219 Transcript

Dr. Sharp: [00:00:00] Hello, everyone. Welcome to The Testing Psychologist podcast, the podcast where we talk all about the business and practice of psychological and neuropsychological assessment. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.

This episode is brought to you by PAR. The Feifer Assessment of Writing examines why students may struggle with writing. The FAW and the FAW screening form are available on PARiConnect. PAR’s online assessment platform. Learn more at parinc.com\faw.

Hello, and welcome back everyone. I am thrilled to be here with you today as always, but specifically, today because we have another happy hour episode to share with you. Now, you may have caught the first happy hour episode back in February, I believe. And if you did catch that episode, you know that [00:01:00] this format is meant to be an informal casual conversation among friends and colleagues about everything: personal stuff, professional stuff, testing, non-testing. And I am really excited to share this one with you as well. I think we’re going to try to make this a regular occurrence, once a quarter or so, because we have such a good time talking with one another and hopefully the rest of y’all find this helpful and engaging as well.

As always with relatively new formats like this, please let me know, give me some feedback if you like the happy hour format or not. But my guest today, Dr. Chris Barnes, Dr. Stephanie Nelson, Dr. Andres chou, and Dr. Laura Sanders, again, are back to have a wide-ranging conversation about any number of topics in and out of the testing world.

Some of the things that we talk about are aspects of our testing [00:02:00] process that we feel most confident in. We talk about translating our processes so that our admin staff and assistants can understand and help us. We talk about what to do and how to handle it when we may have been “wrong” in the past with our assessment results. And we talk a little bit about the difference between self-compassion and self-care. So, those are just a few things. There are a number of topics that we get into. My hope is that he might enjoy all of them.

Now, if you are looking for CE credits for your license, you can check out The Testing Psychologist podcast episodes over athealth.com. Just search The Testing Psychologist and you should be able to find most of the clinical episodes there.

[00:03:00] All right. Without further delay, let’s get to this happy hour episode with my friends and colleagues, Dr. Chris Barnes, Dr. Stephanie Nelson, Dr. Andres Chou, and Dr. Laura Sanders.

Hey, welcome back everybody. I am so happy to be here for another happy hour episode with some of my favorite psychologists in the entire world. So, like I said, in the introduction, if you did not check out the first happy hour episode from several months ago, go check that out. I’m guessing we’re going to refer back to some of that discussion, and it’ll give you a sense of these fine folks’ personalities as well. But here we [00:04:00] are for another happy hour episode. We’re just going to roll with it and talk about whatever comes up.

For anybody who maybe doesn’t know or didn’t listen to the last episode, let’s do some brief introductions. Chris, you want to go first?

Dr. Chris: Sure. Chris Barnes here. Kalamazoo, Michigan. I’m a clinical psychologist. And based on our last appearance, I’m really excited to see where this one goes.

Dr. Sharp: Oh yes. Andres.

Dr. Andres: Andres Chou here in Pasadena, California. I’m a clinical psychologist. I’m just here to make everyone uncomfortable.

Dr. Sharp: Great. I’m looking forward to that.

Dr. Stephanie: I’m Stephanie Nelson. I’m in Seattle, Washington. I’m a pediatric neuropsychologist. I have a small clinical practice and a growing consultation practice.

Dr. Laura: I’m Laura Sanders. I’m a licensed psychologist in Colorado and in Texas, and [00:05:00] currently in Colorado.

Dr. Sharp: We’re in the same town, Laura and we still haven’t seen each other in person.

Dr. Laura: I blame you.

Dr. Sharp: That’s totally fine. I’ll accept that blame.

Dr. Andres: It’s by design.

Dr. Sharp: I’m already uncomfortable.

Dr. Andres: Welcome to my life.

Dr. Sharp: Okay. So that just makes me reflect back. I think we talked, it’s been almost six months since our last episode, and that really is sad that we still haven’t seen each other in person. Things have changed since then in some big ways. I think a lot of people are vaccinated and that’s changing some things in our lives, but I’m curious for all of you, what has been happening over the last several months. Have there been any big changes in your practices or otherwise [00:06:00] that you want to share?

Dr. Laura: I’ve gotten back into the office, one day. I’m starting two days a week next week. I’m excited. So I’m starting to see people in real life again.

Dr. Sharp: And is exciting.

Dr. Laura: It’s been nice. But it’s also been an adjustment.

Dr. Sharp: Sure. You were doing remote for a long time, right? You’re one of the last people I knew of to go back into the office.

Dr. Laura: I’m liking staying at home all the time. I’m not going to lie.

Dr. Sharp: It’s remarkable. How’s it been to be back in the office?

Dr. Laura: It’s been nice to have that actual personal interaction in real-time, face to face, but it brings up a lot of doing your mask, if you’re not masked, how far apart do you sit? Then how do you structure things? [00:07:00] So I had to rely on the wisdom of others.

Dr. Stephanie: How have you been doing that?

Dr. Laura: The people I’ve been seeing in the office have mostly been kids. Usually, the parent comes in, we talk, the parent leaves, and it’s just me and the child in there for the bulk of the time. And two times we have unmasked because they were eating continuously or something else happened, and then you have to leave the office, then we put the mask back on. And it feels okay. I’ve got two things running to purify the air. It’s just that setup. It feels okay but also very strange.

Dr. Sharp: That’s a good way to sum it up, okay but strange. That’s similar to what we’ve been doing as well. It feels weird to take the masks off, but also okay. What [00:08:00] about the rest of you? How have the last few months been?

Dr. Chris: I’m going back. Oh, I’m sorry. Go ahead, Andres.

Dr. Andres: I was just going to say, it’s just so crazy. It feels like time flew by so fast. I mainly do therapy, so I’ve been seeing people ever since I got vaccinated and then I gave the option for my clients to come in in person. We’ve been messed up. I had air purifiers going on. My office is big enough that we could sit far enough apart, but just recently with the new CDC guidelines, I’ve been giving clients the option of, I don’t check their records. I just can’t take the word for it. If they feel comfortable to unmask. It’s been fine but it’s weird because some clients have actually never seen my face in person. So they were like, whoa, you’re not what I was hoping for. [00:09:00] What happened? You look better online.

But then the weird thing for me has been testing. And when I do testing, the few times I have done in-person testing, I don’t do a whole lot of testing, but we have worn masks. And then I had this encounter this week where we did an interview with our mask and we were distanced enough, but then I had to come up close for some testing, and then I was like, oh shoot. We didn’t really think this through like, do they need to be masked? Do I need to be masked? And so I just kept mine on for the sake of the client. And then I started thinking like, oh, were they nervous about it? You can’t help but feel a little weird that this thing you’ve been doing for months and months and over a year now you’re not doing it.

So it’s weird, and at the same time, it’s [00:10:00] just interesting. I’m just realizing collectively the experience. Each time I think about it, each time something like this comes up, I think about the collective experience that we all get it. And we have very few experiences like that, right? Like, oh, wow, you can talk about the weirdness of the mask. Everyone goes, oh yeah, I get that. Yeah. So that’s been here. It’s slowly going back to normal, but it’s still weird.

Dr. Stephanie: Andres, you should also clarify that the reason you’re not doing much testing right now is that your therapy practice has really taken off. You’ve really built this thing over the last year and now you’re almost overfull, right?

Dr. Andres: Yeah. It’s funny because my story is that I never intended to be an assessment or testing psychologist. I always thought it was interesting. [00:11:00] In fact, in grad school, it was the topic that I struggled with the most. I remember my professor just looking at me once during a pop quiz. I don’t like that she gave us a pop quiz first of all, and then she had the look of dread that I not getting this and maybe that’s carried on a little bit still.

So I never intended to, but looking back half my training has literally been in assessment. It just worked out that way. And the good chunk of my professional career has been in assessment. And so, I thought that would always be a part of it. And then things just change and you go with it. Exactly the therapy practice has been really building up and it makes sense too. There is a lot of need right now.

Dr. Sharp: That’s fantastic. First of all, though, [00:12:00] who gives pop quizzes in grad school? Did anybody else do that? That’s just silly.

Dr. Andres: It’s cruel. We give pop quizzes to our clients in testing though. Here you go. Pop quiz. Here are some blocks.

Dr. Sharp: That’s a good point. It’s just 27 pop quizzes all in a row. This is true.

Dr. Stephanie: Chris. I feel like last time you were also talking about the balance of testing and therapy that you were doing. What has been happening for you over the last two months?

Dr. Chris: Over the last few months, I’ve gotten a tremendous influx in referrals for testing. And it was interesting because I got a new office administrator, probably February/March, and I said, no new testing until June. Well, here we are in June and I looked at my calendar next week and I have 15 intakes for assessment. And I’m just like, I should’ve seen that one coming. I should have looked at that probably 2 or3 weeks ago.

So now we’re in the process. [00:13:00] I met with her two days ago. We went out to a Brewery and had our first retreat. And I was like, we need to work on this. We need to figure out how we’re going to accommodate this because I’ve been all virtual. And so, I’ve been using an abbreviated battery, which I’ve been able to accommodate just pretty quickly, but now I’m going hybrid next week. So I’m doing intakes and feedback via Telehealth, but I’m going to start collecting data in person.

So unless I can break this popular space-time continuum, we need to figure something out there. And simultaneously, I’m having this idea that I don’t like testing anymore. I do enjoy it, but it’s not scratching my edge like I thought it would. And so, I’m in this weird spot where I have this huge funnel of clients and the business is doing great, but I’m just not loving it.

