Holistic approaches to neuropsychology

This is a conversation with Lorraine Haye and Abigail Methley who work as clinical psychologists in neuropsychology within a mental health trust. We discuss the challenges that service context brings to the work that we do and the meaning of trauma in neuropsychology. 

Transcript

Ingram Wright: So welcome both of you so we've got a plan to talk about the sort of interface between.

Ingram Wright: neuropsychology and wider, more holistic holistic aspects of psychological care space and and also a little bit about the context in which you.

Ingram Wright: Work being in the mental health trust, rather than an acute trust and, as far as how that might shift the focus and also constrained some aspects of your of your work so.

Ingram Wright: As usual i've got a few questions and the dreaded quiz towards towards the end, which of course you've been forewarned about and and and fully consented to take to take part in.

Ingram Wright: Lorraine, we talked just just a little bit beforehand about having these conversations, so this is the fifth podcasts that i've done and.

Ingram Wright: it's been great to I suppose meet some people who I haven't spoken to before and I talked last week to Catherine competence, a chair of the.

Ingram Wright: division of neuropsychology in a space one Organizational Structure that's quite important, as the central to my professional life is the division of neuropsychology and i'm wondering what.

Ingram Wright: How you kind of see your relationship with with your psychology generally how you how you got into neuropsychology Lorraine, do you want to say something about that.

Lorraine: yeah well i'd say that my relationship with know psychology is quite ambivalent and even now i'm in the throes of you know, coming towards towards the final stages of.

Lorraine: Being fully qualified neuropsychologist and i'm still like oh it's really for me, am I am I really going to go through this.

Lorraine: But yeah I got into it, I think, from early on, like even from a level I did a double psychology and I kind of at that point knew I wanted to get into clinical psychology.

Lorraine: And I might add, a level psychology I hated it so forwarding finishes for me.

Lorraine: And then, when it came to starting to learn about some of the studies and particularly the have case studies so like phineas gage HM sperry I just I was fascinated and it really.

Lorraine: sparked my interest and then undergrads again, it was quite heavy on a lot of the kind of neuroscience stuff and again all the kind of case studies just fascinated me.

Lorraine: And so I really got interested in it and I thought this is what I want to do, and then after my undergrad.

Lorraine: My experiences where again quite sort of neuro focused, and so I went into training thinking yeah I want to go to narrow or health more broadly.

Lorraine: And that didn't really change for our training and there's other things that Piques my interest but yeah it was it was early on what I wanted to do.

Lorraine: And, but I guess that ambivalence he kind of came because I guess I I kind of had this perception of neuropsychology being a certain way.

Lorraine: and worrying that actually I don't know if that's how I want to practice and how how I want to be so worried about being able to fit my different interests within the context of being a neuropsychologist.

Ingram Wright: When you say a certain way, what do you, what do you mean.

Lorraine: So I guess like like especially Initially it was it was this kind of.

Lorraine: perception that like a lot of people that I hadn't counted, who in your psychology with double double doctors so they've got a PhD even before or after.

Lorraine: That he can say, and it was very research heavy and very academic and academic level was done quite well so that in itself to put me off, but it was just.

Lorraine: It was for me, I was like I really am interested in the clinical aspects in terms of I can really interested in therapies and doing therapeutic work.

Lorraine: And i'm interested in a broad range of therapies and I was worried about actually what kind of therapies, can I use if I work in neuropsychology.

Lorraine: Am I going to just kind of be doing cvt and kind of behavioral stuff is a scope for me to do other stuff sort of more dynamic therapists systemic stuff and.

Lorraine: and work in different ways, and so there was a worry about that, and my interest of really, really broad i'm interested in all sorts of stuff like.

Lorraine: kind of global health and like disaster and crisis response and kind of like culturally sensitive therapies, and so I thought I don't know.

Lorraine: How, you know if I if i'm in yourself, which I felt have to give up all of that, and just do this really narrow thing.

Lorraine: And I guess i've had experiences that in their psychology that have challenged some of that, but then also have some experiences that reinforce the idea that your psychology.

Lorraine: You know, you do have to kind of maybe do quite narrow stuff and so that's why i'm still at this point, even though it's still quite far in my journey to their psychology still feeling like.

Lorraine: I didn't know if Actually, this is, for me, or not so, but yeah I do love it, but there is that perception of what neuropsychology is.

Ingram Wright: Thank you, the right words if you're a balance is shared by by rb or is your journey been rather different one abby.

Abi Methley: Any parallels I think yeah so I knew by level definitely that this was the field, I wanted to go in.

Abi Methley: And I had to make a decision between zoology and psychology actually That was my first choice for degree.

Ingram Wright: And Actually, I think, made the right choice.

Absolutely.

Abi Methley: I certainly think that the nearest psychology side of it brought in that love for the biological sciences, as well as all the more clinically relevant.

Abi Methley: aspects that we do in our practice as well and, and I, I was very, very lucky I had some great mentors and supervised from start.

Abi Methley: And so banker, where I did my undergraduate was very much focused on improving care of people with learning disabilities autism, so I got kind of hooked on that quite early and then work experience at the walton Center was just you know the absolute dream.

Abi Methley: Later down the line, and then clinical placements on the wards itself at Royal and so yeah it's never been a kind of question in my mind as to whether this was the field for me.

Abi Methley: I did do a PhD before I did my clinical training, which was on access to healthcare.

Abi Methley: And because it was in a health services research department actually that's given me a huge amount of knowledge to bring into my neuropsychology practice there's lots about sort of commissioning structures.

Abi Methley: All the quite dry stuff that actually the stuff that's really important in terms of how we get our services out and keep them in difficult Financial Times, and so i've been really grateful to have that experience before kind of coming back to my home area.

Ingram Wright: So one of the things we're going to talk about was the sort of the surface, structure and orientation and and sort of wider framework within which neuropsychology services are delivered but.

Ingram Wright: Before we get on to that, I mean I suppose I was thinking Lorraine, when you were talking about the scope of your practice because I think what part of what you were saying about your personal journey into neuropsychology is your.

