covering all potential relationship scenarios including spouse with injury, sibling with injury, parent/child with injury, parent/ adolescent with injury, parent/adult child with injury, and adult child/parent with injury. Chapters four through eight cover family therapy from the perspective of specific brain injury populations, including post-concussive syndrome, moderate to severe brain injury, stroke and anoxic brain injury, brain tumor, and seizure disorders. The chapters pertaining to specific clinical syndromes are well-supported by current literature and are as empirically-based as one can expect for an area of psychology that is still very much a work in progress (i.e., rehabilitation and psychotherapy for person with brain injury and illness). The impact of neurological illness on family members is placed front and center, and the book outlines methods that providers can use to communicate complex concepts to families, including neuroanatomy, the meaningfulness of neuropsychological evaluation results, the role of education about one’s brain injury, recovery expectations, treatment needs, and advocacy efforts. These chapters also include detailed and comprehensive descriptions of typical sequelae for both the acute and post-acute stages, which may be especially helpful for individuals who are unfamiliar with the specific clinical manifestations of the neurological disorders reviewed. There are “helpful hints” sections in each chapter that are rather detailed tips for coping with various cognitive and behavioral impairments. Here one will find some real clinical gems, such as suggestions for dealing with behavioral issues and communication difficulties, a topic that has not been adequately addressed in other textbooks on this topic. For example, in the chapter on stroke and anoxic injuries one can find a list of assistive technologies available for aphasia. A central theme that is repeated is the importance of family members and caretakers caring for themselves, a message that is often overlooked by many medical professionals. There are well articulated case examples at the end of each chapter to illustrate the points contained within. If there is any distraction in this text, it is that much of the disease-specific chapters are written at such a basic level that neuropsychologists may find the information to be too elemental (e.g., basic functions of the various cortical lobes and understanding the normal curve), but non-neuropsychologists will be greatly aided by the comprehensive nature of the text. While the majority of the text refers to work with a single family unit, Chapter 9 is particularly helpful as it reviews work with family group intervention. As a practical measure, it includes tables that note example educational topics, guided exercises, and sample attendee verbalizations to aid the practitioner in assessing how the group is transitioning through the therapy process. Chapters 10 and 11 reviews group intervention formats. For example, Chapter 10 covers specific questions and issues regarding end-of-life and death of the injured individual. Chapter 11 presents an examination of family aftercare groups to assist with both practical and process issues in the long-term. Despite covering an array of content matter, the structure of each chapter lends cohesion to Psychotherapy