So I’ve been doing a lot of soul searching over the last few days, weeks, et cetera, to figure out what’s going to happen next. But I’m hoping to be getting back and the in-person data collection is going to change some [00:14:00] of that because that’s the piece that I enjoy is interacting with the client, having that back session with parents or the client themselves, and creating some lexicon of understanding of where they’re at. But seeing 15 intakes in one week, that makes me sick to my stomach even just saying it out loud for the first time.

Dr. Sharp: So you’re not booking any more intakes until September, right? That’s a summer’s worth of evaluations right there.

Dr. Chris: Yeah, that is ridiculous. It is what it is. And it’s like poor management on my end. I’m seeing that was like totally poor management and my side. My admin was just following the rules. No new intakes till June. And here we are.

Dr. Stephanie: That’s the best part about getting an admin, as you suddenly realized, there’s a lot of stuff in your head that you maybe haven’t put out there yet to the world.

Dr. Chris: Sometimes we only think two or three steps into the process, not five.

Dr. Sharp: Right.

Dr. Chris: So that’s my Mess for the next 10 days is figuring out how we’re going to manage that and not piss too many people off along the [00:15:00] way.

Dr. Sharp: That sounds like a nice problem to solve.

Dr. Chris: It’s definitely.

Dr. Sharp: What about you Stephanie? The last time we talked, we talked about your consultation has ramped up and clinical. Is the consultation still a big part of your time?

Dr. Stephanie: It is. It is becoming more of a part of my time. I’ve been able to reduce my clinical work a little bit so that I can start ramping up some of the offerings that I’m able to do. I get a lot of requests for a group consultation experience or people asking if they can buy things that I’ve been putting out there somewhat for free. And so, I’m going to start making those available and I’ll have more time to keep my blog up and going and offer some things like that, which I’m very excited about. I’m also in the process of downsizing my house [00:16:00] and moving and changing my office and all sorts of other things. So, we’ll see. I have big dreams. We’ll see how well I’m able to translate those out into the real world.

Dr. Sharp: That’s so exciting.

Dr. Stephanie: It’s great because the consultation is amazing. The people that I consult with are brilliant and lovely. I can’t believe that I get the opportunity to work with psychologists from all over the country. I wake up excited to talk to these people and to hear about their challenging cases and what’s going on with our lives. So it’s really amazing.

I think Chris, I was in the space that you were in where you’re starting to get a little bit concerned for burnout for yourself are concerned about, is this all that I can be doing right now? Am I going to have a stroke giving the WISC for the 247th time? And you start [00:17:00] thinking about some of those types of things. To be able to have this new invigoration and excitement about your career again has just been amazing. I assume, Jeremy, this is a little bit how you felt when you started the podcast and changing your direction a little bit of this new excitement for a profession that can sometimes drain out up a little bit.

Dr. Sharp: Yeah, absolutely. I love the idea that we can do so many things with our knowledge. The trick though, is that we don’t really get taught that in grad school, which is fine. Grad school is for clinical stuff and mastering our craft. I would love for there to be a few more courses or some education on outside-the-box ways to do psychology. I love that you’re finding your way into that, and many of us are finding our way into that, but yeah, it is exciting. [00:18:00] It’s like, oh yeah, I don’t have to sit in this chair and give the WISC until I keel over. There are other things to do.

And I think, I don’t know, this is maybe going down a rabbit hole, but I’ve been paying a lot of attention to just the surge in technology and mental health startups and all that kind of thing. It hasn’t really reached testing yet that I know of, but to me, that’s just more opportunity. I think the next 5, maybe 10 years, it’s going to be crazy. There’s going to be a lot of different opportunities for us to use our knowledge and who knows, consult on app development or a bigger company. I don’t know. Who knows what it’ll look like. But I like that that door is open.

Dr. Andres: That reminds me of what’s been going around is there are those online screeners for ADHD that they’ll give you a [00:19:00] diagnosis. I don’t know why companies, I don’t want to name them, but it’s coming. I don’t know how valid those things are or reliable or all the above, but where there are opportunities, people are going to try to fill that.

Dr. Sharp: Right. I think it’s the same process that we all do clinically. We’re trying to solve problems for people, right? And this is just another problem. Like there’s a problem that you can’t get an assessment with a qualified person for a year. That’s a problem without paying however much to do so. And it’s not surprising that there are companies that are stepping in and figuring out how to solve that problem in a way. I don’t know if it’s the best way, but that’s what it’s about. So, if we can think creatively, [00:20:00] I’m sure we can solve some of those problems too.

Dr. Stephanie: I love how optimistic you are, especially because the colleges are known for dragging in their heels. Remember how many of us were like, I’m never doing anything online, not even intakes and feedbacks. And then finally a year into the pandemic, we’re like, well, maybe. So I love that you think that we’re all going to be able to rush in and fill this void. But if there is a silver lining to the pandemic, it might be that it has forced us to do some things that we thought we would never do. And that we’re actually starting to look maybe in the direction of change and growth and technology.

Dr. Sharp: Sure.

Dr. Chris: A tremendous exposure therapy process, no doubt. We’ve been forced into it. We’ve had to figure it out. Orange jumpsuits probably aren’t going to happen with the decisions we made, but we’ve had to pivot from some of the things that we’ve done. We just get so stuck in our ways [00:21:00] I think

Dr. Andres: Well, jumping on that. The thing that I’ve been able to walk away with, and I think through the help of some of the guests on your podcast, Jeremy, and just discussions we’ve had in the Facebook group and just even my own process is, how much of, maybe because where am I in my career, I relied so much on like, am I administering this straight battery?

Don’t get me wrong, norming, standardization, testing are all very important, but then the reason why people pay us money to do what we do is not to give them tests, it’s to analyze the data and to assess and interpret. And we can’t forget that. And being forced into the situation, we agree on what’s the minimum we can do and still do our job,? Like using the technology and just realizing that [00:22:00] the tendency to over-rely on measures to get data that we could get otherwise. That’s been a real challenge and encouragement for me, like, okay. I know some stuff and that’s okay. I don’t have to have a measure for every single detail and even then, I think I forgot your quote, Chris, but the data is only as good as how you interpret it. I just totally butchered it.

Dr. Chris: It’s how you get the data, not the data you have.

Dr. Andres: Yes.

Dr. Chris: I also paraphrase my own quote, but whatever.

Dr. Stephanie: Listeners will have just listened to the previous one. That’ll be fresh in their head.

Dr. Chris: It’s funny, Andres, as you say that, it sends shivers down my spine, like, oh my God, am I doing this the right way? Am I not doing this the right way? I mean, there are right and wrong ways, definitely. But there’s this gray area that we have to get comfortable with. [00:23:00] And we’re trained to sit within that. I think we just throw our own stuff on top of it that makes it difficult for us to sit in that gray.

Dr. Laura: Yeah. And to figure out how not to overtop. We don’t need 48 measures of the same thing. Trusting that clinical instinct and all of that, that has been different going back into the testing office. I’m not giving the extent of the things that I used to get. I don’t know if that’s right or wrong, good or bad?

Dr. Sharp: Can you talk through your thought process in moving in that direction? How did you decide not to do that anymore?

Dr. Laura: That’s a great question. I think it’s been partially wanting to avoid exposure, right? So like keeping exposure a little bit shorter. So thinking about how to do it quicker. I don’t know that I have a good rationale, [00:24:00] but I think previously the tendency might’ve been to give several different measures, looking at the same thing to make sure that we’re seeing what we’re seeing. And I don’t know if it’s economical at this point. And I don’t know if it is helpful for the person. And I don’t know if it’s helpful for me. And maybe that’s fun out of having to pair down that battery and really focusing when it’s online.

Dr. Stephanie: I think we’re so trained that the numbers will tell the story and you’ll just be able to look at your test scores on your beautiful tables and it’ll just jump out at you. And that can lead sometimes to over-testing as well, because when the story doesn’t jump out, you’re like, well, I just need to give 17 more tests, and then it still doesn’t jump out.

I think we’re starting as a field to recognize that while testing is important [00:25:00] and it is something unique that we offer, testing is not synonymous with assessment and assessment is a bigger process. I think it’s Hasson Carrier who talked about the riot model, where it’s your records, your interview, your observations, and your testing. Testing is only one part of that. And we don’t necessarily need to make that 90% of what we do. We still get a lot of other information.

Dr. Sharp: Right. I did an interview the other day. I don’t know, depending on when this is released, if it will be before or after. So, I might be spoiling an episode, but we talked a lot about the realm of culturally and linguistically sensitive assessment. My guests talked about this concept of dynamic assessment and it’s like there are the norms and then there are not the norms. And there’s a lot of [00:26:00] assessment that happens outside of norms when you’re working with certain populations which it’s just one piece in the puzzle of my conceptualization of testing and how it’s evolving. And it’s like, what are we doing here? What are these tests actually telling us? How important is this standardization all the time? I don’t know. It’s these big questions, existential testing questions that I think we’re like touching on right here. We’re questioning our batteries and what’s that test…

Dr. Chris: Test essential.

Dr. Sharp: There we go. Yes, you heard it here first.

Dr. Andres: You know what’s been messing with me tremendously is when you find out how they do the norming. It just messes with me because then I’m thinking about a new test and I’ll look at the manual like a good psychologist should, but most of us often don’t. I will [00:27:00] look at it and go, oh, you know what? This has been with 99% white male college students, the norming and in somewhere in the Midwest and I’m here in a really diverse area in California. Does it apply? Maybe. And then we just go with it and we think everything’s fine.