Ingram Wright: orientation is much more towards treatments and intervention and and broad based therapies that perhaps can easily be accommodated within your psychology well how would you define the scope of your practices things currently stand.

Lorraine: Well, I think.

Lorraine: I guess currently working near psychology it's more in the department working is definitely more sort of assessment focused and there are bits of intervention, but it's quite brief.

Lorraine: And I think, as a result, I mean that's kind of partly why try to have a bit outside of my court NHS work to maintain those therapeutic skills and I guess that that is something I definitely think about longer term in terms of.

Lorraine: You know it's like juggling act between if I you know if i'm doing working it just narrow services and we're going to have to also make sure that I do stuff outside.

Lorraine: To maintain my therapy skills and maintain that that broad skill set so yeah I think it is very kind of assessment heavy.

Lorraine: In terms of manage has practice and then outside of that, I do have a bit, so I guess again about that broad focus and parts my workouts I didn't interest is also working with.

Lorraine: Children and adolescents, because I again don't want to be restricted to you just have to work with adults and so.

Lorraine: yeah that's a fascinating area for me as well and I guess you know, am I crazy moments there's times, where I started looking into.

Lorraine: I wonder if I could be qualified as a pediatric nurse psychologist but then obviously that's kind of crazy but yeah it's that it's that desire to want to maintain a broad skill set and.

Lorraine: yeah the juggling act of how you do that, within a service where obviously you have a certain remember that you have to cover.

Ingram Wright: Thank you and i've just was interested in in what you were saying about about the jewel qualified, I guess, we make kind of restrictions for ourselves and and there are there is structures that may be imposed some restrictions on our on our professional lives but it's.

Ingram Wright: I think it's interesting and helpful sometimes to think about breaking the mold isn't it really.

Ingram Wright: explore the opportunities to do things that are slightly broader than are easily permitted at the moment but you're you're in the midst of your training or towards the end of your training at the moment right.

Lorraine: Yes, i've done the knowledge component and doing the component and fingers crossed next year should be fully qualified as well yeah.

Ingram Wright: Thank you, what What about the scope of your practice rb.

Abi Methley: Yes, I think, very similar to the rain so actually I spent half a week in the NHS and in kind of a formal neuropsychology service and the other half the week i'm in my private practice.

Abi Methley: And what i've loved about that has been the opportunity to not be siloed in the way that I think we can easily end up in an HR services, so I work across the lifespan.

Abi Methley: In that practice I use lots of different therapy modalities and, just like the rain says, I think that's actually a really key aspect of feeling like you keep your skill set.

Abi Methley: And I know when they did the scoping exercise on them your psychology services they were wasted very heavily towards assessment.

Abi Methley: and, obviously, they need to as a as a sort of training, environment and I do wonder, as resources get squeezed if things do become more assessment focused rather than long term intervention.

Abi Methley: focused, but I think that's a really interesting professional discussion there for us about we're not just testers you know, in the way the Americans have this like magicians so kind of what does that mean for us professionally.

Ingram Wright: And I think some of the some of these sort of resource based constraints of often I mean, certainly in my view, it's an explanation that i've offered is that the the.

Ingram Wright: confinement of neuropsychology to more diagnostic assessment focused work is largely about NHS resources and often about our intention, but I do wonder if some if some of it's.

Ingram Wright: about our intentions as well, and actually we maybe don't feel quite as comfortable with extending into therapy and treatment, as you say, Lorraine, in terms of where neuropsychology.

Ingram Wright: Has conventionally grown from it doesn't quite have the practitioners that are have that kind of expertise that you're talking about have made those kind of brave steps to try and integrate their practice in a more in a more holistic way.

Ingram Wright: And it's interesting that your practice it both of your practice kind of has this divide between what you do.

Ingram Wright: In your private practice and what you do in the NHS and i'm assuming that the private practice has much more of a of a treatment focus and you're much more liberal in terms of how you interpret those those boundaries is that is that fair.

Abi Methley: yeah.

Abi Methley: Definitely and.

Ingram Wright: The lovely thing about it, yes, from both of you.

Abi Methley: got yeah I was just gonna say I think part of that is there's there's a freedom.

Abi Methley: cena, particularly when some of the discussion started in lockdown about you know things like walking therapy that kind of thing it's much easier to get those slightly more creative approaches up and running.

Abi Methley: outside of a big sort of formal system like the NHS so I wonder if that's part of it, but.

Abi Methley: I also think about your point in Graham one of your guests on your previous podcast mentioned about you know it is a bit of a trade off on your psychology training is so intense that actually it's very hard to do that and develop your therapy skill set in equal measure alongside.

Abi Methley: yeah I wonder if it's partly about the type of people that are interested in your psychology but also about that professional development pathway that we have yes.

Ingram Wright: And I guess what you're describing Lorraine, is a desire personal desire to keep those skills alive and to not confine yourself to a particularly narrow area of interest and make sure that you keep that skill set broad.

Lorraine: yeah definitely and I think also my experiences since i've qualified i've worked in a range of services, I think, generally it's been kind of more broader.

Lorraine: Chemical health psychology services that have had a neuro bit so you know my stroke service and then also neuropsychology and what i've been based in.

Lorraine: Class psychology that has been more of an emphasis on the computer skills which is really made me sort of.

Lorraine: push to kind of train up and learn different therapies, but then when you're in the narrow bit and there's some time is less of a focus on the therapeutic skills.

Lorraine: But then there's then there's that worry i've actually will thinking longer term if I return back to our kind of setting or move on i'm going to lose all those skills that i've been invested in it kind of training in.

Lorraine: And so, then having to find ways to maintain those kind of skill sets.

Ingram Wright: So what are the things that you said was the rain was, I think about.

Ingram Wright: The some of the constraints are sort of an inch about NHS service delivery and I suppose the the kind of sort of personal constraints that you might exert on yourself I don't mean you personally, the rain, but I mean all of us.

Ingram Wright: And I suppose I was thinking about the wider service contracts now you both working in in the mental health, trust is that is that right, and I think one of the things we flagged up when we were.

