Hey y’all, welcome back to another episode of The Testing Psychologist podcast. This is Dr. Jeremy Sharp. I hope all is well today wherever you are. As far as I know, we aren’t having any major snowstorms anywhere in the country right now. So that’s always a good thing.
Speaking for us here in Fort Collins, Colorado, we have had an amazing run of pre-summer springy weather, which is awesome as far as I’m concerned. I think I’ve mentioned before that I grew up in South Carolina. I’m definitely a summer person as opposed to a winter person. So this is excellent for me and also for our family.
I’ve mentioned that I have 2 little kids and having some nice weather has let us get outside and just do some really cool, fun things with the kiddos. The biggest thing is that my 3-year-old learned to ride her bike just two weeks ago. So we’ve been really getting into family bike rides and cruising around. It’s just been awesome to spend some time with them and share something that we really love to do.
Today, I am doing a solo episode. I wanted to talk with y’all about what I would think about as the vulnerability of going through the testing process. I had two things happen over the last few weeks that really got me thinking about what a vulnerable process it is for parents to go through the evaluation process or for anyone really. Again, I work primarily with kids, so I think a lot about [00:02:00] vulnerability from the parent side, but certainly applies to adults or to anyone who’s coming in for a psychological evaluation.
I just wanted to talk through some of that, some of the ways that I handle that from the clinician side and really I think just go out of my way to help parents feel comfortable and provide services that really address what they’re looking for, and try to help them go through the process with grace and ease.
So, like I said, two things really got me thinking about this. One is that our oldest kid I think is, oh, how would I describe him? A lot of people would probably describe him as a spirited child. You maybe have heard that term before. He has just been that way since he was born. I think it’s a temperament kind of thing.
And that’s brought with it some challenges and a lot of positive aspects as well, but one of the secondary factors with that is that he has actually been evaluated in two different settings over the years. And so, I’ve had some experience with this from the parent side.
The first time, it was fairly benign. It was a grad student who was just getting some practice with administering some tests and wanted to do a little bit of testing with him when he was, I think about 2, just to practice like I said. Of course, being in the field, I thought, this is great. Let’s see what’s going on.
Even with that, back then, we weren’t really concerned or anything like that, but I was very aware of how much I was wrapped up in the outcome: how he was doing, was he bright, and was he on track? Even in this practice setting, it was something that was really weighing on my mind. There was a lot wrapped up in it for [00:04:00] me as a parent and how he was doing. So that was my first experience with that.
And then later down the road, it was probably, I think when he was 4, we took him to occupational therapy for the first time. I was the one that took him to that appointment. We had been having some trouble with him just getting overwhelmed in the classroom, striking out at other kids, yelling, melting down, and stuff like that.
We took him to OT and they did an evaluation there just to gauge how he was doing. And that was really eye-opening for me. I was aware, just sitting in the waiting room, of what it’s like to be in a doctor’s office and the emotional mindset that I was in at that time- feeling a little nervous and having this dichotomy between wanting them to see what was going on and validate my experience and my wife’s experience with him, but then at the same time, not wanting anything to be “wrong.”
That is an intense process. And then, of course, going through the actual evaluation and some of the appointments with him afterward, there’s, like I said, a vulnerability associated with being in that parent position and bringing your kid in for an evaluation. So that’s the personal side.
And then from the professional side, I had something happen last week or two weeks ago where I did a feedback session with a family. This happens rarely but it does happen, being a human like everybody else, I was not on my game during this feedback session at all.
I think the night before, our 3-year-old had been up throughout the night and so I was groggy. Basically, I did not review that file as thoroughly as I should have prior to the [00:06:00] feedback session. And the parents rightfully so called me on it. They got in touch afterward and said, Hey, we felt like this was not as thorough as we thought it would be. We were really disappointed.
That hurt but it also was good motivation and really got me thinking again about just how much families invest in this process and how valuable it is to deliver good service and really take care of them. They’re putting their family and their kid and their well-being in your hands and trusting a lot to you. All these things combined got me thinking about vulnerability in the testing process.
So that’s what I’m going to be talking about a lot today. And I’m going to talk about it primarily from a procedural standpoint. So the things that I do throughout the evaluation process to help parents and adults who come in for evaluations, just help them feel comfortable, try to provide them good service, let them know that we’re here and we care and that we’re aware that it’s a vulnerable process.
