Dysexecutive Problems and Interpersonal Relating Following Frontal Brain Injury: Reformulation and Compensation in Cognitive Analytic Therapy (CAT)

Common sequelae following frontal acquired brain injury include problems in maintaining relationships with significant others, and dysexecutive deficits (cognitive difficulties in initiation, planning, organizing, sequencing, and monitoring). The efficacy of psychotherapy interventions aimed at exploring psychosocial and relationship issues with these clients is in itself challenged by these problems: the therapeutic relationship is also subject to dysexecutive influences. A working clinical reformulation of relationship problems in the context of dysexecutive impairment is suggested. This is achieved via an integration of the supervisory attentional system neuropsychological model of Shallice and Burgess (1991, 1996) and a form of relationally focused brief psychotherapy, cognitive analytic therapy. The use of electronic alerting and other compensatory interventions is specified within this reformulation. Two case studies are presented for illustrative purposes, including one outcome evaluation using sta...