Ingram Wright: planning our discussion today was you know how that might.

Ingram Wright: exert a different set of constraints from, say, a you know, a logic acute trust and what's what's your perception of the kind of particular challenges of working and opportunities if working in the mental health trust I beat you want to pick up on that first.

Abi Methley: Yes, I think so i've actually worked in them to mental health, trust consecutively now.

Abi Methley: So at one in and i'll drive let's see if he were there was a huge element of that role was in your psychology but it wasn't your psychology service per se.

Abi Methley: And then the current one, and I would say that the benefits are exactly as we've been discussing in terms of scaling up.

Abi Methley: So being able to join things like cat supervision groups, having those people that can go to have consultations in forensics or whatever it might be, and so that's definitely a real skill.

Abi Methley: I think difficulty is that there's a very different focus between a mental health trust way of working that's very much about things like.

Abi Methley: CPA appointments psychiatry lead services very kind of old school hierarchical models of service provision and the way, I think we would like to work in your psychology which is.

Abi Methley: Not wanting to say that mental health services are not person centered, but I think sometimes the system is getting the way.

Abi Methley: I think we would hope in your psychology that because sometimes the people we work with a less risky in mental health terms that we can be a bit more flexible.

Abi Methley: You know, we can be a bit less rigid in the ways that we work with people and we don't always have to have that typical psychiatric hierarchy, and so I think that's a big difference to me.

Ingram Wright: So the management of risk within the within the system is oriented towards typical mental health risks and.

Ingram Wright: So, because you don't experience those constraints in your psychology you're potentially at liberty, but actually liberties and manifest because you still gotta live by the constraints of the organization is there.

Abi Methley: Is there and I think it depends on the.

Abi Methley: cool.

Abi Methley: I was because I think it depends on the type of people that we see as well.

Abi Methley: So I think where i've worked in more traditional neuropsychology services we maybe haven't seen people at the highest risk end of the spectrum, they would maybe have been seen as better supported by mental health services.

Abi Methley: So it raises a really interesting question when you are at, and you know, a clinical psychologist in your psychology within that mental health service and as to who's who it's appropriate to see who your best place to support.

Ingram Wright: lebron you work in the same in the same trust.

Lorraine: That right yeah.

Ingram Wright: I mean what.

Ingram Wright: What would your obviously without without without naming names I mean i'll be worked in to mental health, trust, so you didn't seem to be highlighting any particular differences.

Ingram Wright: between them as such you're shaking your head and and the rain, I wonder whether you kind of perceive that to be particular constraints around working within a mental health trust environment.

Lorraine: I think, similar to what abby is that I think the idea of what your role is as a psychologist or neuropsychologist is shaped by.

Lorraine: What psychologists do in mental in the mental health kind of contacts and so.

Lorraine: That is quite constraining in terms of the things that you're expected to do the ways you're expected to work when i'm comparing that to.

Lorraine: say when you're based in an acute sort of health trust were actually because it's very medical.

Lorraine: There there's a sense that all kinds of psychology you kind of you know you can set your own way of doing things in your own kind of.

Lorraine: pathways and so it's a bit it's a bit different it doesn't feel as constraining in that respect, because we don't have that that fixed idea of psychology is here for.

Lorraine: The mental health to shape how we deliver a service and that way, and so it if there's that there's that difference, overall, but there's lots of opportunities as well.

Lorraine: And like abby was saying in terms of being in a mental health trust there is all that support that you get from em therapeutically from the other services where they do that as a really cool part of their of their job yeah.

Ingram Wright: I wouldn't it, especially in terms of really kind of operational things.

Ingram Wright: The infrastructure around clinics and the length of an episode of care, I mean working in an acute trust it's all about you know confirmed appointments and follow ups there isn't a sense of being a.

Ingram Wright: sort of therapeutic narrative in terms of engagement with patients the conversations that I enjoy as a neuropsychologist so you know.

Ingram Wright: Yes, with neuroradiologist new resurgence, and a neurologist but but I missed the kind of stuff that it sounds like you have like.

Ingram Wright: The conversations with psychologists working within a mental health setting or oriented therapies and treatments, I am I right about that is that just the fantasy I have that.

Ingram Wright: You get to have lots of conversations about.

Ingram Wright: What you're doing therapeutically.

Ingram Wright: abby's you want to pick up on that.

Abi Methley: Sure yeah I think it's definitely very helpful in terms of professional identity as clinical psychologists.

Abi Methley: And what's interesting is what it means professionally for your identity and your psychologist because actually i'd say as a neuropsychologist sometimes we are more comfortable with an mtt.

Abi Methley: Like you say, with the medics and neurologist and that kind of thing, then we may be with other clinical psychologists.

Abi Methley: across the different disciplines yeah so.

Abi Methley: I guess.

Ingram Wright: it's the grass is always greener, for me, so I think I miss my clinical psychology colleagues but it's it's an I mean I happen to work in a in a psychological health services department, so there are.

Ingram Wright: lots of different kinds of psychologists around me, which is, which is helpful but i'm wondering if Lorraine you kind of feel that maybe the dresses a little bit greener, on the other side, or do you think it's perfectly green enough where you're where you're sitting.

Lorraine: I think it's it's difficult because I think there's pros and cons today, and I think, like, I think, for example, to give it a really concrete example when I worked in sort of a health kind of trust.

Lorraine: And I kind of tried to do some training in in, say, India, I remember in the training, like everyone else, all the other psychologists they're like.

Lorraine: Oh we've got someone in house, you can provide supervision, and all this other colleagues, you can do this, and I was like well i've just done this of my invitation because.

Lorraine: I felt there was a need, but then there was a sort of dawning of like well who's gonna support me with this when I go back to service and this isn't that support isn't there.

Lorraine: And then, whereas, in contrast, in now being based in the mental health trust.

Lorraine: I mean, like, I mean obviously and you're trying to solve, which is which I was really excited to learn about so that's great, but if if you know that wasn't the case.

Lorraine: I then have the benefit of being in a trust were actually there are other psychologists, who have that that training, so I can join that peer supervision group.

