Difference between neuropsychology and rehabilitation psychology

neuronstudies

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I'm an undergraduate student student and hope to eventually enter a clinical psychology program with a focus on neuropsychology. I recently learned about rehabilitation psychology and it seems to align with my interests very well. However, it seems that neuropsych and rehab psych are very similar. I was wondering if anyone could further explain the differences between the fields? Or how either specialty could lead to clinical or research work in rehab settings (particularly for stroke and TBI)?
 

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Broad strokes:


Rehabilitation psychologists tend to already know the neurological diagnosis of the patient, and use neuropsych instruments to describe the patient's current level of functioning to inform treatment plans.

Neuropsych tend to not know the neuro diagnosis of the patient, and uses neuropsych instruments to make neurological diagnoses.



Pragmatically, rehab psychs tend to work in rehab hospitals where they try to explain to medicine how SLPs are misusing neuropsych tests, while hoping they don't get fired. The nature of rehab hospitals mandates that the patients are mostly moderate- severe TBIs and stroke. Hint: this practice area tends to smell bad.

Neuopsychs tend to work in hospitals and PP where they see patients, and express bewilderment that the medical staff doesn't consider them the same as neurologists. There are some additional tools available in academic medical centers including WADA stuff. Patients are more broad and include tumors, TBIs, epilepsy, dementias, movement disorders, psychiatric patients who claim their memory is messed up, ADHD people, etc. If you do peds, include learning disorders for reasons that have never been clear to me.
 
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futureapppsy2

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Broad strokes:


Rehabilitation psychologists tend to already know the neurological diagnosis of the patient, and use neuropsych instruments to describe the patient's current level of functioning to inform treatment plans.

Neuropsych tend to not know the neuro diagnosis of the patient, and uses neuropsych instruments to make neurological diagnoses.



Pragmatically, rehab psychs tend to work in rehab hospitals where they try to explain to medicine how SLPs are misusing neuropsych tests, while hoping they don't get fired. The nature of rehab hospitals mandates that the patients are mostly moderate- severe TBIs and stroke. Hint: this practice area tends to smell bad.

Neuopsychs tend to work in hospitals and PP where they see patients, and express bewilderment that the medical staff doesn't consider them the same as neurologists. There are some additional tools available in academic medical centers including WADA stuff. Patients are more broad and include tumors, TBIs, epilepsy, dementias, movement disorders, psychiatric patients who claim their memory is messed up, ADHD people, etc. If you do peds, include learning disorders for reasons that have never been clear to me.
In-patient rehab psychs also do a lot of consultation and assessment around mood, adjustment, behavior, etc. There's also possibility of working with spinal cord injury, MS, amputation, etc--I know a fair amount of SCI and MS focused rehab psychs as well as rehab psychs who do primarily or exclusively outpatient adjustment and coping work and do fine financially. A lot of rehab psychs are also double-boarded in neuro.
 
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when comparing specialties it is important to consider training, science, and practice.

Training: same generalist training in grad school. Specialization during internship and post doc. Neuro is 2-year postdoc but rehab could be 1 or 2.

Science: rehab is very inclusive of research areas but has a lot of research on disability. Often lots of advocacy for that as well. Neuro typically is behavioral neuroscience.

Practice: there is a good deal of overlap on assessment but I’m sure the two specialties would argue over who should be doing what. Again, rehab much more likely to provide treatment to individuals with disabilities and typically more short term or consult treatment. Neuro tend to do more assessment historically than intervention.

All of this isn’t clearly distinguished. There are exceptions and the fields are always evolving.

You could google some videos on each speciality.
 
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DynamicDidactic

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Oh Yeah. Don’t worry about that now. First get into a good program and you will find what interests you most. Don’t pick a program bc they advertise neuropsychology training. That is often a red flag.
 
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PsyDr

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In-patient rehab psychs also do a lot of consultation and assessment around mood, adjustment, behavior, etc. There's also possibility of working with spinal cord injury, MS, amputation, etc--I know a fair amount of SCI and MS focused rehab psychs as well as rehab psychs who do primarily or exclusively outpatient adjustment and coping work and do fine financially. A lot of rehab psychs are also double-boarded in neuro.


Oh yea, and burn victims. Which was the only time I peaced out in grad school. Debridement is F'ing AWFUL.
 

