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This paper describes how a psychodynamic input is currently being introduced to an NHS Neurological Rehabilitation Unit, to work alongside the established neurological and physical treatments, which make up the main focus of rehabilitation treatment. Flexibility of the therapeutic frame in certain respects is advocated in order for the work to become possible and meaningful in the context of daily life on the Unit.
The author draws on research and clinical work by writers and clinicians in the fields of neuropsychology, neuro-psychoanalysis and psychotherapy, who address the complex nature of working with patients who have neuropsychological impairment.
Extracts from the writer's clinical work with a young man with right hemisphere acquired brain-injury is presented and discussed. The effect of brain-injury on his internal world is explored, together with narcissistic defence structures with which he protects himself against unbearable loss. The writer's thoughts about the effects and outcomes of the work are presented in the context of severe residual physical and cognitive impairment with which the patient continues to live at the end of 2.5 years of psychodynamic work. It concludes with a statement on how the patient's cognitive deficits have not contraindicated his suitability for such work, and assesses the gains he has achieved.