Areas of Practice
My main areas of practice focus on neuropsychological and psychological assessment and intervention with persons with medical illnesses - particularly neurological illness and injuries. This includes (but is not limited to) brain injury, stroke, epilepsy, attention-deficit/hyperactivity disorder, Parkinson’s disease, dementia, cancer, and pain, as well as individuals with trauma in the health context. I focus my practice on these specific areas because they are the areas where I have most training and experience, and this allows me to provide you with the best quality of care.
ACQUIRED Brain Injury
Traumatic brain injury and stroke are often classified as “acquired brain injury”, meaning there has been an abrupt insult to the brain that has caused an acute change in your thinking abilities and your emotional functioning. Other types of acquired brain injury include hypoxia/anoxia (i.e., brain damage caused through oxygen deprivation) and encephalitis (e.g., damage to the brain caused by the herpes virus). It is common in the early stages to be focused on your physical health, and making sure you get the right medical treatment. However, once the acute event is over, then people can start to become aware of the changes in their mood and mental abilities. These changes can be upsetting, as the person discovers that they are not who they once were.
Neuropsychological assessment can be used to understand exactly how your cognitive and emotional functioning have changed since the injury, what you might expect in terms of recovery, and what steps you can take to improve your functioning and expedite the healing process. Assessment for acquired brain injury is typically the first step in developing a treatment plan that includes psychotherapy and cognitive rehabilitation.
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Neurological Illness
There are many chronic illnesses that can affect the central nervous system, and also have an impact on cognitive and emotional functioning. Some of these affect movement, such as Parkinson’s disease, multiple sclerosis, and dystonia. There are also seizure disorders, such as epilepsy and post-traumatic seizure disorder (e.g., after a TBI). Some of these illnesses are associated with cancer, such as a primary brain tumor or CNS lymphoma. Finally, some of these illnesses begin in childhood (e.g., spina bifida or attention-deficit/hyperactivity disorder), while others might begin later in life (e.g., amyotrophic lateral sclerosis, or ALS). Because these illnesses persist over time, they can have an ongoing impact on our cognitive and emotional functioning.
Emerging data is showing that a significant proportion of people who have experienced COVID-19 go on to develop persistent cognitive and emotional difficulties, such as mental fatigue, impaired attention and concentration, depression, anxiety, and post-traumatic stress disorder. Even when the acute physical symptoms of illness have abated, people may struggle to function in daily life with these lingering effects.
Neuropsychological assessment can help determine exactly what kinds of difficulties you are dealing with, as well as how best to compensate for those difficulties and improve your quality of life. Assessment may also be necessary if you are going to have surgery, such as tumor removal, epilepsy resective surgery, or deep brain stimulator implantation for Parkinson’s disease. Assessment can help determine whether you are a good candidate for surgery, what cognitive changes (if any) you might anticipate after surgery, and how you can cope with those changes.
Finally, like persons with acquired brain injury, individuals with neurological illness can often benefit from treatment, including psychotherapy and cognitive rehabilitation.
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LATE-LIFE Cognitive Decline and Dementia
It is normal as we age to experience some decline in our mental abilities. The majority of people cope with and adapt to this decline without much of an issue, and continue to live a full and rewarding life. However, for some people, this cognitive decline is “more than normal”, and could indicate an underlying disease or disorder that requires monitoring and treatment. Neuropsychological assessment can help to answer the question of whether any cognitive decline you are experiencing is normal aging or more than normal aging.
If more than normal aging, the assessment can help direct your healthcare providers toward an appropriate diagnosis. Learning about your strengths and weaknesses can help you focus on ways to compensate for your difficulties, as well as adopt strategies to maintain your cognitive and emotional health.
Separate from any cognitive decline, older adulthood can be a very rich and meaningful time to enter into psychotherapy. It allows us the opportunity to reflect on our life path, make sense of what has happened, and find peace in moving into the chapter of “becoming an elder”.
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TRAUMATIC STRESS DISORDERS
I have a particular interest and growing expertise in the treatment of traumatic stress disorders. This includes persons dealing with post-traumatic stress disorder (PTSD) following discrete events, such as medical trauma (e.g., secondary to invasive procedures), or following a car accident or concussion. Emerging data indicates that a significant proportion of persons recovering from COVID-19 may also be dealing with PTSD. Sometimes a major medical illness also activates latent trauma and abuse from childhood, making it difficult to cope. We are learning more and more about the role of adverse childhood experiences in the development of mental and physical health difficulties in adulthood, and being “ACE-aware” is an important part of my work.
Fortunately, trauma is very treatable and there are many valuable tools and approaches to help people not only survive but also thrive after trauma.
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