Collaborative Therapeutic Neuropsychological Assessment


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A synopsis of the book "Collaborative Therapeutic Neuropsychological Assessment". See website

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Collaborative Therapeutic Neuropsychological Assessment

  1. 1. Collaborative Therapeutic Neuropsychological Assessment Presented at the Pennsylvania Psychological Association 75 th Anniversary Convention Tad T. Gorske, Ph.D. Assistant Professor of Physical Medicine and Rehabilitation University of Pittsburgh School of Medicine
  2. 2. “ The presentation of brain facts about specific damages is meaningless to patients unless they can begin to understand how the changes in their brains are lived out in everyday experiences and situations” (Varella, 1991 as stated in McInerney and Walker, 2002)
  3. 3. This is about……… <ul><li>Neuropsychological Interview </li></ul><ul><li>Neuropsychological Testing </li></ul><ul><li>Interpersonal Feedback Session </li></ul><ul><li>Neuropsychological Report </li></ul>
  4. 4. Challenges for Clinical Neuropsychology <ul><li>Case Examples </li></ul>
  5. 5. The Role of Neuropsychological Assessment: Historical Perspective <ul><li>Period of Neuropsychological Localization </li></ul><ul><li>Period of Neurocognitive Evaluation </li></ul><ul><li>Current Period?? </li></ul>
  6. 6. Technician / Artist <ul><li>Neuropsychologists are challenged to expand their roles from a purely technical endeavor to a more holistic perspective. </li></ul><ul><li>Cognitive theorist, functional anatomist </li></ul>
  7. 7. Technician / Artist <ul><li>Neuropsychologists are challenged to expand their roles from a purely technical endeavor to a more holistic perspective. </li></ul><ul><li>Cognitive theorist, functional anatomist, psychotherapist, family therapist, emotional adjustment, viewing the person from a holistic perspective. </li></ul>
  8. 8. Holistic Neuropsychological Principles <ul><li>Empower patients and families to take an active role in the treatment process; </li></ul><ul><li>Believe people with neurological disabilities are more like people without neurological disabilities (ie. Go beyond the brain ) ; </li></ul><ul><li>Convey honesty and caring in personal interactions to form a foundation for a strong therapeutic relationship; </li></ul><ul><li>Develop practical plans for rehabilitation; explain rehabilitation techniques in understandable language; </li></ul>
  9. 9. Holistic Neuropsychological Principles <ul><li>Help patients and families understand neurobehavioral sequelae of brain injury and recovery; </li></ul><ul><li>Recognize change is inevitable and help families cope with change; </li></ul><ul><li>Every patient is important, treat with respect; </li></ul><ul><li>Remember that patients and families have different perspectives regarding treatment approaches; </li></ul><ul><li>Be willing to refer if appropriate. </li></ul>
  10. 10. Collaborative Therapeutic Neuropsychological Assessment (Gorske and Smith) <ul><li>A collaborative method of interviewing and providing feedback from neuropsychological assessment; </li></ul><ul><li>Enlists the patient/family as an active collaborator; </li></ul><ul><li>Empowers patients/families to be caretakers of their own cognitive health. </li></ul>
  11. 11. Collaborative Therapeutic Neuropsychological Assessment (Gorske and Smith) <ul><li>Comprehensive Neuropsychological Assessment </li></ul><ul><li>Referral question, records review, behavioral observations, clinical interview, quantitative and qualitative assessment. </li></ul>
  12. 12. Collaborative Therapeutic Neuropsychological Assessment (Gorske and Smith) <ul><li>The Information Gathering / Medical Model </li></ul><ul><ul><li>Clinician knows best; </li></ul></ul><ul><ul><li>Fragile patients; </li></ul></ul><ul><ul><li>Knowledge is dangerous </li></ul></ul><ul><li>Collaborative Model </li></ul><ul><ul><li>Clinician is an expert in neuropsychology; the patient/family is the expert on themselves </li></ul></ul><ul><ul><li>Patients are resilient </li></ul></ul><ul><ul><li>Knowledge is power </li></ul></ul>
  13. 13. Challenges for Clinical Neuropsychology <ul><li>The patient does not understand the nature of a neuropsychological examination and are confused as to the purpose, methods, and potential outcomes; </li></ul><ul><li>2) Patients are often not informed of the results except for final conclusions. This leads to even more confusion because the rationale for the conclusions is unclear; </li></ul><ul><li>3) There is an aura of secrecy around the whole process. </li></ul>
  14. 14. Challenges for Clinical Neuropsychology <ul><li>The Information Gathering / Medical Model of Neuropsychological Assessment. </li></ul><ul><ul><li>Clinician knows best; </li></ul></ul><ul><ul><li>Fragile patients; </li></ul></ul><ul><ul><li>Knowledge is dangerous </li></ul></ul>
  15. 15. Challenges for Clinical Neuropsychology <ul><li>Technological Advances </li></ul><ul><li>Managed Care </li></ul><ul><li>Patient Centered Trend </li></ul>
