Dr. Mary Pepping is a board certified neuropsychologist with 33 years of experience evaluating and treating working-age people and older adolescents with various forms of acquired brain injury. These include people with traumatic brain injury, brain tumor, stroke, multiple sclerosis, anoxic injuries, residual effects of neurological conditions such as meningitis, encephalitis, Huntington Disease, early-onset Parkinson disease, lupus, normal pressure hydrocephalus, and various forms of dementia. Dr. Pepping has long-standing involvement in neuro-rehabilitation of these populations of individuals. This includes an emphasis on detailed neuropsychological evaluations as a foundation for treatment, cognitive rehabilitation and psychotherapy in a milieu model context, and the role and functions of interdisciplinary teams to achieve good outcomes. With her PhD in Clinical Psychology completed 1981 from Washington State University she went on to a postdoctoral fellowship in Clinical Neuropsychology at the University of Washington School of Medicine. After fellowship she spent six years in the Section of Neuropsychology, Department of Neurosurgery, at HCA Presbyterian Hospital in Oklahoma City, OK, directing the milieu-based treatment program there in her final two years. This was followed by a return to Seattle to work for five years in the Physical Medicine and Rehabilitation Department at Virginia Mason Medical Center, continuing with evaluation, treatment and clinical research. After a subsequent six years in private practice, Dr. Pepping was recruited by the Department of Rehabilitation Medicine at the University of Washington Medical Center to serve for 14 years as Director of their Neuropsychology Service and outpatient interdisciplinary Neuro-Rehabilitation Program. Her years at the University of Washington School of Medicine gave her additional opportunities to provide teaching and training to interns, residents, fellows and practicum students from a range of disciplines, as well as shared research and scholarly writing projects with interdisciplinary colleagues. These fields included clinical psychology, neuropsychology, rehabilitation psychology, rehabilitation medicine, psychiatry, speech language pathology, occupational therapy, physical therapy, vocational rehabilitation and cognitive neurosciences. With retirement from direct clinical practice in July 2013, Dr. Pepping shifted to Professor Emeritus within her department to create more time for scholarly writing, research and a return to a private consultation practice.
This second edition (of the original Successful Private Practice in Neuropsychology) provides an updated overview of key principles and processes for establishing, maintaining and developing neuropsychology practice and neuro-rehabilitation program (NRP) treatment in medical center and/or private practice settings. Essential elements of an entrepreneurial model that work well in the medical center context and the necessary role of variety and peer review in the private practice setting are also discussed. - How to gather and report NPE and other evaluation findings with a neuro- rehabilitation focus that lead to specific neuro-rehabilitation recommendations. Benefit: this will make your evaluations and reports more desirable and sought after in the setting and community where you work. - Updated billing/diagnostic code recommendations to accurately capture the actual time spent in evaluating and/or treating patients. Benefit: increased appropriate billing and collections for your time- Recommendations for clinical neuropsychology postdoctoral fellowship training of a Navy psychologist. Benefit: you may be able to obtain funding for an experienced Navy clinical psychologist who wants formal training in neuropsychology. This can expand your clinical services, increase variety and quality of your training program and ultimately support improved care for returning American military personnel.
