Social competence and head injury: a new emphasis

In the push for quantifiable outcome-based rehabilitation programmes, sensitivity to the integrity and uniqueness of the individual has been moved to the background. This has been particularly noticeable in the area of social skills therapy for persons who have suffered a traumatic head injury. We review some of the patterns of normal communication, with particular reference to roles, communicative relationships and individual differences, in order to clarify the difficulties in making clinical judgements about these skills. We propose a shift in focus to establishing a symmetrical therapeutic relationship in which communication is based on respect rather than structure and control. We utilize the clients' insights into their own social communication problems to enable them to be primary managers of their activities. The clinician's responsibility is not only to be a resource but also to be actively involved in the therapeutic process by reviewing his or her own social communication patterns in and outside of the therapy sessions. We argue that, with this perspective, activities can focus on principles of communication rather than specific skills, resulting in improved generalization and long-term outcome.