Lorraine: and get that support there, so in that way it's it is really beneficial, because you have those kind of networks and also quite exciting as well within our department we've set up sort of monthly.

Lorraine: kind of supervision group where anyone across the US can bring a case, so we can help them think about neuropsychology within their area which I think is really great in terms of I know it's come up a lot in.

Lorraine: Some of your previous podcast about how we integrate neuropsychology into kind of all different sort of areas, and I think having that monthly supervision group is doing just that and helping.

Lorraine: People in different mental health services and then disability services be able to understand and think about some of those neuro psychological aspects in their case, so in that way it's great because you get that skill sharing, which is what I think you know, is really needed.

Ingram Wright: See, I mean you mentioned previously, you mentioned trauma outside of this meeting in terms of something that we might might talk about today you're both the md are trained have discovered which obviously has obvious applications in terms of post traumatic and you know.

Ingram Wright: psychology and i'm wondering what your experience has been a particular challenges of integrating the neuro psychology and treatment aspects in a sort of post traumatic context and the rain, do you want it, you want to pick up on that.

Lorraine: yeah I guess this again it comes to those differences depending on where you're based so when i've been based in.

Lorraine: More health psychology services i've been working with neurological conditions like a stroke.

Lorraine: And it's kind of just being like yeah you know we do we do the whole thing we do the cognitive bits and the therapy bits and so.

Lorraine: There hasn't been much restrictions around what we do for a PC it's just whatever if you have skills to do so.

Lorraine: I kind of then had the free rein to use my skills or do whatever I needed to do there, but then I guess when you're involving your psychology service, it is a bit more kind of gate kept around.

Lorraine: Actually we we do the cognitive bits and we can do very brief maybe skills based interventions for a brief and recessions but.

Lorraine: Anything more than that, actually, we need to be kind of thinking about moving on and then it's really difficult because you kind of think well.

Lorraine: It feels really arbitrary about where we're drawing the lines around what is for us to work with, and what we then signpost elsewhere.

Lorraine: And then it does become quite difficult, especially when you recognize that, actually, I do have the skills to.

Lorraine: Do this work and if I don't do it, it means that for this client we're going to have to go off to another clinician.

Lorraine: tell the whole story all over again, and then do all this when actually we already have that relationship and we could do that right here.

Lorraine: So there is that tension about where you draw the line of what is it that is my role today and how I use these skills and what we then signposts on to another another place.

Ingram Wright: Thank you, Marina as you were talking, I was also thinking about where the resources are an issue in terms of the investment in you personally, so if.

Ingram Wright: You know your line manager or your services invested in you, in terms of your training, whether they would say, well, actually we've trained you was in euro psychologist so we'd like you to the euro, psychologists bit.

Ingram Wright: We can train someone else's name, Dr therapist and it's more efficient for us to be able to have that kind of skill mix rather than have one exceptionally well and broadly trained newer psychologist.

Lorraine: yeah I guess that that definitely is a factor, I think, for me, like i've not fortunately had that privilege of having any of my training funded so.

Lorraine: Okay, I found myself.

Ingram Wright: lot of it's been fun you.

Lorraine: know so that's why i'm kind of like well actually i've spent money and time so I really want to use my skills and so.

Lorraine: yeah I guess if it if it was funded, I guess, there is more of an argument and say, well, actually we've funded usually there, so do this because it hasn't been it yeah is it yes bit more difficult than yeah.

Ingram Wright: What What about your experiences have you have you experienced that kind of funding issue by the sort of personally or in terms of what your service be prepared to offer has that constraint your practice at all.

Abi Methley: yeah and I think it's it's it all comes down to resources remake capacity, you know as these conversations always do, and I think and.

Abi Methley: We know that we don't have enough neuropsychologists, we know that the waiting list when your psychology a very long, so it is always going to be a trade off of you know, we know that people have multiple needs.

Abi Methley: What can we meet what we best place to meet versus other services and and a lot of the time The difficulty is that actually the other services out there to refer them to you know the care pathway just stops.

Abi Methley: With us a lot of the time and that's very tricky because then you either pick up the work or you leave people with unmet need.

Abi Methley: But there is always the argument that just because there's unmet need does not mean it it's best met buyers that said about kind of building your business cases getting services working together, going to commissioning level if you need to.

Abi Methley: That type of thing, but I think ethically it doesn't feel quite that clicker when you're kind of the frontline person having saved someone i'm very sorry we can't have trauma therapy.

Abi Methley: and

Ingram Wright: Obviously, some of the.

Ingram Wright: experiences we have and the legitimacy of offering therapy around trauma has been influenced by particular events and no.

Ingram Wright: Rain you mentioned outside the meeting that the Manchester arena bombing and how that might well have changed our perception of what our function, our role is within services.

Ingram Wright: In neuropsychology i'm wondering if you want to say a bit more about about that your kind of perception of how that's that's changed things.

Lorraine: yeah well I guess at the time that happened, I was working again in a large clinical health psychology department.

Lorraine: And, and you know part of my role was in stroke, as well as kind of more broadly of areas.

Lorraine: And I think at the time I was in terms of for PC I kind of use the main purpose that might be used in areas that kind of act and kind of third wave stuff.

Lorraine: And then I think when that you know when I managed to bomb attack happened we started getting referrals.

Lorraine: And because we started getting fired up kind of plastic service, because obviously a lot people with.

Lorraine: shrapnel injuries and we didn't have a waiting list per se, we can see people straight away so because mental health services we're inundated we just got people.

Lorraine: And I remember just the panic of oh my God okay we've got all these people who've experienced this trauma and actually and It made me reflect that actually were original trauma service but.

Lorraine: No one who was trained in a trauma therapy is like what.

Lorraine: What have we been doing, because actually a lot of our caseload even the people I see you had a stroke like sometimes they're you know they're coming with experiences that basically trauma and actually.

Lorraine: What skills were having that and so that then led me to kind of fell upon me to this is a gap in my conversation to fill that and so.

Lorraine: That was the motivation for going off to end our training.

