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Joseph Palombo, LICSW, a practicing psychotherapist, has written a dynamic and comprehensive book on treating patients with self-deficits resulting from neuropsychological disorders. He discusses the complexities of treating these patients, and their families, integrating neuroscience, developmental, attachment, and psychoanalytic theories into his discussion.
Neuropsychological deficits may stem from impairments in functional areas of the brain, which may be neurodevelopmental, neurocognitive, or be due to traumatic brain injuries and other brain disorders. Innate deficits include “learning disorders such as dyslexia, attention-deficit/hyperactivity disorder, executive function disorders, and nonverbal learning disabilities” (p. 3). In addition, “deficits may result from trauma, emotional deprivation, or social conditions” (p. x).
Some patients might develop deficits later in life, resulting from physical problems such as “brain tumors, traumatic brain injuries, or histories of posttraumatic stress disorders” (Van Der Kolk, 2014). Neuropsychological impairments often diminish patients’ capacity to accommodate successfully to their social environments.
There are some commentators who find the term self-deficits objectionable because it “label(s) the person rather than the condition” (p. xiv). Disagreeing, Palombo argues that in labeling the self-deficit as a disorder, “we identify for patients the neuropsychological sources of their difficulties, which provide(s) them with an understanding of the reasons for some of their dysfunctional feelings, thoughts, and behaviors” (p. xiv). This allows these disturbing deficits to be out in the open, where they can be discussed, normalized, and remediated with patients, their therapists, and families.
Patients are generally upset about the limitations imposed on their lives by their self-deficits, and may also find themselves criticized or bullied by others for being “different”; at times they may inadvertently act in ways that su