Front Cover 1
Successful Practice in Neuropsychology and Neuro-Rehabilitation 4
Copyright 5
Dedication 6
Contents 8
Foreword to the Second Edition 16
Reference 20
Preface 22
Chapter 1: The Challenges of Practice in Neuropsychology 24
Pros and Cons of the Institutional Setting 24
Maintaining High-Level Skills 25
The Interdisciplinary Network 27
Do Not Go Gently into That Research Decline 28
Creating Educational Opportunities 29
Productively Managing Anxiety: Income 29
Protectively Managing Anxiety: Malpractice 30
Personality Factors in Private Practice 31
Ego Needs and Decreased Prestige 32
Ongoing Consultation: Are You Willing to Seek It? The Buck Stops Here 33
Chapter 2: Other Potential Indignities 36
No Paid Sick Leave or Holidays 36
No Additional Reimbursement for Professional Fees 37
No Guaranteed Salary or Health-Care Benefits 37
Overhead Expenses 37
Billing, Collections, and Taxes 37
Chapter 3: The Good News 40
Integrating Skills and Interests in Patient Selection 40
Creating the Optimal Schedule 41
Flexible Hours and Days 42
First Choice on Vacation Slots 43
Design Your Own Contracts 43
Setting Your Own Fees 45
Brief Comment on Fees and the Institutional Setting 45
Determining Salary 46
Choosing Your Own Support Services 47
Office Location, Space, and Atmosphere 48
Developing Your Own Letterhead and Brochures 49
Personalized Report Formats 49
Test Selection 49
Tax Advantages 50
Chapter 4: Getting Started: Practical Preliminary Questions 52
Are You Experienced Enough to Be on Your Own? 52
Individual or Group Practice 53
Interdisciplinary Practices 54
Full-Time or Part-Time Private Practice 55
Income Factors 55
Related Scheduling, Dictation, and Billing Factors 56
Consultation or Supervision Practices 57
Teaching 58
Classroom Teaching 58
Workshops 58
In-Service Training 58
Developing and Running Your Own Continuing Education Course 59
Medical-Legal Work 59
Neuropsychological Evaluations and Expert Witness Work 59
Hospital and Clinic Affiliations 61
University or Medical School Positions 62
Adjunct Appointments 63
Part-Time Clinical Faculty 63
Chapter 5: A Practical Guide for Opening Your Business 66
Dont Burn Bridges 66
Clinician, Know Thyself 66
A Moveable Feast: The Menu of Practice Options 67
Maintain a Part-Time Practice with Your Previous Employer 67
Developing a Safety Net: Starting with a Group 67
Offering Contract Services to Inpatient Rehabilitation Units 68
Offering Contract Services to Private Clinics 68
Membership in Managed Care Panels 69
Obtaining Adjunct or Clinical Teaching Appointments 70
How to Determine Fair Fees 71
How to Find Good Help 72
Developing a Business Plan and Practice Management Statistics 73
Chapter 6: Marketing and Other Matters 76
First: The Other Matters 76
Next: The Marketing Piece: The Introductory Letter 76
Develop Seminars and Workshops 77
Give Guest Lectures 77
Offer a Memory Course to the Public 78
Contact Local Physicians and Fellow Neuropsychologists 78
Contact Independent Nurse Case Managers 79
Contact Private Vocational Firms 79
Attend Weekly Hospital Teaching Rounds 80
Supervise Residents, Interns, and Postdoctoral Fellows 80
Obtain Graduate Student Help for Research 80
Conference Participation: Yours and Other Related Professions 81
Publish 81
Final Comment 82
Chapter 7: Creative Approaches to Financial Issues 84
Next Steps 85
Trading Consultation Time for Office Space 86
Sharing Testing Materials 86
Advice on Billing and Collections 87
Obtaining Basic Data from Your Patients 88
Obtaining Insurance Authorization 89
Contract and 50% Down for Private NPE 90
ICD-9 and CPT Codes 90
How to Bill and Collect for Legal Work 92
Reduced Cost Malpractice Insurance 93
Contract Assistants 93
One Final Insurance Note on Using Contract Neuropsychologists 95
Tax Deductions, a Good Accountant, and Type of Business 96
Chapter 8: Medical-Legal Work 98
The Problems with Legal Work 98
True Believer Polemics in the Absence of Strong Scientific Data 99
Integrity and Reputation-Are You a Plaintiff or a Defense Expert? 100
Potential War of the Clinical and Legal Worlds 101
Subtle Influence and Examiner Drift 102
Inadvertent Promotion of a Litigious Zeitgeist 102
The Benefits of Forensic Work 103
Reference 106
Chapter 9: Consultation and Supervision Practice 108
Clinical Psychologists, Primary Care Physicians, Nurse Practitioners, Physician Assistants, and Neurology or Rehabilitation... 108
Neuropsychologists Who Wish to Augment Their Training 110
Therapists in Social Work, Counseling, or Pastoral Counselors 111
Rehabilitation Therapists, Occupational Therapists, Physical Therapists, Speech Pathologists, Vocational Counselors, Rehabi... 112