Lorraine: And I guess at that point, I guess you know i've talked about that ambivalence about is nearing for me, or is it not, and at that time, I thought, maybe help clinical health is just like kind of Nice middle ground but I think.

Lorraine: going down that path of doing trauma therapy it kind of also diversity kind of brought back to narrow as well, because it made me really realize that.

Lorraine: The two things that come up wherever I work I kind of neurological stuff and trauma and so that's why i've really kind of spent a lot of time trying to develop skills and both of those because.

Lorraine: they're there is a lot of stuff, especially with the bomb attack around kind of the trauma of stuff but I guess we've have a traumatic incident is that people experience.

Lorraine: and, especially, you know, having watched the trauma Ward subsequently after that image trauma unit, there is that that kind of tension between you know.

Lorraine: The I guess my service room it's kind of like your hair for the narrow, but actually a lot of people have trauma, so it is really beneficial to have have both of those and being part of.

Lorraine: An image trauma service we that we had we were kind of part of a mailing list with all trauma services across the country.

Lorraine: And I remember someone was kind of asking about you know, do you guys use kind of trauma therapists because i'm trying to build a case to get some funding for that.

Lorraine: And then you know, some people kind of responded saying no, no, no, as major trauma psychologists were here for the narrow week there's no space and trauma therapy so then another person was saying.

Lorraine: Wait a minute like there's no way you should have measured a trauma service without trauma therapy is absolutely no way so there's that so again, even across the country there's a real divided about what our role is and what it is that we are expected to do and, within that context.

Ingram Wright: And I guess some of that's about holistic care isn't it so it's about you know I mean I suppose I i'm sort of rather embarrassed to have characterized it in this way, but I often characterized my posts about 80% of the time i'm a clinical health psychologist right.

Ingram Wright: who's got some euro skills and 20% of the time it's exclusively about brain behavior relationships and developing your own formulations, but most of the time working in a major trauma pathway.

Ingram Wright: you're dealing with individuals, where there is a subtle need to understand that attentional functioning memory functioning are effective as much by trauma.

Ingram Wright: as they are by the by the patterns of brain injury they see on on on that kind of pathway I don't know what your experience has been abby in terms of.

Ingram Wright: Whether you're 80% of clinical psychologist and training said you're a psychologist or whether you wouldn't fall into the trap of crudely characterizing it that in in that way, but but what's your take on this sort of major trauma.

Ingram Wright: Things.

Abi Methley: I think it's a fascinating question, I think we see that in the in where these posts are placed.

Abi Methley: So actually the fact that in one service, you could be in clinical health and then just down the road or in the nearest psychology service and that just says to me to sort of confusion.

Abi Methley: about it, but I think it's a great question when we say major trauma i'll be talking about psychological trauma and what and what does it mean.

Abi Methley: When we say that because, like say the disconnect between trauma work within major trauma services is a very interesting one.

Abi Methley: And I wonder if that's because primarily an award based environments trauma therapy may not feel appropriate.

Abi Methley: So maybe we extrapolate from that and say you know it doesn't seem to have a home within major trauma but exactly like Lorraine said.

Abi Methley: pretty much everybody that we see from those early neuropsychology pathways has experienced anything traumatic so trying to separate the two is quite artificial.

Ingram Wright: Yes, and there's a question of timing, as you say, as well isn't there on top of that it's about you know, is the is now in a word, based environment in the acute context, is it the right time to be thinking about.

Ingram Wright: You know trauma therapy is presumably not in many cases, but it doesn't mean as a construct it's something we ought to we ought to neglect I guess there's also they're kind of.

Ingram Wright: I mean it, you know from some you know major incidents major so nationally.

Ingram Wright: Significant traumatic experiences that people have had that have really shaped and shaken up.

Ingram Wright: service delivery there's obviously the also the recent experience that we can't avoid talking about if sort of covert and and and how we've worked in in rather different ways.

Ingram Wright: And it's basically been my experience has been that covina certainly stirred things up in terms of the way that we.

Ingram Wright: deliver our services generally and encouraged us to be a little bit more flexible, you know in our practice and i'm wondering what what your experience has been what lessons it's kind of taught you really.

Lorraine: yeah I think we've covered in.

Lorraine: Like I think in many ways, I feel I feel like i've had to in my case, if I do a lot of explaining of what i've been trying to do, why i've had these kind of seemingly random experiences and jobs and stuff.

Lorraine: and actually before we came along, I was ready to jump off and go and kind of work for humanitarian organization, but then it kind of grounded me.

Lorraine: And I think having to explain this to people how people haven't got it, even though i've tried to explain how all these.

Lorraine: experiences are linked, and so I feel like who bid is kind of provided the validation of exactly what i've been saying in that you can have a physical health health thing that causes neurological issues that kind of also presents a bit like.

Lorraine: Potentially mental health difficulties in terms of trauma and also on a more systemic level, you know you need to have a crisis response.

Lorraine: So, actually, you need to have all the skills to be able to at least kind of deal with some of that work and, obviously, arguably, you can kind of say.

Lorraine: As a neuropsychologist we might just do the neurological bit, but still, and it really depends on what other pathways are around, because if actually.

Lorraine: There aren't that those pathways and actually it might be that you are expected to do there's other bits as well.

Lorraine: And undoubtedly as well you know there's going to be that that need to kind of provide a kind of crisis response and support to staff teams and so.

Lorraine: And you know i've been working too hard to develop all of these skills, I felt like it's really justified what i've kind of been arguing for and the need is as your psychologist to be quite flexible and brought in the skills that that we have.

Ingram Wright: And there's nothing so I suppose challenging you're thinking about you know you're kind of.

Ingram Wright: US who've been drawn towards the humanitarian crisis response type service and especially if you're working in that kind of context there's no way you could get away with saying i'm sorry i've just brought the way so like I can't possibly I can't possibly do anything else.

Lorraine: yeah exactly that, but I think equally like I remember, we used to joke relaxing clinical health like sometimes would get like.

