Collaborative Therapeutic Neuropsychological Assessment
Edited by Tad T. Gorske, University of Pittsburgh, School of Medicine
Steven R. Smith, University of California at Santa Barbara
Perhaps the greatest challenge faced by neuropsychological assessment is its image as a bearer of bad news, i.e., the diagnosis of cognitive impairment. To meet this challenge and better address patient needs, practitioners need to fill the void that too often exists between diagnosis and treatment, starting with exchanging feedback about test results. The contributors to Collaborative Therapeutic Neuropsychological Assessment have developed methods that expand on traditional information-gathering means to build rapport with patients and let their voices be heard in decision-making: this client-centered approach has shown to lead to more personal interventions, better compliance, and stronger recovery.
In contrast with other books in the field, this reader-friendly volume provides detailed methods and procedures on client feedback as well as assessment, in addition to conceptual and practical basics:
- The CTNA model and its underlying assumptions.
- The history and development of client-centered feedback in assessment, especially its roots in motivational interviewing.
- Empirical literature review, including the latest research on CTNA methods.
- Guidelines for conducting collaborative interviews in CTNA.
- Basic method for conducting collaborative feedback sessions in CTNA.
- Practical suggestions for using CTNA in clinical, rehabilitative, school, and other settings, and adapting the method to specialized populations such as children, the elderly, and minorities.
- Case studies illustrating salient concerns and techniques.
The clinical knowledge presented in Collaborative Therapeutic Neuropsychological Assessment builds on the centrality of assessment in care to signal potent new directions in practice and training. As such, it deserves to be read by neuropsychologists (as well as rehabilitation, clinical, and school psychologists), and used in courses and certification programs in psychological and neuropsychological assessment.
Written for: Professional: neuropsychologists, including school and rehabilitation psychologists; clinical psychologists - Academic: courses and certification programs in psychological and neuropsychological assessment
- collaborative assessment
- neuropsychological Assessment
- patient-centered feedback
Table of contents
Foreword by Stephen Finn, Center for Therapeutic Assessment
I. Introduction: Overview and Background of CTNA
a. This chapter will begin with brief case examples of feedback sessions conducted in a traditional manner and according to CTNA methods as a segue to an overview of CTNA as contrasted with standard practice in neuropsychological assessment, commonly referred to as the "information gathering model."
b. The next section describes current challenges facing the field of Clinical Neuropsychology. Psychological and neuropsychological assessment have struggled in the era of managed care for a number of reasons, not the least of which include the advent of radiology methods for identifying brain lesions, consumer and provider misunderstanding of the rationale and usefulness of neuropsychological assessment, and the identity confusion many neuropsychologists face in the roles of treatment and rehabilitation planning. CTNA will be introduced as a method for meeting these challenges and helping to make neuropsychological assessment responsive to consumers, providers, and referral sources while enhancing collaboration between professions. An overview will be provided of a published survey, conducted by the editors, on neuropsychological assessment feedback practices.
II. Conceptual Foundations: Brief history of neuropsychological assessment feedback
a. Therapeutic Assessment Models: The historical background for using psychological testing as a collaborative and therapeutic intervention. First, a review of the early projective test studies will be described. Then the chapter will describe Constance Fischer’s Individualized Psychological Assessment and Stephen Finn’s Therapeutic Psychological Assessment.
b. Luria’s work: The chapter will begin with an analysis of Alexandr Rumanovich Luria’s Neuropsychological Investigation and how his methodology provides a precursor to contemporary client centered neuropsychological interventions and rehabilitation.
c. Literature review: Second, a review of the empirical literature will be provided on recommendations for providing feedback from neuropsychological tests.
d. Motivational Interviewing: The next generation of client centered feedback. The section will discuss the application of Motivational Interviewing methods for providing client centered feedback. This is relevant because CTNA feedback methods are based on the MI conceptual framework.
e. Contemporary applications: In this section a review will be provided on the current work being conducted on CTNA methods. This will include a review of research conducted by the primary editors; the work of Dr. Diane Engelman from the Center for Collaborative Psychology and Psychiatry; Dr. John Strang’s work with the Neuropsychology School Conference; and the study by Dr. Phillip Pegg on providing medical and neuropsychological information to traumatic brain injury patients.
III. CTNA Model
- Basic Assumptions of CTNA
- The patient/caregiver/referral source have noticed a change in the patients cognitive and/or behavioral functioning and would like a professional to tell them if there is a true change and to what degree, severity, and if possible potential causes.
- The patient/family are distressed because of the change in the patient’s cognitive/behavioral functioning. Part of the reason they are coming in for the evaluation is to receive help, direction, and guidance in order to feel less distressed.
- Patients would like to know of potential ameliorative strategies so that the patient performs better in school, work, social spheres, and begins to feel better about him/herself.
- While patients seek guidance and direction from the psychologist, they also want their individuality and autonomy respected and to be empowered to be active participants in treatment and decision making processes.
- Neuropsychological tests provide objective, concrete information about patient’s cognitive and behavioral functioning that applies to their daily life and problems they may be experiencing.
- Feedback to patients, from neuropsychological tests can help answer questions regarding changes in cognitive and behavioral functioning, provide hypotheses as to the causes of these changes, and provide direction for treatment planning or rehabilitation.
- Feedback presented in a client centered manner can elicit the patient as an active collaborator, empower them in the treatment and decision making process, and lower resistance to hearing difficult or discrepant information while motivating them to work closely with professionals to alleviate their problems and distress.
- The Initial Interview: Collaborative Information Gathering
This section provides guidelines for a collaborative interview and assessment as setting the stage for a CTNA feedback sessions. The emphasis is not on specific interviewing techniques but rather a set of guidelines for conducting interviews in a collaborative and client centered manner.
1. Understanding the problem, when it occurs, and for how long.
- Overview: Balancing developing rapport and a collaborative relationship versus gathering important assessment information
- Developing a collaborative agenda
- Developing Rapport and Understanding
- Balancing questions and self disclosure
2. Understanding the patient’s emotional experience of the problem by developing the Central Cognitive Emotional Complaint (CCEC)
3. Understanding the patient’s expectations for the assessment, results, and eventual outcome. Developing patient questions they hope the test results can answer.
4. Understanding Neuropsychology and neuropsychological assessment.
5. Schedule and conduct the assessment session.
- The Feedback Session
This chapter will provide the steps for conducting a CTNA feedback session. It will include detailed explanations with case examples to illustrate the methods.
1. Introduce the feedback session as a collaborative endeavor.
2. Assess patient status since the initial assessment, changes, new developments, setbacks, successes, etc. Review the CCEC and modify if needed. Review patient questions previously developed and modify if needed.
3. Provide a copy of the feedback report
- Understanding neuropsychology and neuropsychological assessment
- Skills assessed
- Reviewing strengths and weaknesses, how determined
4. Reviewing personal strengths
- Elicit – Provide – Elicit: OARS
5. Reviewing challenges or weaknesses
- Elicit – Provide – Elicit: OARS
6. Summarizing results and main findings: Making recommendations
- Providing a summary in a collaborative manner
- Asking the key question to elicit patients ideas about how to use the information
- Making recommendations
2. Practical Issues and Future Directions
This chapter will provide suggestions on ways CTNA can be useful in clinical work, research, and teaching. Suggestions will be provided on ways to incorporate CTNA methods in various disciplines, including clinical practice, rehabilitation psychology, school psychology, and others. Suggestions will be provided on ways to include CTNA in graduate level curriculums, internships, and postdoctoral experiences. In addition, the chapter will provide information on the applicability of CTNA with special groups such as those of different cultures, children and adolescents, the elderly, and families.