What is a neuropsychologist and how do you find one?
About a year after my concussion in a car crash, while still suffering from post-concussion syndrome, I began working with a neuropsychologist. A neuropsychologist is a specialist psychologist who has expertise in the area of different brain and nervous system conditions and an understanding of how these can affect a person’s daily life.
If you have post-concussion syndrome, and if you haven't already done so, you may find it beneficial to work with a neuropsychologist, preferably with experience of working with people with concussion and brain injury. You could go via the NHS in the UK: via a referral from your GP and probably on the recommendation of a neurologist. Or you could go privately: Google ‘neuropsychologist’ and look for one, if possible near you, with good reviews. The UK brain injury charity, Headway, has a list of neuropsychologists, which you can request a copy of, either by calling their helpline on 0808 800 2244; contact them via email at firstname.lastname@example.org or via their website, www.headway.org.uk. Their website also contains blog posts and a number of leaflets on strategies and tips on different aspects of recovery; go to the Information Library section.
If you're involved in a personal injury case and have a solicitor who specialises in brain injury, then there may be the possibility of being assessed and treated by a neuropsychologist. There are two reasons why you might be referred to a neuropsychologist in a legal case: firstly, for medical evidence for the case and secondly as part of your treatment and recovery plan. Not all solicitors offer this but it’s worth finding one who does or finding out if yours does. If you do work with one, then it's likely this treatment will be one part of a wider package of care, involving a number of different medical professionals, as post-concussion symptoms can be multiple and complex, and treatment will likely need be varied in order to address all the different aspects of your injury and recovery.
Below I will share some of my experiences of working with a neuropsychologist.
Having cognitive assessments with a neuropsychologist
I think it was almost a year after my injury that I was in contact with the neuropsychologist's office. Initially, I was triaged by a doctor on a call from the office. It was a huge relief as this was the first time in a year that my ongoing symptoms were clearly validated and the severity of what I was experiencing was understood.
A short time later, I then had a phone call with the neuropsychologist who asked me some questions about the collision and my symptoms and gave me an initial assessment. I felt reassured by her calm manner, and I was hopeful she'd be able to shed some light on why I was still experiencing certain cognitive symptoms. I also hoped she'd give me some suitable treatment and a prognosis.
The neuropsychologist also spoke to my husband about my condition and asked him about how he was coping with caring for me and how he and my children were being affected by my ongoing health issues. I think it was the first time anyone had properly checked in with my husband to see how he was managing with a very difficult situation. I'm very grateful for the genuine care and concern shown to him and my children on that occasion.
On the next call, I underwent a number of tests to assess my cognitive abilities. At that point, I was struggling with my memory and finding it hard to find the correct words for certain things. I was also still finding simple tasks like switching my computer on and cooking meals hard. I had difficulty multi-tasking and switching from one task to another.
The problems I was having with my memory and slower processing and thinking really upset me. I felt like I was losing my mind. I knew that my brain did not work as well as it had done prior to the collision and that I wasn’t as alert or focused as I had previously been. I have a university degree and in my working life, prior to having children, I'd worked as an executive PA, in sales and administration, and had been a freelance copy-editor and proofreader. I was a wife and mother and competent at running my home and looking after my husband and three children. Prior to the collision, I'd been pretty switched on and then literally overnight my life changed and that was no longer my reality. I was slow and forgetful and not as sharp anymore. It was a frightening experience. Over time, thankfully, and with the help of the neuropsychologist, I learned to understand more about these issues, and I've been able to improve in many areas and regain a lot of my functionality.
So, on that occasion, I had various cognitive tests carried out over the phone, which involved recall and various tasks and tests using words and numbers. A short time after the assessment, I was sent a report on the findings, which confirmed that I was having cognitive challenges. On the one hand, this was depressing news but on the other, it was helpful to have confirmation that I had some problems and wasn’t making things up and going completely crazy.
Several months later, I met with the neuropsychologist in person for further tests, which I believe lasted an hour or two. These assessed a number of different cognitive abilities and skills. They were more in-depth than the ones I’d had on the phone and some of them were timed. They were quite challenging and I was tired at the end.
When I received the results from these tests a while later, they showed that I was functioning at a lower level than I should have been, and this confirmed the cognitive difficulties I was having. The good news, though, was that I’d improved on some of the scores since the first assessment on the phone, so that was very encouraging. It was a relief to know that, finally, somebody understood what was going on with my brain, having seen similar results time and time again with other clients. Now I didn’t feel so alone or weird.
