ABSTRACT
Many brain injured people who require post-acute social rehabilitation present changes in personality that alter their behaviour and affect their capacity for meaningful social relationships. This is particularly evident after traumatic brain injury because of the vulnerability of the frontal lobes and their role in selfawareness (see Chapter 1). Whilst usually only too apparent to relatives and friends, these changes often appear to remain beyond the client’s own awareness (Oddy, Coughlan, Tyerman, & Jenkins, 1985; Prigatano, Altman, & O’Brien, 1990). Deficits in awareness can be as frustrating to carers and relatives as the original behavioural excesses themselves, not least because they can represent an impenetrable barrier to therapy. When clients do not acknowledge the existence of a problem they understandably see no need to alter their behaviour or their perception of life. Thus attempts at engagement in rehabilitation often lead to confrontation, resistance, and rejection. This chapter discusses cognitive therapy and its possible dual role with this client group; first, increasing clients’ motivation to engage in the rehabilitation effort, and second, helping to establish enduring behaviour change.