So even the idea of norms is just like, again, I believe in standardization, I believe all norms are important. I’m not going away from that but we have to interpret that in context. But then when I read these manuals, I’m like, oh my gosh, the sample size was like a hundred people and I am just going to base it on this number? No way. We have to interpret it into context. And we have to confront that.

We’ve been talking about this a lot, like the imposter syndrome, like, wait, now I have to do the interpretation. I have to wrestle with the data, make this make sense in the context of this client, and [00:28:00] the criteria and all that stuff. And it’s very different from other fields when a technician draws blood and goes, well, it’s clear here, this is some disorder. We don’t have that luxury or the ability and then we have to go back to that. So it’s unnerving a little bit especially when you look at how these tests are developed.

Here’s another thing and I might be stirring the pot a little bit is a lot of the research on these measures are done by the people who make the tests. Huge conflict of interest. And maybe that’s just the way it is because there’s no funding for it but, of course, they’re going to release research that supports the use of their tests. And it’s still good research. It’s important but we have to think about these things a little bit. I don’t know. These are the things that keep me up at night. Yeah, I’m just kidding, but not really.

Dr. Stephanie: I think [00:29:00] you’re really hitting on the fact that the numbers do not tell the whole story and you can’t get rid of the numbers. We need those. You can’t do testing without some normative basis. But so much of what we do is so much more. And I was sitting here reflecting on the fact that we’re all at this point having the exact same conversation.

And I think something about The Testing Psychologist Facebook page has actually helped with that. Like people will put up cases and they’ll include some numbers that are de-identified and there are 40 different interpretations of them. And you realize like, oh wow, the numbers don’t. Like, if the numbers told the whole story, there would be 40 of the same interpretation. And there definitely isn’t. And so I think some of us being able to come together a little bit more as a field and looking at test scores from multiple different perspectives in that group has actually helped us start to question what we’re doing and how to make it deeper without losing the statistical and normative basis that makes it special. [00:30:00]

Dr. Sharp: Yeah. There’s so much to unpack here, I feel like. I mean, that idea that we use… Well, we have to keep in mind these numbers are not skills in and of themselves. They are proxies for these skills that we think we are measuring, right? And then it’s a whole other question of whether that even translates to the real world.

Dr. Stephanie: I’ve been calling them behavior samples. You’re getting behavior samples. And so, I was using an analogy of like, if you want to see if someone’s anxious, you might record them over a day and then just stop the tape at 10 different times and see if they look like they’re anxious at that time. Sometimes they will be and sometimes they won’t be, but you’re looking at the overall pattern.

And so, sometimes when people are trying to interpret, say, they’ve given a lot of executive functioning tests and there’ll be like, well, some of them are normal and some of them are impaired. How do I [00:31:00] interpret that? And it’s like, well, we have behavior samples. Just like a person wouldn’t be anxious 24/7, that doesn’t necessarily mean they don’t have an anxiety disorder. You’re getting these little snippets of how they approach executive functioning tasks. And some of them are going to be fine and some of them are going to be a problem. And you’re looking more at that pattern and how that fits with the referral question that they brought in.

Dr. Chris: And it’s kind of like a Costco when they have the samples.

Dr. Chris: We all just talk at the exact same time.

Dr. Andres: Okay.

Dr. Andres: That’s awesome.

Dr. Sharp: I’ll moderate. Laura, you go first.

Dr. Laura: I just was saying, that was beautiful. That made a whole lot of sense.

Dr. Stephanie: Thank you. Andres started with Costco samples.

Dr. Andres: Costco samples, right. If you’re going to buy a month’s supply of pizza, you better sample it and see if it’s good, right?

Dr. Stephanie: So you have to sample all the samples and decide?

Dr. Andres: Yes.

Dr. Sharp: What else? Chris.

Dr. Chris: You raise such a great point about the referral question. And I think that that is one of the, I don’t want to say it’s the [00:32:00] most important, but I do think it’s that initial lens that we have to start seeing everything through. When you’re doing your interview, you’re weaving and bobbing through, where’s the confirmation data, where’s the disconfirming data? And then the data we actually collect, the numbers that also we have to interpret, that’s either a confirming or disconfirming as well. So I just love the idea of refining the referral question. Hey, I want an evaluation. Okay. For what and why? And who really wants this? Is it the physician? Is it the parent? Is it the client? Is it whoever?

And I’ve really seen myself move towards refining that referral question even more because it helps facilitate what I do next. And then that data is the data and y’all know how I feel about the data. And it’s just data. And you have to make sure you’re using your brain to understand it. That’s really helped me a lot lately because we don’t have to figure it all out. We just have to answer one, two, maybe three questions along the way. And then that sets the next person up in the process to be better at their job too, whether it’s the physician or a [00:33:00] specialist or what have you.

Dr. Sharp: That’s an interesting point. Yeah, though we don’t necessarily have to be the truth, the capital T truth. We’re just doing our job at this moment and hopefully answering the questions we can answer and pointing people in the right direction.

Dr. Chris: At the very least, we just rule a bunch of stuff out. And that’s good.

Dr. Sharp: Yeah. I want to throw a question out there that may be hard to answer. We’ll see where this goes. So the question is, what part of the testing process are you all most confident in? By which I mean, which part do you feel gives you the best, most reliable information in the assessment process? Now, these could be specific measures. It could be the interview. I’m just curious. Of the whole testing process, where do you feel most confident in what you’re getting?

Dr. Andres: When the client gives me their [00:34:00] name and birthday.

Dr. Sharp: That’s a great answer.

Dr. Chris: I think the interview is our best tool. I think that weeds out and rules in so many things immediately. And then that fuels the data collection that we have moving forward, which is, I don’t wanna repeat myself but that’s just extra data to help confirm or deny our hypothesis.

Dr. Stephanie: Well, Chris, I’m going to push back on that and say, there’s a lot of research suggesting that clinical interviews, we’re not that great at it. So what do you do to protect against bias or drift in your interviews?

Dr. Chris: Use the data afterward to help confirm or deny the interview. I don’t think that after an hour, hour and a half, two hours of the patient, we know what’s going on, but we have a better idea of what’s going on. And that helps fuel our final conclusion.

So I’m picking wine and I love like the sommelier movies. They do a blind tasting. And so, they smell it, they look at it, they taste it [00:35:00] and it helps narrow down country, region, grapes, style, et cetera. And I feel like that’s what we’re doing in our assessment practice where initially we have someone coming in and they say, I have ADHD, or my doctor sent me, or my wife is mad at me or whatever, and we have to start narrowing down, country and then region. And so the way we do that is through collecting some data. And those are the measures that we use. So I think that that is the biggest weed. The weed out is the interview, and then it just refined the next level of possible conclusions you can derive.

Dr. Andres: So jumping on that, I’ve been obsessed with Stephanie’s secret question when it comes to the interview, like, what’s the question I’m really answering here and really weeding that out. Even at the intake, I do initial consultations. I don’t know what you guys do, but [00:36:00] because I might not even be the right person for that referral. And that’s been tremendous for me just trying to get to that secret question and just pulling from the therapeutic assessment model too, is that helps inform or help set up the tone for the data I’m going to collect later.

I think Steve the originator of Therapeutic Assessment talks about, if you want to talk about validity is, it starts with how we interview, the rapport that we build, that’s all going into if our tests are going to be valid, right? And I do a lot of personality testing and that’s huge in that.

And it’s so clear when I used to teach grad students, the bulk of the time that the measures would come back with some questionable validity. And why is that? It’s because these students haven’t built that skill yet. And they’re just like, oh, I’ll just give this test. They’re going to be honest with me or honest with themselves. [00:37:00] Not that clients necessarily lie on purpose, right? They do but most of the time it’s just a lack of awareness. And in there they’re like, what do I do now? I don’t have any data. And then I go, no, you have plenty of data. Let’s go with that.

But also you have data about how we approach this and that’s the thing I’ve been struggling with. Like, okay. Just really pay attention to it from the very beginning. What’s the rapport I’m building with this client? Do they feel comfortable here? Am I seeing where they’re struggling? And by answering the question they want to be answered, is it really going to help them?

Just answering if they have ADHD is not necessarily helpful. I’m sure we’ve all encountered this. We can go online and do that. Just fill out that questionnaire. Okay, you have ADHD. Good. Enjoy your wonderful life. So, yeah, the extra questions, the deeper secret questions, and also how am I going [00:38:00] setting up the data that I am going to collect to confirm the information or disconfirm the information I’m getting in an interview?

Dr. Laura: Yeah. I totally wanted to say interview, but now I don’t. Thank you.

Dr. Chris: I’ll still say interview.

Dr. Stephanie: Laura, what would you say instead.

Dr. Laura: Well, I was thinking about it while you guys are talking. And I think the Wechsler tests are pretty good. It’s easy. I’ve done it a trillion times. I’m not really paying attention to the questions that I’m asking them, I’m paying attention to the behavior and what’s going on in the room. I’m getting the data but also that behavioral stuff. And I feel like maybe that is where I get a lot of information, like more than I really realized.

Dr. Andres: I’m curious, what tends to come up in terms of what you pick up? Like, what are you looking [00:39:00] for when you, I’m totally putting you on the spot. Now you have to think about it, but I’m curious about that because everyone has a different way of looking at observations. We don’t teach that in grad school. It’s really hard to teach in grad school, right?