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Oh yeah...no wound care for us. :laugh:

In-patient rehab is great for ppl who want to be busy and work as part of a multi-disc team. Those positions tend to be a mix of quick consults, ongoing counseling, education about injury, some testing, working w the family, coordinating w other providers, etc. Sometime teams lack a rehab psych and use neuropsych for a consult, though it's more trad...consult & recommend than actually following a case. Of neuro is available, it often will do a quick cog screen, but really are there to setup out-pt follow-up for testing.

Out-pt neuro is typically eval, consult, feedback, next. Rehab tends to know the basic issues and they want data to direct care. A rehab psych may or may not stay involved as an out-pt practice.

In-pt rehab practice is generally on a multi-disc team usually run by a physiatrist (PM&R doc). Areas of in-pt work can include: TBI, SCI, Neuro (mix of neuro conditions), some places have a dedicated CVA/Stroke unit, Epilepsy, Gen Med (knee/hip replacement, somaticizing pts, & kitchen sink...nowhere to put them), & Burn.

Out-pt rehab can be more trad treatment and assessment. It can also include residential treatment centers (pts live there for wks/months...sometimes longer) and more intensive out-pt.

I started in neuro and got pull over to rehab during internship, so I have a foot in each camp. I think Division 22 (Rehab Psych) is the best division of APA for students and early career folks bc they are so welcoming and inclusive. Div 40 is good too, though it has a different feel. I will say, Div 40 is also quite engaged w students and early career and I think either group (really both) are worthwhile and support each training area quite well.

What was written earlier about dx v confirm in regard to diagnosis is pretty accurate. I miss the hunt to figure out a zebra diagnosis when I was straight out-pt neuro.
 
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NeuroPsychosis

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Clinical Neuropsychology is assessment heavy but could either consult or administer treatments as well. Rehab is more treatment heavy rather than assessment. Anyways, div 40 & 22 both can be good friends! :)
 
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Psycycle

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Broad strokes:


Rehabilitation psychologists tend to already know the neurological diagnosis of the patient, and use neuropsych instruments to describe the patient's current level of functioning to inform treatment plans.

Neuropsych tend to not know the neuro diagnosis of the patient, and uses neuropsych instruments to make neurological diagnoses.



Pragmatically, rehab psychs tend to work in rehab hospitals where they try to explain to medicine how SLPs are misusing neuropsych tests, while hoping they don't get fired. The nature of rehab hospitals mandates that the patients are mostly moderate- severe TBIs and stroke. Hint: this practice area tends to smell bad.

Neuopsychs tend to work in hospitals and PP where they see patients, and express bewilderment that the medical staff doesn't consider them the same as neurologists. There are some additional tools available in academic medical centers including WADA stuff. Patients are more broad and include tumors, TBIs, epilepsy, dementias, movement disorders, psychiatric patients who claim their memory is messed up, ADHD people, etc. If you do peds, include learning disorders for reasons that have never been clear to me.
I'm working in rehab psych. This made my day. Thanks.
 
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neuronstudies

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Thanks for all the replies everyone! I'll definitely keep my options open for both rehab psych and neuropsych going forward b/c they both seem to fit my interests well. I checked out the division 22 website and they have lots of info and resources!
 

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It was a constant battle....one of the things I don't miss. Now I get paid well to shred those "findings" during record review.
An SLP at my practice location said he does the same thing as a neuropsychologist.
 
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DynamicDidactic

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An SLP at my practice location said he does the same thing as a neuropsychologist.
I'm not sure how I feel about this. I've seen a few rehab psychologists call themselves neuropsychologists without the postdoc training (or boarding) that is typically associated with the term. I am not the biggest fan of any term past clinical/counseling/school psychologist.
 

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Thanks for all the replies everyone! I'll definitely keep my options open for both rehab psych and neuropsych going forward b/c they both seem to fit my interests well. I checked out the division 22 website and they have lots of info and resources!
Definitely consider joining the listservs as well. They are great.
 
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Psycycle

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I'm not sure how I feel about this. I've seen a few rehab psychologists call themselves neuropsychologists without the postdoc training (or boarding) that is typically associated with the term. I am not the biggest fan of any term past clinical/counseling/school psychologist.
Maybe misread? it's an SLP that said his work is the same as a neuropsych. That said, I'm not sure how I feel about it either.
 
