447 Transcript

Dr. Jeremy Sharp Transcripts Leave a Comment

[00:00:00] Dr. Sharp: Hello everyone and welcome to The Testing Psychologist podcast. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.

Many of y’all know that I have been using TherapyNotes as our practice EHR for over 10 years now. I’ve looked at others and I keep coming back to TherapyNotes because they do it all. If you’re interested in an EHR for your practice, you can get two free months of TherapyNotes by going to thetestingpsychologist.com/therapynotes and enter the code “testing”.

This episode is brought to you by PAR.

PAR offers the SPECTRA: Indices of Psychopathology, a hierarchical-dimensional look at adult psychopathology. The SPECTRA is available for paper and pencil assessment or administration and scoring via PARiConnect. Learn more at parinc.com/spectra.

Hey everyone. Welcome [00:01:00] back. I’ve got two fabulous guests for you today. Dr. Emily Trittschuh and Jae Purnell are here to talk with me about gender-affirming neuropsychological assessment. We have talked about gender-affirming care on the podcast, I think in one other episode, but primarily through the lens of providing gender-affirming letters or support letters for gender-affirming medical care.

Today, we’re looking through a little bit more of a neuropsychological lens, so we are talking about things like what the literature says about brain-based sex differences, we talk about the role of test norms in gender-affirming assessment. We talk quite a bit about language considerations in gender-affirming assessment, and we touch on gender-affirming interviewing and report writing skills among many other things.

Let me tell you a little bit more about my guests and then we will jump to this conversation. Dr. Emily [00:02:00] Trittschuh is a Clinical Neuropsychologist and the Associate Director of Education & Evaluation with the VA Puget Sound Healthcare System’s Geriatric Research Education Clinical Center. She is a Professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine. She specialized in neurodegenerative disease and geriatrics throughout her career.

Her clinical work and research have been focused on the full continuum of cognitive aging – from dementia to healthy brain aging into the 90s and beyond. At the VA since 2008, she developed additional and complementary interests in the care of older veterans who are transgender and gender diverse and for those with PTSD and cognitive concerns. Her pronouns are she and her.

Dr. Jae Purnell is an early-career Clinical Neuropsychologist at the Center for Cognition and Communication in Manhattan, New York. He is queer and transmasculine. While his background has been [00:03:00] more generally in neuropsychological assessment of adults and older adults, his passion projects center affirmative care of marginalized demographics, specifically for his community and adjacent LGBTQ+ communities. His pronouns are he and they.

So this is a fabulous conversation. Like I said, we dive into quite a few areas of gender-affirming assessment and I enjoyed being able to spend some time with both of my guests. I think there’s a lot to take away from this conversation and plenty that you can apply in your practice tomorrow if you would like.

So without further ado, here’s my conversation on gender-affirming neuropsychological assessment with Dr. Emily Trittschuh and Dr. Jae Purnell.

[00:04:00] Hey, Emily, welcome to the podcast.

Dr. Emily: Hi, Jeremy. Thanks for having us.

Dr. Sharp: I’m glad to have you. I would love to do a little orientation to your voices before we dive into it. This is standard with two different guests. So if you could just say who you are, a little bit about what you do, we’ve already done the biography, so you don’t have to tell the whole story but just a little something to give people a sample of your voice so they know who’s talking throughout the interview. Jae, do you want to go first?

Dr. Jae: Oh, surely. My name is Jae Purnell. My pronouns are he and they.

Dr. Emily: Hi, my name is Emily Trittschuh and my pronouns are she and her

Dr. Sharp: Right. I’m excited to have this conversation with y’all. We haven’t talked a [00:05:00] whole lot about gender-affirming assessment on the podcast, and there’s always more to say, I think and it seems to be an ever-evolving area in our field. So thanks for being here.

I’ll start where I always start with folks, which is, of all the things you could spend your time and energy doing in this field or in this world, why spend your time and energy on this particular area? Emily, do you want to go first?

Dr. Emily: Sure. I’m a clinical neuropsychologist by clinical training. I finished up fellowship in 2008 and took a job at the VA Puget Sound Health Care System. In that job, it is a memory disorders clinic, early diagnosis of mild cognitive impairment and things like Alzheimer’s disease, I was [00:06:00] not prepared for working with folks who were not cisgender and had a veteran come and it kicked off for me an appreciation that professionally, I was not done growing. I needed to push my boundaries. I needed to educate myself.

There are some studies that show that the number of veterans who are transgender is about two to three times higher than if you just look across the general population. It’s a whole other topic to talk about why that might be the case but regardless, that’s a population that I have seen and I wanted to do better because when I went to the literature, there was really nothing there back then. This is like in 2009, 2010ish.

