Report on Neuropsychology CPD day, by our Clinical Director for Neuropsychology, Dr Steven Roundhill

I attended one of the Division of Neuropsychology’s regular CPD events on 14^th September. The day was an interesting look into various psychological therapies being used with people with acquired neurological disorders. It was really well attended, impeccably run, and as with most good CPD seemed to raise lots of things to consider, as it felt like another day was needed just to discuss the issues evolving. Due to the packed nature of the programme the brief plenary at the end couldn’t hope to fully answer questions about the presentations let alone offer much opportunity for debate.

From the brief points that were aired it was evident that the threats we are all facing in both the NHS and the independent sector need broad discussion and planning around at this kind of Division, Faculty, SIG, or network level. As well as issues of maintaining standards of professionalism in a changing employment landscape it feels like there may be increasing constraints on what we can actually offer our clients, with commissioners necessarily having a close eye on evidenced practice and outcome data. I wonder if the forums we engage with, whether formal or informal, are going to be quick enough off the mark and sufficiently coherent to address these issues before the ‘solution’ is handed down to us and we all just have to get on with  it.

Anyway, climbing off my soapbox a minute (but probably not for long I warn you...), what was most encouraging about the day was the evident sophistication of the therapeutic models and techniques in use by neuropsychologists, and the reflective and open nature of the audience. This CPD day was a refreshing acknowledgment of the importance of good therapy in acquired brain dysfunction, and certainly no dry convening of neuro test-bashers!

The topics were ride ranging in nature, easily fulfilling the ‘across the lifespan’ aspirations of many CPD programmes these days. We had information on working with children and families with web-based interventions and in paediatric intensive care, through to using Compassion Focussed Therapy for people living with dementia. Similarly the range of ways therapeutic relationships may develop and inform interventions was highlighted. This was most evident in the seeming disparity between one talk that advocated the therapeutic uses of text messages and another that gave insight in to the mirco-anaylsis of non-verbal signals in short term psychodynamic interventions.

One thing that raised a wry smile for me, working at Psychology Associates where often there is an Attachment Theory orientation, was the use of Attachment models in working neuropsychologically. I’ve had the view that in the last few years that Attachment research and theory has increasingly emphasised neurological and neuropsychological foundations...using ‘hard biological science’ to offer a compelling slant on the application of broader psychological theory...and here we had neuropsychology clinicians now turning to Attachment to inform their work with adult survivors of brain injury. How refreshing is that?!

[n.b. climbing back onto soapbox now]

Working as both an Expert Witness offering medicolegal reports, and as a therapist working with clients, families, case managers, and multidisciplinary teams, it seems to me that there increasingly needs to be this kind of emphasis on interventions rather than assessing and reporting. Or rather, there has always been the need for this kind of emphasis but that historically neuropsychology has neglected it (with some notable exceptions of course).

It will be important also to inform the practise of neuropsychology with other therapeutic models, and to persuade the people instructing us in work that non-neuropsychologists have so much to offer neuropsychology clients. Often it is the case that an expert Neuropsychology report recommends intervention by a neuropsychologist only for the case managers to have difficulty finding qualified neuropsychologists to take up regular therapeutic input. The initial assumption that neuropsychologists need to be the ones doing the neuropsychological intervention may need to be questioned, especially when it transpires is that what would be of most benefit to the client is a systemic approach or coupe’s work rather than cognitive rehabilitation. We need to be working together on this, across traditional clinical distinctions, not only to offer these vulnerable clients the best service we can, but often to offer them any kind of psychology service at all.

More on this to come!

Stephen

Clinical Lead for Neuropsychology