Personal Injury
Forensic Services
(Civil Capacities Assessments of Elderly and Disabled)
Financial Capacities
With the dramatic increase in the elder population many suffers from dementia. Here clients may present to attorneys with questionable difficulties managing his or her business or personal finance. Also, concerned family members may raise questions concerning a relative’s financial capacities. Currently, there are objective means to assess such individuals, leading to a thoughtful, fair, and well-formed expert assessment of a client’s financial capacities. This neuropsychological assessment has proven to be helpful to attorneys, concerned family members, and to client’s by protecting their interests in areas of finances.
Healthcare Decision Making Capacities
Healthcare decisions are often difficult ones even for persons that are cognitively intact. They are especially difficult for persons of advanced age, or persons with certain complex medical-psychiatric-alcohol disorders. Assessments of clients with questionable cognitive capacities Is often challenging. It is necessary to establish if these individuals have a reasonable understanding of their treatment options, appreciate how such treatment(s) or lack of treatment(s) may affect their well-being, have an intact reasoning process-to include the capacity to weigh the consequential and comparative consequences of their decisions, and then are able to disengage from the information process and form a decision. Current neurocognitive assessment processes illuminate an otherwise murky situation helping the patient, interested and concerned family members, and attorneys better understand the client’s cognitive capacities in this area.
Testamentary Capacities
With the graying of America and with increasing numbers of elder people often living into their 9th decade, compounded by complicated family structures, there is likely to be an increase in problems associated with questions concerning clients’ testamentary cognitive capabilities. Neuropsychological assessments of various cognitive processes are very useful in determining a person’s cognitive capabilities to make a will or to change an existing will, as directed by their free-will, values, and reasoned self-interests, rather than due to undue influence by others. Attorneys, family members and those persons involved directly in making or in changing their will benefit from this assessment process. Probate attorneys, the Court, the respondent, and family members benefit greatly for this assessment.
Driving Capacities
Driving a car is considered close to a God-given right in advanced and automobile dependent societies. Understandably then elderly and/or disabled persons struggle to maintain this method of travel as an expression of their independence. However, with aging/ or traumatic brain injury comes physical changes to include cognitive changes that are often insidious to the elderly or disabled person, and thus go unrecognized by them. Family members often grow concerned about their loved one’s cognitive and physical capacity to drive a vehicle. Attorneys are frequently contacted for advice. A neurocognitive assessment sheds light on potential cognitive problems, helping all concerned to sort out this thorny problem and arrive at a thoughtful and more objective decision that is fair to the elderly person, and to society. Too, it may be necessary to have a multidisciplinary assessment conducted, along with a neuropsychological assessment.
Adult Guardianship
Adult guardianship is a complex matter. Often a comprehensive assessment of an individual’s neuropsychological and cognitive status has not been fully assessed. Cognitive competency and or capacities must be carefully reviewed as such an assessment helps protect the individual in question, while informing the Court of objective neurocognitive findings, and assisting attorneys in sorting out these matters. Client populations that benefit from this assessment are young and middle-aged adults with mental illness or mental retardation, and the ever-increasing elder population that with each decade of life are at a higher risk of suffering with dementias as they pass through the life cycle. The Court, probate attorneys and the respondent gain from this assessment.
Personal Care and Indpendence
Appropriate adult self-care is partially conditional upon an individual having adequate cognitive and physical capacities to perform Instrumental Activities of Daily Living (IADL’S) and more rudimentary Activities of Daily Living (ADLs). With the elderly or those that have experienced cardiovascular accidents (CVAs), those with a traumatic brain injury, and those with psychiatric or substance abuse problems present with different patterns of problematic decline in awareness. Individuals may have a gradual decline in cognitive functioning (elderly clients), other may have a sudden decline in their cognitive functioning (CVA and TBI patients), and still others (patients with psychiatric or alcohol abuse conditions) may show a slow decline in personal awareness of their judgment, memory capacities, and problem solving capabilities, and selfcare. Probate attorneys, the Court, the respondent, and family members need clarification regarding these important matters.
Family Law
Comprehensive Parenting Plan and Child Custody Evaluations: This is a comprehensive and highly structured approach to fairly, humanely, and professionally assessing the question of child custody matters and what is in the best of interests of the children at critically difficult period.
Criminal Law
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Competence to Proceed
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Sentencing and Mitigating Factors
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Criminal Competence-Adult and Juvenile as described in Code of Criminal Procedure, Title 1, Chapter 46-B, Sub-chapter A
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Violence Risk Assessment
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Police and Public Safety
Personal Injury
Accidents often bring intense physical and emotional distress to their innocent victims. Frequently, with serious injury there is a resulting loss of employment, loss of physical mobility, and a change in one perceptions of life leading to depression, anxiety, and at times post-traumatic stress disorder. Additionally, and especially with traumatic brain injury, there are often problems with poor concentration, impaired memory, poor problem solving, and other post-concussion symptoms. Personal injury attorneys, the court and affected victims can benefit from the results of neuropsychological assessment that are conducted in a professional and ethic manner. Dr. Ingram provides such services in selected cases.
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Areas of Psychotherapy
Couples Therapy
Emotion Focused Therapy for Couples: In brief and cutting through the understandable romantic and commercialized images of modern marriage, deeply committed love relationships (i.e., marriage and commitments to a significant partner) rest upon a fundamental foundation of mutual trust, mutual emotional and physical safety, and mutual predictable support and caring. This secure foundation permits deep individual emotional and physical needs to be met within the relationship. Marital problems are viewed as damage to the foundations of marriage, with resulting marital discord and individual psychological distress. The focus of treatment is on the interpersonal dance between the married or committed couple-not individual faults, failures, and individualized psychology. When possible and desirable, the goals of treatment are the restoration of the foundational underpinnings within the relationship, a deeper understanding of each person’s psychological needs system, and a restored willingness to maintain the connection between the couple in a caring and loving manner.
Cognitive Behavioral Therapy
This therapy is based on current research data suggesting that a cognitive-based treatment approach where a person, through a structured approach of assessing thoughts and making changes in thoughts, can positively affect disturbing emotional states, while improving a person’s functioning and behavior. Specific behavioral assignments are often included and combined with cognitive techniques.
Cognitive Behavioral Therapy - Insomnia
Cognitive Behavioral Therapy- Insomnia: This is the “Gold Standard” treatment approach for chronic insomnia. Patients suffering from insomnia often fail to respond to medications designed to treat this condition-and most “sleep aids” are designed for short-term use only. Research findings and clinical experience points to the effectiveness of cognitive behavioral therapy for insomnia. This is a structured approach.
Cognitive Processing Therapy
This therapy is designed to help psychologically traumatized persons to achieve reduced emotional distress and improve functioning. It is a structured treatment effort using the principals of cognitive therapy. Research and clinical experience show that this treatment is highly effective.
More Traditional Therapy
Sometimes a cognitive approach is not appropriate, for various reasons. When this is the case or when a more long-term approach is indicated, a more traditional psychotherapy model can be utilized. Here achieving psychological insight, a reduction in emotional distress, coupled with behavioral changes, is the goal.