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Common Queries

What differentiates you from other psychologists that perform neuropsych assessments?

Neuropsychology has a tradition of overutilization of testing, oftentimes requiring examinees to undergo upwards of 6-8 hours of testing. In contrast, Dr. Rehmel utilizes the Meyers Neuropsychological System (MNS)/Meyers Neuropsychological Battery (MNB), which emphasizes tests that are both sensitive and specific. In other words, tests that reveal abnormal cognitive functioning and also help differentiate between possible sequelae. This effectively truncates the number of tests necessary to produce a comprehensive profile that can be used to address most referral questions. Many psychologists and neuropsychologists also use what is called a "flexible" battery, choosing tests that they feel provides the information necessary for the situation. However, these test batteries typically have no empirical justification, often include insufficient performance validity measures, and meaningful comparisons (e.g., discriminant functions, advanced statistical analyses) are often unavailable to facilitate the decision-making process.

Dr. Rehmel has diversity in academic experiences that illuminate his work. This includes master's degrees in psychology (MA), counseling (MA), clinical psychopharmacology (MSCP), and theology (MAT), in addition to a doctorate of philosophy in clinical psychology (PhD) with an emphasis in neuropsychology. 

 

Dr. Rehmel has diversity in clinical experiences that allow for flexibility in the types of evaluations he can complete. This includes years of pre-and post-doctoral training in neuropsychology, forensic psychology, & psychotherapy in various settings including hospitals, community mental health, detention facilities, school districts, and college/university settings, and in collaboration with a broad range of healthcare professionals. 

Dr. Rehmel has also previously worked in multiple academic settings, undergraduate and graduate levels, as a professor, supervisor, staff psychologist, and resident neuropsychologist.

What ages do you work with, how long does an evaluation take, and what insurances do you accept?

1) Generally 6-90+. 2) Full evaluations typically occur over three sessions, interview, testing, and feedback. Testing appointments typically take around three hours with the other sessions typically taking one hour. 3) Several. Although not convenient, please contact Clarity Clinic to see if your carrier is accepted:

Clarity Clinic

219-595-0043

Munster, IN

https://claritynwi.com

Is psychotherapy effective?

Yes. Often emphatically so. Although finding the right therapist can be tricky. In general, be wary of those that overemphasize a particular therapy "brand." The acronyms are everywhere, but the hype often extends beyond the substance. Research does not support ascribing to a particular therapy brand as being predictive of effectiveness. In contrast, research demonstrates that the therapy PROCESS is predictive of outcome and many that ascribe to a particular theoretical orientation do not actually provide an experience that is consistent with their claimed philosophical convictions (Shedler, 2010). 

For example, Castonguay, Goldfried, Wiser, Raue, & Hayes (1996) analyzed therapy transcripts and recordings collected as part of a larger study researching the effects of CBT and psychotropics on depression. They grouped therapists based on whether their process adhered more to a CBT prototype or more to a dynamic process orientation. What they found was that even though all these therapists were supposedly providing CBT, those that adhered to a more dynamic process and less to a CBT prototype were vastly more effective. In fact, a unique aspect of CBT, focusing on "distorted cognitions" was negatively correlated with outcome (i.e., the more it was emphasized the poorer the outcome). They found that this was often done to provide a "cognitive" rationale for a rupture in the working alliance (i.e., working relationship). Similar findings have emerged with comparable methodologies (Ablon & Jones,1998) but this level of analysis is not reflected in most research on psychotherapy. 

Some key variables associated with positive therapy outcomes include the therapist having an emotion-focus, process orientation, and appreciation of the developmental nature of the condition being addressed. Psychotherapy is not about focusing on the past but the past illuminates the present. The therapist and client/patient should have a shared understanding of the goal(s)/purpose of treatment (i.e., working alliance; What's wrong? What do they hope to change? How will psychotherapy be helpful? Why now?). The relationship that undergirds treatment is ideally imbued with trust which fosters vulnerability and allows them to experience and work through the difficult emotions that drew them to therapy initially (Schore, 2012). Also, the relationship in "the room" can be used as a tool for understanding experiences, identify and explore patterns of behavior, and use this information to translate therapy gains into everyday life. Understanding typically precedes change.

The emphasis on the relationship is not just a vague "liking" of each other, but is characterized by a certain level of bonding that allows for the patient to "take chances", for difficult emotions to be expressed (e.g., anger, heartbreak, shame) and worked through, for an independent perspective to be received and considered, and in turn this process tends to foster growth and autonomy.  

