MHM Magazine

24 | MENTAL HEALTH MATTERS | 2024 | Issue 6 MHM Acute Psychological Intervention After an individual has a stroke, they get admitted to a general hospital and as soon as they’re stable, are transferred to a physical rehabilitation or sub- acute. This is because the first three-months after a stroke are extremely crucial and need to be capitalised on. During this three-month window, there is opportunity to take advantage of the brain’s potential to increase plasticity. Recovery after a stroke focuses on maximising the effects of neuroplasticity: the brain ability to re-wire itself and find new neuropathways to perform tasks. The combination of learning new principles, neural re-wiring and pruning, repetition with great difficulty and consistency is what encourages neural re- wiring and strengthening of the desired skill. This is done through physio therapy, speech therapy, occupational therapy and psychotherapy. The role of psychotherapy in the physical rehabilitation context is focused on providing supportive therapy to my patients and assisting them with coping strategies to adjust to their current limitations. Psychotherapy sessions aim to emotionally contain patients, provide a safe cathartic space for patients to explore their thoughts and feelings surrounding their stroke diagnosis, equip with effective emotion regulation strategies, ensure remission of psychological symptoms and avoid future re-admission for more severe psychological challenges. Psychological intervention as acute as possible can ensure the avoidance of psychological illnesses such as Post Stroke Depression (PSD) in future. Summed up in one phrase as one of my directors says, “My role is to become a witness to suffering,” to walk a journey with my patients as they slowly adjust their new normal, face the uncertainty of their new reality while assisting them to integrate their real self into their altered self. Psychotherapy sessions are also focused on providing support to family members. I always say that a stroke is a family illness, because the system that surrounds the patient also gets impacted, as they now need to assist and take over certain roles and responsibilities. Psychopharmacological Intervention A neurological insult such as a stroke is likely to increase the chances of developing depression and should be used as a precautionary measure. Anti- depressants help play a vital role for these patients: • They help reduce the amount of inflammation caused by a stroke. • They improve and speed up recovery. • They reduce psychological effects of the stroke. • Help with overall re-wiring of the brain and allow for neuroplasticity. Anti-depressants can pose a general risk of haemorragic complications, re-stroking and myocardial infarction. Hence this process is a done in collaboration with the patient’s physician (neurologist or neurosurgeon) as they have the medical history of the patient. In more severe cases, the guidance of the resident psychiatrist. The responsibility of the psychologist in this instance is to empower and psycho-educate the patient on the risks and benefits of the anti-depressants. Especially with the stigma that still exists regarding psychopharmacological intervention. Psychology as an Art Psychology is a science, but it is also an art and the art of psychology really gets to shine when working with stroke patients. Some of my patients have difficulty with their linguistic impairments such as Aphasia. Aphasia refers to a range of word finding difficulties to severe communication difficulties. Which will require creative ways of communicating with the patients, because communication is not just verbal; these patients can communicate non-verbally using eye-gazes, writing, alphabet boards, text-to-speech, communication-based apps and yes/no gestures to answer closed- ended questions/options. This helps patients to feel empowered and it creates a corrective emotional experience where they know that during sessions, a psychologist sits across them and allows them to express themselves despite their linguistic challenges. Family members and other therapists can tend to speak and make decisions on behalf of patients, as it sometimes can be easier due to the patient experiencing speech difficulty, and the fact that it may take a while to understand what the patient is saying. Providing this space in the psychotherapy sessions gives patients their voice back and some level of independency. Patients affected by a stroke need to receive psychological intervention, as well as their family members, as this is a huge life altering adjustment which they will need effective strategies to utilise throughout the journey of adjusting to this “new normal”. References available on request. MHM | 2024 | Volume 11 | Issue 6 | Psychotherapy with stroke patients in the physical rehabilitation space H