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Oh yeah...no wound care for us. :laugh:

In-patient rehab is great for ppl who want to be busy and work as part of a multi-disc team. Those positions tend to be a mix of quick consults, ongoing counseling, education about injury, some testing, working w the family, coordinating w other providers, etc. Sometime teams lack a rehab psych and use neuropsych for a consult, though it's more trad...consult & recommend than actually following a case. Of neuro is available, it often will do a quick cog screen, but really are there to setup out-pt follow-up for testing.

Out-pt neuro is typically eval, consult, feedback, next. Rehab tends to know the basic issues and they want data to direct care. A rehab psych may or may not stay involved as an out-pt practice.

In-pt rehab practice is generally on a multi-disc team usually run by a physiatrist (PM&R doc). Areas of in-pt work can include: TBI, SCI, Neuro (mix of neuro conditions), some places have a dedicated CVA/Stroke unit, Epilepsy, Gen Med (knee/hip replacement, somaticizing pts, & kitchen sink...nowhere to put them), & Burn.

Out-pt rehab can be more trad treatment and assessment. It can also include residential treatment centers (pts live there for wks/months...sometimes longer) and more intensive out-pt.

I started in neuro and got pull over to rehab during internship, so I have a foot in each camp. I think Division 22 (Rehab Psych) is the best division of APA for students and early career folks bc they are so welcoming and inclusive. Div 40 is good too, though it has a different feel. I will say, Div 40 is also quite engaged w students and early career and I think either group (really both) are worthwhile and support each training area quite well.

What was written earlier about dx v confirm in regard to diagnosis is pretty accurate. I miss the hunt to figure out a zebra diagnosis when I was straight out-pt neuro.
Can you speak to starting out in your career, specifically beginning your doctoral program, and how you came to focus on rehab in practice relative to what research you were conducting? Did you initially pursue research in a completely different topic area and then through the practical experiences transition toward a more clinical, practitioner role? Or would you say your rehab role is both practice and research that you pursued from Day 1?

I ask because I am planning to apply with research interests that fit my current background, but I'm interested in transitioning to neuropsych for career aspirations, but there is no alignment between the two.

Is it common to enter a PhD program in clinical psychology and then make a career choice later that goes far outside your original research interests?
 

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My research was in a completely different area. I actually shifted a bit when my mentor left after my first year, but it was still pretty different. My secondary research work (started w. my primary assessment instructor) that later got me interested in neuro and then rehab.

There is a push by students to hyper-specialize on day 1, but it's a mistake. Getting a solid foundation FIRST as a generalist and THEN pursuing specialist training is what I recommend. I fell into this path, but I realized afterwards it was the better path.

It's very possible to transition into a more assessment heavy area during training, though you still need a foundation in therapy and intervention. I never completed a neuro practica, though I did have a lot of assessment experience and added classes and didactics in my 4th & 5th years. I worked w. my second mentor to identify sites and mentors w. strong neuro/rehab training options. I was able to match to an awesome site and that opened the door for fellowship, etc.

I greatly benefited from my rehab and neuro mentors, both in regard to training and also connections for interviews. It's so much more about mentorship, connections, and 1:1 training than it is racking up a zillion assessment hours for internship applications.
 
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Genuine question from ignorance: at least in my part of the world, insurance is very happy to pay for people with functional movement disorders to go through acute rehab. Is there literature on rehab psychologists playing a role in treating these folks? I did not see them mentioned on above lists of common populations and I can imagine reasons why they might not fit as well as the others.
 

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Genuine question from ignorance: at least in my part of the world, insurance is very happy to pay for people with functional movement disorders to go through acute rehab. Is there literature on rehab psychologists playing a role in treating these folks? I did not see them mentioned on above lists of common populations and I can imagine reasons why they might not fit as well as the others.

We do lots of things.

Constraint induced movement therapy was invented by a psychologist who founded the rehab psychology division of the APA. The other psychologist cofounder of that same division
was a prolific author in treating functional disorders through some methods, and treating pain through operant conditioning.

A psychologist also invented the specific type of cannula used for vacuum based abortion; as featured in Roe v Wade.
 
