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People First | QLI’s Hands-On Approach to Psychology


The team of experts that make up QLI’s psychology department have the responsibility to know precisely what is happening inside the brain. Anatomically, cognitively, emotionally—all of the complex influences both internal and external to the brain’s function. Consisting of an industry-leading neuropsychologist, talented clinical psychologists, and a nationally renowned research expert, QLI’s psychology team possesses both tremendous academic knowledge and decades of experience utilizing therapy techniques.

But serving as the be-all-end-all clinical authority, contrary to what might be typical of psychologists and neuropsychologists in other rehabilitation and care environments, isn’t the team’s role at QLI.

“In many hospital settings,” says Dr. Jeff Snell, QLI’s director of psychology services, “psychology is treated like any other specialization. You assess your patient, make a recommendation—is this person safe to discharge, safe to go home—and then write a report. In hospitals, it’s difficult to have any level of deep collaboration.”

For QLI’s psychology team, collaboration represents not just their duty within the greater clinical environment, but the process by which they can sow the seeds of recovery.

The difference is every bit as structural as it is philosophical. And it’s a difference that has manifested in QLI’s ability to create tremendous long-term successes.

RELATIONSHIPS EMPOWER PURPOSE

The effectiveness of QLI’s psychology team, and, by extension, QLI’s entire program, is a function of the relationships individual clinicians build with each client. Expertise, as Dr. Snell explains, can only accomplish so much within a vacuum.

“We have a bank of knowledge and techniques and theories,” Dr. Snell says, “but the most important ingredient is the person knowing you’re invested in their individual success.”

Like other rehabilitation programs, there is a formal component to this relationship. Initial assessments with both the individual and their family members sketch a detailed picture of life before injury—who the person was, what roles they fulfilled in family and occupational and personal settings, what got them out of bed each morning.

In these early assessments, the psychology team begins quantifying the effects of an injury, the aspects that are difficult to spot and often harder to measure. Things including a person’s emotional functioning, processing speed, expressive and receptive language capabilities. It is from this information that the other arms of QLI’s clinical team begins building targeted therapy plans.

But QLI’s psychologists spend an enormous amount of time with clients beyond formal assessments. One-on-one discussions aren’t outside of the norm, but just as often these opportunities to build relationships put psychologists into different environments—taking an active role in a person’s physical therapy, for instance, or as part of an adaptive sports training session.

It’s a rejection of the traditional expert/non-expert relationship. Rather than loom as a voice of authority, the psychology team operates as a partnering force, as a tool to be utilized.

These relationships open inroads used to identify and target the complex emotional journeys clients must make over the course of recovery. The men and women who live through injury face enormous change and seemingly perilous uncertainty. Genuine, one-to-one relationships foster mindsets that encourage change, that minimize the sense of catastrophe in favor of a sense of achievement and growth.

“We’re dealing with people who’ve had an injury, yes,” says Dr. Snell, “but they’re people first. Our job is not to be the experts who come in and consult, who have all the answers. Our job is to collaborate with the person to empower them to make the change, whether physical, cognitive, or emotional. Through that, we can put in place the bigger picture. It’s not about putting one foot in front of the other, but to reinforce why you want to walk again.”

MAKE IT AUTOMATIC

Here’s a thought experiment you can try at home, perhaps one you’re familiar with already:

Try to command someone to do something. Tell them how. Even better, try to tell someone they should do something that they currently are not.

What happens when that someone gets that particular something wrong? What happens if that someone is defiant, determined to find their own solution to a problem? What happens if that someone rejects the very notion that there is a problem in the first place?

It’s likely the same reaction you might have if a stranger were to tell you what to do. Or if that stranger were to say you were doing something incorrectly, especially if they were to do so unprompted.

You might just tell them to go mind their own business. And that request may or may not be polite.

In one way, this experiment underlines the importance of strong relationships in a rehabilitation setting. By building a sense of community with an instructor or expert, information is shared. Not delivered by way of commands. Yet, in another way, it calls to attention another unique quality of QLI’s psychology team (and, again, QLI’s entire rehabilitation method)—the system by which teaching is delivered.

It isn’t a system of behavioral reinforcement—that is, rewarding good behavior and punishing unwanted behavior—but one that modifies the environment to ensure a much higher likelihood of a pre-specified behavior. The team functions like a mold, funneling and shaping an individual’s activity to output the desired performance in tasks.

“If you can change what leads to a given behavior, we can change whether or not that behavior occurs,” Dr. Snell says. “How can I teach you in an environment that leads to meaningful, purposeful, appropriate, adaptive behavior? With lots and lots of repetition, it allows you to be more independent.”

Hundreds and thousands of repetitions of any particular task—proper walking, for instance, or functional speech—sparks a process called neuroplasticity. In short, it’s the brain’s ability to reconfigure itself based on usage, repeated practice, and habits. Eventually, common functions become automatic. It’s the science that explains how you can and have acquired new skills throughout your life, and how individuals who have suffered severe brain injuries can eventually reacquire function that was formerly dependent on now-injured parts of the brain.

For neuroplasticity to take hold with maximum impact, an apprenticeship style of structured teaching is key. Telling someone how to perform an action, only to grade the performance after the fact, has little benefit for an individual with impaired short-term memory or impulse control.

Instead, our psychologists and therapy teams must work with rehabilitation participants side-by-side.

“It’s how expert craftsmen learn their trades,” says Dr. Snell. “They work alongside someone who really knows how to do their particular skill very well. Showing, and then doing it together. By seeing it modeled, a person will have a greater mastery over those skills.”

TEAMWORK, DREAM WORK

Collaboration doesn’t begin and end with the rehabilitation client alone.

Each person recovering at QLI has a discrete team made of therapists and specialists. Dr. Snell and QLI’s team of psychologists are hardwired into each of those teams, not only participating with direct therapies, but exchanging critical information in order to, together, build dynamic rehabilitation plans.

“In a hospital setting, it makes sense to plug in and plug out experts for each medical component. If one of those components doesn’t work, then you are not going to work,” Dr. Snell says.

“At our point of rehabilitation though, our job is to empower all of our staff to be helpful in any situation, especially from a psychological standpoint. It’s to give away as much information as we can to everyone around us.”

Each QLI team member, as a result, becomes an ad hoc psychologist, fully equipped with crucial information and behavioral therapy strategies delivered by the psychology team itself.

Whether part of QLI’s residential services staff or one of the nurses managing an individual’s day-to-day needs, QLI’s team members use their relationships with rehab clients or families to monitor cognitive and emotional need. And they apply the very same apprenticeship-style training methods to ensure abilities transfer from formal training to functional practice. Moreover, this thorough collaboration allows QLI to educate families, not only to be a source of support, but to maximize their loved one’s independence in the weeks, months, and years after rehabilitation.

In short, the psychology team is less a removed entity informing a bigger program and more an interwoven thread in a tightly knit tapestry. In many ways, the work of these psychologists is foundational to all of the therapy services provided at QLI.

But it has a reflexive quality as well, reacting and adapting to the expertise brought to the fore by QLI’s other clinical leaders, as well as to the growing, dynamic needs of each rehab participant.

That collaboration empowers each person at QLI—from clinician to client—through shared experience, not authority.

“In rehabilitation,” Dr. Snell says, “if you treat only one piece, you’re missing the big picture. You need to have an integrated and collaborative process for whatever you’re trying to change, because we’re treating human beings, not a single diagnosis.”

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