Consultation with Psychologists Preparing for Licensure 113
Chapter 10: Psychometric Concerns 114
The Interview: Who Should Be Present and Why? 114
The Collateral Interviews: When, Why, and with Whom? 115
Preparing the Patient to Be Tested 116
Test Selection 117
Core Batteries: Key Areas of Function That Must Be Assessed 117
My Typical Comprehensive Battery 117
Brief Batteries: Screening or Pre-Postprocedure Testing 118
Core Battery 119
Supplemental Tests 119
Selective Additional Testing: Divided by Specific Areas of Concern 120
Effort 120
Premorbid IQ Estimates 121
Significant Memory Impairment 121
Mild but Real Neuropsychological Impairments 122
Modified Batteries Secondary to Physical or Sensory Limitations 122
Evaluating Personality in Neuropsychological Assessment 123
Cross-Cultural Issues 124
Use of Psychometrists 125
Report Formats 127
Review of Test Results 128
Dictation Versus Typing it Yourself 129
Dissemination of Reports 130
Preservation of Testing Files and Raw Data 130
Chapter 11: Treatment Practices for Neuropsychologists 132
Your Training Background and Future Training Needs 132
What Kind of Practice do you Want? 133
Other Parts of Good Clinical Practice Development: Outpatient Psychotherapy 133
Establishing Short-Term and Long-Term Groups 134
Individual Treatment in a Neuropsychology Practice 135
Psychotherapy 135
Cognitive Rehabilitation 135
Billing and Reimbursement Issues 136
Other Practice Options: Employee Assistance Program Contracts 136
Other Practice Options: Case Management Services 137
References 137
Chapter 12: Nuts and Bolts of Your Evaluation Practice 138
Referrals 138
Referral Etiquette 138
Educating Referral Sources 139
Purpose of Testing 140
Working Diagnosis 141
Scheduling of Patients for Interview and Testing 141
Time Frame for Report 142
Mechanisms of Feedback to Referral Sources and Patients 143
Clinician Feedback 143
Feedback to Patients 144
Estimated Costs of Evaluation 144
Patient Information Handouts and Registration Forms 144
Obtaining Records 146
What Are Pertinent Records 146
Release of Information for Additional Information 146
Insurance Preauthorization of Services 147
Private Insurance 147
Contract Services and Legal Work 149
Timely Billing and Collections 150
Billing 150
Collections 150
Chapter 13: Neuro-Rehabilitation Program Treatment: Principles and Process 152
Introduction 152
What Is Milieu-Based Treatment? 152
The Value of Work in the Lives of Humans 153
Why Is the Traditional Versus the Milieu-Based Rehabilitation Distinction Important 154
What Is Traditional Outpatient Rehabilitation? 155
Why Is Milieu-Based Treatment Needed for the ``Medium-Severe?´´ 156
Guiding Philosophy and Principles of the Milieu Model 161
Some Implications of Psychological Factors in Evaluation and Treatment 162
Unwitting Misinterpretation of Evaluation Findings 162
Clinicians are Not Blank Slates 163
Practical Considerations for Neuro-Rehabilitation 164
Team Constellation 165
A Commentary on the Critical Function and Role of Psychometrists 165
Key Practical Program Components 166
Fundamental Relationship Between NPE and NRP Treatments 170
Why Is It Useful for Neuropsychologists to Fully Understand Cognitive Rehabilitation? 171
Other Practical Examples of NPE-NRP Connections 173
NPE in Return to Work, School, and Community Independence 174
General Comments 174
NPE and Return to Work 175
NPE and Return to School 176
Some Problematic Challenges to the Confidentiality of Students NPE Data 177
Student Athletes 177
Medical School and Medical Residency Applicants 178
NPE Findings and Increased Independence in the Community 179
How Can the Milieu-Based Model Be Modified for Your Practice? 179
For Private Practitioners or Institution-Based NPs in Non-NRP Departments 179
A Brief Aside on Speed of Information Processing and Flexibility of Thinking 181
Implications for Return to School, Return to Work, and New Technologies 181
Closing Comments 182
References 183
Further reading 185
Chapter 14: How to Design and Implement a Cognitive Group 190
Introduction 190
Which Patients? 191
Basic Clinical Rules and Procedures 192
Patient Screening 192
Attendance, Participation, Confidentiality, Respect 193
Use of Co-Leaders 194
Individual Therapy as an Adjunct to Group Therapy 195
Basic Billing and Documentation 196
One Model for Cognitive Group Treatment 196
Chapter 15: The Value and Use of the MMP1 in Neuropsychological Practice 198
Introduction and Background 198
Why Use Personality Testing? 198
Why Has the MMPI Fallen into Disrepute in Some Circles? 199