I think that we’re working uphill, to be honest, when people come in for an evaluation. Unless they’ve done it before, they generally don’t have an idea of what it looks like.
We do not get a great representation in the media. I think I’ve talked about this on other podcasts just briefly, but what people see in the media for a psychological evaluation is usually not great. It’s some variation of the Rorschach, which is the Inkblots test, or maybe a discussion in a forensic setting or courtroom drama about the insanity defense or something like that.
I think it’s pretty rare that we get a positive representation in the media, and so, most families or individuals don’t really come in with a great [00:08:00] idea of what to expect. They just hear the term psychological evaluation or psychological testing or even assessment and those terms are loaded. They usually don’t have a positive connotation.
I start from the initial phone call by doing my best to help families and individuals feel at ease. And what I do to help with that is, in the end, initial phone call, I give a really clear description of the evaluation process. Usually, they call with some variation of hey, my doctor so and so said that I should call for an evaluation, with that implied question mark at the end. And then it’s just an open conversation like where do I go from here? I don’t know what to do. I don’t know what this is about.
So I just immediately jump in, say something really affirming like, thank you for calling. It takes a lot to make that step. Let me talk you through the evaluation process and what you can expect. I’ll also get some information from you about what’s going on and why you might be coming our direction. Let’s get started. Do you have a few minutes to have a 10 or 15-minute phone conversation?
So I prep them and just let them know we’re going to be spending a fair amount of time on the phone here initially to talk through your concerns and make sure that this is going to be a good fit.
If they say that that’s all right, then I will dive in and say, tell me a little bit about what brought you here, just to make sure that an evaluation is appropriate for your concerns. And, of course, listen to that, validate that. At some point, of course, if it is an appropriate concern, I will say something like, that’s great. That’s exactly what we specialize in. I definitely think that there’s room that we can help you out and we can shed some light on some of these concerns for you. I’m glad you called.
Throwing in [00:10:00] those little small affirmations throughout that initial phone call can be super helpful.
I do give a really clear description of the evaluation process. I’m not going to dive totally into that here in this episode, but suffice it to say that I have typed out a clear description of our evaluation process and have developed almost a script for that too where I can talk with parents, or at this point, our admin assistant can talk with parents or individuals on the phone and just tell them exactly what to expect.
We even break it down into here’s how much time we spend with the initial interview. This number of days after that, we’ll schedule your testing day. And then this number of days, we’ll do a feedback session. Here’s how long that is. Then you can expect to get the report this many days after that. So we’re prepping them right from the very beginning about what they can expect with the evaluation process.
Now, after they go through that initial phone call and schedule, the next step in our process is the initial interview. So again, just thinking from the very beginning about that initial interview and what will help families or individuals feel at ease.
I greet them in the waiting area. I always make sure with initial interviews that I walk out, I have a smile, I’m very welcoming. I, of course, over the years have developed some amount of small talk and a bank of comments to make to them:
Did you find our office okay? How are you doing this morning? How’s the day treating you? Stuff like that. Just little things like that to communicate that I’m totally on board with them and I’m going to not make this a super clinical process, that we are able to have some conversations. We can ry to be at ease right from the beginning.
[00:12:00] And that sounds pretty basic and pretty simple, but that is something I think, as we greet clients over and over for interviews over the years, can be easy to forget. And just easy to forget that they are sitting there, especially before the initial interview, probably really nervous, and unless they’ve been through it before, really have no idea what to expect.I’ve had folks come in and think that right in the initial interview we are going to hook them up to machines and do brain scans or draw blood and stuff like that. So you never know what people might be expecting when they come in for that initial appointment. So like I said, really friendly cordial greeting in the waiting area. Definitely have some things to chat about walking back to the office.
And then, as soon as they sit down, they’ll usually ask politely, of course, kind of making conversation. How are you today? And I generally try to actually answer that question. That’s a good opportunity for me, if our kids did something a little crazy that morning or something funny happened, I’ll always try to find a way to share that in an appropriate way, not overly disclosing, of course, but something to connect with them.
So as we get started, I spend a fair amount of time at the beginning of the interview just explaining the process again; just making sure that they’re on the same page with how things will go. So I talk about how much time we have in the interview. And that’s actually another piece that I could talk about is we do spend two hours on the initial interview with people, which I think is maybe a little different than some other models, but I made that shift actually pretty early.
