Framework for Psychological Evaluations

Here is the framework I use when making recommendations. I hope it will be helpful to you in making use of the recommendations I provide, and help you to come up with ideas of your own.

What is well-being?

The latest neuroscientific and psychological research defines “well-being” as a state of integration in which the different parts of our brain and nervous system are all working together harmoniously.   Since our brain has a natural inclination toward integration, the best treatments are those that either support this natural process, or remove what may be interfering with it.

Ok, that may sound a bit complicated. So what does it feel like when our brain and nervous system are working together in harmony?  If you’ve ever experienced even a brief moment of “being in the flow” or “being in the zone” – moments in which  everything feels connected, effortless and joyful - that’s  what harmonious brain functioning feels like.  It can happen anywhere, anytime – tending a garden, throwing a ball, playing music, watching a beautiful sunset, or in a special moment of connection with someone you care about.

The Rings of Awareness – A Metaphor For Brain Integration

 Imagine two rings, one inside the other.  In the outer ringis everything we see, hear and touch - all the people, places and things in the “outer world” that we’re aware of.  In the inner ringare the thoughts, feelings, hopes and desires that make up what we call our “mind.”  The inner and outer rings together contain everything we’re aware OF. 

At the very center of the rings is the quiet, calm experience of simply being aware– an experience sometimes referred to as getting back to that “still quiet place” within.  No matter what stuff is going on in the world around you – in the outer ring– and no matter how dramatic or stressful the stuff going on inside your mind – in the inner ring – the center of awareness is always calm. The experience of the center is characterized by a sense of spaciousness, tranquility, and connection to ourselves and others. 

Our attention is almost always captured by the “stuff” of the inner and outer rings, causing us to lose our connection with the still quiet place within.  Ultimately, everything that contributes to our experience of happiness and well-being works, in some way or other, to free our attention so we can get back to that still quiet place at the center of it all. The more we are connected to that, the more the brain’s natural tendency toward greater integration can take effect. 

The brain has a natural tendency to coordinate and harmonize our thoughts, feelings and actions, as long as we let it do its job. And the best way to do this? Remember, over and over, to shift our attention from what we’re aware OF to that center of quiet, calm awareness.  Making this shift has been shown to lead to reductions in virtually all symptoms, from depression, anxiety and PTSD to bipolar disorder and even schizophrenia.  It improves relationships, school achievement, and success at work, and leads to feelings of deep contentment and happiness in every area of our lives. 

The PFC  - 

The Key To Integration of our Instinctive, Emotional and Mental Brain Programming

Human beings, among all living creatures, have a unique part of their brain, the pre-frontal cortex (or “PFC” for short) which enables us to make this shift.  The PFC is kind of like the captain of our mind-body ship, the coach of the mind-body team, the CEO.  The main activity of the PFC – what psychologists call “executive functions”  - involves decision-making, planning, and focusing attention, all contributing to the job of guiding our thoughts, speech and actions.  

Perhaps the main reason the practice of mindfulness has become a basic practice in almost all of contemporary therapy is that training attention (which is basically what mindfulness is) is among the most powerful ways to train the PFC.

But why is it so hard to make use of the PFC? Over a billion years of evolution has created brain programming which is very complex and very good at overriding the best intentions of the PFC. Here’s some simple terms I’ve made up to help you understand your brain programming:   

·      The instinctive programming is the most ancient, dealing with our basic needs for survival, utilizing pleasure and pain mainly as a means of identifying what helps or hinders survival, and our capacity to master our environment.

o  When our survival needs are not met, we are far more prone to anxiety and anger, we desperately seek out for possessions and/or people who can make us feel safe and secure.  We may become obsessed with satisfying our desires and avoiding pain, and we either seek domination (rather than healthy mastery of the environment) or passively accept being dominated by others.  It becomes extremely difficult to control our attention, and we are far more subject to being overwhelmed by even minor everyday stress.  As a result, we may also develop all kinds of unhealthy habits related to food and various addictions.

·      The emotional programmingemerged most powerfully with mammals, and represents a shift from competition as the main means of survival to cooperation and collaboration.  Its strongest characteristic is the capacity to form strong emotional bonds with others.  

o  When our needs for emotional bonding are not met, we become depressed; we may avoid interactions altogether, or become overly dependent on others.  This can have a negative impact on virtually every area of our lives.

·      The mental programmingextends way back in evolution, and can be seen in its initial forms even in one-celled organisms. However, as the capacity to form highly complex ‘stories” about other organisms, and most important, to direct one’s own behavior and to choose to refrain from mechanically following the instinctive and emotional programming, it emerges most powerfully in human beings.

o  Almost everyone, to some degree, has distortions in the “stories” they have about themselves, others and the world in general.  Research on cognitive behavioral therapy (and really, all therapies to some extent) has shown that the simple act of becoming aware of and developing more accurate “stories” is enough, in many cases, to dramatically improve and even cure a wide range of psychological issues (and even some physical ones as well, including insomnia, Type 2 diabetes and many kinds of physical pain).

In addition to the various programmings that come together to make up our unique personality, there’s something extra - what I call “the little me” – this little thing that nags and harasses us every moment of our waking lives, always trying to get its needs met, in whatever way it can.

