Psychotherapy and Neuropsychotherapy

Abstract

The management of problem emotions, behaviors, and thoughts as well as personality changes in people with neurological dysfunction is distinctly different from management of the same issues in patients with psychological disorders. This is because much of the time, in patients who happen to have brain conditions, these are not simply psychological disorders but rather they are distinct syndromes due to disruption of the neural substrate of those functions. Neuropsychotherapy is distinct from conventional psychotherapy in content, technique, and social context. This chapter discusses the core elements of neuropsychotherapy and discusses important questions commonly asked by physicians, such as when to refer for psychotherapy versus neuropsychotherapy; what patterns of neural substrate dysfunction affect behavior, emotional, cognitive, and social functions; what on-label and off-label drug therapies are effective or, more importantly, should be avoided; and how does the collaboration between mental health, medical, and other multidisciplinary team members influence treatment outcomes? This chapter concludes with a clinical case example that demonstrates the use and effectiveness of the neuropsychotherapeutic approach for improving the quality of life of the patient following neurological dysfunction.

Chapter Review Questions

• 1. The contemporary relationship between referring physicians and neuropsychologists concerning medication management for neuroaffective symptoms is optimally one in which:

  • A. The neuropsychologist assumes responsibility for such medications.

  • B. The referring physician and neuropsychologist collaborate in medication choices, monitoring, and management, and the referring physician maintains ultimate responsibility.

  • C. The referring physician makes all medication decisions independently and informs the neuropsychologist of the rationale.

  • D. The neuropsychologist with prescription privileges only shares medication changes with the referring physician when the underlying cause is neurological.

• 2. Neuropsychotherapy:

  • A. Is distinct from conventional psychotherapy in content, technique, and social context.

  • B. Refers both to psychotherapy with patients with brain disorders and to psychotherapy that takes brain functioning into account.

  • C. Can only be performed by neuropsychologists.

  • D. All of the above.

  • E. A and B only.

• 3. Neuropsychotherapy:

  • A. Focuses primarily upon behavior management by staff and family members, since the emotional problems of brain disorders cannot be modulated.

  • B. Relies upon neuropsychopharmacology to change emotional states and upon behavior management and environmental manipulation to regulate behavior.

  • C. Integrates emotional rehabilitation strategies of restoration, compensation, and accommodation, along with medication management to address neuroaffective problems.

  • D. Uses individual psychotherapy approaches only, since the patient ultimately must bear responsibility for their own self-image and behavior.

• 4. Referrals to neuropsychologists:

  • A. Should contain only general questions and behavioral descriptions and few medical records so as to not prejudice the neuropsychologist’s clinical judgment.

  • B. Need not be specific since the neuropsychologist will give a standardized battery to all patients.

  • C. Need not state specific referral questions since the referring physician will be making the diagnosis.

  • D. Should focus upon cognitive issues only, since emotional issues should be referred to psychiatrists and psychotherapists.

  • E. None of the above.

  • F. All of the above.

Definitions retrieved and amended when relevant from https://www.merriam-webster.com/medical and http://psychologydictionary.org