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A psychologist also invented the specific type of cannula used for vacuum based abortion; as featured in Roe v Wade.

shooting star psa GIF
 
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telemental90

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Genuine question from ignorance: at least in my part of the world, insurance is very happy to pay for people with functional movement disorders to go through acute rehab. Is there literature on rehab psychologists playing a role in treating these folks? I did not see them mentioned on above lists of common populations and I can imagine reasons why they might not fit as well as the others.

There are not a lot of structured inpatient programs for FND/FMD to my knowledge, but if there are psychologists embedded in a rehab dept (inpatient or outpatient), it is definitely a patient population that rehab psychologists can work with.
 
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We do lots of things.

Constraint induced movement therapy was invented by a psychologist who founded the rehab psychology division of the APA. The other psychologist cofounder of that same division
was a prolific author in treating functional disorders through some methods, and treating pain through operant conditioning.

A psychologist also invented the specific type of cannula used for vacuum based abortion; as featured in Roe v Wade.
Geez, what were his hobbies in the evenings? This makes me fear a situation similar to the "father of modern gyno" (Sims) whose speculum came because he experimented on slave women.
 
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PsyDr

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Geez, what were his hobbies in the evenings? This makes me fear a situation similar to the "father of modern gyno" (Sims) whose speculum came because he experimented on slave women.

Ready for this? You know who his mother was? No kidding... the voice actor from the original cast of Alvin and the Chipmunks.
 
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Ready for this? You know who his mother was? No kidding... the voice actor from the original cast of Alvin and the Chipmunks.
OK, this sounds like pulled chains, so I had to Google this, and lo and behold ... yes this guy was in fact performing unlicensed abortions on women. He caused a death and went to trial. And then managed to happen upon a correct procedure. Good lord.

But Wikipedia says that Theodore the chipmunk was his daughter, not mom.
 
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PsyDr

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OK, this sounds like pulled chains, so I had to Google this, and lo and behold ... yes this guy was in fact performing unlicensed abortions on women. He caused a death and went to trial. And then managed to happen upon a correct procedure. Good lord.

But Wikipedia says that Theodore the chipmunk was his daughter, not mom.

Karman also had a physician he worked with to demonstrate the efficacy of his technique. That guy’s name? Dr. Kermit Gosnell...the serial killer.

Sorry for the inaccuracy, I can’t be right about every detail.
 
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Sanman

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Karman also had a physician he worked with to demonstrate the efficacy of his technique. That guy’s name? Dr. Kermit Gosnell...the serial killer.

Sorry for the inaccuracy, I can’t be right about every detail.
Apparently he used a speculum and a nutcracker to perform abortions?!? @PsyDr, the facts rolling around in your head...
 
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uhhhhh...


View attachment 324769

Like musashi said: something something the absolute acceptance of death is ...something something good .

edit: that’s like 400 years of references!
Conversations about "experimentation on minorities" thanks to covid vaccine have become rather common recently. In pointing out the history of medical experimentation, this guy and his cannula and nutcracker proved useful for making a point.

Also, back to the main points of this thread, can anyone speak to the value of master's-level training for mental health counseling in terms of career outlooks? Has anyone seen a trend where say college counseling offices are hiring master's-level employees INSTEAD of PhDs?
 
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Likewise, entire MH outpatient therapy clinics at several hospitals in my old system, and not a single psychologist.
Sounds like the nurse-ification or PA-ification of mental health. Lesser licensure so orgs can pay less for more workers. Does this affect employment chances at the PhD level like you might see in teaching where a PhD within tenure-track academia is practically gone in favor of "lesser" adjuncting? Or is a PhD still worth something in psychology circles?
 

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Sounds like the nurse-ification or PA-ification of mental health. Lesser licensure so orgs can pay less for more workers. Does this affect employment chances at the PhD level like you might see in teaching where a PhD within tenure-track academia is practically gone in favor of "lesser" adjuncting? Or is a PhD still worth something in psychology circles?

It's all money. These systems can pay SWs and masters level people a lot less. It affects employment prospects in organizations in certain regions, for sure. Additionally, we're pretty saturated with therapy providers. Zero wait time to get in with someone, PhD, SW, or MA. Specialty services are doing ok at the moment.
 
