integrating neuropsychological and psychodynamic … · 2018. 10. 22. · integrating...
TRANSCRIPT
INTEGRATING NEUROPSYCHOLOGICAL AND PSYCHODYNAMIC THINKING:
EXPERIENCE,EVALUATION, INTERVENTION
Stephen Seligman, D.M.H.(Adapted from Lois Black, Ph.D.)
October 22, 2018San Jose, CA
GOALS
•What does a “neurogenic” difficulty look and feel like?
•An integrated approach to neuropsychological and
psychodynamic evaluation and intervention.
KEY POINTS: AM--DIAGNOSTIC CLUES
--NEUROPSYCHOLOGICAL FUNCTIONS
--NEUROPSYCHOLOGY AND THE SENSE OF SELF
DIAGNOSTIC CLUESDoesn’t Fit the Usual Diagnoses
Discrepancies
Many Previous and Often Frustrating Evaluations
“Weirdness”
Doesn’t fit the Usual Diagnostic Categories
Many and Puzzling Evaluations
“Weirdness”
No one quite knows what to make of the child.
Hard to understand, by peers and/or adults.
Alternatively, gets along well with adults but not with kids.
Discrepancies I: An Important Clue
• Family Environment and History doesn’t seem to “explain” the extent of the presenting problem
• Confusion and “Self-Disturbance” not reflected in Family Environment or History of Trauma
• Doesn’t fit the usual diagnoses
Discrepancies II: An Important Clue
•Verbal vs. Nonverbal
•Expressive vs. Receptive Language
•Spontaneous vs. On-Command Language Performance
An Important Clue III
• ADHD Diagnosis that Doesn’t Feel Right
NEUROPSYCHOLOGICAL FUNCTIONS
•Motor
•Sensory-Perceptual
•Visual-related
•Memory
•Language-related
•Affect
•Social Awareness
•Organizational/Executive Functions & Attention
AT THE CORE OF KEY DEVELOPMENTAL PROGRESS
AND…HOW WE RELATE TO OTHERS
What do I mean by “neurogenic” disability
Is brain-/body-based
(I will explain)
What do I mean by “neurogenic” disability
Can affect how a child:•Moves•Sees•Speaks•Senses•Thinks•Understands•Reasons•Remembers
AND …..
Motor Functions
•Fine and Gross Motor Coordination
•Motor Tone and Motor Strength
•Motor Planning and Praxis
•Graphomotor Functions
Sensory-Perceptual Functions
•Auditory
•Visual
•Tactile
•Stimulus Sensitivity and Modulation
Visual-Related Functions
•Visual-Perceptual
•Visual-Spatial
•Visual Cognitive
Memory
•Verbal Memory
•Visual Memory
•Short-term
•Long-term
•Etc.
Language-Related
•Auditory Processing (sound discrimination, sound analysis, sound blending)•Speed/Temporal Order Processing (Sequencing)•Phonological Production, Speech, and Other Oromotor Functions•Auditory Cognitive Functions (including language comprehension and expressive language)
Organizational/Executive Functions
•Selective Attention
•Vigilance
•Mental tracking and Cognitive Flexibility
•Initiating, Shifting, Inhibiting, Sustaining Attention
•Dynamic Motor Coordination, Persistence and Modulation
Affect and Social Processing
•Affect Recognition
•Arousal/Alertness and Mood
•Understanding and linking affect, affect display and subjectivity in the social interaction
How are these subjectively experienced?
NEUROPSYCHOLOGY AND THE SENSE OF SELF
These are intertwined:
We live in our bodies.
KEY POINT:A neurogenic disability can be
fundamentally intertwined with socioemotional development
KEY POINT:“Neurogenic” difficulties can be
intertwined with the fears, worries and other experiences of the
parents(including culture, gender and class!)
How do YOU see this??
• In Culture
• In Gender
• In Class
• Otherwise
“Neurogenic” Difficulties Are:
•Interpreted by Family and Others (school, friends, professionals, etc.)
•Played Out in Behavior and Communication
•Subjectively Experienced and Become Part of the Child’s Sense of Self and the World
•The Child Reacts to these Interpretations and Reactions
The Child Reacts to these Reactions and Interpretations
This framework can itself become a perpetuating factor in the child’s
emotional and behavioral problems
VERY IMPORTANT:
Try to Interrupt Such “Vicious Cycles”
SUMMARY:KEY
POINTS
What do I mean by “neurogenic” disability
Is brain-/body-based
(I will explain)
What do I mean by “neurogenic” disability
Can affect how a child:•Moves•Sees•Speaks•Senses•Thinks•Understands•Reasons•Remembers
AND …..
KEY POINT:A neurogenic disability can be
fundamentally intertwined with socioemotional development
How the Child Relates to Others!!!
…..And Sees Herself!!
??????
Time for a Break??
NEUROPSYCHOLOGICAL-PSYCHODYNAMIC
EVALUATIONWhat do you look at?
What do you look for?
What is going on with the child?
“Ideal” Assessment Format for an Integrated Neuropsychological-
Psychodynamic Evaluation
•Parents
•The Child
•History and Prior Evaluations
Clinical Interview with Parent(s) (without the child present)
•Get information
•Open to their feelings, and feelings about their child
•Build Alliance through empathy and professional approach
Assessment of child•Observation of play, games and
interaction with parents
•Home Observation
•School Observation
•Meetings with Child in Office and/or Home
•Neuropsychological Evaluation if indicated
Evaluation is an Ongoing Process
•Cases are often Very Complicated
•Situations are Fluid
•New Information Comes in
•Sometimes You Don’t Know until You’ve Tried Some Interventions
Don’t expect too much from yourself!
Instead---use your feelings as information.
(Imagine how the parents and child must feel)