There wasn’t even much in the general clinical psychology literature, so some colleagues at VA Puget [00:07:00] Sound and I, we decided that we would write a paper calling out the issues and the lack of information. And so then my professional interests moved on from there. I’ve had the luck and opportunities to work with many other awesome folks over the years and try to push things forward a bit more and raise awareness and be an advocate.

I’ve also now in more recent years have personal connections more at the teen-adolescent end of things and that is definitely not the area of Jae’s or my expertise because we’re adult neuropsychologists. That is, of course, an important topic as well.

I think as someone who finished their training when I did, there’s a recent study that was published in 2022 [00:08:00] led by Anthony Carrero and I’m one of the authors on that where we did a survey of neuropsychologists and the demographics of the survey are that almost 98% are cisgender and over 70% are heterosexual. So these are people out there practicing.

However, when you ask people about their training, just broadly in LGBTQ+ health and neuropsychological assessment topics, people only had gotten their any training after licensure, and that was through their own efforts and actually about somewhere between 20 and 30% reported never having had any training at all in this area.

So I think that’s a big deal and is also why Jae and I appreciate you doing this podcast because the prevalence, sorry, I hate that I just used the word prevalence, population estimates for trans [00:09:00] folk and gender-diverse folk suggest that this can be anywhere from 0.5% of the population up to 6%, especially if we consider a broader category, it can get broader if we include folks with variable sex characteristics as well. Sometimes that’s referred to as intersex.

I’ve had fellow neuropsychologists serving my age range comment like I’m never going to see anyone who is gender-diverse or trans. I frankly think they may have already done so and they don’t even know it or they’ve somehow unwittingly sent them away with some messages in their website, in their materials, that made someone perhaps not even feel welcome to approach them as a provider. I think those are opportunities lost and I’d like to see that [00:10:00] changed.

Dr. Sharp: Absolutely. Yes. Well, you raised so many points that we’re going to dig into over the course of our conversation. I’d love to hear Jae, just for you, what’s meaningful about this? Why spend time on this for you?

Dr. Jae: I think early on, I recognized myself as Emily mentioned, one of the few transgender people who are working in this field, and though my professional interests have not gravitated towards working within my community, my passion projects have. So this is in service to my own community.

I think that I did my first poster on this topic a few years back, and in doing so, my impression of the literature was that it wasn’t getting good clinical information but that much of it was actually actively harmful. So I am interested in having a voice in the body of work that exists. I think it’s important for [00:11:00] marginalized people in professional and academic spaces to bring their lens to research and clinical practice.

And then two years ago, Emily and I connected, and I’d like to give Emily credit for this. She was actively looking for transgender people within the field who she could collaborate with because it’s part of her ethos to center marginalized people as well in this work. And since then we’ve been collaborating on different talks and educational pieces, and I found that the work that we do is very helpful to a lot of providers and I love continuing to do it.

Dr. Sharp: I feel so fortunate to have y’all here. I told you before we recorded when we first connected, I found your presentation on the AACN agenda for this year and I thought, oh my gosh, I got to reach out to these folks because the amount that we’ve talked about gender-affirming assessment on the [00:12:00] podcast is:

1. Very limited.

2. Not necessarily looking through this more neuropsychological lens.

And that is super attractive. Even the fact that we’re already talking about some of the research is pretty compelling and I’m looking forward to getting more of that perspective here as we go along. I think y’all bring a pretty unique perspective that’s both affirming but also grounded in research and there’s going to be a lot to dig into there. So I’m glad to have y’all. Thanks for being here.

So with this whole thing, maybe just kicking off with a discussion of language and what that might look like for our conversation and of course, for the broader practice of neuropsychology, where can we start with language?

Dr. Jae: We both led with giving our pronouns and I think in working with trans patients, that’s [00:13:00] one thing to acquire when interacting with somebody so you know how to talk about someone. And then also I think that the other point is just how a person identifies with their gender, and what gender descriptor they use.

We can talk a little bit about which kind of existing descriptors there are.

I do want to give the caveat, as we’ve done previously, that language within this community has evolved tremendously and continues to, so the language that we might use in this podcast might outdate itself in the time to come but I think pronouns and gender descriptors are the starting point for things.

Dr. Emily: Just as a sidebar, it’s one of the things that makes doing a literature search in this area challenging as well as the language has changed. And so while we definitely would never promote the use of clearly outdated language, if anyone does want to do their own deeper dive into the literature, you may have to use some of the older [00:14:00] potentially less positive, less affirming terms, aren’t inaccurate sometimes. So that that’s a challenge.