Dr. Laura: Yeah. Just the pushback that you get or don’t get. Like how excited they get about a task or how frustrated they get, how much they’re talking themselves through things, how much they’re saying to me about it and commenting, are they getting up out of their seats? Are they leaning close to the blocks or close to the things to really inspect it? Just all of that different commentary that goes along with it. And are they getting anxious about it? Are they saying self-defeating things or I can’t do this? I’m so stupid kind of stuff. All of that. And this is kids mostly. I don’t think I’ve ever seen an adult do many of those things.

[00:40:00] Dr. Stephanie: I’m obsessed with systems. So I have a five-step system that I use but that’s like step number four. And I think of that as like the therapeutic assessment model of how does the problem come into the room? How does it show up both on your tests but also in giving the tests? If the person says that in their everyday life, they have trouble solving unstructured tasks or they’re struggling with their self-esteem, or they feel like everyone can do things more easily than they can, which I think is a feeling a lot of us can relate to, how does that problem come into the room that you have, especially this room that you’ve set up, that you’ve done with a thousand other people?

Like Laura has given the WISC more times than probably anyone on earth? So she knows what it looks like when something different is coming into the room. And how do you use that systematically? How do you gather that data so that [00:41:00] you’re looking for themes and you’re looking for singular really unique responses? And you’re looking for representative responses that really reflect the problem the client is having. And thinking of that is just as important as the actual numbers that you got.

Dr. Laura: I had a kid the other day come in. It was an anxiety/ADHD sort of referral. He had long hair and every time that something got hard, that bang would come and cover his eye. And it was so interesting because it was every time something got hard. I could really tell what he liked and didn’t like based on where the hair was. And just interesting.

Dr. Sharp: It’s such a good example. Well, I like this idea too. We talked last time about process versus content. We have the content- the scores that we’re getting and the answers that we’re getting, the literal information, but then the process is so fascinating and being able to tap into that.

I [00:42:00] told you all those stories in our group chat two weeks ago about this ADOS that I gave. This was the most unique ADOS I’ve done in going on 20 years now. That stood out. Even though the answers themselves weren’t completely off the wall, the way and the process was just like, oh my goodness, this was notable. So, pay attention to the process.

Stephanie, I’m going to turn your question back to you. When you asked about how to control drift and bias in interviewing, do you have a means of doing that for yourself?

Dr. Stephanie: Well, I think the thing that I most often try to do is when I’ve done my first two steps where I figured out, like, why now? Why is the patient coming in now? What’s prompting this evaluation currently? And then I’ve looked for what Chris was talking about with the referral [00:43:00] question, the ostensible reason that they’re here. And then I’ve looked for what Andres was talking about, the secret questions, my third step is, now I need to expand my hypothesis pool. And I try and come up with 20 different hypotheses. Obviously, some of those are going to be in the DSM. And a lot of them are not necessarily things that are going to be in the DSM. They might be about the individual’s temperament or about the environment kid match or about life circumstances and how well the parent was able to attune to the child or a variety of other things.

And I try and have 20 different Ideas by the time I’m ready to try and bring the problem into the room so that I am protecting myself against drift, and I’m not just saying like, oh, there’s a family history of bipolar. So that’s what I’m going to be assessing. Yes or no. I try and use my interview to generate the hypothesis instead of trying to [00:44:00] confirm or deny them. Like, it’ll keep my list from being 40 hypotheses based on the things we’ve talked about in the interview, but I’m using it more for what else could be going on here. What things can I test in the testing?

Dr. Sharp: Yeah, makes sense.

Dr. Laura: Are you writing this all down? 

Dr. Stephanie: Yeah.

Dr. Laura: Are you jotting down your notes and then striking them out? I think that would feel good.

Dr. Sharp: With a feathered quill?

Dr. Stephanie: I keep it in the chart. I’ll definitely write myself little notes of like, no, or, oh, this one’s still on the table or things like that.

Dr. Andres: I’ve had an experience where something like that would have been very helpful for me because the client did the research and figured out every diagnosis they could have been having. And they asked me for one to look into and I ruled it out, but [00:45:00] they already did that on their own. So this is one of those things where they were seeking their diagnosis. Had I had that list, I would have been able to answer when they said, but what about this disorder? Did you look into that? And I’m like, I did but it wasn’t on the radar because you weren’t asking you about it. This was earlier on in my career, but that would have been helpful. Yeah, I could show them my list and go, Hey, see, I crossed them all out. I did my homework.

Dr. Stephanie: I think it also helps remind me that I’m a psychologist and not just a neuropsychologist. It helps remind me to look for example, at things like normal temperament variations. I think a lot of people who are maybe introverted in a world that’s more set up for extroverts or who aren’t very conscientious in a world that values conscientiousness or who are neurotic in a world that values people who are more emotionally stable can feel very different and feel like [00:46:00] everyone else can do things more easily than they can, or that their skillset isn’t valued.

I think we’re often pathologizing that when that may not necessarily be what the message that they need. They actually may need a message of like, no, this is normal and it’s okay. This is why it feels bad. This is what will help support you. So by forcing myself to come up with 20 different diagnoses, they can’t all fit in the DSM. So it requires me to think about other concepts that we know about like development, normal personality variation and stages of life that people are going through.

Dr. Chris: It just reminds me of how we think about this from a business perspective like, what are we selling? What is our product? I believe hope, answers, a glimmer of some understanding, et cetera. And so, it doesn’t have to necessarily fit so nicely into the scientific method and all those things. Now, we can’t be dumb. We can’t let someone look [00:47:00] at like a tomato plant and say, well, what do you see? And therefore that means, but I think we have to speak with some confidence based on how we understand data and statistics and give people this is where we’re at. These are the potential outcomes, these are the potential recommendations, and these are all the different things that we can jump towards based on the information we have and simultaneously we can rule a bunch of things out also.

Dr. Stephanie: The way you marry your therapeutic perspective with your business sentence just never fails to blow my mind. I love that you’re thinking about the therapeutic aspects of giving hope and things like that but then saying like, well, that’s a good business decision. That’s amazing, the way you put it like that.

Dr. Chris: I feel like I had to learn that the hard way though. I wasn’t taught that stuff. I was like, let’s look at the data. This is what we should do. This is empirically validated, yada yada yada. And that came across differently than I want to do. I’m not poo-pooing those things, but we do way more than that. And when we can take it from the [00:48:00] 20,000 foot to the 50,000-foot view of what we’re actually doing, I think we give so much more value to the people we’re working with which is why we do what we do anyway, is to provide value. And sometimes I just think we understand what value we’re really doing. We’re just doing it because we’re supposed to do it in certain ways.

Dr. Stephanie: How did you learn it and how do you teach it to other people?

Dr. Chris: I think it was two years ago. I was doing just doing testing and this stuff, and I just had this moment. I was like, “What the hell am I doing? Why am I doing this?” And I started in therapy and gravitated towards assessment. And once I started really thinking through what value are we giving here? Sure there’s the diagnosis, there are recommendations, there’s consultation with a medical provider potentially, a school system potentially, but you can provide so much more than that. And it takes like two Iotas more energy. It takes hardly any more energy for us to have a real therapeutic conversation with someone about what this really means instead of you meeting the criteria for [00:49:00] X disorder and your invoice will come in the mail and I’m going to chat with the school psychologist or the provider and peace out if I see it. Well, I think that we can provide so much more value than we ever give ourselves credit for.

Dr. Sharp: Let’s take a quick break to hear from our featured partner.

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All right, let’s get back to the podcast.

I think that’s such a good point. It reminds me of hundreds of websites that I look at. When I’m consulting with folks, I always do a website review and so many websites list the testing process and go into all those details about the testing process. And I’m like we are going to like sell the outcome. Don’t sell the nuts and bolts. Sell what the person is going to walk away with: what they will feel and how you’re the bridge between how they feel now and how they will feel later, which is hopefully better in some way.

Dr. Chris: Earlier the question was, what do we feel most proficient at? I said I loved the interview. Thanks, Stephanie, for pushing back on that one. Being pushed back by [00:51:00] Stephanie Nelson on a podcast is an instant panic attack, by the way. But the thing I feel the best about, however, is that feedback session. There’s nothing more fulfilling than having that conversation with someone and having some numbers because I think the people we work with want to see data. That’s what they’re coming for. And then having this data and wrapping a realistic, not some fantasy story around it and saying, oh, now I get it. And then validating that person’s experience because they’ve probably known it all along.

And now we have this information to suggest like, Hey, like you’re not capital “C” all over the place right now crazy. You’re not all these things that you thought you were. We have some understanding of why you’re having the experience that you’re having. And there’s just something really fulfilling as a clinician about that. So it’s always fun to talk about what we think we’re good at and what we enjoy the most because everyone I talked to they’re very rarely aligned.

Dr. Andres: Can I jump on that. I know exactly [00:52:00] that feeling you’re talking about. When you help affirm the client’s struggle and give answers to them, it feels really good. And now, I’m going to swing you another way. There’s a temptation now that I want to give every client that experience. And so I’ve been wrestling with this a lot. There’s been a lot of discussion in this in the Facebook group about this.

The hot diagnoses right now are, and I’m mindful of how this could sound. So I’m giving a lot of caveats here, but at least for me, I know a lot of people have been talking about this is that I get a lot of referrals now. People asking for adult autism evaluations, adult ADHD evaluations, and I struggle with that because we’ve talked about how statistically it’s really slim that someone enters into adulthood, but it could [00:53:00] happen. And I’m also looking at these clients and going, you’re really struggling. I want to help you. I want to help you understand that. And then all that kicked in with that feeling when you affirm of the client when they are struggling with these things and it feels good.

