I had never heard of neuropsychology when I began my Master's degree in Psychology at the University of Auckland, NZ, back in 1979. I was a young mother with four children and I'd planned to work with children as a clinical psychologist. I took the Clinical Neuropsychology course because it was a pre-requisite for the postgraduate clinical psychology programme. It was the most difficult of my four courses—not only because my knowledge of neuroanatomy was sketchy, despite having my Bachelor's degree in zoology and psychology, but also because our lecturer, one of the world's most eminent neuropsychologists in mild head injury and concussion, was a hard taskmaster. Every week we wrote extensive reports on a neuropsychological case study, and we were required to give seminars, write essays, assess a real patient, and pass a test on neuroanatomy as well. We all complained about the workload. But when time came for course evaluations Clinical Neuropsychology came out on top for student satisfaction, as well as "the course that taught me the most."
I fell in love with everything about clinical neuropsychology. Early on I wrote up a case study on a woman who had suffered a stroke in the right hemisphere (side) of her brain. She had a strange disorder called hemineglect where she ignored people and objects appearing on her left side, drew only the right sides of pictures, and ate only the food on the right side of her plate, then complained she was hungry! I decided to research hemineglect for my doctoral thesis dissertation. Six years later, after a stint at Massachusetts Institute of Technology, I was running Auckland University's clinical psychology programme and teaching the Clinical Neuropsychology course.
Clinical neuropsychology research is often carried out on large groups of brain-damaged patients who are compared to groups of healthy people. This is a very important method of discovering how the brain and mind work, and how different neurological disorders affect people. But it misses many of the important aspects of clinical neuropsychology. For example, individual differences can be lost in group studies where results are averaged. Quantitative data including test results, the age and sex of the patient and so on, can be analyzed in group studies, but a lot of rich qualitative information is missed. Qualitative information can include everything from the head-injured patient's complaint that despite achieving good scores in school homework projects, they take much longer to do them than before their head injury (and they feel exhausted by the time they finish), to their frustration when they can't complete a neuropsychological test.
Two important aspects of being a clinical neuropsychologist make this an exciting career choice: 1) the clinical aspects of working with neurological patients, and 2) the detective work required to parse out exactly what neuropsychological abilities have been affected and which abilities are still intact. If you want to be a clinical neuropsychologist, you must first be a good clinical psychologist. This will allow you to build a good rapport with your clients, enabling them to perform to their best ability on the tests you give them and feel comfortable talking about their lives and how their neurological symptoms have affected them. Second, you need to be curious about how the brain and mind work. Our brains are the most complex systems on earth, and no two brains are identical-not even twins' brains! Both the environment and our responses to the environment influence our neural development. As a clinical neuropsychologist, every patient you assess presents a new opportunity to discover the mind's secrets.
Of course, you can always focus on research, rather than clinical practice. If that is your aim, you'll be joining one of the most cutting-edge research arenas of today and the future. Discovering how the human mind works is truly the ultimate frontier. However, to be a great neuropsychology researcher you'll still need to be a good clinician—putting people at ease, listening to your research participants and their family members, caring about how your participants feel and responding to those feelings with respect. (This means putting your participants ahead of your research goals: If one has a headache and feels unwell the day their functional MRI scan is scheduled, you'll need to have a backup plan—perhaps you can test another patient that day.) Respecting your participants is also good research practice. An unwell patient is not going to give valid and reliable results on your tests.
Clinical neuropsychologists can chose many different careers. Some primarily work in the area of neuropsychological assessment where they test different client populations. They may be based in a school, a hospital, a rehabilitation setting, assessing accident victims for insurance purposes, or in a private practice. They may specialize in adults, children, the elderly, forensic neuropsychology, or in assessing minority cultures. Other neuropsychologists become involved in the rehabilitation of patients with neurological disorders. Often they work in a multidisciplinary team, planning and putting into practice rehabilitation programmes that include neuropsychology, speech pathology, occupational therapy, physical therapy, vocational training, and individual, group, and family psychological therapy. Other neuropsychologists become clinical supervisors and teachers or work in policy planning.
I was fortunate to assume most of these roles in my career, and in this blog I invite you to join me as I talk about some of the amazing and courageous "patients" I have worked with, as well as what I and others have learned about the brain and how to cope when something goes wrong with it.