Jae, do we want to go over any, I already used the term cisgender without explaining what that is. I don’t think it’s uncommon that folks who are cisgender don’t know that they are cisgender because that is a gender majority. And that is when one’s gender ID, identification, matches the biological sex or at the very least, the genitalia that was presented to the doctor that pulled you out at birth or on ultrasound and identified it. So it’s a woman who’s assigned female at birth or a man who is assigned male at birth, and that actually matches with their gender identity.

Dr. Sharp: Great. Are there any other, I know there are others, but maybe just a little [00:15:00] broad stroke common language that we’re going to run into in gender-affirming care? We can cover as much of that as you’d like.

Dr. Jae: I will try to be brief because I know we have limited time, but there’s so much I can say on this topic. I will start from a simpler language to a more complex language. I do want to give the caveat that I think that this is important for psychologists to be doing to honor the patient in front of them. I also think that there’s reciprocal learning when we start to use different language to think about or describe people, it affects our perceptions of those people. And so being precise about the language we use is necessary and also helps the provider conceptualize the person accurately.

So to start, general pronouns, he/she. I think one that’s come into popularity also has been they/them as a singular pronoun, which we use routinely [00:16:00] but typically not to discuss a specific person after we’ve met them. I think those are some of the more common pronouns used. There are other neopronouns that are less frequently used. And then starting, a transgender man is a man who was assigned female at birth. A transgender woman is a woman who was assigned male at birth.

Two words that I think are used more frequently in the trans community are transmasculine and transfeminine. These words are more expansive because they describe identity along the lines of masculinity or femininity and they’re a little less binary than trans man or trans woman. For example, transmasc or transmasculine, which I use for myself, can encompass transgender men but also nonbinary people. That’s another important one.

One of the shifts that we’ve seen in population estimates has been due to the inclusion of different gender identities, including [00:17:00] nonbinary gender identities.

Dr. Emily: And gender fluid as well, right, Jae, in terms of thinking about there’s folks who are not just static in their gender identity as well.

Dr. Jae: Totally. When we give these presentations, we usually use the term TGD, transgender, and gender-diverse, to include people who are transgender but also just generally to be expansive and encapsulate nonbinary people who might not identify as transgender or anybody else who has gender questioning people but anybody who is not cisgender.

Dr. Sharp: Sure.

Dr. Emily: It’s better to say transgender and gender-diverse than not cisgender because then you are making it an exclusionary different than statement rather than a statement of who people are. Does that make sense? I think I’ve seen that [00:18:00] before. Oh, my patient was not cisgender. Okay. Is that helpful? I don’t think so. I don’t think they would say it’s helpful.

Dr. Sharp: Right.

Dr. Emily: Sorry to cut you off there.

Dr. Sharp: No, that’s an important distinction. I think that dovetails well with how we may be right in our reports too, we want to use more affirming language across the board rather than someone was not something that’s confusing or really complicated.

I see my job in a lot of my podcasts is to ask questions that people might be thinking out in the audience and sometimes that means asking what might be dumb questions but I’m just going to go for it and hope that someone out there is also wondering, but just quickly, talk about the difference between trans or gender-diverse and nonbinary. I’m sure that [00:19:00] there are folks out there who are like, well, what’s nonbinary even really mean? What do we do with that?

Dr. Jae: That’s a fantastic question. I think it’s so individualistic. I think that if you’re using interestingly, binary categories of trans and cis, most nonbinary people would fall into the category of trans because they do not identify with their sex assigned at birth or exclusively so but this is really individualistic. There are nonbinary people who the term transgender, it just doesn’t resonate for them. So I think that that’s a simplistic explanation, but it is also probably the one that exists.

Dr. Emily: Yeah. I think for people whose identities are strongly masculine or strongly feminine, whether they’re trans or cisgender, if you’re strongly masculine or strongly feminine, it may not be so [00:20:00] easy to imagine not feeling either of those strongly. And that could be nonbinary, that sense of that genderness is not the way it is for others.

Dr. Sharp: Right.

Dr. Jae: I would like to think about that we think about the spectrum of masculinity and femininity. Emily is hinting at this other spectrum that is highly gendered versus less gendered. And so for some people, there is a sense of high gender resonance in one or more ways, and for some people, there’s the absence or the dissociation of gender.

Dr. Sharp: Yeah, that’s a good way to put it. That’s easy to wrap our minds around, I think. I just want to name the other kind of variable out here that we’re not talking explicitly about but maybe [00:21:00] comes into this whole discussion is the sexual orientation question, there’s an intersection there of who you’re interested in as well as how you identify.

I don’t know that that comes into the neuropsychological process as much but I’m just naming another thing that comes into the discussion and maybe throws people off when we simple, clear, familiar labels and whatnot.