I came in the field not to tell people that they’re wrong, but I want them to feel better to get better, to help them. And so I’m really wrestling with that. And there’s a lot of hard questions to ask about that but I’m curious how you guys approach these things. And even as I’m saying that, there are so many conversations that could be held about this. That’s been a challenge for me. Seeing like, okay, maybe I’m looking at this incorrectly. Maybe there is value in affirming clients. And I do believe there’s value but then is there also harm to? I’m trying to balance that and I’m not just counting either department.

There’s not [00:54:00] going to be a perfect answer of course, but I love to hear you guys’ thoughts on this and concerns. I feel like I’m dodging the real questions we’re trying to ask. Is there really an influx or have we missed these diagnoses into adulthood, particularly autism and ADHD? And is it really being missed out that much? Statistically, I feel like maybe that can’t be true but at the same time, we get a lot of these calls. How do we handle this? How can we do good for our clients?

Dr. Stephanie: Well, we know from the Facebook group. And I know from my consult work as well, that the five of us are not the only ones having this conversation. This is a conversation that every single person who’s listening right now is having with their colleagues or in their own head, or in the group of like, how do we answer these hard questions about [00:55:00] diagnosis, diagnostic accuracy.

The position that I’ve come around to is that people will contact me and say, like, I’m really eager to get this diagnosis. I try and take the pressure off of that and say, we’re probably going to get the diagnosis wrong. Just statistically based on what clinical judgment says, the research on critical judgment, we’re probably going to get the diagnosis wrong or slightly wrong or not be complete enough. But if you do a thorough and empathic and deep evaluation, you can’t be wrong about what the client needs.

You might be wrong about the actual name of what’s going on for them or you might miss some of the processes going on, but if you do your evaluation right, you can’t be wrong about what they need to move forward. The new story that they need, the roadmap that will help them move towards [00:56:00] solving some of the problems that they have in their life. And so, I’m trying to let go a little bit of the question of being right because for me, really that’s for my own ego of being right and having figured out what’s going on and more about, well, what does this client actually need?

Knowing that they have diagnosis X, they could have found that online and then read a book with all the recommendations for diagnosis X. That’s not enough. They need this roadmap and this story that helps them move on to the next step. And so that’s what I’m trying to focus more on.

Dr. Chris: Absolutely. I have that exact conversation with people during my intakes, which I’ll have 15 times next week, unfortunately, and then I’ll be on vacation, but we worked so hard for diagnosis. In my feedback sessions, I talk about the diagnosis for 30 seconds because it only fuels what happens next. And I think that part of our job is to educate folks through this [00:57:00] process that, that diagnosis only means as much energy as we give it as a society because everyone says, oh, I have this, I’m an ADHD or I’m this I’m blah, blah, blah, whatever. And that’s only so good as what do we do next?

And my feedback sessions are talking about data for 10, 15 minutes depending on how much engagement there is. We talk about the diagnosis for 30 seconds. And we spend a tremendous amount of time of like, what’s next? What other resources do we engage in this process? Who else can we pull on board? Who else do you already have onboard that you’re wasting your time and energy and money on? How do we have this discussion rather than about how do we effectively utilize everyone’s resources, time, energy, money, all of those things?

I’m a big fan of energy management. And I just see that translating into the work that I’m doing with folks moving forward. And it’s funny because I’m a stats mind, that sounds weird to say because it’s been so long since I’ve even talked about it, but I love data so much but we only use it just an [00:58:00] infinitesimal amount in our work. We’re really setting people up for success and we’re just using that data to provide that using our own clinical judgment along the way.

Dr. Laura: What do you do though, with the person that is fixated on the diagnosis?

Dr. Chris: I had this conversation last week and it got escalated. This person was pissed off. They’re like, “I have ADHD” and I was like, “You totally don’t.”

Dr. Laura: It doesn’t feel good at all.

Dr. Chris: It’s 2021. We all feel like we have it. There’s no evidence to suggest historically. You’re not meeting symptom counts. The intensity and the impairment are not there. Just ran through all of these reasons based on the DSM, showing them the DSM on my camera at one point. And they’re just pushing back. And I said, so let’s pretend I’m a radiologist. And I see something that’s abnormal on a screen and in some imagery and you want me to call it cancer when I don’t think it’s cancer? I’m not going to do it. It’s going to do you harm in the long run. This is something else.

And I think that our most efficient use of everyone’s energy here is to [00:59:00] address the anxiety that’s in the room. Let’s first get all of us, me and you down from a 10 to a 6. And let’s talk about this more objectively that treating you with an anxiety disorder with stimulant medication is going to be pouring gas on fire right now. This is going to do harm and I’m not going to go down that route. And so sooner or later, I think when you just use these different avenues of understanding. It helps tone it down a little bit, but people are still pissed off because they’re so convinced that they have that diagnosis.

Dr. Sharp: It sounded like a broken record here, but it’s, again, a process piece. So, in that moment I’m like, What is happening for this person that it is so important to have this diagnosis and trying to get some questions around that and pull the therapeutic part into it, into the feedback and really connect with whatever part of them is [01:00:00] desperate to have that diagnosis. What would that mean for them? What’s it mean to not have it? Does that rewrite their life story? Are they having an identity crisis? Who knows what’s going on, right?

Dr. Andres: Yeah. I learned way early on in my career that I want to figure that out even before we even do the interview. I had a bad experience with that because I didn’t figure it out, what does it mean to have this diagnosis? I won’t get into it now, but just asking, talking it through, like how would this explain things for you? What if I told you this wasn’t it? I think Stephanie likes to ask, what’s the worst thing I could tell you and those kinds of things, and to really get to the bottom of it so that they understand that I really care about their struggles. [01:01:00] Not that I get the label, right?

And then I get a sense and we could have an honest conversation, direct conversation, like, okay, if you just want the label, I’m not the person to give you that. There are a lot of people that could help you with that. And maybe I’m wrong. Maybe I’m just not the person who’s fine-tuned enough to your specific struggles and that’s okay. And so that’s how I approach it.

And one thing that’s been helpful to me, I’ve been conceptualizing a lot of things from a trauma perspective. Just thinking about this past year, like that’s one thing we all have in common. We just went through some pretty major trauma, I would say. And I’m talking about, there’s a lot of debate on what that term trauma means. I’m just talking about trauma and in terms of having this lived experience [01:02:00] and this reaction and emotional reaction to this experience. But that’s really changed the way I’ve been working. I’m like, okay, how is this explaining what this person’s experiences have been? And just thinking through like adverse childhood experiences and all that stuff.

And that’s helped with this kind of referrals, helped my clients really understand, of course, you’ve been struggling, of course, this is the way you’ve had to survive. And that’s a lot of trauma language. This is what you needed to do to help you survive, but it’s not working anymore. And we’re trying to figure out why it’s not working and what’s a better alternative. And I’ve been thinking a lot about that. And then the pandemic is a gateway to that. Yeah. We know that now you’ve been faced with even more trauma and these things are coming up. Let’s talk about that.

Dr. Chris: Have you guys been dealing with all of this over the last [01:03:00] 18 months?

Dr. Stephanie: The trauma?

Dr. Chris: Yeah. I can say we all have a collective experience but as clinicians, we haven’t really had any time off. I was just having this conversation with my wife this morning. This whole idea of burnout and being bruised over the last few months that we in the medical field and as healthcare providers, we pivoted very quickly because we could. And so we didn’t get the corporate two-week vacation. When all the states shut down, we didn’t get all these things. And we’ve been on go for probably over ago for the last 15 to 18 months. I’m curious to how you all have been handling those things, or if you’ve been handling those things.

Dr. Andres: I’ve actually taken more time off than I ever had in my entire life. It’s been weird. I think I said this last time is that there’s this quote that the pandemic exposed a lot of our underlying conditions. If you did not like your house before, or you definitely do [01:04:00] not like it now. If you do not like your spouse before, that all comes up.

Dr. Stephanie: Worst Dr. Seuss’s book ever.

Dr. Andres: I know, right.

Dr. Sharp: Oh, man.

Dr. Andres: Yeah.  And for me, the pandemic exposed how hard I was working, how much I was taking work home, and how much I was missing out. I’ll try to share this experience without getting too emotional. One of the things I’ve been up to is I’ve been doing some training in trauma and EMDR, which I still don’t understand. Anyone out there wants to talk to me about it, we could talk. I was totally skeptical but then after this training, I’m like, what is going on? It’s like voodoo magic. But we won’t get into it because this is about testing. But I had this experience where [01:05:00] in California, we had a recent shut down because of the holidays, and then I had to watch my kid for a week. And it reminded me of early on the pandemic where I had to watch my kid and work during his naps. And it was just overwhelming.

Anyway, through this training, you do your own EMDR process, whatever to process, whatever mini trauma that we went through. And I had this memory come up of my kid walking to me on video. I have this on video. It is one of my favorite videos of him just walking for the first time. And it was really cute because he’s the cutest kid in the world, obviously. But then this realization came that I would have never had this video of him walking to me if it weren’t for the pandemic. I would have been at work [01:06:00] editing a million reports. Now you’re trying to squeeze in as many intakes as possible and all this stuff. And I would have missed out on this moment when he was walking.

How many people would get that experience of videotaping their kid walking in the middle of the day? And it was this profound experience I had. And it’s really shifted the business and the income. It is important but for me what’s important is why am I doing this is to help my clients, to help my family, to support them. And also ultimately, I want to be there for them. And the pandemic has really exposed that for me.

