Recognition of mild traumatic brain injury among clinicians and potential effects on the psychotherapeutic process.

摘要

Traumatic brain injury (TBI) is a significant and prominent disability that affects millions of people every year, ranging widely in severity based on the existence or absence of certain symptoms. More specifically, concussions and other forms of mild TBI (mTBI) have the highest prevalence as they account for about 75% of all TBIs (CDC, 2003), with sequelae occurring in any of several areas of functioning (e.g., emotional, cognitive, relational, personality). Although impairments are likely to attenuate naturally to sub-clinical levels within three months post injury for a majority of individuals, some continue to demonstrate significant problems years after the injury (Hibbard et al., 2001). Sometimes referred to as the "silent epidemic," mTBI is likely to be present in many clients presenting for psychotherapeutic services but is not always explicitly related to the clinician, thereby creating a potential obstacle to successful treatment. The purpose of the current study was twofold. First, are clinicians able to effectively recognize and identify a client with possible mTBI when provided with symptoms alone without information about a specific traumatic event? Second, does evidence exist to suggest clinicians' style of clinical judgment has a significant influence upon what information is deemed salient and is therefore utilized in the conceptualization, diagnosis, and treatment of the client?;Forty-nine licensed clinicians were asked to read two separate vignettes of a fictional client presenting for services with several typical mTBI symptoms and asked to complete a related questionnaire about their resulting concerns and conceptualization of the client. Although data analyses did not support either hypothesis, there was evidence to suggest that the timing of when clinicians obtain relevant salient information may have an impact on whether it is utilized or even recognized. The data also suggested that clinicians may be engaging in specific types of more informal methods of clinical judgment. Results of the study are significant in that they highlight the importance of identifying salient client characteristics, assessing clients for neurological deficits, and how influential such information can be in the psychotherapeutic process and treatment outcome.