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The Disordered Life and the Need for Psychotherapy

Posted Nov 04 2009 10:04pm

At Get Real Results, an organization dedicated to helping folks with disabilities, there is a list of Ten Myths of Head Injury Recovery. Here’s

Myth #8: The Disordered Life and the Need for Psychotherapy

Many people who enter traditional psychodynamic psychotherapy do so because they are dissatisfied with their lives. Their dissatisfaction may be due to being unsure of themselves, goals that are not clear, inability to accomplish what they want, unsatisfying relationships, anger or fear, or they are depressed. Psychotherapy offers them a chance to explore their feelings and past, uncover and resolve the conflicts that interfere with their lives, vent their frustrations, and get on with their lives. Unfortunately, although many head injured persons fit the above description and thus get sent into traditional analytic or psychodynamic therapy — they 0ften get worse, not better, to everyone’s dismay. This happens because the disorder in their lives reflects not primarily underlying psychological conflicts, but the damage to their brains that has resulted in cognitive and executive dysfunctions. Their lives are disordered because their brains are disordered.“Talking things out” does not solve the problem and may worsen it. This is because traditional therapy removes structure and encourages the spontaneous expression of whatever thoughts and feelings seem most important. Such a process is guaranteed to lead to further disorganization and confusion in a person whose major problem is structuring and organizing the thinking processes, while trying to keep surges of emotion from washing everything away entirely. When individual “therapy” is a successful adjunct to a rehabilitation program, it is a structuring, supportive, problem-solving approach. This does not mean that head injured persons cannot have mild or severe psychological problems that either result directly from, or exist (usually existed) separately from the results of their injury. They can, and often do. It does mean, however, that the traditional psychodynamic approach seldom offers the head-injured person relief from their disordered life. The psychotherapist who specializes in brain injury must have an appreciation of the impact of brain damage on the patient’s capacity to benefit from the process of therapy. Rehabilitation professionals should seek out such specialists if their clients require psychotherapy.

This is absolutely brilliant. I had an inkling that this might have been the case, when I first started to realize the extent of my MTBI-related issues. A part of me wanted to seek out a different therapist who specialized in TBI — or at least knew about it — but I also didn’t want to lose the company of the therapist I’d been seeing before. They were very kind and accepting, and in retrospect, our sessions were more like getting together to chat with a friend, than doing therapy.

I needed it, at the time. I’ve been quite alone for a long, long time, and this was the first place I ever felt comfortable talking about lots of things I’ve never discussed with anyone. Those sessions helped me learn how to talk to another person, how to have give-and-take conversations with someone I wasn’t married to or working with. But it wasn’t really therapy, and in fact, I think my logistical, day-to-day life progress has been limited by the emotional upheavals that those sessions put in play.

My old therapist was very keen on getting me to feel my feelings… but lots of those feelings have apparently not developed normally the way others’ have throughout my life, nor did I experience them as all the non-TBI-survivors around me said I “should”. My brain is different, my life experience has been different, my childhood development was different, and my emotional landscape is non-standard. None of that was factored in, in those old therapy sessions, and I think I actually may have suffered setbacks as a result.

Now, with my new therapist, I’m taking a much more pointed approach, and I think it’s going to be very productive. I need to focus on logistics — and steer clear of the counter-productive, over-emotional approach I tend to take.

New day, new therapist, new agenda.

All good.

At Get Real Results, an organization dedicated to helping folks with disabilities, there is a list of Ten Myths of Head Injury Recovery. Here’s

Myth #8: The Disordered Life and the Need for Psychotherapy

Many people who enter traditional psychodynamic psychotherapy do so because they are dissatisfied with their lives. Their dissatisfaction may be due to being unsure of themselves, goals that are not clear, inability to accomplish what they want, unsatisfying relationships, anger or fear, or they are depressed. Psychotherapy offers them a chance to explore their feelings and past, uncover and resolve the conflicts that interfere with their lives, vent their frustrations, and get on with their lives. Unfortunately, although many head injured persons fit the above description and thus get sent into traditional analytic or psychodynamic therapy — they 0ften get worse, not better, to everyone’s dismay. This happens because the disorder in their lives reflects not primarily underlying psychological conflicts, but the damage to their brains that has resulted in cognitive and executive dysfunctions. Their lives are disordered because their brains are disordered.“Talking things out” does not solve the problem and may worsen it. This is because traditional therapy removes structure and encourages the spontaneous expression of whatever thoughts and feelings seem most important. Such a process is guaranteed to lead to further disorganization and confusion in a person whose major problem is structuring and organizing the thinking processes, while trying to keep surges of emotion from washing everything away entirely. When individual “therapy” is a successful adjunct to a rehabilitation program, it is a structuring, supportive, problem-solving approach. This does not mean that head injured persons cannot have mild or severe psychological problems that either result directly from, or exist (usually existed) separately from the results of their injury. They can, and often do. It does mean, however, that the traditional psychodynamic approach seldom offers the head-injured person relief from their disordered life. The psychotherapist who specializes in brain injury must have an appreciation of the impact of brain damage on the patient’s capacity to benefit from the process of therapy. Rehabilitation professionals should seek out such specialists if their clients require psychotherapy.

This is absolutely brilliant. I had an inkling that this might have been the case, when I first started to realize the extent of my MTBI-related issues. A part of me wanted to seek out a different therapist who specialized in TBI — or at least knew about it — but I also didn’t want to lose the company of the therapist I’d been seeing before. They were very kind and accepting, and in retrospect, our sessions were more like getting together to chat with a friend, than doing therapy.

I needed it, at the time. I’ve been quite alone for a long, long time, and this was the first place I ever felt comfortable talking about lots of things I’ve never discussed with anyone. Those sessions helped me learn how to talk to another person, how to have give-and-take conversations with someone I wasn’t married to or working with. But it wasn’t really therapy, and in fact, I think my logistical, day-to-day life progress has been limited by the emotional upheavals that those sessions put in play.

My old therapist was very keen on getting me to feel my feelings… but lots of those feelings have apparently not developed normally the way others’ have throughout my life, nor did I experience them as all the non-TBI-survivors around me said I “should”. My brain is different, my life experience has been different, my childhood development was different, and my emotional landscape is non-standard. None of that was factored in, in those old therapy sessions, and I think I actually may have suffered setbacks as a result.

Now, with my new therapist, I’m taking a much more pointed approach, and I think it’s going to be very productive. I need to focus on logistics — and steer clear of the counter-productive, over-emotional approach I tend to take.

New day, new therapist, new agenda.

All good.

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