Lorraine: Calls frantically from the world saying you need to come, like right now we need to urgently and then we kind of joke like what what we're going to do come along with our like you know we needed emergency ways kind of thing.

Lorraine: yeah yeah, but there is that that sense of yeah you kind of need to have that emergency kind of crisis response.

Lorraine: And just that broadness and what you do I mean that was that was how clinical psychology was always sold to me that you are this kind of jack of all trades, which I don't see a negative thing.

Lorraine: Because I think.

Lorraine: There is value in having this really valuable skill set.

Lorraine: Like for me the the ambivalence about neuropsychology is that, am I trading off and having to relinquish identity of being this kind of.

Lorraine: jack of all trades that i'm just doing this one thing and and that yeah but tension is still something I feel even now, this fire into the neuro psychology journey.

Ingram Wright: So i'm intrigued hope, hopefully, none of your employer's online managers are listening, but you're still drawn to that sort of humanitarian.

Ingram Wright: challenge that's out there.

Lorraine: yeah yeah absolutely if it wasn't for Kobe dad hopefully be off right now working for doctors without borders, but.

Lorraine: yeah I.

Lorraine: mentioned it like right like I was talking about all the time, because one of my passions so it's out there, people know and I guess yeah I mean yeah it's something I definitely want to revisit one day when that is i'm not sure, but for sure it will, it will be yeah be part of my plan.

Ingram Wright: So even if they were listening they wouldn't be surprised to hear to hear you say that.

Lorraine: No cuz I don't think so, but i'm also thinking I should I might get once this as I might find that I get people to live it to me so.

Lorraine: I think about that so yeah.

Ingram Wright: So I don't think that's within the within the appropriate boundaries of employment legislation, listening to a podcast initiating issuing a P 45.

Lorraine: Well yeah i'll hold your words that the.

Ingram Wright: Campaign starts now.

Ingram Wright: i'd be any any any.

Ingram Wright: Any any thoughts about the kind of a broader lessons, maybe the cove it's taught us in terms of our practices neuropsychologist.

Abi Methley: yeah I mean what i've been amazed at is just how responsive than your psychology workforces danger and covert I think our practices come along decades in the space of a year.

Abi Methley: You know and it's challenge so many assumptions about you know we can't possibly change their forgot possibly do that and then all of a sudden we're doing remote testing.

Abi Methley: And I know it comes with a lot of caveats and it will be interesting to see what you know if we go back to solely face to face testing and things like that, but actually I think it's shown as a.

Abi Methley: workforce, we can be a lot more flexible in the way that we do things, provided we feel like we have the backing of the services that we work in yes and again.

Abi Methley: Now, today, the breadth and your psychology role as well, so I know Kathy was talking about leadership and actually I think on the ground, the leadership from your psychologist has been really very impressive at a time we're actually everyone's going through it together, yes.

Ingram Wright: I mean you mentioned online testing has been a lot of focus of attention on that, from a sort of technical standpoint, and I suppose one of the things I.

Ingram Wright: noticed is also be much more flexible in terms of what we do you know when we can't use tests, we can still address questions and we've discovered that actually even without the tools or with one arm.

Ingram Wright: tied behind our back, we can still be neuropsychologists we aren't exclusively rely on tests yeah.

Abi Methley: And that goes to the heart and your psychology doesn't really you know it's that kind of idea that you should be able to.

Abi Methley: assess somebody's function by seeing how they are in a kind of more normal environmental by seeing you know what you pick up when they walk across the waiting room that kind of thing rather than purely be.

Abi Methley: only able to use a very formal testing procedures, yes.

Ingram Wright: And it's been a it's been an issue I don't know whether it's affected you Lorraine, in terms of people's sort of training aspirations that they've.

Ingram Wright: Seen themselves as being constrained by the inability to deploy themselves as training, your psychologist in quite the same way, I think we've been quite keen as a training community to emphasize.

Ingram Wright: there'll be a neuropsychologist maybe you need to be a different kind of neuropsychologist in this environment and and maybe place less emphasis on formal assessment are being and things that you're suggesting how someone uses zoom or.

Ingram Wright: You know, stands up sits down or into the camera has a conversation that all of those kinds of things are things that we can pay attention to is newer psychologists.

Lorraine: So really and even like i'm thinking about some of the work i've done, where it was just telephone based I had never actually even saw.

Lorraine: The people I was working with but from my descriptions and also working as part of an mtt like having feedback from the physios who were.

Lorraine: seeing them that was enough to be able to still do those kind of you know, supports around kind of compensating strategies and all that kind of stuff as well, so.

Lorraine: It you know it really emphasize actually the testing bit and the test doing test is actually is quite easy to to do is it's obviously the interpretation which is where the skill is.

Lorraine: And then, how you integrate that into a wider formulation, but all of those things that you do as an error psychologists, you still can do them about the tests.

Lorraine: And the tests just kind of help provide you with I guess more concrete grounding around what's going on for that person, but you're still using.

Lorraine: All those skills and and yeah, so I think I mean I really, really do feel sorry for trainings in this context but they're still going to be learning a lot and actually it's probably emphasizing the fact that it isn't just about testing and it's about those skills and that knowledge.

Ingram Wright: So we got to the time in the podcast where we've been sitting nervously holding off on the the quiz that I promised you at the start.

Ingram Wright: So, having taken a break in the last one and i'm bringing it back and I suggest as just we do this now, if only to get out of the way and and alleviate some of our anxiety about it.

Ingram Wright: So i'm going to ask i'm going to these are forced choice questions you can't not choose one of them, and unless you have really serious objections to the question.

Ingram Wright: So we'll start with abby.

Ingram Wright: abby i've got first wave or third wave.

Abi Methley: third wave.

Ingram Wright: That was really clear.

Ingram Wright: Lorraine stand up desk or sit down chair.

Oh.

Lorraine: Oh.

Lorraine: Sit down chair yeah.

Ingram Wright: Very good, I shouldn't do it shouldn't pass judgment on any of your answers that's the other rule i'll try and keep my expression to a minimum abby me total doritos.