And so, then we’ve taken more time off than ever. I’m more present for my clients doing better work than I ever had. So it has been weird. It’s been weird for me. I’m not used to this, especially from a [01:07:00] cultural perspective, it’s all about like, I got to work really hard all the time and move to the next step. So it is a long answer to that, but yeah, I’ve actually taken more time off. It’s weird.

Dr. Sharp: Well, I don’t think I can match that meaningful experience. My kids have been walking for a long time and now they’re just shouting more than anything at me, but similar experience. We took probably three weeks in November to do a road trip from Colorado to Arizona and stayed with my mother-in-law during that time and had Thanksgiving with her and everything.

In the past, even though I’m always focused on vacation and time away and that sort of thing, I would have never said okay to leaving for three weeks. That was never really an option but we did it.  [01:08:00] We pushed. My wife, thankfully she pushed me to just give it a shot and it worked. It wasn’t terrible. It was really nice. And now I’m trying to carry that forward to think, maybe we could do that again. Maybe we do that this fall. Maybe we do that over the summer. It just opened the door to what’s possible in terms of slowing down and taking a little time away. So, I’m in the same boat.

Dr. Andres: I’m also realizing as I say this, we’re all in private practice and the people who work for agencies are like, well, what do I do? And so, I don’t want to discount that this might not be the situation you’re in. So people listening, I’m sorry.

Dr. Sharp: A good point.

Dr. Stephanie: Well, I think for me, I’ve been thinking a lot about… personally, I’m a little bit on the struggle bus right now. Like right now is a difficult time for me. I’ve had a lot of deaths [01:09:00] in my family and things like that. What I’ve been thinking a lot about is the experience that I think so many people, not just in our profession, but just so many people are having right now, which is that life is really hard.

A lot of times we only see the highlight reel of everyone else, and we don’t see that everyone is struggling and that it’s hard for all of us. We can all walk around feeling why can everyone else adapt and function and manage and I can’t. What’s wrong with me? Why do I feel so different?

And it’s really helped me empathize with that question that I think a lot of our clients are coming in with of like, what’s wrong with me that everyone else seems to manage? And it’s given me a lot of empathy for like, there’s nothing wrong with you. Life is just really hard or there is the usual amount of stuff wrong with you. None of us are paragons of virtue [01:10:00] all of the time. And really just empathizing with that question that I think a lot of us even just wake up with of like, why is this so difficult all of the time, or why does it feel like there’s something wrong with me? And it’s helped me get in touch with that a little bit more.

Dr. Chris: I think that speaks so highly to like how our clients are showing up too. These people that are coming to us rather, it’s like, damn life is hard right now. And it’s hard for everyone. And because it’s been going on for so long, I think that I’ve witnessed a significant increase in the intensity of the presenting stuff. And fortunately been reflective enough because people force me to be reflective in my life that I can see that I’m also adding intensity to my own stuff, and then projecting that onto their stuff and saying, oh, it’s so intense. It is intense and we’re also adding everything to everything and we have these magnifying glasses all over the [01:11:00] place.

So the reason I asked that question y’all is that I don’t know how to handle all this stuff. This has been a rough year. I hope that folks listening can also hear y’all aren’t alone. There’s a lot of people struggling out there. Even as clinicians who have to have their shit together, who have it together between 9 in the morning and 6 o’clock at night, and then go to bed at 8:30 and wake up at 8:30, things are tough.

Dr. Stephanie: I think about you a lot, Laura, like bandaging all this while being in a place that’s new to you that you really haven’t even gotten to set down roots because of COVID. How has that been for you?

Dr. Chris: And snow.

Dr. Laura: It’s been hard. And the stupid weather is acting down. It’s very hard. I need some heat. How have I managed? By the seat of my pants Like when we ask questions about [01:12:00] what are your goals for the next six months? I’m like, still be here, still be doing this, like beyond the treadmill.

I started to go to therapy because it’s hard. I don’t know. You hold it together for your clients, and then there’s nothing left over afterward. And there’s so much empathizing with like, your kids are home. You’re still working. Oh my God your husband’s still working too. And your kid has special needs. Oh my gosh. I can’t even imagine like, just layer upon layer for everybody right now. It’s just hard. Everything is hard.

Dr. Chris: Whoever came up with the #thestruggleisreal five years ago, I wonder what they think right now?

Dr. Stephanie: Little did they know.

Dr. Sharp: Right. I [01:13:00] finally figured out that the answer is not just to keep working and try to be more productive.

Dr. Laura: No. 

Dr. Sharp: That’s not the answer.

Dr. Laura: It’s not.

Dr. Sharp: Well, that’s my default. When things get hard or I start to feel stuff, I’m like, let me get some things done and maybe start a new project and take on a bunch of things that I don’t need to actually.

Dr. Stephanie: That’s always when I decide I need to learn Japanese, right then. That’s my way of coping.

Dr. Sharp: Totally.

Dr. Andres: What were your guys’ hobbies at the beginning of the pandemic? You know that first few weeks when everyone’s like, oh, let’s bake bread and learn new martial arts and learn how to do construction. I don’t know, whatever.

Dr. Laura: We did yoga for like two seconds, the whole family, and then like two seconds. That was that.

Dr. Sharp: Nice. Well, I decided to do two [01:14:00] podcast episodes a week, which we’ve seen where that’s ended up.

Dr. Laura: What’s happening in your world, Jeremy? What’s going on?

Dr. Sharp: What is happening in my world? I have gotten myself too busy. I am not taking my own advice. So over the last, probably 2 to 3 months. It’s just on all sides.

I’m in the process now of unwinding with my coach/therapist. Why now? And why are you making these choices? I took on too much clinical work, committed to two joint projects that I probably don’t need to be involved in. My kids are super busy with their sports schedules. It was just poor timing all around. And these are all opportunities. [01:15:00] So it feels strange to complain, like, oh, I’ve taken on too many of these really amazing things that so many people would probably want to be doing but that’s where I’m at right now. So I’m super busy. I’m working on the weekend this weekend for the first time in I don’t even know how long, so it’s not great.

Dr. Chris: Do as I say, not as I do, right?

Dr. Sharp: Yeah, totally. Well, there’s that part too. I’m feeling fraudulent because that’s not practicing what I preach. So that’s a layer as well that just gets mixed up that makes things hard.

Dr. Stephanie: Well then, what advice would you give to someone else who is having that same problem?

Dr. Sharp: Right at this moment? Pprobably to be kind to themselves and work through it and use it as a [01:16:00] learning experience to shape future behavior.

Dr. Andres: So what measurable steps are you going to take this week, Jeremy?

Dr. Sharp: Oh Christ. Stop. Who’s next?

Dr. Stephanie: But that does bring up the point of self-compassion and how hard that can be. We talk to our clients about it but how hard it can be to actually apply it to ourselves. Like I’m feeling so much compassion right now for all of you guys, but it’s so hard to direct that inward. Sometimes we really do get on this treadmill and don’t necessarily give ourselves credit at grace and all of those things for the stumbles when this treadmill was going too fast.

Dr. Andres: Do you think that’s unique to assessments psychologists/testing psychologists?

Dr. Stephanie: I think it’s unique to this group. No, I’m just kidding.

Dr. Andres: Probably. Well, I’m just curious of your thoughts [01:17:00] because I come from more of a therapy background where it’s encouraged. I don’t know how many people actually follow through with it. I know therapist burnout is huge or really high. But it’s encouraged to go seek your own therapy. And I wonder for those of you that do primarily just assessment, I’m curious, your experience of that and like how much that’s encouraged, where does that fit in doing your own work?

Dr. Stephanie: Well, I want to make a distinction between self-care and self-compassion. We’ve been talking a lot about self-care, but for me, it’s ended up being like this to-do list of other things that I’m not doing. Like, oh, I’m supposed to be somehow making time for my own therapy and going for a walk and meditating and doing a gratitude journal. And it’s just more things that I’m not failing at. And I want to shift the conversation at least for myself more to actually [01:18:00] self-compassion, grace. Recognizing that I am doing the best that I can more than I want to talk about like self-care and chores that I need to do. Does that distinction resonate with anyone else?

Dr. Sharp: Oh, for sure.

Dr. Andres: Absolutely. Now, I’m just working on it.

Dr. Sharp: That’s good. This is maybe related. I think it is. My coach said it really simply, she said something like the world doesn’t need anyone feeling any more shame. The world doesn’t need any more shameful people right now. That doesn’t help anything. So just bend your brain around to be self-compassionate.

Dr. Andres: Is that evidence-based, Jeremy though?

Dr. Sharp: I’m sure it is. Yeah.

Dr. Chris: I think this is where imposter syndrome plays a significant role though because I’m doing the best I can and what if it’s not good enough? What if it’s like [01:19:00] negligent? What if I’m just really screwing up right now? And so I think that we have to try to balance that perspective. It’s a constant rebel I think we face as clinicians because we have these licenses and we have these degrees and we have all these things. The big brother is always watching. We’re still human. We’re making mistakes and all this stuff. And then we add this extra layer of, oh God, I’m not good enough. And now here’s the opportunity that I’m going to prove that I’m not good enough because I didn’t do this or I didn’t do that.

