I
attended one of the Division of Neuropsychology’s regular CPD events on 14th
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