Ingram Wright: Lorraine post traumatic amnesia or post traumatic growth.

Lorraine: Oh posttraumatic growth definitely.

Ingram Wright: Happy diagnosis or formulation.

Abi Methley: I feel like i'd be shocked if I say formulation.

Ingram Wright: Well, you shouldn't feel coerced to give a particular answer.

Ingram Wright: The rain breakfast brunch.

Lorraine: apprentice still breakfast isn't it really so yeah French definitely brunch.

Excellent.

Ingram Wright: Happy bio psychosocial.

Abi Methley: psychosocial.

Ingram Wright: I think that was one of the longest periods of consideration we've had so far.

Abi Methley: or professional identity and a false choice question.

Ingram Wright: Lorraine hippocampus or amygdala the.

Lorraine: amygdala I didn't even think about that yet.

Ingram Wright: Even though you didn't you're.

Ingram Wright: you're a mixer fired up.

Ingram Wright: yeah the answer that what you were looking for excellent.

Ingram Wright: Be soothing or threat.

Ingram Wright: Excellent Lorraine netflix or Disney plus.

Lorraine: netflix definitely netflix.

Ingram Wright: Okay i'll be working memory or processing speed.

Abi Methley: Working them.

Ingram Wright: And finally, the rain.

Ingram Wright: percentile or standard score.

Lorraine: Oh, I was actually checking on and.

Lorraine: i'm going to get some cool I thought that might be a bit controversial, but I do like a standard score so yeah.

Ingram Wright: The the the questions and more controversial than one might than one might think i'm pleased that the quizzes has found its place back in this podcast.

Ingram Wright: i'm wondering, alongside the important things that we've discussed with the things that.

Ingram Wright: Have.

Ingram Wright: You wanted to talk about as neuropsychologist within this podcast things that I ought to have asked, I that I haven't asked.

Ingram Wright: I suppose it might be helpful, the rain abby and if we just kind of press pause now the things that are kind of we've discussed maybe you want to elaborate on I can set up a question and ask you about so I can.

Ingram Wright: edit this out and, obviously, then just insert the questions and and because, obviously, we end on the quizzes just a bit weird.

Ingram Wright: And we can't do that, but if there were things that you wanted you thought actually we could have gone a bit further with that are there any things there so far that we could pick up on.

Abi Methley: i'd like to mention trauma informed care and the role that has in your psychology if that's all right.

yeah.

Abi Methley: So I think i've got this really interesting distinction between major trauma.

Abi Methley: trauma is in the psychological terms and trauma informed care, and I think there's overlap, but they're very different yeah yeah.

Ingram Wright: The room, what about what about you anything else happy.

Abi Methley: That I mean there's something and ground but it's it's maybe a drum for me to bang in a different setting I don't know.

Abi Methley: That there's a big professional issues question for me about your psychology training and how accessible, it is within mental health trusts if you're not in your psychology service.

Abi Methley: yeah maybe it's not for this one, it might go bit off theme, but.

Abi Methley: it's something that.

Abi Methley: We could.

Abi Methley: We could.

Ingram Wright: We could try, we could try and do both What about you, the rain.

Ingram Wright: And you might be happy with those, but if you want to add anything else.

Lorraine: I was just thinking like because we talked about, I guess, like maybe about the end.

Ingram Wright: So so.

Ingram Wright: So I mean a couple of things we talked about earlier one was.

Ingram Wright: around major trauma and this, and this, I think you were mentioning it rain that we sort of oddly.

Ingram Wright: That that we don't think about trauma as a psychological construct with it within major trauma and and i'd be one of the things that we weren't intending to talk about, I think, also about.

Ingram Wright: That concept of trauma and the different meanings that we might have a tribute to trauma and what's your what's your take on that in terms of how we define trauma how we think about trauma as psychologists neuropsychologist.

Abi Methley: yeah I think it's a really interesting one, in particular, because when we work in physical health services that definition of trauma that's used is very much.

Abi Methley: kind of referring to the physical side of things, which is very different to our clinical psychology colleagues yeah and my mental health based trust.

Abi Methley: there's also a lot of focus at the moment on trauma informed care and wanting our services to provide trauma informed care and there's a really interesting conversation there about.

Abi Methley: How does that go above and beyond just providing trauma treatments because within a trauma informed care pathway that should be access to good quality trauma treatments, but it should also really permeate every level of the pathway from.

Abi Methley: The experience people have when they meet you know the admin team, all the way through to the discharge process and actually is that attachment based.

Abi Methley: Does it meet people psychological needs and that's a really interesting question terms of how we provide that within physical health settings I think.

Ingram Wright: And what's the meaning of the word trauma and trauma informed care.

Ingram Wright: Because, not everybody will necessarily understand what what.

Ingram Wright: What trauma informed care is coming, could you give us a description of.

Abi Methley: Your description, not a definition.

Abi Methley: I see it very much is that challenging experiences that people have been through.

Abi Methley: different stages of their life quite often childhood, a lot of people that learning, and I suppose at the moment of had complex trauma.

Abi Methley: So very difficult childhood circumstances, compounded then by difficulties into their adult life and the the sense of meaning that people make of those events really is how I would see.

Abi Methley: And trauma and our focus is always on.

Abi Methley: very much like lorenzo's quick question what we're looking at how do we support them, overcoming these adverse experiences and making sense of them and also developing that post traumatic growth.

Abi Methley: So that actually its resilience is an overused word, but how do we help focus on people's strengths and that's traditionally been a real strengthen your psychology, I think, so I think the two come together easily in that sense.

Ingram Wright: What about your means you're kind of how does your sort of personal orientation and then sort of them, I suppose, professional drive in terms of how you would want our services to be delivered.

Ingram Wright: How does that relate to this issue of trauma informed informed care.

Abi Methley: I think conversations about attachment and missing in euro psychology.

Abi Methley: The time, so we do tend to go down that bio bit of the bio psychosocial yeah and maybe there are people who have had you know traditionally very healthy attachments and then something completely unrelated like a tbi.

Abi Methley: And that's not as needed in that conversation, but I also think you see a lot more of a complex cases.