Dr. Stephanie: I think some of that might be a shame talking a little bit. I think our idea of the level at which we’re failing sometimes when we’re not doing our best work, I often tell people not every report can be your best report, just statistically that doesn’t work. Sometimes you’re not going to be able to do your best work but if you have… none of us are really going to fall much below a minimum but that breaks up the whole idea of [01:20:00] like other professions do this better. Like physicians have impaired physician programs for when you need help and you realize like, wow, I’m falling below even my minimum, and that’s the best I can do. And how do I get help for that? We don’t have that conversation in our field. The idea is you’re just doing a 100% of the time.

Dr. Andres: I read this quote. I think I shared it with you guys before that if you were at your best all the time, that wouldn’t be your best. That would be your average. And I know for those that like sports analogies, my Lakers just got knocked out of the playoffs last night, but even the best shooters in the NBA miss half their shots. And just thinking about that, like what are we capable of? Having that compassion. That’s really hard.

Dr. Chris: That is the whole inner critic idea. We’re just so hard on ourselves all the time.

Dr. Andres: Oh, why can’t I have [01:21:00] self-compassion?

Dr. Chris: I’m just not good at it. Damn!

Dr. Laura: I know. You say that, and I’m like, “Oh my God, what if I’m failing half of the time?” I fail a fair amount of time.

Dr. Sharp: But you can. Here’s the thing. So we’re drifting into chicken soup for the soul territory here, but it’s not what you do most of the time. We’re all going to make mistakes. It’s the next thing. What do you do after you do the wrong thing? And that I’ll anchor it in research to get away from some of this chicken soupy stuff.

There is good research around malpractice in medicine and people getting sued, really being dependent on how the physician responds when confronted with their mistake. I keep that in my mind a lot, actually. We’re going to mess up. We’re going to fail or whatever you want to call it. But [01:22:00] it’s that next thing. Do you stay in that shame cycle or defensive cycle or whatever and get yourself in bigger trouble or can you be gracious to yourself and others?

Dr. Stephanie: That research is fascinating because they’re literally talking about people who’ve had medical errors like the wrong leg cut off and still ended up not suing that physician if their physician does a good job of responding to the mistake that was made. And so, when you put it in that context, I haven’t cut anybody’s wrong limb off. I feel pretty good about myself.

Dr. Sharp: We’re all doing great.

Dr. Andres: So it comes speaking from a therapist. I’m thinking about at least the way I conceptualize cases is the repair is much more important. And that’s the intervention in itself and how we could use that in assessment. So in therapy all the time I’ll tell clients, I’m going to mess up and if you feel comfortable and you [01:23:00] notice it, let me know and we’ll work through it. You don’t get to do that elsewhere. That has been your experience that people will dismiss you when you say that you were hurt or something like that.

Dr. Stephanie: […] My husband and I as well. We often talk about like, we’re going to break it all the time. It’s all about how we repair it. We can not drop things emotionally and break some things. It’s not about trying to avoid breaking things any more than basic. It’s about how we come back together and repair. It’s beautiful. But I may have interrupted you, sorry.

Dr. Andres: No, that’s where I was going. Just the idea of that process is more important at least research-wise and just experiential-wise, admitting to the mistakes and trying to resolve those [01:24:00] missteps if you will. Honoring those missteps.

Dr. Laura: That brings up, like in the Facebook group, the discussion about did I miss the diagnosis and what do I do with that? And that gets so tricky because you can put your product out there and then do your backpedal and say, oh yeah, maybe I’m missed that or go see someone else.

Dr. Chris: Good to see Jeremy Sharp.

Dr. Stephanie: Well, Laura, in your practice you must have a lot of people who come in looking for a very specific diagnosis and you must have some of those uncomfortable feedbacks that we’ve all had where you’re telling something new that they don’t want to hear. So when we were talking about that earlier, I was so curious about what your process is because it must come up for you sometimes. And you can [01:25:00] deflect it with a question if you want. I’m honestly just curious here.

Dr. Laura: Yeah, it happens more than I would like it to happen. It is super uncomfortable and really hard. Hopefully, that groundwork that we’ve been talking about was all laid. And hopefully, we’ve talked about what would this be like for you, but occasionally that has happened. It’s uncomfortable and unsettling. There are cases where I’ve thought consultation or feedback from other people and tell the person, you can’t say it to them. Oh, I talked to three colleagues and they all think you’re not autistic. It’s not just me. Trusting that you put in the work is all you can [01:26:00] do.

Dr. Stephanie: I think it’s so lovely that we’re having this conversation in public because I think everyone who is listening has had that difficult feedback or 15 difficult feedbacks recently where it’s been very uncomfortable. And we may think that we’re the only person that our patients are pushing back against and that’s getting our imposter syndrome activated. And I think it’s so important to be saying like, no, every psychologist who does testing or gives feedback to clients in any way has had that struggles with it, is maybe having it more now and feels these ways.

Dr. Sharp: Can I tell a shameful story to validate and normalize some of this experience? So this was probably 2 or 3 years ago. I evaluated a little girl for autism. I think she was, let’s just say 3, maybe 2.5 years old. I did not diagnose her [01:27:00] with autism and I was relatively confident in that and whatever. I did the feedback. It was fine. The family goes on their way.

I get an email from the mom maybe a year later, let’s say. She was just checking in to let me know that they had gone to our local children’s hospital and the girl had been diagnosed with autism. She just wanted to send me an email in hopes that it would increase my awareness or help me rethink my assessment process to diagnose autism in girls. And that was so difficult. The tone, the whole thing, it was the whole thing. So I just want to say that happens and I still don’t think she has autism.

Dr. Chris: It was handled well, though. [01:28:00] It was handled very well.

Dr. Sharp: Well, sure.

Dr. Chris: Maybe not.

Dr. Sharp: You mean like from a parent’s side?

Dr. Stephnanie: Who is handling it well?

Dr. Chris: Well, I don’t know about how Jeremy’s handling, but I would appreciate a parent doing that instead of saying, you did this and you’re wrong and we’re going to the board and blah, blah, blah, blah, blah.

Dr. Sharp: Oh, sure. Yeah, that’s preferable. I couldn’t tell, but it was challenging.

Dr. Stephanie: Just listening to the story, you feel like that’s shame rise like you got it wrong and you can feel like the only person who’s missed it and it can make you question everything you know about autism or autism and girls or assessment in general. It’s such a horrible feeling. And I think we need to talk about it more as a profession and more about how it happens to all of us and more about…

Also [01:29:00] realizing that maybe you did get it wrong, maybe you didn’t, but I bet your recommendations were spot on for this family. And they must have trusted some part about it that she wanted to, there was part of her that wanted to shove it back in your face but there must’ve been some trust that she’d knew she could protest to you safely. And she knew she could give you this information safely. So there has to have been a part of it that really was valuable for them.

Dr. Sharp: That is a very kind reframe. I appreciate that.

Dr. Stephanie: I don’t even think it’s kind. I think we need to recognize, I think we’ve all been saying that what we offer is not just the diagnosis, and when the diagnosis is wrong or not what the parents wanted, that can feel like the most important thing. I feel like a bit of a broken record that I just keep saying, it’s not the most important thing.

Dr. Andres: Yeah. And just to jump on that, [01:30:00] the one experience that jumps out in my head is not that I necessarily think I got the diagnosis wrong but I missed an underlying secret question of like, why am I struggling, is this my fault, that kind of thing? And looking back, maybe the report didn’t reflect that or the feedback didn’t reflect that and we didn’t assess for that part, those questions. And so I was all confident with my diagnosis but I missed the point of the evaluation. I’m not saying that’s what happened with you, Jeremy, but what jumps out at me is, my client’s reaction to me wasn’t like that. It wasn’t like I felt safe enough to bring this to your attention. It was like, “No, you did harm to me.” That’s how they felt. So I’ll never forget that. I’ll learn from that experience.

Dr. Sharp: Yeah. Well, and I think another humbling [01:31:00] related experience, I think all of us have been doing this long enough where I’m sure you have evaluated kids or maybe even adults multiple times, and you see them at 4 and then at 10 or 7 and 16, and it’s like, ooh, this is way different than what I thought the first time. And both evaluations are probably equally valid based on what’s going on at that moment, but the first several times that happen, that is super humbling to go to the parents and say, you know all that I told you back then and those diagnoses that we were so certain about, that’s going to change a little bit.

So I’ve been on the flip side too. I’ve had to go back and be like, yeah, I think maybe we missed it that first time around, or it was wrong or you were right or whatever it is, like processing the changes that your [01:32:00] kid doesn’t have an IQ of 146.

Dr. Stephanie: Scoring error.

Dr. Chris: I think it’s how you handle it though. You can try to force the story onto the previous hypothesis, or you can say, hey, we messed that one up. What are we going to do about it now? I think there’s this way of like I have to be right, so how do I make it right? Instead of, well, maybe I wasn’t so right. So how do we now move forward and make it beneficial for everyone involved?

Dr. Sharp: Well said.

Dr. Laura: It’s interesting too. I have had a kid recently. This is in the third time I’ve seen them. So the first time very small, some genetic stuff, a syndrome going on but the autism layer on top of that, and it was a PDD-NOS diagnosis. And so then the second time that I saw them, it was not a PDD-NOS because that wasn’t a thing anymore, obviously. [01:33:00] And so it reflected in the diagnosis like autism spectrum disorder, formula, PDD-NOS, like to try to move them into that. And then this time it’s ASC level three. It’s just interesting to see the teams and the diagnostic way that you’re labeling and the conceptualization. And then also this time we have to have the talk about things that aren’t getting better, the IQ piece we need to address now, and add on some additional ID, so it’s not easy. This job is never easy.

Dr. Sharp: It is not easy.

Dr. Andres: Why do we do this?

