Application of Motivational Interviewing to Neuropsychology Practice: A New Frontier for Evaluations and Rehabilitation

Abstract

A mounting number of persons live with a form of cognitive disability (20 million) (US Department of Health and Human Services, Administration for Children and Families, Federal developmental disabilities programs, US Department of Health and Human Services, Administration for Children and Families, Washington, 2000), with approximately 4.1% of the population aged 6 and over (10.7 million) requiring personal assistance to complete one or more activities of daily living. Although specific types of cognitive impairments result from multiple etiologies and vary throughout the life span, these populations share a core commonality: increased risk for difficulty in treatment compliance (HCH Clinicians’ Network, Dealing with disability: Cognitive impairments and homelessness, HCH Clinicians’ Network, Nashville, 2003). Furthermore, as a consequence of their disability, these patients may inadvertently sabotage their own progress in treatment by the refusal of necessary services due to an inability to understand the goals and benefits of participating in recommended treatments (Backer and Howard, J Primary Prevent 28:375–388, 2007).

In addition to intra-individual issues, the role of the family for pediatric and adult patients is crucial for those with cognitive disabilities (Gan et al., Brain Injury 20(6):587–600, 2006). The deleterious effects of patient’s cognitive impairment on individual family members is well documented (Ergh et al., J Head Trauma Rehabilit 17:155–174, 2002; Gillen et al., J Head Trauma Rehabilit 13:31–43, 1998; Hall et al., Arch Phys Med Rehabilit 75:876–884, 1994; Kreutzer et al., Brain Injury 8:197–210, 1994; Minnes et al., Brain Injury 14:737–748, 2000; Perlesz et al., J Head Trauma Rehabilit 15:909–929, 2000; Wade et al., J Head Trauma Rehabilit 17:96–111, 2002), with some studies reporting family members can be more distraught than the impaired patient (Brooks, J Clin Exp Neuropsychol 13:155–188, 1991; Gan and Schuller, Brain Injury 16:311–322 2002). Additionally, these negative effects on the family have shown to continue well past the initial and acute phase of the patient’s disability (Gan et al. Brain Injury, 20(6): 587–600, 2006; Davis et al., Brain Injury 17:359–376, 2003; Brooks et al., J Head Trauma Rehabilit 2:1–13, 1987; Rappaport et al., Arch Phys Med Rehabilit 70:885–892, 1989; Thomsen, J Neurol Neurosurg Psychiatry 47:260–268, 1984). Thus, treatment compliance can be compromised not only as a result of the patient’s disability but also as a result of the family member’s difficulties in adapting to the responsibilities required to support the patient in their rehabilitation and management (Gan et al., Brain Injury 20(6):587–600, 2006).