Psychologists with holistic approach to rehabilitation bring therapy into homes

Rehabilitation psychologists might not be as well-known as physical and occupational therapists, but the specialists have emerged as integral players in the recovery process for many victims of catastrophic injuries or life-altering illnesses.

According to University of Colorado School of Medicine (SOM) Professor Lisa Brenner, PhD, that is because rehabilitation psychologists like herself have a unique view of the recovery process. They are able to work with patients after they leave the hospital or a rehabilitation clinic to help them restore as much of their old lives as possible. Rehabilitation psychologists coordinate care between doctors, therapists and family members to help patients cope with new challenges and build fulfilling and meaningful relationships.

Lisa Brenner, right
University of Colorado School of Medicine Professor Lisa Brenner, at right, at an American Psychological Association conference for rehabilitation psychologists

This holistic approach can improve the well-being of patients as they adapt to a different world, which can be a difficult process.

“For many people, the big adjustment is after they go home, and that’s when the psychological impact for them and their families really begins to unfold,” said Dr. Brenner, who is a member of the SOM’s Department of Physical Medicine and Rehabilitation.

Dr. Brenner has spent her career studying traumatic injuries and helping people recover from disabilities caused by accidents or chronic illnesses. Her work at the CU Anschutz Medical Campus puts her on the front line of a rapidly expanding and evolving field as the medical world becomes more aware of how holistic care benefits patients. Rehabilitation psychologists treat a wider range of conditions than ever before, including strokes, multiple sclerosis and AIDS.

Focusing on the whole patient

Rehabilitation psychologists are one of many different therapists a recovering patient could encounter. Their job bridges the divide between specialists who focus on physical recovery or provide support for mental health issues.

Dr. Brenner gives the example of someone with a traumatic brain injury (TBI) who has returned home from the hospital. Often, a physical therapist might focus on improving a patient’s coordination, and an occupational therapist might help them relearn how to do household tasks. A doctor might prescribe an antidepressant if the patient became depressed.

When different doctors and therapists focus on separate problems, they might not communicate effectively with each other, which Dr. Brenner said could lead to gaps in treatment. Rehabilitation psychologists coordinate the work of multiple therapists to develop an integrated treatment plan.

“The more we’re able to provide holistic and comprehensive care, the better it will be for our patients,” Dr. Brenner said. Rehabilitation psychologists also form long-term relationships with patients and their families to establish reasonable expectations for recovery and make sure the treatment plan is working. A rehabilitation psychologist’s training in mental health care could help them see emerging mental health issues before anyone else.

Greater urgency for treating veterans

Rehabilitation psychology has existed for decades, but the field has developed rapidly in the past 15 years. One cause has been the U.S. military campaigns in Iraq and Afghanistan. Veterans have returned with life-changing injuries such as TBI or amputations, and doctors and therapists have had to develop new ways to help them adapt.

The suicide rate among veterans also has skyrocketed, bringing added urgency to those who help veterans recover from injuries and post-traumatic stress disorder. Dr. Brenner, who directs the Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC) for the U.S. Department of Veterans Affairs hospital in Denver, sees the difference rehabilitation psychologists and new holistic approaches can make.

“TBI and negative psychiatric outcomes such as suicide travel together, and we need to be thinking of them together,” Dr. Brenner said. “It doesn’t need to be one set of providers addressing the mental health problems and challenges, and one set of providers dealing with the brain injury.”

An expanding discipline

Lisa Brenner
University of Colorado School of Medicine professor Lisa Brenner, PhD, discusses rehabilitation psychology with peers in Israel in December 2016 as part of an exchange program.

Dr. Brenner, who is the president of the American Psychological Association’s Division of Rehabilitation Psychology, said the field has expanded its scope beyond TBI and catastrophic injuries. Strategies that have proven effective for treating veterans and accident victims have started being applied to other chronic conditions. Rehabilitation psychologists now treat patients who might live decades with a chronic disease such as AIDS.

“Many more people are thinking holistically,” Dr. Brenner said. “We’re rethinking the way we’ve siloed things.”

Rehabilitation psychology has spread worldwide. Recently, Brenner led a delegation to Israel as part of an exchange program that visited 15 hospitals, rehabilitation centers and other facilities across Israel. A delegation from Israel will visit the U.S. this summer.

The purpose is to share best practices, develop collaborative research opportunities and draw lessons from different experiences. One difference Dr. Brenner noticed is that Israelis have more experience helping civilians with post-traumatic stress disorder manage the strain that comes from being in a region that experiences repeated conflicts close to home. Because the sources of stress cannot be removed from individuals’ lives, therapists have to help them cope in an environment that often does not feel safe.

“There’s a lot we can learn from each other,” Dr. Brenner said.

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