Dr. Ronald Ruff
Dr. Ronald Ruff is a San Francisco-based neuropsychologist with a myriad of psychology degrees – both undergraduate and graduate – from the University of Zurich in Switzerland. Dr. Ruff has also been a post-doctoral research fellow at both Oxford University and Stanford University.
Dr. Ruff specializes in working with patients who have sustained traumatic brain injury and the focus of his research and clinical work has been assessing and treating the cognitive and psychological changes that result from a neurological issue.
He has extensive experience working in both the hospital setting and the university setting and is currently a neuropsychologist and rehabilitation psychologist at San Francisco Clinical Neurosciences and doubles as a clinical professor of psychiatry at the University of California, San Francisco.
He also serves on the editorial board of multiple neuropsychology journals, is a peer reviewer of a handful of other journals, and was honored with the distinguished service award from the National Academy of Neuropsychology in 2011.
How did you first become interested in psychology and therapy? What was it that attracted you to the profession?
Well, my father was a minister and I would tag along when he would go and do visits to sick individuals. I was always interested in helping people but I didn’t know anything about how to counsel people, and he encouraged me to go and get special training, and that is what prompted me to pursue the career. At first, I wasn’t sure I could become a psychologist because of all the schooling and so I thought maybe I would become a school counselor. But then, when I took some experimental psychology courses, my professor said I had a knack for that and encouraged me to go to graduate school.
With so many different career paths in the field, how did you settle into the neuropsychology route you ultimately ended up taking?
I am a dual-citizen and was raised in Switzerland. During that time I was training to be a psychologist and I wanted to be a therapist. But I realized more and more that the only people who could afford the help we were offering were typically rich people.
Now I have nothing against rich people, it was just going against what I had hoped for; I didn’t want to only help the rich. I was also very interested in the brain. I was interested in neuropsychology and in one of my first lecture classes, the professor said he needed someone for a paying job that summer, so I went up and volunteered.
There were two beautiful girls in front of me and I thought I was toast. But they went up to him and asked a few questions, and I went up and just said, “I want the job,” and I got it. The first time I walked through the neurosurgery unit, I saw all these people with very serious brain injuries, and I told myself that if I could help these people, I would be thrilled. I knew right then that I wanted to be a neuropsychologist.
A neuropsychologist obviously works with the brain, but what specifically does your job entail?
A neuropsychologist is a clinical psychologist first. However, I was in such an early generation that wasn’t essential. I came from neuroscience and I wanted to become a hardcore scientist. But then my dad had a little stroke, and I couldn’t help him, so I went back into clinical work full steam. Most of what we do is focused on the assessment and testing aspect.
It’s just like if you got a physical or emotional evaluation. We assess someone’s ability to take info in through their senses, and then we look at how well can they remember; how intelligent they are; how they solve problems; and what their language abilities are. Then, we look at those profiles, and that allows us to be of assistance to the team we are working with.
Let’s say someone has a tumor and the question always comes up – what are their problems – and that requires a careful neuropsychological exam. Those exams are lengthy and they can take six or seven hours. This assessment is what we get trained to do. There is a lot of skill involved. You need to be able to interpret complicated patterns in test results and localize brain damage even without CT scans.
Given the severity of some of the injuries to your patients, it would be easy to assume your work can be exhausting. Do you ever get burned out from the work you do?
I don’t think I ever burned out. I had the really great fortune to be asked to be a faculty member at the University of California San Diego. I did ten years working full-time in the medical school and it was really interesting. But where I got stuck at that university is that I was so focused on research that while it really cemented my tools as a researcher, I got tired of seeing patients and never having the time to treat them.
That’s when I got interested in joining a rehabilitation clinic. Eventually I worked at the St. Mary’s Medical Center for 14 years and it was a really great team. I think maybe I worked a little too hard there and so I wanted to move on one more time. Basically, I take a ride somewhere for awhile and then I move on. Life is short and that’s why I feel you should move on and do as many things as you can pack in. That’s a great way to keep your job interesting and fresh.
You seem to feel strongly about helping those that are less fortunate. How rewarding and gratifying is your job? How much do you actually learn from your patients?
I have a funny story. My son came up to me once and told me, my knee hurts and I know you always say you have patients who don’t have legs, but my knee hurts and I want help anyway. I tell that story because these people’s problems and stories help put things in perspective.
When you are working at a university and you go through as many years of education, you realize there is a bit of a bias and professors say if you aren’t in academia, you are a bit of a lightweight. I realize that I bought into it while I was in San Diego, and I have to confess that I did things for publications and buddied up to people so I could get ahead in the academic world.
I remember one day driving to work planning my career, yet at work while I was pulling out the charts for my patients I had a big nexus moment where I said, “Damn it! What are you devoting your life to, your career?” I felt really sad that I got caught up in all of this and I went home and told my wife that I think I got warped.
I decided then that I was going to focus on my patients, and interestingly, what happened as a result was that my writing is much more beneficial to my colleagues. A patient-oriented approach has been a huge boom for me academically ironically. Really though, the people I see, they overcame adversities and people like that become my hero.
Many of my patients have become my role models just because they have had to fight so hard to overcome their problems. When someone opens up their life that has been shattered by an accident and I see what they have to go through and how hard they need to work just to walk or a pay a check, I am inspired by those people every day.
What advice would you offer to those who are interested in becoming a neuropsychologist? How should they go about deciding whether this is the right profession for them?
My advice is to be the best you can be in your profession and never worry about money, because it will all work out. I never chased money and I was not super talented, so I had to work hard. I think talent is overrated and that diligence and persistence can make up for that. I would like them to examine some of their inner core values and see if they enjoy spending a day sitting across from the patients.
Do they like to unravel a puzzle? Can they find that curiosity to go in depth and analyze? Do they have the patience to work with those individuals? Those are the devotions they have to have; otherwise this is the wrong field. The big advice for anyone starting out is that if you want to be successful, you need to tolerate ambiguities. If you like things black and white, this is the wrong field.
What do you think the future of neuropsychology will be? What do you like and dislike about your profession and its direction?
* Clinical Neuropsychology has clearly burgeoned as a diagnostic discipline. Over the past
decades there has been an impressive increase in the number of newly published tests. Even more impressive is the growing literature that identifies what aspect of cognition
is compromised by different neurological disorders. In comparison to these advances, the research and development of treatment modes remains lackluster.
In order to create a discipline that benefits patients, we must evolve beyond diagnosis and begin to focus on patient care. Why have we stagnated as a diagnostic discipline? In part the answer is based on the reality that far too many of us are riding the litigation gravy train. This explains why casual conversations between neuropsychologists often focus on war stories about litigation cases.
Rarely do my colleagues share stories that promote exciting new treatments. With patients I am finding it progressively more difficult when I have so little to offer in form of efficacious treatments after testing them for hours and hours. Therefore, what I do not love about my discipline is that we are merely stumbling forward without a vision for our future.
For more information about what exactly a neuropsychologist does and how to become one, please feel free to visit our Neuropsychologist Careers page in the careers section of our website.