UNDERSTANDING AND USING  PSYCHOLOGICAL EVALUATIONS

Introduction

I’d like to help you get the most out of the evaluation. I’m going to give a brief explanation of the purpose of each section of the report. I’ve also provided a special section on “mindfulness” practice, with information about training the brain.

The psychological evaluation serves two primary purposes:

1.     To provide clarification of diagnoses

2.     To provide recommendations for treatment

I’ll explain each section of the report in light of how it relates to these two things.

The “Background” Section of the Evaluation - The Importance of Narrative and “Stories”

Our brains begin to construct what might be called “stories” (first non-verbal, then both verbal and non-verbal stories) about who we are, how we relate to others, and how we relate to the world in general, from the moment we are born. These stories get more and more complex as we get older. We begin to filter everything we experience through these stories, and this can ultimately have negative effects in all areas of our lives, from our individual state of mind, to our relationships, schooling, effectiveness at work, etc. 

It may be hard to believe that something as seemingly intangible as a “story” can have such a profound effect on us. But consider the placebo pill; it’s basically a pill that has no known curative properties, sometimes no more than a “sugar” pill. Yet this pill can raise or lower blood pressure, dramatically reduce pain for even the most severe migraine headaches, reduce symptoms in epilepsy, Parkinson’s, asthma, and other purely physical conditions, and significantly reduce psychological symptoms in depression, anxiety and other mental health conditions. It works in large part because we all have a “story” that “pills” can improve our health. This simple belief can have a powerful therapeutic impact on our minds and bodies.

Simply helping people to understand the story of their lives can itself be very therapeutic and help them to make sense of things. Sometimes, with posttraumatic stress disorder, understanding the meaning of the trauma and the role it plays in the larger story of one’s life can be enough to bring about profound relief.   Even medical schools are teaching med students the importance of “narrative” (i.e. story telling) in helping their patients understand the meaning of their disease. This not only helps them come to terms with their condition – it often reduces their physical symptoms as well.

Because of the healing value of narrative I always strive to create a kind of “story” for each person I evaluate.  The “General Background Information” section of the report is not just a collection of facts. It’s intended to be a “story” that makes sense of the person’s life and provides the foundation for the diagnoses and the treatment recommendations that follow. 

Cognitive Testing: The “IQ” Test and Cognitive Skills Development

The IQ Test

The first thing to keep in mind when considering IQ and academic scores is – they are not “set in stone.”  The IQ, in particular, is sometimes thought to represent the full measure of someone’s intelligence.  But, in fact, it is simply a snapshot, representing some general features of the way someone’s mind works during that period of time – or at that point in their life.   However, when properly used – that is, when taken in the context of all the other information - it can provide much insight into how a person thinks, and how their thinking affects their emotions and their behavior. 

I’ll just mention one of the many ways the IQ can be helpful.  The two IQ tests I give – the “WAIS-IV” (for adults) and the “WISC-IV” (for ages 15 and under) – each give two kinds of overall intelligence scores – the “Full Scale IQ” (FSIQ) and the “General Ability Index” (GAI).

The FSIQ is made up of four separate scores:  one for verbal reasoning, one for visual-spatial skills, one for working memory, and one for what is called “processing speed” (the time it takes to understand what you are seeing or hearing.

The GAI takes into account only two of these scores: verbal reasoning and visual-spatial skills. One of the main reasons they separate out these two measures is that they tend to be more stable – that is, less affected by mood, sleep deficit, anxiety, and other passing conditions – and are therefore a more accurate long-term reflection of the person’s cognitive abilities.  Working memory and processing skills tend to be more variable.  So for example, if you’re exhausted or have 101 degree fever, you probably won’t have a problem defining the word “generate,” but you might very well have difficulty repeating a series of five or more numbers.

The significance of this for diagnosis and treatment is that both working memory and processing speed can be improved – often much more easily than verbal or visual spatial skills.  If the testing shows problems with memory and processing speed, I will include suggestions in the final “Recommendations” section of the report to improve them.  

