Guidebook for Psychologists: Working with Clients with Traumatic Brain Injury

Margaret A. Struchen, PhD, Lynne C. Davis, PhD, Stephen R. McCauley, PhD, and Allison N. Clark, PhD, TIRR Memorial Hermann
Guidebook for Psychologists: Working with Clients with Traumatic Brain Injury


Traumatic Brain Injury (TBI) is a pervasive public health problem in the United States, as well as worldwide. Given that the estimated incident of TBI is 1.4 million new injuries per year in the United States, with approximately 5.3 million individuals living with significant disability as a result of TBI, it is very likely that psychologists in the healthcare arena will encounter at least one client who has sustained a TBI in their work experience. Despite the high incident of TBI, information to help guide psychologists who may not have had specialized education or training regarding issues relevant to working with clients with TBI has not been readily available.

Specialized services are often available for those who experience TBI through trauma centers and neurosurgical intensive care unites in major medical hospitals, rehabilitation hospitals with specialized units for brain injury rehabilitation, outpatient comprehensive brain injury rehabilitation programs focused on community re-entry, transitional living centers for persons with brain injury, and community-based brain injury programs. Psychologists who are employed in or serve as consultants to these various settings will likely become “experts” in working with those with TBI. Training for such psychologists may happen “on the job,” and through inservices, seminars, and individual study.

While a subset of individuals affected by TBI will receive specialized brain injury care in one of the aforementioned settings, a great number of such individuals will receive their post-injury care in general medical settings, in a general rehabilitation unit with no special expertise in working with issues related to TBI, in primary care settings, and in social service settings. In these situations, psychologists encountering individuals with TBI will be less likely to have access to training or educational materials that may assist them in the care of those with TBI. This manual has been developed to help fill this gap, by serving as a resource to psychologists who encounter clients with traumatic brain injury in their clinical practice. The goal of this educational tool is to assist clinical and counseling psychologists to fell more comfortable and confident in their clinical interactions with clients with brain injury, to increase knowledge regarding TBI, to outline skills that are useful in working with clients with TBI, and to highlight resources that may be of use to clients with TBI and their family members. Ultimately, the aim of this training tool is to improve the overall quality of care that individuals with TBI receive in various healthcare settings.

In the initial sections of this manual, general information about TBI and clarification of some terminology are presented. The remainder of the manual will outline the likely reasons that clients with TBI might be referred to a psychologist for care, will address issues relevant to assessment for those with TBI, and will review issues relevant to the provision of interventions for such individuals.

Table of Contents


General Information; Brain Injury 101 – Traumatic Brain Injury FAQs

  • How does the brain become injured?
  • What is the difference between head injury and a TBI?
  • What is the difference between TBI and acquired brain injury?
  • To what extent is TBI a common health problem?
  • What does it mean to say a client has a mild, moderate, or severe TBI?
  • What is the typical recovery course after TBI?
  • What are common problems faced after TBI?

Reasons for Referral to Clinical or Counseling Psychologists

  • Post-concussive syndrome
  • Depression
  • Post-traumatic stress disorder and other anxiety disorders
  • Anger, agitation, aggression, and violence
  • Behavioral regulation
  • Lack of awareness
  • Sexuality, sexual functioning, and intimacy
  • Relationship issues
  • Alcohol and substance abuse/dependence
  • Family/caregiver distress

Assessment Issues

  • Identification of TBI
  • Obtaining relevant information from the medical record
  • Possible modifications needed in conducting assessments
  • The neuropsychological assessment
    • Why is it helpful to have the neuropsychologist’s report?
    • Understanding the terms and constructs
    • Common tools utilized
    • Referring clients for neurological testing
  • Understanding disability

Issues Related to Interventions

  • Making use of the neuropsychological report
    • Identifying client’s functional strengths and weaknesses
    • Common recommendations
  • Practical tips to assist your client with common TBI sequelae
  • Psychotherapy and clients with TBI
    • General modifications that may impact clinical interactions
    • Modification of clinical practice
    • ncorporating structure in your treatment approach
    • Enhancing commitment and addressing compliance
  • Cultural issues
  • Referrals/resources

Appendix I: Mild versus Moderate/Severe TBI

Appendix II: Neuroanatomical Correlates to common Referral Issues

Appendix III: Resources

Appendix IV: References

Go to complete manual

Posted on BrainLine March 3, 2011.

From TIRR Memorial Hermann. Used with permission.

Comments (2)

Please remember, we are not able to give medical or legal advice. If you have medical concerns, please consult your doctor. All posted comments are the views and opinions of the poster only.

As a TBI patient in my 3rd year of recovery, Thank you!!!  It was because of a friend of mine that I received my neuropsych eval and my psych therapy- she highly recommended and encouraged me to seek it (1 1/2 yr after the accident, we need more advocates like her!).  As I went through the table of contents, under "Reasons for Referral..." I mentally checked each of the sections: got it, had it, got it, got it,... This guidebook indubitably contains like valuable reading -now that I'm finally able to- to help me to understand what I'm experiencing!  THank you!!! -C

Wow. Thank you so much for making this whole guidebook available for free download! It was amazingly helpful. TBI's mom