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Mark: I had all the time in the world fungus mouth cheap 10 mg lotrisone with amex, and I used it holding pipes in a bag for 15 years. Mark: I think playing would have been allowed, but I dared not; there was nothing we would share. Mark: Now I think again and again how to express myself to avoid hurting my wife anymore. Both Mark and Lise: There is not much humour in our relationship, but some anyhow. I try now to be more sincere, to be myself, to show my feelings, though there is a well-developed and alert controlling unit in the back of my head. Mark: My actions seem nowadays to speak for themselves and whatever they want to say. Lise: There is hardly any intimacy, tenderness, or sex; some tenderness is anyhow on its way back to our lives. Lise: I am used to this situation, and I even have given some responsibility back to him. She also had to give care to all who needed it, but was not able to get any care herself. Lise missed her partner, whom she formally could have trusted in everything, and with whom it was fun to be. Mark was disappointed with himself all the time and could not understand his actions. The most frightening act was the incident of abuse, which was completely against everything Mark had always believed. The total difference of these two situations meant that these spouses had a long bridge to build from the first narrative to a new and possible present one. They both could have avoided the despair they were experiencing when neuropsychotherapy started. Lise was able to choose to stay in the relationship, as she could see both the possibility of leaving and the possibility for change in their relationship. Most importantly, she become again a partner instead of the assistant and caretaker she had been for years. The most important moment in the course of the therapy was when Mark and Lise for the first time in many years looked each other in the eye. After that, they started communicating with each other, often, if not always, without a mediator.

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At the postacute stage fungus monsters inc lips best 10 mg lotrisone, men seem to suffer from depression more often than do women. Despite individual pioneering articles and literature indicating the need for a more comprehensive approach, the research on cognitive neurorehabilitation, or reeducation to overcome the hampering neuropsychological deficits, continued to be overemphasized. This eventually led to a misunderstanding of the importance of only treating cognitive deficits with cognitive exercises. Experiences in the practice of neuropsychological rehabilitation during the past three decades have finally allowed for the questioning of the emphasis on purely cognitive retraining in treating people with brain injuries. A welcomed critique for purely cognitive treatment has come from Sohlberg, and Mateer (2001), who state about neuropsychological rehabilitation: "The term cognitive rehabilitation was perhaps always too narrow, and focused too heavily on remediating, or compensation for decreased cognitive abilities. The last 25 years have allowed a richer appreciation for the influence of contextual 6 Introduction to Neuropsychotherapy variables; the personal, emotional, and social impacts of brain injury; and their interactions with cognitive function. All of these factors have been incorporated to an even greater degree in to treatment plans and goals" (Sohlberg and Mateer, 2001, p. The term neuropsychotherapy has also emerged, with different conceptual connotations. However, the list of articles including cognitive­behavioral, or other theoretical models of psychotherapy needed in treating the brain-injured population, is much longer. Wilson used the behavior therapy approach together with neuropsychological knowledge in treating brain-dysfunctional patients (Wilson & Moffat, 1984; Wilson, 1999; Wilson, Herbert, & Shiel, 2003). One of the landmark studies penetrating the subtleties of the interpersonal process with brain-injury survivors was published by Judd and Wilson (2005). They identified the combination of educational and cognitive strategies that was most effective in addressing the challenges encountered in working with the distress of patients. They made the argument that psychotherapy is a relational process, regardless of theoretical orientation, in which both the therapist and the client co-constitute and actively participate in the therapeutic encounter. In clinical practice, we can see the complex interplay between psychological and organic damage. It is of utmost importance for the therapist to understand the nature and severity of the brain damage, as well as the meaning the survivor gives to the personal experiences, postinjury identity, and the psychosocial consequences. For a Neuropsychotherapeutic Approaches in the Rehabilitation Context 7 successful outcome, we need to see the person as a unique human being, with deficits and strengths that challenge the therapist to engage in a mutual and sometimes lengthy arduous process of treatment collaboration. The therapeutic alliance has been a theme in a few outcome studies in neurological population. Schönberger and collaborators found correlations with the efficacy of neuropsychological rehabilitation outcomes and the therapeutic alliance, together with patient compliance with psychosocial measures like going back to work and also cognitive functioning in postacute brain injury rehabilitation (Schönberger, Humle, & Teasdale, 2006, and 2007).

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