Sometimes I’ll give specific techniques for improving memory, and often I’ll provide suggestions for developing mindfulness, which research has shown improves both working memory and processing speed. I may also provide behavioral tips for getting more exercise and eating healthier food, which are among the best things one can do to improve one’s brain functioning.

 

The Beery-Buktenica Visual-Motor Integration Test (“Berry VMI” for short)

The Beery VMI assesses visual motor skills, which affect both schoolwork (writing, math, and other subjects) and many aspects of daily activity.  Visual motor deficits also appear in a number of mental illnesses.  This test provides insight into cognitive, adaptive, and psychological functioning.  As with all other tests, it’s only one small piece of a larger picture, and only becomes meaningful in relationship to all the other test results.

The WRAT-IV – Cognitive Skills Development

We at Grandis Evaluation Center do not provide diagnoses for specific learning disabilities, but make recommendations regarding further exploration when a learning disability is suspected.  One indication of a possible learning disability is an unusual difference between the IQ and achievement scores. If you have a particular concern about your child regarding schoolwork, I’ll usually include a recommendation tailored to his needs, taking into account not only the test scores but his interests and unique strengths.

Adaptive Functioning: The “Vineland” Test of Communication, Daily Living Skills and Socialization

A very important part of testing is the assessment of the individual’s capacity to “adapt” to their environment.  This includes three major areas:

·      Communication: the ability to understand others as well as to express oneself in writing and in speech.

·      Daily Living Skills: personal care, attending to household chores, and interacting with people, businesses, workplaces and schools in the community.

·      Socialization: interpersonal relationships, how one uses one’s leisure time, and the ability to cope with challenging interpersonal situations. 

I generally look at test results to identify areas that need improvement, and offer recommendations in the closing section of the report.  If it’s relevant, I may talk about how a particular area of adaptive functioning may be affected by the person’s diagnosis. 

I also often recommend retesting after a period of successful therapy, to see if any or all areas of adaptive functioning have improved as a result of treatment.

 Specific Diagnostic Tests: Bipolar Disorder, Depression, Anxiety, Autism, Post-traumatic Stress Disorder

A diagnosis is rarely if ever based on one single test.  We have to take into account the person’s  background as well as the results from the entire body of tests, including cognitive testing, adaptive functioning and personality testing.  A positive test for bipolar disorder doesn’t, by itself, mean that it’s the correct diagnosis.  Similarly, a negative test for PTSD doesn’t, by itself, mean that it is not the correct diagnosis.

General Diagnostic Tests and Personality Testing: Conners and the Personality Assessment Inventory (“PAI”)

General diagnostic tests like the Conners and the PAI cover a very wide range of diagnoses. The Conners is primarily a diagnostic tool, though it also identifies a wide range of specific behavioral concerns as well (related to academics, social interaction, and more).  The PAI provides diagnoses along with the features of an individual’s personality.   The PAI also provides insight into how an individual is likely to engage in therapy – both their potential strengths and the kind of resistance they’re likely to have to treatment.

Projective Tests: The Rorschach Ink Blot Test and Figure Drawings

A “projective” test is based on the neuroscientific fact that we don’t simply perceive the world “as it is.”  Our brain filters every single moment of our experience through a complex set of “stories” (made up of past experience, assumptions, beliefs, etc) that lead us to interpret people and events in our own unique way. 

Here’s a simple way to understand how much we interpret things in our own way. Say there’s a very nice guy named Sam at work or in school.  He’s always very kind and considerate.  And then one day, out of the blue, for no apparent reason, he just punches Joe.  One person sees what Sam did and thinks, “Joe must have done something really awful to make Sam that angry.  I’m mad at Joe.”  Another sees the same punch and thinks, “Sam has a lot of nerve – he’s not the nice guy I thought he was.  I’m never talking to him again.”   And still another person sees the punch and thinks, “This isn’t like Sam.  Something must be happening in his life to make him act that way.”

All three people bring a lifetime of experience, views, perceptions, interpretations and assumptions to what they saw.

Well, projective tests are a great way to find out someone’s unique way of seeing things.  It’s especially helpful for diagnoses, since depressed people and anxious people, for example, will see the world in very different ways.