  16. 16. Challenges for Clinical Neuropsychology <ul><li>Developing a patient-centered neuropsychological assessment process. </li></ul>
  17. 17. Challenges for Clinical Neuropsychology <ul><li>Psychologists are giving feedback………but what are they doing? </li></ul>
  18. 18. Survey of Feedback Practices <ul><li>719 Participants from NAN, SPA, INS in an online survey. </li></ul><ul><li>Over 70% provide feedback, nearly half the time consisting of a “therapy hour.” </li></ul><ul><li>Clinicians providing feedback overwhelmingly perceived it as having a positive impact on patients. </li></ul><ul><li>(Source) Smith, S., Wiggins, C., & Gorske, T. (2007). A survey of psychological assessment feedback practices. Assessment , 14(3), 310 – 319. </li></ul>
  19. 19. A Brief History <ul><li>Neuropsychological Test Feedback </li></ul><ul><li>Psychological Testing as a Therapeutic Intervention </li></ul><ul><li>Collaborative Individualized Psychological Assessment </li></ul><ul><li>Therapeutic Psychological Assessment </li></ul>
  20. 20. CTNA Conceptual Basis <ul><li>Collaborative Individualized Assessment (Dr. Constance Fischer) </li></ul><ul><li>Therapeutic Individualized Assessment (Dr. Stephen Finn) </li></ul><ul><li>Recommendations in the Literature (Gass and Brown, 1992) </li></ul><ul><li>Motivational Interviewing (MI) (Miller and Rollnick, 2002) </li></ul>
  21. 21. CTNA <ul><li>The spirit of the CTNA lies in Collaborative and Therapeutic Assessment Models </li></ul><ul><ul><li>Open sharing; explore results contextually; use results to facilitate empathic understanding </li></ul></ul><ul><li>The framework for conducting the CTNA is drawn from MI. </li></ul><ul><li>The CTNA adopts and adapts the MI Personalized Feedback Report </li></ul>
  22. 22. CTNA Feedback Session <ul><li>Two primary components </li></ul><ul><li>Provide information from neuropsychological test results </li></ul><ul><li>Interact with clients in a collaborative manner consistent with TA and MI. </li></ul>
  23. 23. CTNA Personalized Feedback <ul><li>Introduction </li></ul><ul><ul><li>Provide feedback report; explain session purpose; facilitate collaboration and empathic understanding </li></ul></ul><ul><li>Develop Questions </li></ul><ul><ul><li>Develop 2 or 3 well defined questions the client hopes the results can answer </li></ul></ul><ul><li>Explain how strengths and weaknesses are determined </li></ul><ul><ul><li>Percentiles, determine criteria for strength or weakness </li></ul></ul>
  24. 24. CTNA Personalized Feedback <ul><li>Feedback about strengths and weaknesses </li></ul><ul><ul><li>Elicit : What skills did the client use to complete the test. </li></ul></ul><ul><ul><li>Provide : Therapist provides information on the cognitive skill test(s) examine. </li></ul></ul><ul><ul><li>Elicit : Therapist elicits reactions from the clients and applies results to their real life. </li></ul></ul>OARS
  25. 25. CTNA Personalized Feedback <ul><li>Summarize results and provide recommendations </li></ul><ul><ul><li>Summary and key question </li></ul></ul><ul><ul><li>Ask permission to provide recommendations </li></ul></ul><ul><ul><li>Make recommendations </li></ul></ul>
  26. 26. Pilot Study Results
  27. 27. Pilot Study Results: D&A Use NAFI = 6; TAU = 5
  28. 28. Pilot Study Results: D&A Use
  29. 29. Pilot Study Results: Depression NAFI = 7; TAU = 5
  30. 30. Patient Responses <ul><li>“ The assessment was helpful to me. I learned a lot about myself…I would have done it without being paid.” </li></ul><ul><li>“ Allowed me to see why I may be reluctant to participate in groups.” </li></ul><ul><li>“ Helped me narrow in on specific steps I need to take with my therapist re: depression and addiction. Identified couple things we can work on.” </li></ul><ul><li>“ I am so pleased that I participated in the study. It was right on. M- allowed me to share during the process, which really assisted with my overall understanding of the feedback.” </li></ul>
  31. 31. Future Implications <ul><li>Clinical : A high degree of utility for consultation, initiating therapy, working with “sticking points” in therapy, rehabilitation planning. </li></ul><ul><li>Teaching : Developing students into “human-science” practitioners, researchers, and teachers. </li></ul><ul><li>Research : Study at U of Pitt, Collaborative Neuropsychological Assessment at UC Santa Barbara, many other possibilities. Learn outcomes, factors influencing effectiveness, manual development. </li></ul>
  32. 32. <ul><li>CTNA was developed through: </li></ul><ul><ul><li>Funding from the National Institute on Drug Abuse and research in Addiction Medicine Services at Western Psychiatric Institute and Clinic at the University of Pittsburgh. </li></ul></ul><ul><ul><li>Clinical experience at Cognitive Dynamic Therapy Associates (CDTA) in Pittsburgh, Pennsylvania – </li></ul></ul><ul><ul><li>Clinical experience at the Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Division of Neuropsychology and Rehabilitation Psychology </li></ul></ul>