Doing an evaluation like this, I think with [00:14:00] most cases, it’s really hard to do a one-hour interview, or at least it was for me because, by the time I’ve talked about what’s going to happen in the interview and go over confidentiality and office policies, that’s burned 15 minutes right there. And then we take usually 10 minutes at the end of the interview to schedule the testing day and answer any questions they might have. So right off the bat, that’s almost a half-hour gone just with logistics and procedures.
I shifted to doing a two-hour interview years ago and have not looked back since. It’s very rare that I will use less than an hour and a half in that initial interview, even with the most straightforward cases.
So that in itself, I think is a client care policy that communicates that I’m totally on board with them. I’m invested. I’m going to spend the time to really learn about them or their kiddo and their family and the environment. And that just gives me plenty of time to ask all the questions that I need to.
So I’ll talk with them about how we have about two hours for the initial interview. I tell them that it’s very structured. I’m going to ask a lot of questions. I’m going to touch on certain areas and will guide us through the interview. So they don’t have to worry about freestyling or knowing exactly what to talk about. I will help with that. But I also tell them that at some point, I’ll turn it back over to them and make sure that I didn’t miss anything so that they can relax a little bit if they have really big things that they want to make sure to talk about.
As we go along, I make sure to do a good interview, but as we get toward the end of the interview, I always ask several times, what questions do they have? How can I help you? Do you have any concerns? And at the end of the [00:16:00] interview, what I do is I put together a while back a sheet that is called what to expect on testing day. I have a separate one for kids and for adults.
That what to expect sheet just gives some basic information. It says get a good night’s sleep before, make sure to eat breakfast, drink coffee, or take medication as usual, whatever the specific instructions might be. It also gives an idea of the schedule. So we start at 9 o’clock. We take a lunch break at 1200hrs. We’ll be done around 1400hrs or 1500hrs. I give them options for lunch nearby so that they know what to expect there and whether to bring lunch or not. That sheet also we have a little space to put in any financial information like if they need to bring a payment. It also gives a general overview of what kinds of tests we’re going to be doing. I think that’s important just to prepare people as much as possible. So they walk out with the what to expect on testing day sheet.
Often, parents will also ask, how do we talk with our kid about this evaluation, because parents are understandably concerned about their kid thinking something is wrong with them and that kind of thing.
What I generally tell them is just to say something general and fairly vague; not to name any diagnostic concerns or anything like that, but just to say something like, we’re going to go to see the doctor and he’s going to do some tests to help figure out how your brain works, figure out what you’re good at and maybe give us some help to make school be a little bit easier. Generally, we’ll just leave it at that. Kids seem to really like the idea of finding out what their brain is up to. So we’ve stuck with that line over the years.
[00:18:00] During the testing day, now this is, I think really important. Again, people come in, they have this idea that they’re going to be evaluated and they really have no idea what that will actually be, even though we’ve given them some sense from the what to expect on testing day sheet.They come in and often they are fairly nervous. So right off the bat, if it’s a kid, I am jumping in and trying to make some joke, be friendly, engage them if they brought a toy or if they’re holding a game or something like that. I’ll just make a little bit of conversation. Definitely try to be animated and engage the kid as much as possible.
Now, I have mentioned, I think before that I run a tech model where graduate students administer a lot of the testing as well. That’s just a quick side note that if you do run a tech model or thinking about running a tech model, make sure if you work with kids, hire people who actually like kids. That is huge. That’s just made such a huge difference. I have great graduate students right now who do a really good job in engaging with kids and really being silly and helping them feel comfortable.
So as they get started with the testing process, the instructions for most of the tests say, you’re going to be doing a lot of different things today: some will be hard, some will be easy, just try your best.
Of course, we read all of that, but I will go above and beyond and just try to reiterate that and break from the script a little bit and try to reassure the clients or the kid that things are probably going to be hard at some point. These tests are not the kind of tests that you can get 100%. They tend to just get harder as you go along. [00:20:00] So don’t get discouraged. If you do, we’ll take breaks. Just try your best and let me know if you need anything.
We let people take breaks as often as they need to, try to pay really close attention to whether they are getting anxious or frustrated or tired or down on themselves, any of those things, and really being proactive to coach people to take breaks when they need it even if they’re not asking for it.
