Grand Rounds: What is a “Psych Eval?” – and why would I want one? Part 1

By Michael Abruzzese, Ph.D.
© Copyright 2021 Vista Health Services, Inc.

Part 1 of 2

Posted 2/03/21

“You know what, Sheriff? Your problem is, you think you got ‘Flipper’ in here. Well, m***********, say hello to ‘Jaws’. – Jack Justice, “American Justice”

The above quote from a movie explains exactly why Psychological Assessments (also called a “Psych Evals”) are so important. In the above case, a corrupt, small town sheriff thinks he has a helpless, out-of-town loser to pin a murder on; in reality, he has jailed one very skilled and very angry former ‘Black Ops’ soldier who was trying to retire quietly.

Oops; his bad.

And, as it turned out: Real bad. A psychological assessment could have clarified to the sheriff just who he was dealing with – and in this movie example, saved lives. Of course, the needless use of a curse word could have been a tip-off. But psychological assessments can help law enforcement save lives in the real world, also. They also can help improve a student’s academic performance, help a physician adjust medication dosage, determine the need for supervision or promotion in a corporation, reveal who should or shouldn’t have a gun permit and who can be safely inducted into the military. And there are many other uses for psychological assessments, also.

Psychological assessments are used to help explain behavior. Often, such assessments are the only means of understanding and explaining behavior.

My view is that it is better to take a Lifespan Developmental focus on the functioning of children, adolescents, adults and seniors, which means that we recognize that functioning over one’s lifespan is truly developmental in nature and grows over time, building on previous experiences and biopsychosocial functioning. Not every licensed psychologist takes this view however, and licensed clinical psychologists are the only ones who are trained and licensed to perform psychological and neuropsychological assessments: Psychiatrists are not, nor are any other licensed physicians, such as neurologists or internists.

And psychologists have many, MANY tests from which to choose. In this post, I offer a brief description of the types of tests that are available and explain some of their uses. Remember this when you are in a situation where one a psychological assessment may be helpful for you or a family member. I list the common types of Psychological Evaluations – commonly shortened to just ‘Psych Evals” – that are available.

General Psychological Assessments

There are many types of assessments, each one focused on the different requirements of an individual, group and circumstance, but every such assessment is a variation of a psychological assessment. Psychological assessments tend to be understood as falling into two broad categories – Cognitive assessments and Behavioral assessments.

Cognitive evaluations are psychological assessments that tend to focus more on how an individual’s brain functions (that’s the ‘cognitive’ or ‘thinking’ part) interacts with that person’s behavior. Cognitive testing is often also called a Neuropsychological Assessment, but there are different types of Neuropsychological Assessments, too. Cognitive testing is a particular type of Neuropsychological testing that is often called for when there are concerns about someone’s memory, ability to reason rationally or understand others, such as a brief screening for competency, Alzheimer’s Disease or dementia, or to differentiate between dementia and depression.

Behavioral evaluations are psychological assessments that tend to focus more on how an individual is interacting with his or her environment and how they are functioning in the real world. The emphasis here is on the emotions, attitudes, habits and other “behaviors” that everyone exhibits. In truth, every good psychological assessment focuses on both behavior and cognition to some extent because we are all thinking, feeling and experiential human beings. How we think, feel and experience is what comprises our psychological makeup. That is, we are all psychological beings and we interact with the world psychologically, not just physically.

What follows is a brief summary of only some of the types of specialized assessments available. In part 2 of this post, I list examples of how different assessments may be beneficial in everyday life.

Categories of Psychological Assessments

Before any psychological treatment or remediation can begin, it’s important to understand the nature of the problem or difficulty. A psychological assessment is the necessary first step in determining the strengths and weaknesses in an individual’s functioning when that functioning has been called into question, either by displaying actions that are unexpected or by not displaying actions that are expected, in a given circumstance or environment. Psychological assessments can be brief versions or more extended versions. The decision is made by the psychologist doing the assessment and is based on the referral inquiry. That is, what is the specific purpose of the evaluation?

