Tools
Tools
Stone, Philip Terence (2026) Self-regulatory strategies for brain injury patients: how can the therapeutic relationship in cognitive rehabilitation therapy help? Doctoral thesis, London Metropolitian University.
Background and aim:
The research aimed to describe how clinicians use the therapeutic relationship to facilitate the process of training patients use a self-regulatory strategy to aid an executive impairment due to an acquired brain injury (ABI). The research was motivated by the underdeveloped role of the therapeutic relationship in training interventions for promoting self-regulation (Muraven & Baumeister, 2000), the optimal technique for improving patient self-regulation (Muraven & Baumeister, 2000), the sensitivity required to achieve this (Worthington, 2010), the limited awareness of the therapeutic factors affecting the working alliance (Stagg et al., 2019) and the limitations of studies in this field (Heredia-Callejón et al., 2023).
The current study attempted to address this gap in the research by examining how psychologists and therapists integrate and weave together the micro-skills of the therapeutic relationship to facilitate the training of a cognitive rehabilitation intervention. The training process examined in this research was embedded within a meta-cognitive or self-instructional protocol that trained ABI patients with complex executive impairments to use a self-regulatory strategy with fluency in their everyday lives.
Methodology:
Four psychologists, two occupational therapists, three speech therapists, and one cognitive rehabilitation therapist completed a qualitative questionnaire. The clinicians had successfully helped ABI patients use self-regulatory strategies for complex executive impairments. A mixed methods design was used, and the qualitative questionnaires were analysed using thematic analysis.
Findings:
The analysis revealed that clinicians used the therapeutic relationship to train selfregulatory strategies through distinct relational stages: establishing, developing, and maintaining the alliance, and these were embedded across the assessment, treatment, and evaluation stages of the therapeutic process. Core relational processes of empathy, rapport, therapeutic bond, and presence were integral to enhancing clients’ awareness, motivation, and emotional regulation during cognitive rehabilitation.
Conclusion:
The findings highlight that effective self-regulatory training in cognitive rehabilitation depends on integrating relational and technical modes of therapeutic engagement. Clinicians used empathy, presence, rapport, and flexibility to cultivate clients’ selfawareness, emotional regulation, and motivation across all stages of therapy. This integration of relational depth within cognitive rehabilitation highlights the therapeutic relationship as a central mechanism for internalising self-regulatory strategies through coregulation, mutual regulation, and relational modelling, leading finally to internalised coregulation. The study therefore supports a cognitive-relational approach to rehabilitation that fosters both cognitive recovery and the nurturing of a client’s sense of personal agency and psychological adjustment.
 |
View Item |