Cognitive impairment

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In the process of treatment, it may become clear that the client has impaired or poor functioning in one or many areas of cognition, such as verbal or non-verbal memory, information processing, problem-solving, reasoning, attention and concentration, decision-making, planning, sequencing, response inhibition and emotional regulation. Sometimes these cognitive impairments can result in behaviour that is mistakenly interpreted as the result of poor motivation or lack of effort. These cognitive difficulties often bear no relation to mental illness and are frequently the result of heavy AOD use or intoxication [276].

When a client is experiencing some level of cognitive impairment, the effectiveness of therapeutic approaches can be diminished unless care is taken to adapt the approach to address these difficulties. Table 46 presents some simple techniques which can be useful in overcoming cognitive impairment [276].

Table 46: Techniques for managing cognitive impairment

Techniques to address attention problems
  • Have a clear structure for each session.
  • Consider shorter but more frequent sessions.
  • Avoid overloading by limiting the content of each session.
  • Keep sessions focused on relevant topics.
  • Reduce session pace and provide breaks.
  • Conduct sessions in a quiet, non-distracting environment.
  • Provide written handouts of important information.
Techniques to address learning and memory problems
  • Present information to be remembered both verbally and visually (e.g., draw diagrams).
  • Repeat and summarise key information.
  • Ask client to recall information from previous sessions, and suggest techniques to improve recall (e.g., writing things down, using memory aids).
  • Review key points from previous sessions at the start of each session to compensate for poor memory.
  • Remind client of appointment times and keep appointments at routine times.
Techniques to address difficulties with mental flexibility, problem-solving, planning, and organising
  • Encourage routines and daily planning
  • Explain step-by-step problem solving and how to break goals into smaller, more manageable tasks.
  • Discuss and practice responding to high-risk situations
  • For impulsive clients, encourage self-monitoring and use of cue cards with strategies to use

Adapted from Marsh et al. [276].