To deal with this, we can learn to use our PFC to help us step back from both the inner and outer rings, let go of our preoccupation with the “little me,” and rest in the center of awareness.  From there, we can help to organize the various activities of thought, emotion, etc on the inner and outer rings.  As our outer personality becomes less chaotic and presents less of an obstacle, we will get more and more glimpses of that calm, quiet, joyful awareness at the center.  

Ideally, therapy, medication, supportive family and friends– even our homes, neighborhoods, towns and cities – can be set up in a way to assist this process of harmonizing our brain programming, and reminding us again and again to return to that innermost center of calm, quiet, joyful awareness.   

Treatments:

“Natural” Treatment Interventions

What then is the most effective way to help connect to the quiet place within that is our natural, innate source of greater happiness and well-being?   

Though they have an important role to play, it turns out that therapy and medications are not the most effective methods.  Over 20 years of research in “positive psychology,” tells us that the greatest factors for increasing happiness and well-being are having an environment where people care about and support each other, and having work or interests that inspire us.  

Some of the most powerful interventions we can make as therapists - and parents – are based on a recognition of the interests a patient already has interests that take them out of themselves and give them a sense of connection to something or someone beyond their own needs, problems, and desires. That sense of connection to purpose and people outside ourselves, is a natural and effective way to connect to the quiet place within.  Finding ways to support and encourage those interests can make a powerful difference in the person’s life. 

“Active” Treatment Interventions – Where do therapy and medication fit in this picture?

Medication

Ultimately, what interferes with the brain’s natural capacity for integration, is the fact that our attention gets caught up in the stuff we’re aware of – whether it’s the “inner” stuff of thoughts and emotions or the “outer” stuff of people, places, things, and events.  

In cases where the person’s brain is in so much conflict – that is, when their attention is so trapped in the ”stuff” of the outer circle that they lose access to the center, medication can be a useful tool.  It can help to calm the intensity of the moods and thoughts that keep our attention fixated on the outer circles – and make it easier to get a taste of the quiet integrating power at the center.   

Therapy

Although there are more than 100 different forms of therapy, recent research suggests that – to the extent they are successful – they’re all really doing one thing.  They are helping to train our attention to let go of its tight grip on the stuff of the outer circles and shift it to the still quiet place within.  In brain language, attention training is a way of strengthening our prefrontal cortex (“PFC for short).  The pre-frontal cortex is what gives us the ability to reflect on our thoughts, feelings, and behaviors, evaluate their usefulness to our well-being, make new choices that will have a more constructive result – and ultimately, redirect attention back to that innermost place of quiet, calm awareness, the experience of “simply being.”

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Putting It All Together

So when I am working on the main section of the report andwhen I’m putting together recommendations, I’m keeping the following in mind:

·       What is the best way to foster a supportive environment for this patient, one which will give him or her a strong sense of connection to others and a sense of being part of something greater than him or herself?

·       What are the patient’s interests that are most likely to develop the ability to self-regulate, to be empathic and caring toward others, to make wise decisions, to be strong and calm in the face of adversity?

·       What specific therapeutic interventions might be most helpful?

o   I may recommend specific, well-known, “evidence-based” therapies. However, I may also advocate specific interventions that, based on test results and diagnoses, are likely to help them “shift” their attention from “the stuff” of the “inner and outer circles’ to the “still, quiet place within” (which, after all, is the fundamental core of all therapy and counseling; in fact, of all psychological development).

·       How much medication will the patient need if they are not able to make use of the above ways for developing greater well-being?

Perhaps most important of all – once we have had a glimpse of that state of calm, peaceful awareness that comes from shifting to the still, quiet place within – we can train our brains to remember, over and over, to pause, let go of our concerns about the future and past, momentarily set aside our agendas and plans and todo lists (and phones!), and return to that innermost center of awareness.  As we remember to do this more and more frequently, this can

give rise todeep feelings of love, peace, kindness, and connection and a feeling of being at home in the universe – perhaps for the first time.

Memory Training

(Note - this is an excellent summary of memory games from a March 24, 2016 New York Times article. Please keep in mind that, despite what the author says, many researchers are now saying the memory training helps memory in all areas of life)

An Ancient and Proven Way to Improve Memorization:

              Go Ahead and Try It

Austin Frakt 

MARCH 24, 2016

In January, I devoted every walk from my home to the train to the contemplation of work details, hoping to improve my recall of them. That was my New Year’s resolution, and so far I’ve stuck to it.

In every one of those walks I was also retracing a memorization technique known to the ancients and shown by modern science to be highly effective.

The “Rhetorica ad Herennium,” written in the 80s B.C. by an unknown author, is the first known text on the art of memorization. (It’s also the oldest surviving Latin book on rhetoric.) It teaches the “method of loci,” also known as the “memory palace.” As its names suggest, the approach involves associating the ideas or objects to be memorized with memorable scenes imagined to be at well-known locations (“loci”), like one’s house (“palace”) or along a familiar walking route.

