The aim of this study was to investigate the impact of brain injury survivors´ social cognition abilities on their working alliance with their therapist. Participants in this study were individuals who were enrolled in a vocational rehabilitation programme for acquired brain injury. Seventy-two individuals with complicated mild to severe acquired brain injury (49%TBI, 38% stroke, 14% other injury; mean age 44.9 years; 75% male) entered in the study between 1.5 and 31 years after their injury (Md=5 years). The therapeutic alliance was rated retrospectively at the time of study by the participants´ primary therapists on the Working Alliance Inventory (WAI). Social cognition measures (Reading the Mind in the Eyes Test, Recognition of Faux Pas Test, The Awareness of Social Inference Test, TASIT; Social Situations Task, Bangor Gambling Task) were administered as well as a standard neuropsychological test battery and the Hospital Anxiety and Depression Scale. Multilevel analyses revealed that both the TASIT and the Social Situations Task, but neither the standard neuropsychological tests nor the HADS were significantly related to WAI ratings. These findings indicate the impact that difficulties with emotions recognition and social rule violations can have on the formation of a therapeutic alliance.

In recent years, the amount of content related to clinical work has continued to increase in our Congresses and meetings. With the development of neuropsychoanalytic course materials such asMark Solms’ clinical workshop, Andrea Clarici’s seminar, and others, together with numerous neuropsychoanalytic clinical case groups, the elaboration of clinical applications of neuropsychoanalysis is now flourishing. In our recent Congress, given the theme of our meeting, numerous research presentations naturally focused on clinical work, and can be explored in the abstracts presented here. Readers can see, just from these brief summaries, the scope of topics within clinical practice that are being addressed around the world. As always, we also welcomed research talks and symposia on any topic of relevance to neuropsychoanalysis. Readers can therefore get a taste of the wide range of empirical and theoretical work being done in our international community on infant development, gender studies, brain injury, memory, trauma, and much more.

Background: Mentalisation (also known as theory of mind) difficulties have been reliably demonstrated across different subtypes of adult acquired brain injury (ABI), and the role of such impairments in negative psychological and interpersonal outcomes for survivors and their significant others has been increasingly highlighted. Aims & Methodology: This study aimed to characterise the most salient aspects of mentalising performance in a large ABI sample, relative to matched controls. The participants were 88 (64 male, 24 female) persons with acquired brain injuries (TBI; CVA; other subtypes) participating in community neuro-rehab services (mean age 45.2 years, SD 10.7; mean time since injury 6.69 years; range 1.5 – 31.3 years).) and 50 (34 male, and 16 female) healthy participants (mean age 45.3 years, SD 13.9). The main measure of mentalising operationalised in this study was the Recognition of Faux Pas Test (Stone et al., 2003), a story vignette task completed by patients and controls. Results & Conclusions: Overall, the patient group made significantly more errors in detecting the presence of a faux pas than the matched control group (t (132)=2.24, p<.05, Cohen's d = 0.4), reflective of 1st order mentalising difficulties in the ABI group. However the patients did not make more errors than controls in explaining the reason for the faux pas (p=.75). Patterns in errors made by the patient group are explored, and implications for rehabilitation are discussed.

In this chapter, the authors present an overview of sources, starting from the relational seeds to be found in clinical studies in neuropsychoanalysis itself. They then take the main developments over the last century from the progressively relational turn in psychoanalysis and intersect these with the social neuroscience knowledge base, to arrive at a proposal for a contemporary relational neuropsychoanalysis. The authors then road-test it with reference to the core interpersonal challenges confronting those with neurological conditions, their loved ones and the clinicians supporting them. The mapping of the impact of different neurological conditions has progressively broadened in scope over the past three decades. Patients' performance on standardised medical and neuropsychological tests has been complemented by a strong consideration of ecologically valid real-world functional outcomes at the individual level. The neuropsychological assessment highlighted a piecemeal perceptual processing style consistent with an autistic spectrum neuropsychological profile.

Acquired brain injury (ABI) in adulthood is a sudden insult to the brain that does not worsen over time. Examples of ABIs include traumatic brain injury, stroke (ischaemic and haemorrhagic), infections (e.g. encephalitis, meningitis), hypoxia or oxygen starvation (often occurring following cardiac arrest) and enduring difficulties following the resection of brain tumours. Difficulties that emerge from these brain lesions are complex, multi-faceted and enduring. Psychological needs are central, including anxiety, depression, anger and irritability, post-traumatic stress and struggles to adjust to the condition (Williams and Evans 2003). These often occur alongside physical restrictions (reduced, mobility, balance, sensation), cognitive impairments (problems in information processing, attention, memory, planning and organising, visuospatial perception and social communication) and strain in interpersonal relationships, with progressive social isolation developing over time (Elsass and Kinsella 1987).

