Psychotherapy in Neuropsychology

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Psychotherapy in Neuropsychology

• Julie Bobholz, Ph.D., ABPP-Cn

Department of Neurology Medical College of
WisconsinMilwaukee, Wisconsin, USA
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• Themes / Goals of therapy
• with NP conditions
• Adjustment to diagnosis
• Adjustment to symptoms
• Moving past the past
• Moving forward in the future

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• Intervention strategies
• It is important that the therapist remain
  flexible
• Therapy in medical settings tends to be less
  general and is typically more focused on
  specific targets
• Therapy often involves multiple strategies
• Strategy depends on the patient and the condition

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• Strategies Supportive Counseling
• Can begin during interview and continue
  throughout the NP exam.
• Is typically done to ease psychological distress
• Can be done individually or in groups
• Often involves education and reassurance

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• Strategies Psychotherapy
• Example Cognitive Behavioral Therapy
• Monitor thoughts for distortions
• Teach rational thinking techniques
• Teach a skill to allow them to cope with their
  emotional distress

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• Strategies Crisis Intervention
• Situations can overwhelm a patients ability to
  cope
• Professional or personal losses
• 3 goals of crisis intervention
• relieve the patients present psychological
  distress
• restore the patient to his/her previous level of
  fx
• help the patient learn what personal actions and
  community resources are available.

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• Strategies Crisis Intervention (how?)
• Acknowledge the patients feelings, thoughts,
  behaviors
• Help them stay problem focused by exploring
  alternative explanations and solutions
• Emphasize their strengths in coping with previous
  events
• Mobilize additional resources
• Provide information / advice as appropriate.

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• Strategies Individual / Family
• Focus is on helping the patient and family cope
  with the diagnosis
• Teaching the patient how to live with symptoms
  but for families to learn how to interact with
  the patient as well
• Helping patients and their families plan for the
  future, practically and emotionally

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• Strategies Support Groups
• Group discussion allows an opportunity for
  patients with similar illnesses or problems to
  meet with each other to discuss their concerns,
  anxieties, and coping strategies.
• Patients share their experiences but also their
  ways of coping with symptoms.
• Patients tend to learn from the example of others

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• Strategies Education / Information
• Many cognitive distortions occur when individuals
  are misinformed or lack information regarding
  their condition.
• It is important that patients understand their
  condition, the cause, the symptoms, the
  treatments, and the prognosis.

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• Strategies Relaxation training
• Used as an intervention to adjust ones
  physiological state but decreases anxiety as
  well.
• Diaphragmatic breathing
• Progressive muscle relaxation
• Autogenic relaxation
• Imagery
• Covert sensitization
• Hypnosis
• Biofeedback
• Systematic desensitization

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Psychotherapy in TBI

• Head injury can cause emotional and behavorial
  symptoms that can often benefit from
  psychotherapy intervention.
• Targets for treatment in TBI
• depression
• anxiety / post traumatic stress
• anger / frustration

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Psychotherapy in Epilepsypseudoseizures

• What is a pseudoseizure
• cause?
• what does it look like?
• how do we treat it

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Summary