Having therapy sessions with a neuropsychologist
A while later I was fortunate enough to have 10 or 12 weekly neuropsychology therapy sessions over the phone and that helped me so much. I was able to address some of the cognitive, emotional and behavioural struggles I was having. The neuropsychologist was compassionate and non-judgmental. It was reassuring to be able to just talk to somebody and offload and process what I'd been going through. I had so much I wanted to say that I hadn't been able to say to anyone else.
Although my husband and some friends were very supportive, it didn’t feel fair to keep burdening them with all my problems and worries. I'd previously had some counselling with a counsellor at my local Headway branch and with a friend who was a counsellor, so I’d had some support, but it hadn’t been enough.
For one hour a week, I could discuss things with a caring professional who had experience of working with people in a similar situation to me. I began to understand what was going on in my brain, mind and body and learnt tools and strategies to help overcome some of my difficulties. I learnt about how neuroplasticity and how the brain is flexible and can change and I became more self-aware and better able to understand my emotions. I was also introduced to the work of some well-known experts in the fields of trauma and post-concussion syndrome and was pointed in the direction of various resources that I could find online and read, listen to or watch. So, with training, over time, I was able improve much of my functioning. I always felt so much better after speaking to the neuropsychologist. It was reassuring to feel heard and understood.
I was given a workbook based on a therapy called Acceptance and Commitment Therapy that explained my relationship with my thoughts. I began to understand that not all my thoughts about my situation were helpful or even true, and that I had some control over what thoughts I allowed myself to believe. This led me to a place of acceptance of my situation and allowed me to see myself and my situation from a different perspective. So, for example, instead of berating myself for my situation I was gradually able to shift to thinking that although there was nothing I could do about the accident and injury, I had some control over the way I viewed my life. I came to accept what had happened to me, see that actually I was doing pretty well in the circumstances and that I could turn around the negative thoughts I had about things to tell myself a more positive and hopeful narrative. For example, I was worried that I was a bad mother and couldn’t do all the things I wanted to do with my children. But a positive outcome was that I had slowed down and could spend more one-to-one intentional time with them at home. I realised they were quite content just having me around to give them attention without us rushing off to lots of different activities, which would have been fun but not allow me to give them as much individual focus.
Another recommendation was to work through an online course created by a bodywork therapist who specialised in meditation, mindfulness, breathwork and movement. Doing this course helped me to calm my nervous system down, move better and reduce my physical pain levels. I also learned how to move with greater ease from the sympathetic state of ‘fight or flight’ and alertness to the parasympathetic state of ‘rest and digest’ and calm.
Post traumatic growth after a concussion
The neuropsychologist introduced me to the concept of ‘post traumatic growth’.‘ You may have heard this term before. In a nutshell, it means that after a traumatic experience, once you are in a stable enough position to do so, you can experience personal growth as a result of the trauma.
When I was in the middle of the trauma of what had happened to me, both physically and mentally, I couldn’t see a way out of my situation. I thought I would never get better and that I would remain in a horrible, unbearable loop of pain and sadness forever. I felt as if I was locked in a prison. I kept going over and over the collision and felt angry, bitter and unforgiving about what had happened to me and how my life was as a result.
Over time, I was able to gradually climb out of the metaphorical hole I was in. I no longer felt stuck on a perpetual hamster wheel of hopelessness, and I began to see a future for myself again. It wasn’t easy and it was quite a slow process, but I began to see both that I was making improvements and that some good could come out of a bad situation. For example, I decided to completely overhaul my health, look after myself better and pace myself. This included choosing healthier food, doing more exercise and implementing a daily self-care plan. Another knock-on effect was that I became aware that having the collision and injury made it easier for me to empathise with others who had gone through similar experiences. For the past three years, I’ve been writing blogs and sharing my experiences online, in the hope of encouraging people with post-concussion syndrome. So, it is possible for good to come out of a traumatic situation and for you to experience personal growth on the other side of that.
A neuropsychologist can share specialist information with you about your injury; help to demystify some of what is happening to you; carry out assessments that test your cognitive abilities; address cognitive, emotional and behavioural challenges; offer psychological support and provide techniques and strategies for recovery. Education is an important part of recovery from post-concussion syndrome as is being listened to and having your symptoms validated. Having knowledge of and a deeper understanding of your condition and how it affects you can go a long way in helping you to know what to do to get better and create a better life for yourself. So can having practical tools and strategies to put in place to help make life run more smoothly. It’s tough to go it alone as you recover, but a neuropsychologist will support you in many different ways and can be a very valuable member of your concussion recovery healthcare team.