Many times, I have received referrals from physicians, lawyers, social service agencies and Courts for “a basic psych eval.” There is no such thing. When I explain this to the person making the referral, they tend to get very upset with me and argue. When I ask what the purpose of the evaluation is, they often fumble around for an answer to my question simply because they have no idea of the variety and specificity of psychological evaluations that can be done. Sometimes, agency personnel are just trying to avoid doing their jobs and “dumping” a client for “a psych eval” without even knowing what the presenting problem is. That’s a big mistake, even if it is understandable, because there is so much misinformation and mythology out there about psychology and psychological assessments. I hope to change that with this post.

Individual Psychological Assessments

Psychological assessments involve the observation, measurement and evaluation of an individual’s or organization’s adaptive functioning in the modern world. Assessments are used to assess the developmental, behavioral, academic, psychological, neuropsychological and personality functioning of infants, children, adolescents and adults in a wide variety of circumstances ranging from career counseling to marriage compatibility, school performance to job performance, normative to criminal behavior, and competence in someone’s aged parent to a need for a conservator or guardianship of that person. What is a guardianship? Think: Brittney Spears. Was there ever a Psych Eval done? I have no idea.

There are literally thousands of psychological assessments available and all such assessments must be done by experienced, licensed and credentialed professionals to ensure that such assessments are not accidentally or deliberately misused to provide false or misleading information.?? Skilled, experienced psychologists are trained to focus on the appropriate psychological assessment of infants, toddlers, children, adolescents, adults and seniors by taking into account the referral question and the type of assessment tools available.

Group and Organizational Assessments

Psychological assessments may be conducted on the functioning of an individual, family or group. Examples of group assessments include assessments of public organizations such as schools, government agencies, non-profits and nursing homes as well as small-medium sized family-owned private businesses and typically focus on how to make the group or organization function better to meet its goals in dealing with customers, students, employees, vendors and contractors.

Forensic Assessments

Sometimes, the question of a person’s psychological functioning becomes a matter that involves the legal system, including the Probate, District or Superior Courts. Psychological Assessments done for use in the Courts are commonly referred to as Forensic Assessments. Such issues may involve competency, drug or alcohol abuse, divorce, juvenile matters, CHINS, allegations of child or elder abuse, domestic violence, being arrested or other issues. Few defense lawyers utilize forensic assessments, but I think they should be a part of every civil, criminal and domestic legal matter to present a clearer picture to all parties about the underlying psychological functioning of the involved individuals.

Behavioral & Health Assessments

Common uses of such assessments include “health” behaviors such as smoking, obesity, eating disorders and other maladaptive behaviors which compromise an individual’s health. In general, we are able to assist physicians and staff with evaluation and management of patients with dementia, sleep disorders, ADD, anxiety, panic, depression and the like. We are also able to offer cognitive and psychological tests and a host of other measurements and procedures for use in medical and forensic evaluation and management of patients and clients in a private practice atmosphere.

Psychological assessments are beneficial in the diagnosis and treatment of children, including very young children, who have serious medical issues, such as bed-wetting or encopresis, failure to thrive, diabetes, obesity and general non-compliance issues with following the treatment advice from their Primary Care Providers (PCPs). There is also a benefit to assess and treat adolescents, including those with Eating Disorders, cutting disorders and other self-injurious behaviors (SIB), and, of course, assessments used in the treatment of adults and senior family members, whether living at home with their families or in assisted or skilled-care facilities or rehab setting and who may have emotional or cognitive declines or competency or self-care issues.

This concludes part one of the two part posting on Psychological Assessments. More to follow…..

Michael Abruzzese, Ph.D. is a clinical psychologist on Cape Cod and a former Clinical Instructor at Harvard Medical School. He is the author of Ten Lessons in Power Psychology; Psychology Tips and Techniques For People Who Would Never Visit a Psychologist’s Office.

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