A dissertation submitted to the Faculty of Arts, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Arts in Clinical Psychology / This study investigated the emotional functioning of people who had been diagnosed as having traumatic brain injuries (TBI) of the frontal lobes. This was done with a view to examining whether there were changes in the emotional functioning of people with TBI in the period following their injuries. The pre-injury (or premorbid) emotional functioning of the respondents with TBI was assessed retrospectively through self-reports, which were compared with the ratings by the primary and secondary care-givers of these respondents. The current (post-injury) emotional functioning of the participants with TBI was also assessed through self-reports and the ratings by the primary and secondary care-givers. (abbreviation abstract) / Andrew Chakane 2019

D.Litt. et. Phil. / Head injury is the major cause of death for individuals under 35 years old in the United States of America, and a similar picture exists in South Africa. A major cause of traumatic brain injury is motor vehicle accidents. In addition, the advances in modem medical technology increase the chances for survival, for example, sophisticated medical diagnostic techniques such as computerised tomography (CT), and magnetic resonance imaging (MRI). Advances in emergency trauma and neurosurgical procedures have also increased the number of survivors following a head injury. The symptoms resulting from head injury include disturbed physical, cognitive, psychological and behavioural functioning. Long-term management of these symptoms is usually required. A body of evidence exists that demonstrates the value of rehabilitation during the first year of recovery from traumatic brain injury. Head injury cases often result in litigation in that the injured person may be entitled to compensation for the injuries sustained. Considerable forensic debate exists around the issue of whether the victim's symptoms are attributable to organic brain damage, or whether they reflect a pre-existing functional psychological state of psychiatric illness, or personality disorder. Further still, the individual may be 'malingering' or faking postconcussion symptoms of headache, dizziness, fatigue, memory deficit, impaired concentration, irritability, anxiety, insomnia, concern about bodily functions, and hypersensitivity to light and noise. Alternatively, a common diagnosis is traumatic neurosis with a psychogenic basis, and in the context of litigation is referred to as "compensation neurosis". Specifically, the issue of contention revolves around concussion, and mild or minor head injuries. This study proposed that both neuropathophysiological and psychosocial symptoms occur in the event of a traumatic brain injury. This view supports the traditional model that pain or the sequelae of head injury are not affected by compensation. Therefore, the objective of the study was that follow-up assessment after compensation pay-outs should produce similar results to the assessment results obtained during the litigation process. The hypotheses of the study were essentially confirmed. The neuropsychological error scores produced in the assessments during litigation, and two-to-four years after the completion of litigation were similar. However, similar to other studies, variations were evident. Four exceptions were demonstrated in that significant improvement was evident with regard to shotterm verbal memory delayed recall for paragraphs, and for immediate recall (without and after interference) in verbal memory for a word list. These improvements therefore pertain to verbal memory. The fourth improvement occurred with respect to manual dexterity and visual-motor work speed, although the improvement may be peripheral or primary (neurological). Further findings included that no gender differences were evident in the neuropsychological posttest scores. It was confirmed that individuals with a good Glasgow Outcome Scale rating showed less posttraumatic amnesia, a shorter time since injury, less additional injuries, and a lower compensation sum. It was also supported that individuals with a good Glasgow Outcome Scale rating showed less impairment on neuropsychological indices. However, an exception was that individuals with a moderate Glasgow Outcome Scale rating showed improvement on the neuropsychological index measuring immediate concentration, visual scanning, and visual-motor work speed. The qualitative data or psychosocial measures of severity and outcome produced a similar picture that the majority of subjects maintained their pretest status although some exceptions were evident. Within the medico-legal domain it was shown that, in general, concordance of severity was high amongst the medical experts for the plaintiffs and the defendents. However, their prognoses were indicated to be less accurate, and whilst their consistency in documenting diagnoses in the reports of the subjects was adequate, they were found to be inconsistent in documenting severity ratings and prognoses. It was suggested that improvements may be attributed to neurophysiological differences, non-participation in a rehabilitation programme, the interference and delay of rehabilitation, increased psychological reactions associated with litigation, and mechanisms of secondary gain which may by attributed to the other players, such as the family, the attorneys, the medical experts, among others, and not only to the individual or victim.

The research process illustrates the interaction between the therapist and the neuropsychological impaired client in the therapeutic context where we utilised drawing and painting as a creative medium I descn'be the interaction from a systems paradigm New paradigm research is used as the researcher is included in the research findings. The focus is on new meanings that the therapist and clients generated. Three case studies are descn'bed in this study. A circular description is given of the use of drawing and painting in therapy. The losses that the clients suffer are described and explained to make sense of the interaction. The use of art is described and incorporated in the therapeutic process as creative exercises were important ways to connect with the clients. This study illustrates that creativity should always be part of the therapeutic endeavour, especially when understanding the verbal expression of the client is difficult. / Psychology / M.A. (Clinical Psychology)

The research process illustrates the interaction between the therapist and the neuropsychological impaired client in the therapeutic context where we utilised drawing and painting as a creative medium I descn'be the interaction from a systems paradigm New paradigm research is used as the researcher is included in the research findings. The focus is on new meanings that the therapist and clients generated. Three case studies are descn'bed in this study. A circular description is given of the use of drawing and painting in therapy. The losses that the clients suffer are described and explained to make sense of the interaction. The use of art is described and incorporated in the therapeutic process as creative exercises were important ways to connect with the clients. This study illustrates that creativity should always be part of the therapeutic endeavour, especially when understanding the verbal expression of the client is difficult. / Psychology / M.A. (Clinical Psychology)