Behavioural psychotherapy of the frontal-lobe-injured patient in an outpatient setting

We present two cases of outpatient behavioural psychotherapy of frontal-lobe brain-injured adults. Unlike inpatient treatment of severely frontal-injured patients in which the hospital setting acts on the patient to modify behaviour, outpatient treatment teaches the self-motivated individual to use the structure and directiveness of behavioural psychotherapy to overcome his or her neuropsychological deficits. The literature describes two types of frontal syndromes: disinhibition and adynamia. Treatment of both types of syndromes is illustrated using case presentations. The therapeutic interventions for both syndromes are designed to exaggerate the link between stimulus and response to counter impaired processing of feedback. A six-stage behavioural psychotherapy model of the frontal-injured patient is outlined.