We do spread the testing day out. We make sure to give a pretty long lunch break. We are in an office park where there’s the opportunity to take a walk. There’s a coffee shop. So that’s getting into environmental things that I think are important, but if you are in the position where you’re considering office space or have the opportunity to move or anything like that, I think those are important things to think about when you’re doing testing is to make sure you’re in an environment where clients can take off and get a little breather if they need it.
After the testing session is done, then people come back for feedback. Now, I tend to think that, well, and others do too there, that the feedback is just a whole separate beast on its own.
I will mention, there is a great book by Karen Postal. It’s called Feedback that Sticks. I will definitely have a link to that in the show notes. She just goes into so much detail about how to do a good feedback session, how to explain results, how to be compassionate, how to deliver hard results like for low IQ or difficult diagnoses or things like that.
I will likely do an entirely separate episode just on the feedback session, but generally speaking, you want to be clear, you want to be concise. I tend to spend about 40 to 50% of the feedback session [00:22:00] talking about results and the tests that we did; explaining those, what they mean, and what they looked at.
I definitely start with talking about the person’s or kids strengths- emphasizing those and talking about how those are going to prove helpful in different environments and making some comments about how we can play to people’s strengths especially kids like in the school environment, what kind of learning environment might be helpful, that kind of thing.
So I spend a fair amount of time on strength before transitioning to what I call challenges. Even using the word challenges for me is very deliberate rather than using a more maybe clinical model and saying deficit or even weakness, words like that. I tend to stick with challenges or frame it more casually and say just things that so and so is not so good at.
So we’ll talk through challenges. And then, I quickly transition and spend at least half the time on recommendations and what to do. I try to focus on specific concrete ideas that folks can take away so that they have a really good idea after the feedback session of what the next steps are and where to go from that point.
And the whole demeanor that you employ during that feedback session, I think is huge. It’s hard to articulate that, but I think it’s safe to say that just coming from a place again and reminding yourself before you go into a feedback session that this is really vulnerable for folks and they have no idea what to expect.
They might think you’re going to tell them exactly what’s wrong with [00:24:00] them or that they’re crazy. I’ve heard that a lot. You’re going to tell me I’m crazy. Parents are often quite nervous. Individuals are quite nervous. They had likely no idea what the tests they did were and what they mean. And so just keep that in mind as you go along.
I will say to them at the beginning of the feedback session, I know I’m jumping around a little bit, but I will say something like, do not hesitate to interrupt me. This information is really important, but it’s also a lot in a relatively short period of time. And a big part of getting together face to face is that you understand all the testing we did and where to go from here. So do not hesitate to interrupt me. That’s really important and that’s not offensive to me at all. I just try to give them permission as much as I can to jump in whenever they want to.
So feedback session again, just generally keeping in mind that this is super important for people. Most of the time, people just want concrete strategies about where to go and what to do from that point.
So I will often send them away with a referral sheet. We’ve put together a referral list that is printed out here in the office. Often, a big part of the feedback is referring folks to other services either within our own clinic or mostly out in the community, to be honest. So I have a nice lengthy referral list for any number of services that clients might need.
I always hand that to them. I really try to talk through each of the providers I’m recommending. That sheet has the provider’s name, a little description, their phone number, and what they do. And I try to communicate with folks at the feedback session why those individuals would be a good fit and really try to match them up based on everything I know about the family or the individual and [00:26:00] everything that I know about that provider.
Now, when I deliver the full report, that’s another place to, again, just take into account this vulnerability and try to support people and help them feel comfortable with the process. So here you have this very concrete tangible result of all the testing that you did. So there’s a lot of power with that.
And again, report writing as a whole, I could probably do a series of episodes on that, but generally speaking, you want to make sure to write up the history accurately. I always go out of my way to give it a little bit more of a narrative feel where it’s not just super short and clinical. Of course, this depends on the setting that you’re practicing in. Are you writing for physicians or other medical professionals or more for parents or the client? I tend to err on the side of being a little more narrative instead of brief and short, just to fill it out a little bit and hopefully make it a little more relatable and personable.
I always think that even though I’m going to be sending that report to a bunch of different folks usually, the parents or the individual are really the individuals who is going to be reading that report. And that’s who I tend to write to. I consider the client to be my audience.
