We know that a significant number of people with a TBI have PTSD / trauma. The essence of treating PTSD is equipping the person with skills, supporting them in confronting the original threat and reducing avoidance. What is not recognised so much are the embedded and ongoing activating 'threats' presented by a TBI (cognition, employment, family, social and financially) and the case itself (assessment interviews requiring re-telling the story, adversarial experts, confronting impairment etc.). The 'threats' must be dynamically addressed before exposure and behavioural change can be sustained. In interview, dissociation can be mistaken for an absence of distress. All this takes time, and does not fit with 8-10 sessions of TFCBT or EMDR, the NICE suggestion for a 'simple' trauma treatment programme! Hopefully, medico-legal experts on both sides of cases can become better informed regarding the complexity and challenge in treating these clients.
Dr David Quinn
Clinical Neuropsychologist
Halliday Quinn Limited, Apr 25 2019