You can test the method for yourself. If you’re like most people, you would not easily commit to long-term memory a 10-item shopping list. But I bet you could remember it — and for more than a few minutes — if you first visualized it along a walk through your house: The entryway of your house is festooned with toilet paper; your kitchen sink is full of lobsters, dancing; a bathtub-size stick of butter melts on your dining room table; your family is singing karaoke in a swimming pool of hummus in your living room; your hallway is so full of grapes you cannot avoid crushing them with each step; your stairway has a runner of lasagna noodles slippery with tomato sauce; a mooing cow is being milked in your bedroom; stalks of corn grow down from the ceiling in the spare bedroom; a crop of multicolored mushrooms blooms in your shower.

Take a few moments to burn these images and locations into your mind (adding motion, sounds, smells and tactile sense to your imagined scenes helps). We’ll test your memory with an imaginary trip to the grocery store at the end of this article. [Note - you're much more likely to pass the "memory test" at the end of the article if you take enough time with each image in the previous paragraph to visualize it as vividly as you can]

Joshua Foer wrote a book about how he trained to win the United States Memory Championship. He points out that we’re so good at forming mental maps and recalling images that we hardly notice it. Recall the last party you attended at a home you had not previously visited. 


Though you probably only walked through the house a few times, you can probably remember most or all of its layout and location of major furniture. Anything else distinctive you saw — like unusual or appealing pieces of art, vivid wall colors — and the faces of people you met are probably also easy to recall. Effortlessly, you retained hundreds or thousands of visual memories and spatial details.

Research backs this up. After people viewed thousands of images for a few seconds each, studies found that, on average, they could correctly distinguish over 80 percent of them from images they had not seen. This remained true even when the comparison images were of the same object in a slightly different position (like the same cabinet open versus closed or the same telephone at a different angle). Another study found people could usually recall objects they’d seen even after seeing hundreds of intervening ones, demonstrating that visual memories of objects are stored long-term.

It makes sense, then, that numerous studies, extending back decades, show that the method of loci improves memory. Using the approach, people who could remember only a handful of numbers — seven is the norm, give or take a few — were trained to recall 80 to 90.

Another study found that the method doubled the proportion of people who could remember at least 11 of 12 grocery list items. Students who applied it in an undergraduate economics course outperformed those who did noton an exam. Medical students who used the method of loci to study the endocrine system learned more than those who did not.

Patients who have had treatments known to impair recall and cognitive function — like coronary bypass surgery and surgery and chemotherapy for breast cancer — improved their memories with the method of loci. As a memory aid, it’s superior to rote memorization and converting items to images alone. Placing those images in a memory palace helps recall.

Before books were common, the method of loci helped lawyers and others retain and recall information necessary for their jobs. The locution “in the first place” is a holdover from this ancient method of memorizing speeches. It works because it harnesses humans’ evolved skill at remembering details of locations, which helped hunter-gatherers recall what was edible and where to find it, and what was poisonous and how to avoid it.

It does not take an extraordinary mind to develop an extraordinary memory. Competitors in memory championships or those seen on Fox’s “Superhuman” — memory athletes — weren’t born with photographic memories. They have practiced for years using the method of loci, supercharged with other mnemonic methods. With them, some can memorize hundreds of random numbers in a few minutes or the order of cards in a deck in tens of seconds. But, as Mr. Foer learned, memory athletes’ memories excel only in areas they’ve trained — they still misplace their keys like the rest of us.

Indeed, science shows that these are normal minds after extraordinary training — the same hardware running different software. Brain anatomy of memory athletes and those without exceptional memories are the same. Because they have trained specifically to recall numbers and faces, memory athletes outperform others in doing so. But recall of magnified images of snow crystals — for which memory athletes have not trained — is identical. After observing a game for five or 10 seconds, master chess players can recall the positions of nearly all the pieces. A novice can recall only a few. The difference is training, not exceptional memory. Shown a random configuration of pieces that could not arise in a game, chess masters are no better than novices at piece position recall.

My commute has become my memory palace, not for groceries, but for aspects of my work. Features of certain landmarks — specific houses and parks I pass — have become loci for them, converted to images and scenes of my own invention. I figuratively walk through my work as I literally walk to it. For example, I associated an analysis of the time patients wait for care with cars waiting at an intersection I cross.


We think memorizing is laborious, boring work because we’ve been taught to do it by rote. You may recall, as I do, countless hours in third grade poring over multiplication tables or, in ninth grade, endlessly conjugating French (or Spanish) verbs, or in 11th grade, incessantly reciting Macbeth’s “Tomorrow, and tomorrow, and tomorrow” soliloquy in the attempt to firmly place them in long-term memory. These brute-force approaches are dull because they’re devoid of any creativity.

In contrast, the best memorizers place the most flamboyant, bizarre, crude and lewd images and scenes (and their actions) in their memory palaces. The more distinctive, the more easily they’re recalled. This is why the Puritans recoiled from the method of loci — they knew students were relying on “impure” and idolatrous imagery — and it fell out of favor as an educational tool. Today our memories are eroded by external memory devices like cellphone cameras and apps.

Now, about that grocery list. In your mind, enter and walk back through your house. What do you see? Can you get all 10 items?

 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