Dr. Stephanie: Because of what Chris was talking about.

Dr. Sharp: Great question. Well, two of us are drawn to not do it anymore.

Dr. Andres: That’s like the more we listened to this podcast, Jeremy, the more we [01:34:00] are discouraging people from the testing.

Dr. Sharp: It’s the anti-testing psychologist.

Dr. Stephanie: It’s because of the power of a story for a family. Power of a story and a roadmap. We all were talking about that moment in the feedback when you’re able to connect with the person, validate their secret questions, validate their experience, empathize with them, and help them move forward when they’ve been stuck. I think that’s what keeps us all here because it can’t be writing the reports.

Dr. Chris: Not at all.

Dr. Laura: I think it’s the colleagues.

Dr. Stephanie: It can’t be the colleagues either.

Dr. Andres: Personally, it’s the essay composition on the WIAT for me.

Dr. Laura: Yeah, scoring it.

Dr. Sharp: It’s keeping me in the game. I love it.

Dr. Sharp: How many times can you say desk in a paragraph or a question? That’s the worst thing ever.

Dr. Stephanie: Luckily they changed that in the new one.

Dr. Andres: Thank God. 

[01:35:00] Dr. Stephanie: I know, right? Oh my goodness.

Dr. Laura: But it still feels weird when you say it because all I can think in my head is desk, please.

Dr. Chris: Many syllables are desks.

Dr. Sharp: That’s great. Well, we are starting to get close time-wise. Two hours goes by fast when you’re having a conversation. I feel like we’re all in different places and maybe some not-so-great places. And I really like that we can honor all of that and just be real and say like, hey, things are not 100% peachy right now. I don’t know. I don’t want to be too pollyannaish, but I am curious what’s happening in the future, are there things that people are excited about? What are those glimmers in your life right now? What [01:36:00] is keeping you going? And as everyone thinks…

Dr. Laura: I’m going to Florida.

Dr. Sharp: Yeah, you’re going to go to Florida?

Dr. Laura: Yeah, in two weeks.

Dr. Stephanie: Permanently?

Dr. Laura: No, maybe, I haven’t thought about it.

Dr. Stephanie: Fair enough.

Dr. Andres: Start thinking about it.

Dr. Laura: I want to move on. That’s what I need in my life. Just like the vacations, time is marching on, the kids are home, things are shifting. So, that’s what keeps me going.

Dr. Sharp: I love it. When the summer hits, I generally just get hypomanic, maybe even like a mannequin. I’m a hot weather person so I’m just excited to be getting outside. We’re doing a little vacation as well. We have two vacations actually coming up this summer. We’ll get to see family again after having not seen [01:37:00] them for 18 months. Y’all are sick of hearing about my kids, I think, but they are just so fun. They are both just having so much fun. They both play soccer and we’re looking at a nice Summerfield of watching soccer games which I love. People are like, oh my gosh, it takes too much time. And what are you doing? But it is so enjoyable for me.

Dr. Andres: You’re American, how could you like soccer?

Dr. Sharp: Yeah, it should be football, right? That’s the American sport.

Dr. Andres: Yeah, but soccer is football everywhere else. So football is always the right answer no matter what.

Dr. Sharp:  What about the rest of you? Anything. And maybe the answer is no. That’s okay too.

Dr. Chris: My wife and I went to a wedding without our kids for the first time, two weeks ago, like outside. And it was like a beautiful night out in the country, [01:38:00] Southwest Michigan. And it was so reinvigorating for us because we haven’t had a date night in 18 months. We just have not been able to do that. And so we have a few vacations planned over the summer which is really exciting now that we can feel normal-ish again. And we have like these reprieves. One of our vacations this summer is with no kids. So we’re probably not going to know what to do with ourselves. Like who is this person that I’m on vacation with but we’re really looking forward to that siesta from the chaos.

Dr. Sharp: It’s so funny. My wife and I rarely go on kidless vacations. It’s like once every 2 or 3 years or something. We always joke because we’ll get a day into it or so, and there’s always a moment where we turn to one another and we’re like, I do like you. This is awesome. You’re pretty cool. I’m glad we’re hanging out. Awesome. I’m excited for y’all.

Dr. Stephanie: I’m changing everything [01:39:00] about my life. We’re going to sell our house we’re getting rid of everything we own. I’m changing my practice. We’re buying a new RV. People who know me or who’ve ever consulted with me will know that sometimes you’ve seen me inside my office, that’s actually my RV. And so we travel around the state and country a lot and we’re going to be doing more of that. And we’re thinking of maybe even living inside our RV. So we’re selling everything we own and buying a tiny house on wheels.

Dr. Laura: So you could totally do consultation groups everywhere you stop, in-person consultation with Stephanie Nelson.

Dr. Stephanie: Tell me how fun that will be?

Dr. Sharp: And then your RV is a business expense and you don’t…

Dr. Chris: Here we go. Now we’re talking.

Dr. Stephanie: Yeah. This is why I love this group. The business possibilities.

Dr. Sharp: And you also somehow parlay it into becoming TikTok [01:40:00] famous. I don’t know exactly how but I think it’s in the cards.

Dr. Stephanie: Yeah. The van life influencer.

Dr. Sharp: Sure.

Dr. Andres: Are you guys on TikTok at all?

Dr. Sharp: I have browsed TikTok. There was a week because I have older nieces and nephews and so like they’re getting on TikTok. So I like watching but I browsed it for a week and I was like, I cannot do this. It’s truly addictive.

Dr. Laura: I feel too old for it.

Dr. Stephanie: Me too.

Dr. Laura: I don’t know.

Dr. Andres: It’s weird because I’m pretty tech-savvy. So I usually don’t feel old about anything like tech-wise, but now I get it. It is one of the things I know I don’t get into. But speaking of things I’m looking forward to, I’m launching my new TikTok channel. I’m just kidding.

Dr. Laura: It’s called, Get off my lawn.

[01:41:00] Dr. Andres: If I had a lawn. We live in a tiny condo, so thanks.

Dr. Laura: Sorry.

Dr. Andres: Thanks for opening that wound.

Dr. Stephanie: Maybe you can start getting your son on TikTok.

Dr. Sharp: Oh yeah. That’d be awesome.

Dr. Sharp: Never too early.

Dr. Andres: Yeah. For me, I just got some vacations coming up. The thing I’ve been getting back into my life before psychology was graphic design and video. We were on vacation maybe a month or two ago, and just pulled out my little mini video camera device, and started recording and editing some stuff quickly. And I was like, oh man, I miss this. It’s more fun when you’re not feeling pressured to do it to pay the bills. So I’m looking forward to that and thinking about how that could be integrated into assessment and clinical practice, I guess. I don’t know.

People always [01:42:00] ask me about technology. Here’s a common question people ask, it’s like just small things like how do you set up your Google workspace for HIPAA compliance? And maybe I can make a video about that, but those are always dreams I have that never really happen. So we’ll see. But now that I threw that out there, maybe I have to do it now.

Dr. Stephanie: I keep trying to get you to run a business where you help other testing psychologists figure out the technology and you just walk them through it and you show them how to do that. I think there’s a huge need for that. And so I think everyone who’s listening should call you and consult.

Dr. Sharp: Link in the show notes.

Dr. Chris: Ready, buddy. Get ready.

Dr. Stephanie: You’re so good at it. I think it would be great.

Dr. Sharp: Well, that’s a nice full-circle moment, I think. Thinking outside the box, parlaying our skills into something else [01:43:00] that’s fun and not necessarily straightforward. So there you go. So this is awesome. Again, I like this. Hopefully, we can do it again in another few months. I just appreciate all your time and everything that you’ve put into this. Thanks to you all.

Dr. Chris: We should do a live recording at the next conference we’re at.

Dr. Sharp: Hey, that is an idea.

Dr. Andres: Very interesting idea.

Dr. Chris: I made the whole conversation an interesting one. So I’m so proud of myself.

Dr. Sharp: Nice work.

Dr. Chris: It’s the law of averages. Now we’re in the normal range within normal limits.

Dr. Sharp: Nice. Well, on that note, yeah, maybe we’ll see one another at a conference here sometime soon. All right. Take care of y’all.

Dr. Andress: Bye.

Dr. Sharp: Okay, everybody. Thank you again for tuning in. Like [01:44:00] I said, in the beginning, send me any feedback you might have about this happy hour format. I got to say, and I’m trying not to bias any feedback but these are really enjoyable I think for the five of us here on the episode. Great to connect with one another. Great to have some conversations around some deeper testing topics and personal topics. I hope that you enjoy it as well. But send me some feedback, jeremy@thetestingpsychologist.com.

I also mentioned if you were looking for CE credits as your license goes to be renewed, you can get CE credits for The Testings Psychologist podcast episodes, specifically the clinical episodes over athealth.com. Just search for The Testing Psychologist, and you can use the code TTP10 to get a discount off of any CEs that you purchase there, not just the podcast episodes.

All right, that’s it for today. Stay tuned for more [01:45:00] clinical and business episodes in the upcoming weeks. Take care y’all.

The information contained in this podcast and on The Testings Psychologist website is intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric, or medical advice, diagnosis, or treatment. Please note that no doctor-patient relationship is formed here, and similarly, no supervisory or consultative relationship is formed between the host or guests of this podcast and listeners of this podcast. If you need the qualified advice of [01:46:00] any mental health practitioner or medical provider, please seek one in your area. Similarly, if you need supervision on clinical matters, please find a supervisor with expertise that fits your needs.

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