Emphasising A Bio-Psycho-Social Approach to Improve Clinical Effectiveness of the Rehabilitation Process

These conditions are not only physically disabling but also threaten patients’ self-integrity. Traumatic Brain Injury (TBI) and Spinal Cord Injury (SCI) commonly affect younger and middle age people and cause life long impairments in physical, cognitive, behavioural and social functions. Both psychological and personality deficits are usually more disabling than residual physical deficits. These not only affect the individual but also have significant impact on their family, friends, carers and support groups.

Successful rehabilitation involves reintegration into the community and adjustment to a very different lifestyle with the re-establishment of satisfying relationships and regaining opportunities to express one’s own identity and self-integrity. However, strong negative emotional reactions and psychological distress can threaten both psychosocial integration and sense of self-efficacy. Clinicians tend to develop a strong counter-transference and lack of empathy, which forms a potential barrier to the development of a good therapeutic relationship with the individual and thereby impacting the outcome. This further affects the individual to become emotionally upset, frustrated and angry or depressed affecting their participation in rehabilitation process as a vicious cycle.

As we are well aware that each person is unique with his or her own personality characteristics and coping style, these need to be appreciated during rehabilitation. Bio-psycho-social perspective has been formulated (initially by Engel 1977) to encourage a more holistic understanding of the patient’s complex experiences of health and illness. We are also aware that each person will experience illness in an individual manner. This is shaped by their past experiences, coping style, personality structure, social support and most importantly understanding of their condition as serious or life threatening and whether it seems likely to undermine quality of life, identity and future plans. Such wide differences in patient’s needs, experiences, beliefs and coping strategies need to be understood in depth and provide valuable information to the rehabilitation process. Focus on diagnostic categories and pathology rather than establishing a good rapport and communication can significantly affect the rehabilitation process.

According to Carl Roger’s (Rogers 1951) client-centred therapy model, a non-judgmental warmth, genuineness and empathy are vital to the therapeutic approach. This will not only build sufficient trust for the patient to disclose his or her deepest worries and needs but they also begin to gain sufficient support to solve his or her own problems. This eventually strengthens the relationship between the therapist and the patient.

Effective Rehabilitation Approach (Click on image to enlarge)

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