Exploring acquired brain injury (ABI) clients' experience of receiving cognitive behavioural therapy (CBT) delivered by trainees : a qualitative study

A recent systematic review suggests the effectiveness of Cognitive Behavioural Therapy (CBT) with brain injury client groups has been inconclusive and limited (Cattelani, Zettin & Zoccolotti, 2010). Although CBT has beneficial results in many specific psychiatric disorders, the rates of positive outcomes for managing psychological difficulties in the acquired brain injury (ABI) client group are still not satisfactory. Mixed or negative results have been reported in the existing literature (Cattelani, Zettin & Zoccolotti, 2010). Indeed, recent literature has highlighted a need to further develop existing CBT approaches for clients with ABI (Wilson, 2011), to assist practitioners in overcoming potential challenges caused by the complexities faced in this field. This qualitative study explores ABI clients’ experiences of CBT to provide better understanding of what may produce a greater therapeutic alliance and positive outcome. Six participants with ABI were interviewed in a semi-structured format about their experiences of CBT. Interpretative Phenomenological Analysis (IPA) was employed to develop an in-depth and coherent understanding of participants’ experiences. Three super-ordinate themes were identified namely, ‘Professional relationship’; ‘Understanding my struggles’; and ‘Acceptance’. Each super-ordinate theme was associated with three sub-themes. Findings of the present study highlight the essential elements for the effectiveness of CBT. These elements are the quality of the therapeutic relationship, the client’s willingness and readiness to engage in therapy, the adaptations needed in therapy to address the client’s limitations, and the need for a balanced focus between the behavioural and cognitive components employed in therapy. Furthermore, findings imply that process-based adaption is as important as technique-based adaption when delivering CBT to ABI clients, suggesting that the quality of therapeutic relationship and the process issues are both relevant to the therapeutic outcome