Challenges to Providing Balance: Identifying Personality Strengths 200
Is an Emphasis upon Problem Areas Unique to the MMPI? 200
How Do We Protect Against Misuse? 201
How Can We Improve Our Use of the MMPI in Clinical Practice? 202
MMPI Profile Case Examples 203
Case1: ``Brooke´´ (Not Her Real Name)-Female Age 24-Severe (Glasgow Coma Scale Score=6) TBI in Horse-Back Riding Accident 204
Relevant MMPI Profile Features 204
The Ultimate Added Value of the MMPI for This Patient 205
What Did We Learn More Specifically about and from the Patient in the NRP to Augment MMPI Findings? 206
Some Practical Treatment Implications of Her MMPI Profile and History 208
Summary of Where the MMPI Profile Helped Lead Treatment 208
Outcome after Discharge from Treatment 209
Case2: "Andy" (Not His Real Name)-53-Year-Old Man-25+ Year History of RRMS, Now With Secondary Progressive MS 210
Relevant MMPI 3172 Profile Features 211
Some Practical Treatment Implications of His MMPI Profile and History 212
The Ultimate Added Value of the MMPI for This Patient 213
How Did the MMPI Findings Affect Choice and Delivery of Treatment? 213
Why Did This Approach Work? 215
Outcome with Treatment 216
Final Summary Comments 217
In Summary, Why Should We Use the MMPI? 218
A Brief Word on the MMPI, MMPI-2, and the MMPI-2-RF 218
References 218
Further reading 219
Chapter 16: Designing and Implementing a Clinical Neuropsychology Fellowship 220
Introduction 220
Design of the Fellowship: Three Key Components 222
Implementation of the Key Components 224
APA Division 40 Training Guidelines 224
Training Content to Meet General Knowledge Requirements for Our Fellow 225
Specific Skills to Master per Houston Guidelines 225
Our Practice and Training Components 226
Background of the Training Neuropsychologists 226
Patient Groups for Neuropsychological Evaluations 227
Exposure to Medical-Legal Work as Part of Fellowship Training 227
Quantity of Neuropsychological Evaluations 228
Additional Components of Neuropsychologist Training Available to the Fellow 228
An Emphasis upon Interpretation of NPE Results 228
Training in Neuro-Rehabilitation Program Principles, Process, and Practices 229
Involvement in Clinical Team Meetings 229
Organizing the Training Schedule 230
Feedback from the Fellow After Return to Active Military Service 232
Main Criticism of the Training Program 232
How Could We Incorporate Requested Changes in Future Training? 233
Main Strengths of the Training Program 233
A Final Word on Selection of Trainees 234
A Final Comment on How to Make This Happen in Your Locale 235
Supervisor Time Required for Fellowship Training 236
Chapter 17: Research as a Daily Reality 238
What Are Your Research Interests? 238
What Are Your Populations of Interest? 239
How to Arrange Research Access to Patient Populations 240
Setting Up Your Hypotheses 240
Setting Up Your Data Summary and Data Entry Sheets 241
Finding a Graduate Student Assistant 242
Grants 242
Conference Presentation 243
Journal Articles 243
Chapters 243
Journal Groups 244
Collaborations 244
Chapter 18: Summary and Conclusions 246
The Importance of Relationships and Mutual "Best Interest" 246
What Sort of Work Do You Want to Do? 246
Where and How Do You Want to Begin? 247
What are the Best Ways for You to Minimize Costs and Maximize Income? 247
What Sort of Financial Floor Do You Need? 248
How Will You Monitor and Promote Growth of Your Practice? 248
What Do You Do If Plan A Isn't Working as You Expected? 248
What are Your Short-Term, Intermediate, and Long-Term Goals? 249
Practical Ways to Vary Your Practice 249
Periodic or Long-Term Contract Work 250
Clinical Faculty Appointments 250
Be Alert to Clinical, Teaching, and Research Opportunities 251
Enjoying Your Practice 251
Appendices 254
Appendix A 254
Expanded Neuropsychological Evaluation Report Format (for Training and Ease of Dictation) 254
Neuropsychological evaluation report 254
Identifying information 254
Reason for referral and pertinent medical background 254
Evaluation procedures 255
Interview and relevant personal/social history 255
Current medications 256
Behavioral observations 257
Specific tests administered (*my typical battery) 258
Summary of examination findings 258
Intellectual functions 258
Memory functions 259
Simple and complex attention 260
Language skills 260
Executive functions 260
Visual spatial and tactual spatial skills 260
Speed of thinking and performance 261
Emotional and personality factors 261
Diagnostic impression 261
Recommendations 261
Appendix B 262
What Is a Neuropsychological Evaluation Handout for Referral? 262
What Is a Neuropsychological Evaluation? 262