Kristian Kemtrup, PhD, LMFT, talks more about therapy styles and outcome here: https://www.psychologytoday.com/us/blog/making-sense-of-therapy/202310/two-different-things-called-therapy

The best quality research has consistently revealed that the duration of effective treatment often lasts 20-24+ sessions, with larger effects often coming with increased duration (Shedler, 2020). Similarly, multiple sessions per week produce significant therapeutic gains relative to single weekly sessions for depressed patients (Brujiniks et al. 2020) and treatment-resistant depression (Rost et al. 2019; Fonagy, 2015). Although some "brands" advertise short-term fixes, this is smoke and mirrors as the research often includes poor methodology (e.g., irrelevant comparisons, poor controls, arbitrary follow-up evaluations) and typically results in minimal or no improvements for those undergoing treatment (Shedler, 2018).

Do you have any references that support the claims you've made on here?

Where to start...

- Midgley et al. (2021) demonstrates the effectiveness of developmentally focused psychotherapies in adolescents for the treatment of various disorders. However, these therapies appear to be especially effective for the treatment of internalizing disorders (e.g., depression, anxiety) and emerging personality syndromes.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8110733/

- Shedler, J. (2020). The Tyranny of Time. 

This article discusses the psychotherapy durations associated with lasting change.

https://www.psychotherapynetworker.org/magazine/article/2436/the-tyranny-of-time/5d2ed7b6-3a2a-4c7c-b491-2a2742748e83/OIM

- Bruijiniks, S. et al. (2020). The effects of once- versus twice-weekly sessions on psychotherapy outcomes in depressed patients. https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/effects-of-once-versus-twiceweekly-sessions-on-psychotherapy-outcomes-in-depressed-patients/C43C681866F3663A5C55BAFA2A99B8CB

- Rost, F. et al. (2019). Personality and Outcome in Individuals With Treatment-Resistant Depression—Exploring Differential Treatment Effects in the Tavistock Adult Depression Study (TADS). https://pubmed.ncbi.nlm.nih.gov/30998046/

- Shedler, J. (2018). Where is the Evidence for Evidence-Based Therapy.

https://jonathanshedler.com/wp-content/uploads/2018/05/Shedler-2018-Where-is-the-evidence-for-evidence-based-therapy.pdf

- Lilliengren, P. (2017). Comprehensive compilation of randomized controlled trials (RCTs) involving

psychodynamic treatments and interventions. https://www.semanticscholar.org/paper/Comprehensive-compilation-of-randomized-controlled-Lilliengren/bb2f7e5d6265de22aff0c0ee81937c8e30d303a8

- Farhad Dalal, PhD, (2015). In this lecture, Dr. Dalal deconstructs the culture of poor research used to prop up CBT and other "waves" of therapy (e.g., behavioral therapy). This includes a positivistic culture that produces irrelevant or misleading findings to create a false narrative of effectiveness. "...Positivist methodologies are unable, even in principle, to capture the intricacies of human exchange. I suggest that in lieu of positivism, notions of emergence and complex responsive processes are more appropriate (Dalal, 2022)."  https://www.youtube.com/watch?v=T2OsehrTKTA

- Fonagy, P. et al. (2015). Pragmatic randomized controlled trial of long-term psychoanalytic psychotherapy for treatment-resistant depression/ the Tavistock Adult Depression Study (TADS). https://pubmed.ncbi.nlm.nih.gov/26407787/

- Rohling, M. et al. (2015). Application of the Daubert Standards to the Meyers Neuropsychological Battery.

Note: This article discusses the comprehensive nature of the MNB and the permissibility of neuropsychological evaluations as evidence in court proceedings. https://link.springer.com/article/10.1007/s12207-015-9227-1?shared-article-renderer

- Schore, A. (2012). The Science of the Art of Psychotherapy.

Schore describes various neuropsychological changes associated with effective psychotherapy. https://amzn.to/49jP3AS

- Shedler, J. (2010). The Efficacy of Psychodynamic Psychotherapy. 

In this paper, Shedler discusses the efficacy of therapy in general and structured versus process-oriented therapies in particular. One common limitation of psychotherapy literature, highlighted in this publication, is the failure to control for the process in the room when analyzing therapy gains. 

https://jonathanshedler.com/PDFs/Shedler%20(2010)%20Efficacy%20of%20Psychodynamic%20Psychotherapy.pdf

- Rohling, M. et al.(2003). Neuropsychological Impairment Following Traumatic Brain Injury.

Rohling and colleagues discuss the sensitivity and specificity of the MNB for detecting TBI severity and the relationship between the MNB and established but much longer test batteries (i.e., Halstead-Reitan Neuropsychological Battery).

https://pubmed.ncbi.nlm.nih.gov/14704881/

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