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There are (at least) two tiers for treatment though....cheap volume-based insurance reimbursement and then cash/non-commercial insurance. It's less about degree when it comes to direct therapy services and more about who is a better business person. Speciality areas will almost always do better, though it can be geographically dependent.

Companies want to water down and cloud the waters because for hiring because it allows them to pay less. They don't care about "the best trained" or even "most effective"...they care about the least cost to provide adequate care, which isn't a winning combo for any clinician looking to work at such a place.
 
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There are (at least) two tiers for treatment though....cheap volume-based insurance reimbursement and then cash/non-commercial insurance. It's less about degree when it comes to direct therapy services and more about who is a better business person. Speciality areas will almost always do better, though it can be geographically dependent.

Companies want to water down and cloud the waters because for hiring because it allows them to pay less. They don't care about "the best trained" or even "most effective"...they care about the least cost to provide adequate care, which isn't a winning combo for any clinician looking to work at such a place.
So sounds like this is agency-based or privatized, but is this also true in hospital or government environments? I'm still learning about the distinctions between mental health counseling as a practice and something associated with agency work and the distinctions of being a licensed psychologist who, like you mentioned, might be specializing more. Are VA hospitals sticking mostly to master's-level counselors or still preferring to hire from PhDs?

I'm wondering if I could pursue a master's in mental health counseling and get licensed at that level, then consider a PhD after? Is that an acceptable route? I know it's not technically the textbook approach. Anyone I know in psych did a master's in general psych and spent time in labs before getting into their PhD program. But I've encountered IRL elsewhere a lot more people who acquired doctoral work after starting out in mental health counseling.
 

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I'm wondering if I could pursue a master's in mental health counseling and get licensed at that level, then consider a PhD after? Is that an acceptable route? I know it's not technically the textbook approach.

Serious answer: I get it. It’s a lot of training. You want to start, and there looks like there is some quicker route. Notice all the department heads, super respected clinicians, experts, and so on that took that route? No? What are the chances that all those super smart people missed some loophole that shortened training while maintaining prestige? What are the chances that you are smarter than all of those people? What are the chances that people who dedicated 5-7 years in education and an additional 1-2 years in training are going to welcome someone without that training as an equal? Then what are the chances that you can somehow cram a minimum of 7 years of training into the 2 years of masters level training to get an equivalent education base? Why do patients not deserve that? What are the chances that a medically fragile patient under the care of a MA level patient? And what are the chances that someone will pounce upon the training difference, even if that MA level person had nothing to do with it? Finally, what are the chances that you NEVER want to take a dip into some higher paying stuff while watching others do so during your 20-30 year career? Because finding out that Dr. Masterslevelcoubselor has misled people once, ever, is an easy way to get a board complaint and trounced in medicolegal work.

you can do it. It’s just a VERY limiting career choice.
 
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Serious answer: I get it. It’s a lot of training. You want to start, and there looks like there is some quicker route. Notice all the department heads, super respected clinicians, experts, and so on that took that route? No? What are the chances that all those super smart people missed some loophole that shortened training while maintaining prestige? What are the chances that you are smarter than all of those people? What are the chances that people who dedicated 5-7 years in education and an additional 1-2 years in training are going to welcome someone without that training as an equal? Then what are the chances that you can somehow cram a minimum of 7 years of training into the 2 years of masters level training to get an equivalent education base? Why do patients not deserve that? What are the chances that a medically fragile patient under the care of a MA level patient? And what are the chances that someone will pounce upon the training difference, even if that MA level person had nothing to do with it? Finally, what are the chances that you NEVER want to take a dip into some higher paying stuff while watching others do so during your 20-30 year career? Because finding out that Dr. Masterslevelcoubselor has misled people once, ever, is an easy way to get a board complaint and trounced in medicolegal work.

you can do it. It’s just a VERY limiting career choice.
I appreciate the honesty because this is roughly my read as well. But when I'm asking about the master's in mental health counseling, I just mean is that enough academic preparation to get INTO a PhD program? As opposed to a general psych master's? The goal would not be to practice extensively or very long in a medical context with a lesser degree. I really don't want to because I agree, it's not as sufficient.
 

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Agree, most Neuropsych positions/ programs fall under the neurology department.
 
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