ABSTRACT
Some sorts of neurological patients are especially difficult for the early career neuropsychologist to deal with in psychotherapy, notably those with executive dysfunction, and especially patients who are concrete in their thinking style. A patient, Mr J, is described, who worked as a truck driver, and had suffered a severe TBI after a car crash. On assessment, he performed very poorly on executive functions, showing many elements of concrete thinking. However, he presented as a pleasant man, always smiling and cooperative. Indeed, in therapy, he never brought a single complaint to a session. A chance encounter, while checking Mr J’s homework notebook, reveals information that changes the understanding of the case, and suggests a different form of clinical intervention.
