Neuropsychologists

This is what has bothered me a lot this week. You may not care, but this is my blog so I am going to rant on a bit.

I have a more than the usually weird client whom I have mentioned here before. She seems to have some kind of physical symptoms to go along with her spacial disorientation and hoarding behavior. She sees me, and also attends a day program a couple of times a week. She had been improving in fits and starts and stops since I have been seeing her for a year. The day program thought it would be a good idea to get a neuropsych evaluation done. I agreed. Perhaps they could find something more specific, or at least give some insight.

Over the last decade there has been a huge increase in people who label themselves as "Neuro-psychologists". They are supposed to be skilled at using specialized tests to determine the presence and extent of things such as leaning disabilities, ADHD, dementia, brain damage, and other more physiological causes of psychological distress.

I have only gotten about six reports from such people, and I can't say I've been impressed. First, many of the tests they use are the same ones, or perhaps revised versions of the ones I learned when I was in graduate school in the dark ages. Several are now scored by a computer, but that doesn't really make them more sophisticated.

Of the six reports, two told me nothing new, one was helpful, one was very revealing and two seemed to offer wild guesses at things that turned out to be wrong.

The report on this woman was different. It was insightful and accurate and it offered not only new information but support of things I was not sure of.

Now, that would be good except it was written in a way that just condemned the patient. Some of the scores on some of the tests indicated that she exaggerated or even manufactured some of her symptoms -- which is true. But they wrote the report and called her "malingering" which strongly implies that she is devious and manipulative. Their recommendations were that she be given a few sessions of DBT and sent back into the world. She should not be given other services, they said, because she is a waste of time.

Whoa, this is not a helpful presentation. Here is a woman who clearly has issues. Yes, she is confused and she exaggerates and she makes things very dramatic, but her life rally sucks and she doesn't seem to be getting much pleasure out of all of this.

The report offered no explanation as to why she would do this, or what was in it for her, or how she got this way. They could have said that this was a woman who has more strengths than she uses. They could have said many things that would have been helpful to the treatment. But instead they only wrote about the data. They got their conclusions from the numbers. They didn't think about treatment. AND they gave the report directly to her! That set everything back about six months.

So I wrote to the people who wrote the report and told them that I thought they could have been much more helpful. I tried to be nice about it. I don't know if they will respond.

Psychology has enough trouble being a science; it doesn't have to be mean about it to prove that we know stuff. Not helpful.

I will let you know how, or if, they respond.