What Comprises the Formal Neuropsychological Evaluation? 262
What Tests Are Commonly Used as Part of a Testing Battery? 263
What Are General Referral Guidelines? 263
Additional Useful Information 264
Appendix C 266
Sample Disclosure Statement and Informed Consent for Evaluation Practice 266
Professional qualifications 266
Policy 266
Appointment Scheduling 266
Fees 266
Is7 Insurance 266
My Availability 267
Your Record 267
Confidentiality 267
Your Rights as a Psychology Patient 267
Patient's agreement 268
Appendix D 269
Intake Registration Information 269
Appendix E 270
Release of Information and Release to Obtain Information 270
Appendix F 271
Neuropsychology Fees for Service 271
Clinical work 271
Legal consultation 271
Cancellation policy 271
Appendix G 272
Billing Form (on Your Letterhead with Your Contact Information and License Numbers) 272
Appendix H 273
Common International Statistical Classification of Diseases-9th Revision Codes (ICD-10 Will Be Implemented October 1, 2015) 273
Brief Overview of Changes Coming with ICD-10 274
Appendix I 276
Current Procedural Terminology Codes 276
More on Health and Behavioral Assessment/Intervention Codes 276
Cognitive rehabilitation code 277
Appendix J 278
List of Team Members for Milieu-Based Program 278
Appendix K 280
Sample Cognitive Group Handouts 280
Cognitive group 280
Purpose 280
Goals 280
Cognitive group outline 280
Summary of Brain Areas (Figs 1 and 2) and Deficits Following Damage by Mary Pepping, Ph.D. 284
Frontal lobe damage (varies by left versus right hemisphere) 284
Temporal lobe damage (varies by left versus right hemisphere) 284
Parietal lobe damage (varies by left versus right hemisphere) 284
Subcortical injuries: anoxia, tumors, stroke 284
Most Commonly Cited Cognitive Deficits After Traumatic Brain Injury: A 20-Year Review of the Literature 285
Topic: What Is Attention? What Is Memory? How Do They Work in Real Life? 285
Pay attention 285
We use different kinds of attention 285
Ways to aid attention in everyday life 285
Pleasurable activities to stimulate attention 286
We use different kinds of memory 286
Ways to aid memory in everyday life 286
Strategies for Memory Enhancement and Retention 287
Internal strategies 287
External strategies 288
Important principles to remember for improving memory! 288
Short-term memory strategies 288
General Rules of Good Communication 289
Time-Management Strategies 289
Planning and Organizing 291
Planning 291
Abodes 292
Organization 292
Note-Taking Strategies (Cognitive Group) 293
Appendix L 295
Business Deductions to Track for Tax Purposes 295
Direct Expenses 295
Indirect or Other Expenses 295
Appendix M 296
Review of the Mental Status Exam-By Mary Pepping, Ph.D., ABPP-CN 296
Appendix N 297
Narrative Discussion of Interview Format 297
Appendix O 300
Sample Patient Questions 300
Sample Provider Questions 300
Appendix P 302
Marketing Letter Samples 302
The ``too general´´ letter: 302
Appendix Q 303
Marketing Letter Samples 303
The better letter 303
Appendix R 304
The Houston Conference on Specialty Education and Training in Clinical Neuropsychology 304
Policy statement 304
I. Preamble for Conference 304
II. Introduction 304
III. Who Is a Clinical Neuropsychologist? 305
IV. Who Should Have Education and Training in the Specialty of Clinical Neuropsychology? 305
V. Professional and Scientific Activity 305
VI. Knowledge Base 305
VII. Skills 306
VIII. Doctoral Education in Clinical Neuropsychology 307
IX. Internship Training in Clinical Neuropsychology 308
X. Residency Education and Training in Clinical Neuropsychology 308
XI. Nature and Place of Subspecialties Within Clinical Neuropsychology 309
XII. Continuing Education in Clinical Neuropsychology 309
XIII. Diversity in Education and Training 309
XIV. Application of the Model 309
XV. Model of integrated Education and Training in Clinical Neuropsychology 310
References 20
Index 312
The world of neuropsychology and the world at large have changed in many ways in the 11 years since the first edition of this book was published. Within neuropsychology, a wide range of topics continue to evolve from the newly understood chronic traumatic encephalopathy in some professional football players to the fuller explication of neuropsychological difficulties for people with multiple sclerosis or chemotherapy effects for people with cancer. As a specialty profession, we continue to update our core tests, refine brief screening instruments and work diligently to elucidate brain–behavior relationships as they uniquely affect each person yet are characteristic of human function.