Abi Methley: were actually you know just looking at their life events that people have had its kind of predispose them to be much more at risk of.

Abi Methley: Something you're a psychological something can you know the kids in the car system.

Abi Methley: That kind of thing the risk of you know, a head injury and then they go through into adult life and actually a lot of the factors that their adult life.

Abi Methley: predispose them to you know potentially a head injury and then domain dimensional and later down the line you know so it's something that I think is very relevant to our work that we could be talking about more.

Ingram Wright: Do you think it's a struggle for neuropsychology to tackle relational.

Ingram Wright: Issues more generally, because you mentioned attachment, but I suppose one of the things that I suppose it seems to me, is always a struggle is.

Ingram Wright: That neuropsychological models tend to focus on the individual and, although they recognize context it's very much about the individual within a context rather than within a relationship if that makes sense.

Abi Methley: yeah totally and I think you see that in the gap in the market for family therapists that have expertise and and your psychology yes, yes it's a huge thing and typically interventions that we offer like say don't include more relational.

Abi Methley: aspects and maybe that's because people don't have an interest, but I just wonder if it's because we don't see our scope of practice as broad enough.

Abi Methley: Sometimes.

Ingram Wright: And, and I suppose it you.

Ingram Wright: Not necessarily related, but when we were talking earlier about.

Ingram Wright: about working in mental health and we were talking about how that context might shape.

Ingram Wright: Your practice and where you're pulling through in terms of the conversations you're having with colleagues and within the organization and we'd also talked about training, I guess, one of the things that we might think about is the capacity of.

Ingram Wright: Mental mental health trust mental health services to support engagement with newer psychology particularly around around training.

Ingram Wright: Any any thoughts about about that either of you.

Lorraine: Well, actually, I was really encouraged when I did my training at Glasgow there, there were people on the course who were working in mental health dress and.

Lorraine: And yeah and other services over them nutritional neuro services and, for me, that was a really good sign of the recognition that actually that knowledge.

Lorraine: is needed and I, you know I spent a bit of times and locations are kind of changing jobs frequently and pit and like when I was kind of going for jobs and sort of more mental health services.

Lorraine: And that was just the mental health, there was there was a real excitement and an appreciation of the fact that I came with neuropsychology skills, so I think.

Lorraine: There is an awareness of and needed there, but I guess it it just depends, sometimes on em yeah whether that person can get funded and what kind of support they can get in terms of ongoing supervision and around around that.

Ingram Wright: it's also the cases as well right, so if you're if you're kind of.

Ingram Wright: you're on a course and you're acquiring knowledge and demonstrating your practice there's a bias isn't.

Ingram Wright: Historically, I think there's been a bit of a bias towards do you need to be picking up a stroke case in a tbi case you need to be doing diagnostic assessments or.

Ingram Wright: bits of therapy that flow from a diagnostic assessment, rather than something which is about applying your psychological models in a much broader broader context.

Lorraine: I guess, I guess, with that, but it depends on I mean, obviously, if you go onto the practice bit then that's going to be definitely more of an issue but.

Lorraine: I think the knowledge base in itself, I don't think it necessarily disadvantages you if you don't come from that kind of traditional new contacts, because it is quite broad.

Lorraine: In its coverage and I think it's really and actually I think like I was really surprised haven't watched an acute mental health.

Lorraine: kind of Ward about how much Nero there is there was all sorts of came up with neurological conditions it really, really surprised me and yeah there was it was everything it was yeah just pretty much yeah there was a vast range of individual presentations within that context, yes.

Ingram Wright: i'd be any any thoughts on the same topic.

Abi Methley: Yes, I think it's slightly different experience so being based out in an older people's and Community mental health team, there was huge level of neuropsychology need.

Abi Methley: And these were the people that weren't coming through the memory assessment service they were sort of more into the mental health of the service.

Abi Methley: I think I would have really struggled to complete money or psychology training, despite the fact I was working with very good complex and your psychology cases every day.

Abi Methley: And I think that comes down to if i'm right in saying, even the portfolio cases there are exclusion criteria around them having mental health diagnosis, yes, and you can only see a certain number.

Abi Methley: And so, even that is it's a it's a barrier and I think there are additional barriers, you know your access to tests if you're working off, you know.

Abi Methley: One phrase buffeted copy of an our bonds versus having a whole neuropsychology testing cupboard it's not your access to supervision, so we had a fantastic clinical neuropsychologist but she was very, very stretched in terms of time.

Abi Methley: it's how you say your identity as a as a neuropsychologist if you're not in your psychology service with colleagues around you, so I think that's actually a huge.

Abi Methley: Potential part of than your psychology workforce that maybe aren't seeing themselves as neuropsychologists and aren't feeling like to have equal access to training.

Ingram Wright: Yes, and especially in the training kind of abuse reflects the organized the same tensions we talked about earlier in terms of the organization of services it's not just a problem for training, but it also is a problem.

Ingram Wright: For training in terms of that that portfolio and the enthusiasm that there might be for training in euro psychology when there are so many other constraints, you know what we might do and the resources that we have available.

Ingram Wright: I suppose that you know it seems that things have shifted a little bit in terms of those training constraints, but maybe not quite far enough, your liking.

Ingram Wright: You both.

Abi Methley: I think it's just about you know we're always saying what we want to do is bring your psychology out of neuropsychology services, you know, we want to see more on your psychology within cabins on your psychology within mental health services, this type of thing.

Abi Methley: And I don't think we could do that by having a training pathway that's completely constrained to traditional form on your psychology services so it's an ongoing discussion there's nothing.

Lorraine: And also, in your psychology and third sector.

Abi Methley: Like you know what yes.

Lorraine: Populations Domestic violence is very much neuropsychological need there yeah it's just not kind of getting matt so yeah just making it broader.

Ingram Wright: Thank you, both very much it's been a really interesting conversation and it's not without its with its challenges for a specialty, and so I think we, you know there's plenty more to discuss.

Ingram Wright: Thank you very much.

Abi Methley: Thank you.