Pamela Klonoff, PhD, is a neuropsychologist who has worked as a clinician and researcher with several of the leading neuropsychologists over the last 30 years. In this thorough and educational volume, Dr Klonoff elaborates and details effective psychological treatment for an individual with brain injury that can encompass all or many of these interventions and strategies. The author clearly states in her introduction and first few chapters that the ideal setting for such broad and deep interventions is in a team-driven neurorehabilitation program.
Dr Klonoff's model for interventions, her case studies, and her detailed explanations of interventions are well written and thought out. Very early in the book, she describes the bases of her model:
Further, she indicates that her focus in this book is on “the postacute phase of the patients' neurological recovery” (Klonoff, 2010, p. 2).
“Psychotherapy after brain injury” can be defined as the collaborative working relationship between a psychotherapist and a brain injured patient, with the goals of increasing the patient's awareness of, acceptance of and realism about his or her predicament. At the same time the psychotherapist educates and supports the patient's family and community connections, so as to facilitate the patient's renewed sense of identity, hope and meaning. (Klonoff, 2010, p. 2)
What Dr Klonoff essentially lays out in this book is an in-depth and evolved version of the comprehensive model of neurorehabilitation that began to flourish in the late 1980s and 1990s, and which became the ideal for such treatment in that time frame under the expert guidance of such famed clinicians as Ben-Yishay, Cicerone, Kay, Mateer, and Sohlberg and one of the author's mentors, George Prigatano. Dr Klonoff became the clinical director of such a program, the Center for Transitional NeuroRehabilitation at Barrow Neurological Institute. She uses the case study format effectively, using vignettes to illustrate the therapeutic process when it is affected not just by the wide array of “typical” psychotherapy issues, but also by problems related to brain injuries, such as compromised awareness, behavioral regulation, and communication skills.
Other case vignettes illustrate the significant overlap (especially in the outpatient neurorehabilitation setting) of psychotherapy services with patient education, group, and individual treatment. For example, an awareness group which uses screening of “the Karate Kid” as a vehicle for work not just on psychological adjustment but memory, social judgment, and analytic thinking skills (Klonoff, 2010, pp. 72–73).
Dr Klonoff also emphasizes specific concerns related to the cognitive issues confronting brain-injured patients. As well, she correctly emphasizes the therapist's need to consider, during the therapy process, the patient's cognitive impairments—for example, not to expect the patient with a memory disorder to carry over information or emotional content from session to session without strategy use—and the implications of such an impairment on the process of psychotherapy. In such a situation, the use of written strategies, including summary writing of the sessions, might be necessary. How to help develop or increase awareness of the brain-injured patient is another crucial issue handled deftly in this book.
As a clinical neuropsychologist who spent the first 21 years of his career working in a setting similar to the one Klonoff describes (at the Center for Head Injuries at JFK Johnson Rehabilitation Institute, Edison, NJ, USA), my experience of performing therapy, cognitive rehabilitation, and group and individual patient education echoes those Klonoff describes. As she details, it is an incredible setting in which to work, at its best, a vigorous synthesis of one's psychological training and therapy knowledge with equally important problems related to health, adjustment to chronic medical problems, and most dynamically, the plethora of cognitive impairments our patients face.
Perhaps, a shortcoming of this text is the absence of any guidance in adapting a comprehensive model to a non-integrated setting, in either a traditional outpatient rehabilitation center or a general private practice setting. A colleague of mine once brought my attention to the concept of “Neuropsychotherapy,” which has had several uses in the field, but may be best explained by Dr Tedd Judd (Judd, 1999) as the adaptation of psychotherapy to address the emotional and behavioral problems of individuals with brain disabilities (Judd, personal communication, March 3, 2011). In the private practice and traditional outpatient settings, where I have worked since leaving an integrated rehabilitation program, it is not possible (without working unfunded) to play as many roles as the psychologist/neuropsychologist can in Dr Klonoff's model. Perhaps, the next book on the practice of clinical neuropsychology can illuminate the challenges in these settings.
As well, it is our challenge, as clinicians, to help our patients, their families, and the community at large, to understand the complexity and challenge they are facing. Teaching opportunities to raise the public's awareness have recently emerged through the brain injuries suffered by our military men and women, athletes, and specifically by public figures such as Bob Woodruff, the ABC News reporter injured while covering the war in Iraq, and most recently, Congresswoman Gabrielle Giffords, who sustained a traumatic brain injury when shot at an informal meeting session with her constituents in Arizona.
Dr Klonoff's book capably prepares us for such challenges in the treatment venue and in the community, and she has laid out a thorough, knowledgeable, and informative blueprint for integration of Neuropsychotherapy in the cognitive rehabilitation setting. It is a valuable resource for the clinical neuropsychologist, psychologist, or other clinicians providing treatment with the brain-injured population.