There have also been great strides in science and technology, including an impressive array of new capabilities in brain imaging techniques as well as the delineation of the human genome and such advances as targeted genetically related treatments for some cancers.
We are also in many ways a more closely connected global community than was true even 11 years ago, with events in one country or economy having far greater impact on other countries and economies than was appreciated in 2003. This closer connection is complex. It includes exposure on a daily basis though graphic news accounts to the details of terrorism, genocide, famine, disease, mass murders, environmental degradation, and the many other forms of human suffering, most of it at the hands of other humans.
Some of this occurs in our own countries, some in the countries of friends and colleagues throughout the world. It all forms a steady thrum of underlying stress present in all of us, if we take the time to pay attention, rolling like a deep river under the surface of our daily lives.
Yet it is this higher degree of interconnection, interdependence, and awareness that has allowed each of us to be reminded of the importance of each single life, to identify with people of every race, ethnic group, country, and condition, as they seek to survive, and if possible, find a better life for themselves and their children. On a scientific and academic professional level, the greater interconnections of this smaller world yield much better appreciation of, and involvement with, the work of our peers in the many countries of the world. This includes the people and places where neuropsychology and neuro-rehabilitation are employed.
On a clinical level, this awareness of each individual's potential contribution can lead to a redoubling of our efforts to fully understand and assist each person referred to us for care. For me personally, it comes down to this: I can’t singlehandedly stop famine or murder or the melting of the polar ice cap in the service of a better world. However, I can provide the kind of thorough analysis of a given person's neuropsychological evaluation results that can lead to an improved life for that person in the world, in the larger context of effective treatment.
It is this purpose and rationale that has led to this Second Edition of my 2003 book on private practice in neuropsychology. This time, there is an expanded focus, first upon neuropsychology in the private practice and the institutional work domains and second upon neuro-rehabilitation as it may be best carried out in each of those settings by a team of interdisciplinary clinicians. This Second Edition contains three new chapters: on Neuro-Rehabilitation, on the MMPI in clinical practice, and on the design and delivery of a clinical neuropsychology fellowship.
By way of relevant historical review: In 1993, after many years of work in institutional settings, I decided to enter private practice and to become fully self-employed. Although I had a general sense of what would be required, it was only in the day-to-day implementation of myriad clinical and business details (as well as in trying to maintain some teaching and research interests) that I learned first-hand what might constitute a good practice model.
At the end of 1999, an unexpected opportunity arose to direct a neuropsychology service and an outpatient neuro-rehabilitation program in an academic medical center. Part of the reason I was recruited was my history as a private practitioner who knew how to build and operate a successful neuropsychology practice. The teaching and clinical research I continued during those private practice years were also a good fit for the Clinician-Educator faculty position the university was seeking to fill. Prior interdisciplinary neuro-rehabilitation experience rounded out the fit.
