Treating mind and body at the heart of rehabilitation psychology specialty

Individuals across the spectrum require care from a rehabilitation psychologist. Tim Belliveau, Ph.D., ABPP, director of postdoctoral training & research at the Hospital for Special Care in New Britain, Connecticut said pediatric patients with pervasive mental disabilities, individuals who suffered traumatic brain injuries, stroke or spinal cord injuries, and athletes with torn muscles are among those who may seek help.

Elderly patients with age-related physical and/or cognitive decline also could require the services of a rehab psychologist “…to help maximize overall health and encourage a sense of personal choice and independence.”

Established in 1958, Division 22, Rehabilitation Psychology, was one of the earliest divisions created within the American Psychological Association (APA). Throughout the last six decades, rehab psychology has become embedded in other practice areas.

Belliveau noted that in the course of a day he might evaluate a child with a developmental disorder, an adult with neurological impairment, and an older adult with chronic pain. These conditions affect both the physical and emotional aspects of the patient’s life and require individualized intervention.

In theory and practice, the scope of rehab psychology covers a lifespan. As advances in trauma medicine have improved the chances for survival, more people will need long-term care, Belliveau said.

Regardless of disability, every individual deserves respect and encouragement; their diagnosis doesn’t alter their fundamental rights, Belliveau said.

Marcia Liss, Ph.D, staff psychologist, Lifespan Physician Group, Division of Psychiatry/Behavioral Medicine, said rehabilitation psychologists need to understand the physical consequences of the patient’s disability, as well their emotional state.

For example, aphasia affects the production or comprehension of speech. A patient with aphasia might appear unwilling to participate in therapy because of the difficulty in speech production. A psychologist that misinterprets the behavior can be unable to most effectively treat the patient, Liss said.

Liss noted that rehabilitation psychologists attempt to help the patient recognize his values and assets and figure out how to define their future and make meaning out of life.

To be successful in this endeavor, rehabilitation psychologists need to help patients face a number of challenges that include learning to adapt and adjust to their situation while understanding the emotional impact.

“Part of therapy is learning self-advocacy. It’s important for patients and families to recognize what they need and learn how to communicate their needs to others,” she said.

Liss pointed out that practical matters, such as financial stability, add to the patient’s burden. She advocates for policy that allows the patient to earn a decent living without having to worry about sacrificing any supplemental assistance.

“Such a policy would be a win-win for society and for the patient,” she said.

Family participation is also an important component of the process of rehabilitation, Liss said. Rehabilitation psychologists work with families to reduce their sense of isolation, help them in managing their own feelings, and to facilitate healthy and enjoyable communications with each other and the community.

A multidisciplinary perspective is the foundation of rehabilitation, according to Liss. Being able to effectively communicate with other professionals is crucial in this collaboration. In this way, patients know all the professionals involved in their care are working together.

Sarah Gray, Psy.D, director of outpatient rehabilitation psychology at Spaulding Rehabilitation Hospital in Boston, brings her background in health psychology to her work, which promotes greater understanding of the patient’s medical issues.

Spaulding treats patients with a range of conditions, from chronic pain, spinal cord and traumatic brain injury to stroke, amputation, and burns. Gray added that some patients with multiple sclerosis, sports injuries or cancer also receive therapy at Spaulding.

Regardless of the diagnosis, many patients may benefit from some type of psychological support to help with coping and adjustment.

Athletes who are injured, for example, may be anxious that they will be unable to participate in their sport at the same intensity pre-injury, while patients with conditions, such as traumatic brain injury, may need to adjust to a “new normal.”

Gray reported that chronic pain often goes hand-in-hand with injuries and medical conditions.

Gray relies on a team of healthcare professionals, case managers, and therapists to help solve difficult cases. Collectively, they implement the most appropriate treatment approach that enhances cognitive skills and promotes relaxation to reduce anxiety.

Each case presents its own challenges but psychologists are “…trained in good strategies for coping with grief and loss” for patients having a hard time adjusting and accepting where they are.

Gray emphasized that before any psychological rehabilitation can begin, practicalities, such as financial, housing and relational issues related to the injury or illness, may need to be addressed.

For the last 20 years, Anthony M. Podraza, MS, Ph.D, ABPP, has utilized his combined interest in biology and psychology into his rehabilitation psychology work at Northern Lights in Maine.

Patients in rehab often have an emotional reaction to their illness and have altered capabilities post-injury, Podraza explained. They may have difficulty learning how to compensate and there may be more psychological issues, such as depression, anxiety, or post-traumatic stress disorder (PTSD).

“Their disability plays a role in how they are coping with and managing symptoms,” Podraza said.

Before beginning therapy, Podraza looks at the whole person to determine the best approach. Depending on the diagnosis, he may address concentration, memory, psychological/emotional health or ways to adapt to an injury.

Cognitive behavioral therapy (CBT), relaxation techniques and motivational interviewing attempts to help the patient understand the issues, particularly when self-awareness of deficits is part of the psychological profile.

In spite of the challenges, working with patients in rehabilitation can be rewarding, according to Podraza. He reported that seeing the patient make progress and learn to adapt to a new world is gratifying. He added that the positive impact therapy can have on families is also satisfying.

Podraza pointed out that many people don’t realize that a patient’s cognition, mood and behavior are the strongest predictors for medical outcome. By addressing the issues, we can get the patient back to work so he or she can become a contributing member of society, he noted.

Most importantly, rehab psychologists have been instrumental in changing attitudes toward patients with disabilities. Podraza said the discipline has turned aversion to acceptance and understanding. He said that people should not be defined by their disabilities, but should be seen first as people.