Using Client-Centered Psychotherapy Embedded Within A Pluralistic Integrative Approach to Help a Client With Executive Dysfunction: The Case of "Judith"

Abstract

Executive dysfunction refers to a breakdown within a cluster of cognitive and behavioral  processes that regulate, control, and manage the achievement of particular goals. Executive dysfunction can thus encompass problems like disinhibition, poor planning, impulsiveness and unproductive repetition. Previous reports in the literature have suggested that psychotherapy with clients affected by the condition can be complicated. This report consists of a case study on the successful use psychotherapy for "Judith," a 48-year-old client experiencing emotional disruption and affected by long standing executive difficulties due to a head injury sustained at work 10 years earlier who was seen in therapy by the first author (TW). Emotional well-being was assessed before and after a period of psychotherapy, using an ABA design, and appropriate single-case statistical techniques.  The primary approach to the client’s issues was client-centered, but other problem-solving techniques were incorporated within a pluralistic framework and are described. The client’s reported well-being improved, and this improvement was statistically reliable and clinically significant. A previous report of therapy with a client with executive dysfunction suggested that the tendency to perseverate on particular negative thoughts can induce considerable distress in such clients. Judith's case study shows that while this might be a risk, it is possible to work successfully with at least some such clients, and to do so using a client-centered approach.