I have recently returned to private practice in a consulting role, both for clinical consultation and for medical-legal cases, while shifting to Professor Emeritus in my academic life. With a well-developed appreciation for both practice settings, it is my intention for this 2nd Edition to fulfill four specific roles for the reader:
(1) Continue as an updated practical guide for understanding and meeting the requirements of effective self-employment as a neuropsychologist in the scientist-practitioner framework.
(2) Examine features of private practice design and application that can be brought to bear on institution-based practices and vice versa. This 2nd Edition will speak more specifically to ways in which a greater degree of creativity, flexibility, and individual practice freedom can be possible, even within the institutional setting.
(3) Expand exploration of career options for psychology graduate students, interns, and postdoctoral fellows who might find it helpful to learn more details about private practice as well as clinical practice in interdisciplinary medical settings than may be available to them within the walls of their graduate programs.
(4) Psychologists of all stripes, whether neuropsychologists or clinical psychologists, as well as other treating therapists and rehabilitation clinicians, are likely to find portions of this book that could be implemented to maximize quality of work life and patient care options.
This book reflects my beliefs and approaches to the topics of neuropsychological practice and neuro-rehabilitation, in both private and institution-based settings. I have tried to make those beliefs explicit and reference some of the information upon which they are based. There are many additional valuable viewpoints. I encourage you to find and consider them in your reading, conference attendance, and work.
Three caveats are the following:
1. This book is not intended as a primer on how to become a neuropsychologist. Those criteria are well documented in the National Academy of Neuropsychology (NAN) definition of neuropsychologist; in the requirements for candidacy for neuropsychology diplomates via ABPP (American Board of Professional Psychology: Clinical Neuropsychology) and ABCN (American Board of Clinical Neuropsychology); and in the APA (American Psychological Association) Div. 40 (Neuropsychology) and Houston Guidelines regarding necessary training to become a neuropsychologist.
2. Neither is this book intended as a primer on how to create or conduct a forensic practice. While the medical-legal work described here can be an interesting, challenging and satisfying source of work, the skills, training, and experience required go beyond the intent of this book.
3. While I include such topics as billing processes, procedural coding advice, diagnoses useful for neuropsychology, and potential tax deductions and other business matters, these represent my opinions and are never to be construed as legal advice. You need to determine what is appropriate for your practice and assure yourself it conforms to local, state, provincial requirements, and national requirements that govern your business.
One of the most important things I have learned over the past 33 years in both institutional life and private practice is that regardless of our work setting, we have more freedom to craft a practice that works well for us than we may think we do. Although some jobs do not lend themselves to the flexibility I advocate, it is also true that those of us with a particular kind of work ethic may find it difficult to consider the kinds of modifications that would make our lives better. This may be for fear of being perceived as less than productive, as not carrying our weight, or as somehow not being fully up to the task of chronic overwork.
There is a funny (and I don't mean humorous) unspoken competition in many institutions about who is toughest when it comes to bearing unreasonable demands and a subtle pecking order based on those principles. So, you may have some decisions to make about your own quality of life and career. To borrow a phrase from Winnicott, you can be “the good enough” neuropsychologist and find that a sufficiently meaningful, satisfying, and remunerative goal.
You can also play a satisfying role in evaluation, treatment, teaching, training, and research projects, in both the private and institutional setting. You can maximize what is positive about each, and reduce what is negative about each form of employment. It is the intent of this book to assist you in that process.
Finally, while this book necessarily reflects my US-based training and practice, it remains instructive for all of us as neuropsychologists and neuro-rehabilitation clinicians to explore the work of our international colleagues. It may be a journal article regarding a study in Bolivia (Chestnut et al., 2012) looking globally at the comparative use of...
| Erscheint lt. Verlag | 10.10.2014 |
|---|---|
| Sprache | englisch |
| Themenwelt | Geisteswissenschaften ► Psychologie ► Biopsychologie / Neurowissenschaften |
| Geisteswissenschaften ► Psychologie ► Klinische Psychologie | |
| Medizin / Pharmazie ► Gesundheitswesen | |
| Wirtschaft ► Betriebswirtschaft / Management ► Unternehmensführung / Management | |
| ISBN-10 | 0-12-800488-6 / 0128004886 |
| ISBN-13 | 978-0-12-800488-3 / 9780128004883 |
| Haben Sie eine Frage zum Produkt? |
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