Grand Rounds: Why Would I Want A “Psych Eval?” Part 2 of 2
By Michael Abruzzese, Ph.D.
©Copyright 2021 Vista Health Services Inc.
Posted February 26, 2021
“Do not use the truth to injure” – St Augustine.
In my last post explaining the uses of Psychological Assessments, I noted how Psychological Assessments are used to explain behavior. Unstated, but contained in that statement, is the understanding that Psych Assessments are used to get to the truth of one’s behavioral functioning. That’s the “explain” part.
Just as important, however, is the “meaningfulness” part. That is, now that we have the results of the assessment, what do they really mean and how is that meaning demonstrated in the context of the individual’s life and activities? Just because we have a “test” result, that doesn’t mean we have the entire picture. What is necessary, in addition to the test results, is the meaningful interpretation of the results by a qualified licensed clinical psychologist.
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.
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. In any case, however, it is the obligation of the licensed psychologist who administered the test(s) to provide a meaningful interpretation of what the results mean.
You wouldn’t expect a cardiologist to omit an explanation of a stress test or blood test, would you? The same applies to psychologists. Consumers ought not be left to just rely upon the results of a written report about the results of a psychological assessment; there ought to be a meeting with the psychologist to review the report, explain the results in a meaningful way to the individual who was tested – or their parents or guardians – and answer any questions that may come up. The point of getting a psychological assessment is to explain behavior, not excuse behavior or weapon-ize behavior or criminalize behavior or minimize behavior. It is simply to explain behavior.
Too often, in my experience as a consultant, Psych Evals have been used as a hunting ground to “cherry pick” findings out-of-context to support a narrow viewpoint preferred by a school, organization, or even opposing legal counsel, rather than shed light on the whole psychological functioning of an individual. Psychological Assessments are used to explain behavior, not place blame or takes sides. Psychologists advocate for their findings and opinions only, not one party or another.
I repeat: Psychological assessments are used to help explain behavior. Often, such assessments are the only means of understanding and explaining behavior. Explanations are important. Psychological, neuropsychological and personality assessments can be used in a multiplicity of ways and can be loosely grouped in the following areas:Psychological assessments are multi-dimensional and are useful in a wide variety of personal, academic and institutional or organizational needs. And psychologists have many, MANY tests from which to choose, as I noted in my last post. In this post, I offer a brief description of the even more 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.
Academic and School Applications Play is the work of childhood. School is the workplace of childhood and young adulthood. How children make the transition from play to workplace is a vital part of socialization and maturity in the modern world. And it’s no doubt true that many youngsters never accommodate or assimilate very well to the needs of growing up and effectively functioning in an adult world without professional help. When teachers or parents or physicians suspect such a problem, it is appropriate to refer for a psychological evaluation to make sure no problem or difficulty exists in an area of functioning that prevents us from succeeding.
The results of a psychological evaluation in any of these or other areas could result in the legal requirement that a school needing to develop perhaps an Individualized Education Plan (IEP) to remediate academic problems for a particular child, or perhaps offer a different plan of remedial action under the law known as a Section 504 Plan to help a child or adolescent learn better.
Evaluations of common problem areas include:
Shyness and social skills delays or disability.
Learning Disabilities and Non-Verbal Learning Disabilities.
Independent Evaluations for Federal 504 plans and State Special Education laws.
Second Opinions about parent-school conflicts or behavior issues.
Independent Assessment of Developmental Disabilities, birth defects, Autism, Asperger’s Syndrome (now part of the Autistic Spectrum)
General academic, psychological and neuropsychological exams.
Second Opinions regarding a child’s 504 plan or Individualized Education Plan (IEP)
Functional Behavioral Assessments (FBAs).
Clinical and Professional Applications
Not every psychotherapist or psychologist does psychological assessments. It takes specialized training to do so. In general, every treatment plan should be based on an evaluation of the psychological functioning on the individual BEFORE treatment begins and should include follow-up evaluations should the condition worsen or change to be sure the treatment is on the right track. If your therapist doesn’t do psychological assessments, it is easy enough to refer out to another licensed professional who does provide them.
After the assessment is done, the results are explained and presented to the therapist, who then proceeds to do the recommended therapy. In addition to health assessments for medical personnel, psychological assessments can also be done to address a wide range of psychotherapeutic issues.
Below are some examples.
Development and attachment issues in very young children.
Memory, attention and cognitive functions in adults and seniors.
Assessment of personality.
Assessment of functional behavioral disorders.
Memory impairment due to anxiety, trauma or other issues.
Treatment Plan Reviews and Second Opinions.
Workplaces and Organizational Applications
These types of psychological evaluations are evaluations of groups. 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. Such evaluations typically focus on how to make the group or organization function better to meet its goals in dealing with its own employees, customers, students, vendors and contractors.
Sometimes, business and group functions are interrupted due to maladaptive behavior either within the group or work setting by members of the group itself, including management, or by events outside the group that impact the group or workplace functioning. Sometimes, such maladaptive behavior or functioning is grounds for legal action.
Some examples of such events include evaluations of:
Hostile workplace environment.
Residual workplace trauma due to catastrophe, workplace violence or natural disaster.
After The Assessment, What Come Next?
Clinical therapeutic services that help individuals overcome obstacles, exceed expectations, change or enhance behavior, remediate learning or behavior problems and develop new habits – that’s what comes next. Well, it should, anyway!
Behavioral Health Care clinical services help provide restoration of function, remediation of problems and improve the quality of life in a sometimes difficult world. There are a huge variety of clinical psychological services available from different providers.
Some therapists focus on specialized primary behavioral care services, which include behavioral medicine applications, cognitive-behavioral therapy, psychotherapy and play therapy for children and others focus on “talk” therapy that is seen in the movies and on TV shows, and specialized treatments to help restore functioning and improve the quality of someone’s life.
Adults need not involve other family members in their treatments, of course. But when treating adults, it is important to examine the impact of all interactions on the adult’s functioning, including the stresses and benefits of job, family, friendships, spirituality or religion, and hobbies. Treatments that emphasize short-term, outcome-oriented designs to improve, remediate and restore functioning are usually accepted more easily by adults who are un-accustomed “to asking for help.”
Research regarding Behavioral Medicine indicates that many major health problems, including heart conditions, diabetes, high blood pressure, chronic pain, migraine headaches, and other problems are responsive to behavioral as well as medical intervention.
In fact, it has been estimated that as much as 60-70% of visits to medical offices are for behavioral health concerns rather than medical issues. Treatable conditions include habit disorders, stress-related disorders, coping with medical illness and recovery, work-related behavior problems, trauma recovery, anxiety, panic and other problems.
Psychological assessments are used to help explain behavior. Often, such assessments are the only means of understanding and explaining behavior. And that can mean the difference between receiving effective medical treatment and developing a happier life. Or not.
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. https://www.amazon.com/Lessons-Power-Psychology-Techniques-Pscychologists/dp/0991011708