Feedback that Sticks: The Art of Effectively Communicating Neuropsychological Assessment Results

335 Pages·2013·1.84 MB·English

by  Karen Spangenberg Postal

feedback that sticks
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Feedback That Sticks
THE ART OF COMMUNICATING
NEUROPSYCHOLOGICAL ASSESSMENT RESULTS
Karen Postal and Kira Armstrong
1
1

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Library of Congress Cataloging-in-Publication Data
Postal, Karen.
Feedback that sticks : the art of communicating neuropsychological assessment results / Karen Postal and
Kira Armstrong.
p. cm.
Includes bibliographical references and index.
ISBN 978–0–19–976569–0 (alk. paper)
1. Neuropsychology. 2. Feedback (Psychology)
I. Armstrong, Kira. II. Title.
QP360.P67 2013
616.8—dc23
2012026696
1 3 5 7 9 8 6 4 2
Printed in the United States of America
on acid-free paper
To my husband, Bill Postal, and my children, Andrew, Robbie, and Caroline: love
that sticks.
To my father, Verne Spangenberg, who taught me about strength of character, indepen-
dence, and the love of a good book. Dad, you’ll always be one of the good guys.
And to my fi rst mentor in neuropsychology, Dr. Linda Vincent, who thought I might
make a good neuropsychologist, and made some calls.
—Karen Postal
To my wonderful husband, Zack Armstrong, and my children, Aidan and Logan.
Th ank you for your ongoing support – and for patiently nodding your head every time
I promised, “I’m done with the book – for real this time!”
And to everyone who has helped me learn how to make feedback stick – both my
neuropsychological mentors and the patients and families who have shared their lives
with me.
—Kira Armstrong
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Table of Contents
Acknowledgments xiii
Contributors x v
Prologue xxiii
part one | what is feedback and what makes it stick? 1
1. Feedback Th at Sticks: Th e Art of Communicating Neuropsychological Assessment Results 3
Why give feedback? 4
What is feedback? 6
Feedback’s impact on health, hope, and patient advocacy 7
Reframing how patients view their conditions 8
Feedback as a psychotherapeutic moment 8
Helping patients and families become better advocates 9
On giving permission 10
Permission to expose vulnerabilities 10
Permission to ask questions 1 1
Permission to cry 11
Permission to grieve 11
Permission for family members to consider their own needs 12
Permission to hope 12
Learning to give feedback 1 2
References 14
2. Why Some Feedback Sticks 15
Th e six principles for making an idea “stick” 18
Principle 1: Simplicity 18
Principle 2: Unexpectedness 19
Principle 3: Concreteness 20
Principle 4: Credibility 20
Principle 5: Emotions 21
Principle 6: Stories 22
References 23
vii
viii Contents
3. Feedback Protocols and Th eoretical Considerations 24
Feedback begins at the clinical interview 25
Establishing trust 2 6
Th e importance of empathy 27
Framing referral questions 29
Understanding preconceptions 2 9
Protocols for the feedback session 31
Reorienting the patient and family 31
Gathering more information and solidifying formulations 33
Being fl exible 34
Leading with the bottom line 34
Sharing the data 35
Beginning with broad concepts 36
“I hope I am wrong” 37
Multiple feedback sessions 3 8
4 . H ow Is Feedback Presented? 4 0
Th e physical setting 42
Hallway conversations 42
Feedback by telephone 42
Feedback through e-mail 43
Length of feedback sessions 44
Timing of feedback sessions 44
Who attends the feedback session 45
Considerations for the adult patient 45
Considerations for the child or adolescent patient 45
Th e more the merrier: When the feedback session involves more than the
patient 46
Th e use of props, technology, and other resources 47
Social pragmatics of feedback 48
Greeting patients 48
Eye contact 50
Tone of voice and word choice 50
Authority 51
Establishing trust within the community 52
Self-disclosure 53
Th e impact of appearance 54
Cultural considerations 55
Cultural sensitivity for the use of language 56
When using translators 57
Unique cultural issues associated with rapport 57
Cultural issues associated with low socioeconomic status 58
Approaching emotions 5 9
Experience of dependence and independence 59
Reference 60
Contents ix
part two | putting feedback to work 61
5. Putting Feedback to Work with Patients fr om Multiple Populations 63
Developing relationships with patients and families 66
Connecting with the patient and family 66
Affi rming parents’ instincts 66
Establishing a long-term relationship 66
Normalizing the presenting symptom(s) 67
Contextualizing a history of confl icting diagnoses 67
Encouraging questions from patients and families 67
Creating a therapeutic atmosphere 67
Giving parents a space to grieve 68
Scaff olding language to help patients express concerns 68
Complimenting patients on their resiliency 69
Addressing patient distress during the feedback session 69
Praising the child 69
Setting the stage for feedback 69
Reassuring with good news 69
Responding to the patient’s presenting concern(s) 70
Validating patient concerns about memory 70
Acknowledging how tiring testing can be 70
Engaging children in a dialogue about their abilities 70
Inviting parents to help shape the feedback message 71
“Wondering out loud” to engage patients 71
Explaining the testing process and goals 71
Th e rationale for comprehensive testing 71
Why does testing take so long? 72
Giving parents a chance to take the tests 72
E xplaining the normal curve 7 2
Height metaphor for the normal curve 72
Acknowledging the limitations of testing 72
Off ering hope and normalizing fi ndings 73
Explaining memory 7 4
Library metaphor for memory 74
Th e impact of memory/attention defi cits on marriage 75
Explaining the impact of attention on memory 75
Pearls to explain slowed/ineffi cient processing 76
C omputer metaphor for slowed processing 7 6
Walking with a small child metaphor for slowed processing speed 77
Explaining executive function and frontal impairment 77
Explaining “Can’t vs. Won’t” in the context of executive dysfunction 77
Symphony conductor metaphor for executive function 77
Cleaning an attic metaphor for executive dysfunction 77
Dog and a tennis ball metaphor for executive function 78
Facilitating caregiver empathy for impaired reasoning 78
Off ering recommendations and compensatory strategies 79