So I spend a lot of time both in the history, in the interpretation, and in the summary, again, just focusing on strengths. I try to play that up and make it really clear. In the history, I have a whole section just on strengths and places that people excel and what they’re good at.
And then in the interpretation and the summary, I have two separate paragraphs, one at the beginning, one at the end of the interpretation that go over strengths and what they’re good at and how those are going to serve that individual or that kid out in the real world. I really try to tie it, like I said, to pretty [00:28:00] realistic scenarios and talk about how those strengths will help them in day-to-day life.
In the report, like I said, you have a lot of opportunity to talk about strengths and again, reassure folks that all is not lost. There is hope. Recommendations are a big part of that. So writing recommendations that feel doable and clear and concrete. I like to write recommendations that actually play to people’s strengths in addition to supporting their challenges. So that’s just a mindset thing to be thinking about.
An example of that would be, let’s say I have a kid who has really high verbal skills, they’re really outgoing and have a great personality, and maybe they struggle with some attention issues or they have a reading disorder or something like that. I’ll include a recommendation that says something like, play to leadership skills. First name kiddo has excellent verbal ability and strong ability to connect with other kids in the classroom. So please utilize so and so in a leadership role to help build confidence and capitalize on these excellent skills. Something like that.
After you deliver the report, many families or individuals will also ask for a certain amount of follow-up. Again, I just make it really clear and go out of my way to tell them that I’m available for any amount of consultation or follow-up that they have after they get the report. That could be connecting them to resources. It could be reiterating or doing another meeting to go over the report, and answering any other questions that they have.
And even years down the road, I’ll get emails from families or individuals saying, hey, we did testing a few years ago, [00:30:00] such and such has changed, what would you recommend? Most of the time, that’s a pretty quick email just to think about additional resources or things that could be helpful. And I’m okay with doing that.
Of course, if it turns into more of a lengthy process or if they ask for another meeting or something like that, then you can charge for that time. But I find that people are often very willing to pay for that time if you’ve front-loaded with a positive demeanor and just make it really clear that you are totally happy to consult with them and will just be a resource going forward and be something that they can utilize if they really need it.
I think it all just gets back to families and individuals just wanting to be able to rely on you and have a bit of a guide throughout this whole evaluation process that is very familiar to us as clinicians, but very unfamiliar and fairly scary at times for parents or individuals who are coming to go through the process.
So, those are just a few ideas and things that I do here in our practice and have done over the years to really try to address folks’ vulnerability and honor that vulnerability. Even if they may not name it, just to know that it’s a fairly intimidating process sometimes. Folks come into it with any number of expectations or hopes. They really are putting their lives in your hands. I think you having that mindset can be super helpful and really supportive for those folks.
Any resources that I mentioned here during the show will go in the show notes, like I said. I would just encourage you as you go along, [00:32:00] if there are any small places where you might be able to tweak your process a bit or even developing, like I mentioned, a referral sheet or a what to expect sheet or a script for that initial phone call and just revising some of that and making sure that it’s really going in the direction of catering to folks and helping them feel as comfortable as possible through the process, I think will really help.
And then that can really extend and go a long way even beyond your evaluation. I think that a big part of referrals and word of mouth. People having a good experience is as important if not more important than the actual clinical piece.
Thanks as always for listening. Love doing these podcasts. I love talking through these different aspects of testing. I hope that it’s helpful. If it is helpful or if you’ve enjoyed the podcast, do me a huge favor and think about spreading the word in any number of ways. You can share the podcast on your Facebook feed or other social media, you can rate or review the podcast and iTunes, you can share it on your own website, you can blog about it or you can send me comments and questions. That’s always really nice too. I love getting those, thinking through things, and just hearing what’s helpful, what’s not helpful, and maybe other topics that folks are interested.
We have a number of really cool interviews coming up. Like I mentioned last time, I’m going to be talking with Maelisa Hall from QA Prep all about having your paperwork in order and documentation when you’re doing testing. Also, going to be talking with Kelly Higdon- one of the premier mental health consultants and private practice coaches here in the country. Allison Puryear, we have an interview with her coming up in the next month or so. So there’s a lot of exciting conversations that we’re going to be having here over the next several [00:34:00] weeks.
All of you take good care. Enjoy the spring weather, whatever that might look like in your area. We will catch you next time. Bye bye.