If you’re the family member of someone who is being tested, and you’ve been confused about why they act, think, or speak in a certain way, keeping in mind that each person sees things from a unique perspective, can help you make sense of why they do what they do and can actually help that person get better.  The more you can let them know you understand how they think and feel about things, the more they’ll feel understood and the easier it will be for them to connect to you (and – parents will love this – the more likely your children will be willing to do things you want them to do!).

Conclusion and Explanation of Diagnoses

The “Conclusions” section provides a brief summary of the person’s cognitive and adaptive testing, followed by an explanation of the diagnoses.  The diagnostic explanation takes into account the following:

·      Background information, as included in all available records along with all information provided by the patient, family members, and therapists

·      Results of IQ, visual-motor and academic achievement tests (all mental health conditions, including “mood disorders,” are affected by cognitive functioning)

·      Results of adaptive functioning tests, which show specific adaptive concerns related to the diagnoses

·      Results of general diagnostic testing as well as projective tests

The diagnoses are then listed, in order of importance.

Recommendations

Diagnosis and Treatment

The recommendations section begins by addressing the diagnoses directly, and the specific treatments that are likely to help.  If you are the patient, family member, or friend reading this, be sure to ask your therapist or doctor about the diagnosis.  The more you know, the easier it makes their job, so they will be glad to help you understand. But their time is limited, so keep in mind you can find out a lot on your own.

Since there is so much misinformation on the web, ask your doctor or therapist for some recommendations for reading about your specific diagnosis.   If you want some place to start, “New Harbinger” publications (www.newharbinger.com) has been publishing excellent self-help books for many years. 

New Harbinger provides easy-to-understand explanations of a wide variety of mental health issues.  Also, they have excellent, easy-to-use workbooks, many of which deal with specific conditions including depression, bipolar disorder, eating disorders, ADHD, anger management, anxiety, addictions, autism, personality disorders, PTSD and a number of other concerns.

New Harbinger also publishes excellent general therapy books teaching relaxation and stress management skills, assertiveness training, parenting skills, basic cognitive therapy skills, weight loss solutions, physical pain reduction (everything from migraines to fibromyalgia), mindfulness, relationship skills and more. 

Perhaps most important, the folks at New Harbinger have been careful to choose books based on the best available scientific evidence.

Finding Support

What do you think is the most important thing for treating mental health problems?  If you’re like many people, you may believe that medications are the foundation of treatment. In fact, mental health research has consistently shown, for more than 40 years, that the single most important factor in treatment is the level of support people have.  In my recommendations, I always try to identify people who can provide support for the patient, and if possible, additional resources in the community to provide support for them.

Making Use of Interests and Personal Strengths

The relatively new field of “positive psychology” has identified an extremely important factor in treatment that most human societies have known for thousands of years.  Each of us has our unique interests and personal strengths that give our lives a sense of purpose and meaning.  One of my main goals in writing the initial, “General Background” section of the evaluation is to identify what those interests and strengths are.

A person’s interests – whether they’re reading, drawing, music, sports, fishing, hiking, crafts, fashion, even video games! – can provide a crucial element in treatment.  I try to make specific suggestions about how someone’s unique interests can be used in treatment.

Creating a Solid Foundation of Physical Health

Though I’m not certified as a nutritionist or physical trainer, as a psychologist I have a good understanding of behavior, and will sometimes offer specific advice for improving diet, exercise and sleep habits.  There is rapidly increasing research showing the value of these things in the treatment of mental health concerns.

Ending on a Positive Note

Very often, when people are confused and experiencing a lot of stress about a mental health issue, all of their focus is on “what’s wrong with me.”   I like to offset this, when possible, by ending the evaluation with an emphasis on the individual’s strengths and best qualities. 

To support this emphasis, I’ve created a handout on training the brain, which is applicable to virtually all forms of psychotherapy, and which can be used by anybody, whether or not they have a specific mental health concern.

If you have any questions about anything I’ve written here or in my evaluation, please don’t hesitate to contact me at Grandis Evaluation Center - 828 299 7541