As this journal was founded in 1999, and the 20th Congress of the International Neuropsychoanalysis Society took place in 2019, this year seems a fitting time to celebrate the 20th anniversary of n...

Historically, brain injury rehabilitation has often taken an individualistic approach, which continues to be a valuable and important aspect of the rehabilitation process. Rehabilitation is usually required after a sudden one off incident, often unexpected and uncontrollable, has changed the individual's potential to reach their goals and hopes, due to changes in cognitive and often physical abilities. Most readers will be familiar with concepts behind taking a 'psychological' approach to rehabilitation, or incorporating other 'talking therapies', but by the term 'relational' we wish to emphasize relationships as the important vehicle for change. Of course, chronic, long-term difficulties are common to all rehabilitation settings, even within mental health services, although conditions as depression and anxiety are often not framed in the way and there is not an obvious before and after comparison. The chapter also presents some closing thoughts on the key concepts discussed in the preceding chapters of this book.

This chapter explores how spaces between romantic partners can be widened following injury so people who were previously close become distanced, or how inter-subjective space is intruded upon in a way that is experienced as challenging or even disturbing. It presents a theoretical unpacking of strained relationship and challenges. The chapter presents a combination of systemic and neuroscientific ideas, while also bringing in ideas from psychoanalysis. It utilizes the term 'intimacy' in its widest sense—an inter-personal, psychological connection between two people, which may include personal sharing and inter-connection of mental life. The closeness of psychotherapeutic relationships, connections made within these sessions, personal knowledge, and experiences shared, can approach some qualities of couples relationships. The development of a caregiving relationship between survivor and romantic partner during the acute phase is often necessary and over a long period of time may be organized by the physical self-care needs of the survivor.

Abstract This paper explores the African concept of ubuntu, and its potential to influence our thinking about the delivery of long-term health and social care within a neurorehabilitation context. Particular consideration is given to the potential importance of achieving longer-term social connectedness for clients and their relatives after neuro-rehabilitati on interventions have finished. A short case vignette, and a hospital-based practice report, are provided as two examples to illustrate some of the key points made. Incorporating some aspects of the philosophy of ubuntu could potentially help neurorehabilitation programmes to include the reduction social disability as a more explicit longer-term goal for outcome. Keywords: Ubuntu; neurorehabilitation; practice report Resumen Este documento explora el concepto africano de Ubuntu y su potencial para influir en nuestra forma de pensar sobre la prestacion de asistencia sanitaria y social a largo plazo dentro de un contexto de neuro-rehabilitacion. Se presta especial atencion a la potencial importancia de lograr una conexion social a largo plazo para los clientes y sus familiares despues de que las intervenciones de neuro-rehabilitacion hayan finalizado. Se proporcionan una pequena vineta de caso y un informe de practica practica hospitalaria, como dos ejemplos para ilustrar algunos de los puntos clave al respecto. Ademas, los autores incorporan algunos aspectos de la filosofia de Ubuntu que podrian ayudar a los programas de neuro-rehabilitacion que podrian influir en la reduccion de la discapacidad social como un objetivo mas explicito a largo plazo para el resultado. Palabras clave: Ubuntu;  neurorehabilitacion: practica hospitalaria. Resumo Este documento explora o conceito africano de Ubuntu e seu potencial para influenciar na nossa forma de pensar sobre a prestacao da assistencia sanitaria e social a longo prazo dentro de um contexto de neuro-rehabilitacao. Se presta especial atencao a potencial importância de conseguir uma conexao social a longo prazo para os clientes e seus familiares depois de que as intervencoes de neuro-rehabilitacao estiverem  finalizadas. Se proporciona uma pequena vinheta do caso e um informe de pratica hospitalar, como dois exemplos para ilustrar alguns dos pontos chave a esse respeito. Ademais, os autores incorporam alguns aspectos da filosofia de Ubuntu que poderiam ajudar nos programas de neuro-rehabilitacao que poderiam influenciar na reducao da discapacidade social como um objetivo mais explicito a longo prazo para o resultado. Palavras-chave: Ubuntu; neuro-rehabilitacao: pratica hospitalar;

This chapter discusses how curiosity was used in research to understand more about the perspectives of family members, and develops ideas about possible obstacles to development of a working alliance with families, as well as considering potential approaches to the repair of ruptures in relationships, when/if they occur. It considers issues of terminology and identification of the types of dilemmas. The chapter outlines some of the thinking with regard to building and maintaining relationships with family members during rehabilitation, drawing on models of collaboration, and alliance from other areas of psychology as well as the limited research from within neuropsychology. A key task for any therapist is to map out the incidence of predisposing vulnerability factors and heightened risk, and for this a bio-psycho-social-family framework is useful. When considering the development of an alliance between families and therapists, it is crucial to consider the influence of context on beliefs held and the lens through which individuals perceive the problem.