integrating neuropsychological and psychodynamic … · 2018. 10. 22. · integrating...

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)