Dr. Emily: I am glad you’re bringing this up because this is important to know, and everyone should know it, whether you’re a neuropsychologist or not. And that is that historically, there’s been a real conflation of sexual orientation and gender, and they can become their different dimensions of who someone is or can be; [00:22:00] one can be cisgender or transgender and you could be gay or not gay or straight.

The sexual orientation is based more on, I’m just going to be blunt, who do you want to have sex with? Do you want to have sex with everybody? Do you have a particular affinity toward a different gender or not, bisexual, so there’s a lot of options? They run separately.

And so to make an assumption that someone who is trans is homosexual would be as what we currently in our society would think is as ridiculous as assuming that because someone is cisgender, they must be straight. They must be heterosexual. I think we pretty much are knowledgeable about that at this point. So does that answer it enough?

[00:23:00] Jae introduced me to this graphic, it’s called the Gender Unicorn, and I bet someone can google that and look up the Gender Unicorn. There’s lots of similar type graphics out there, but it’s a really nice visual for a reminder that there’s these different dimensions of gender identity, gender expression with that whole sex assigned at birth thing.

Sometimes people have sexual attraction that is different than their emotional attraction as well. So it could be something that if someone wanted to do a little bit more reading on, they could pull up.

Dr. Sharp: Yeah, absolutely. I’ll put a link to that in the show notes. I’ve definitely seen that graphic in the past, so it’s a good one. Thanks for talking through some of these things. I know it’s super basic but it’s all part of the picture.

Anything else language wise, at least here at the beginning of our discussion before we dive into some other [00:24:00] aspects?

Dr. Jae: I think that, you hinted at this and I don’t want to jump ahead, but when you are in the room working with a trans patient, this is one of the quickest ways to build or break rapport is with language use. And also as it pertains to report writing, the language that you use to refer to the individual or their gender should be reflective of the language that they use for themselves.

So thinking about language within the context of the end result and how a person will be talked about throughout the process, but I also think it’s imperative for building rapport, even if it’s for a quick assessment.

Dr. Sharp: Sure. Can I ask a nuanced question with that, that y’all may or may not be able to speak to? I work with kids primarily. I know you’re both adult-oriented folks, but the question that comes up a lot for us is, do we use the minors’ preferred pronouns or do we not [00:25:00] if there’s a conflict there between what the parents would prefer and what the kid wants. We talked about this fairly frequently, actually, and it’s a tricky one. I’m curious what your perspective might be on that.

Dr. Emily: My perspective is that I would use their words they use to describe themselves. You can comment that parents use different language. I see what you’re saying, they’re not the one paying for the evaluation but they’re the one that you’re trying to provide services for, so maybe that’s the stronger director.

Maybe for some folks, that’s difficult because they get pushed back from the parents, but then that’s probably an issue to explore right there because I don’t work in kids, I do though work with a [00:26:00] lot of adults who have adult children or other family members that are involved. I think every clinical psychologist knows this; you’re rarely treating just the individual in front of you. Whether this is a neuropsychological evaluation or psychotherapy, there’s a lot of vectors involved in trying to help and assist someone with moving forward.

Dr. Sharp: Absolutely.

Dr. Emily: Jae, would you add anything there? I know you don’t disagree with me. I just don’t know.

Dr. Jae: Jeremy, in this moment, I’m so glad to be working with adults and have never run into this because it’s complicated. I do also think about who consumes these reports, and if it’s other providers in the future, it will teach them how to speak to and about the child who is the patient.

I see this in various different ways through different institutions, if you misgender a person in [00:27:00] one report, that will be replicated down the line hence creating problems for their care later on. So I agree with Emily, but I also think that if there are additional providers, it will be the consumers of these reports is especially important.

Dr. Emily: Can I take a second? I would like to call myself out on a mistake I just made. I used the expression preferred, and I caught it right away, but I want to call that out because sometimes in reports, I see that. I should not have said that. It’s not that kid’s preferred pronoun, it’s the pronoun they’re using for themselves. That’s their pronoun.

In kids, from what I know from the literature and from colleagues that are pediatric neuropsychologists in this area, there’s more fluidity of gender in younger people. It tends to get more fixed with age. So maybe that was some of what was driving that bad usage, but that’s one of the things I see in reports that’s well- meaning [00:28:00] but is a microaggression to imply that somehow like, oh, well, I could use this pronoun, but I’m going to use this one instead because I like it better.

That’s the sort of thing that as a cisgender person, and especially being a little not so young anymore, I have to retrain myself to not say things like that. So I’m calling myself out.

Dr. Sharp: Well, I appreciate that. Y’all probably noticed I did the same thing, as I was asking the question. It came out halfway so I appreciate you acknowledging that. I will do the same thing.

That’s one of those things just talking about language that I have seen, once I became aware of that, using preferred or not using preferred, I started to see it everywhere, like in our paperwork, in our EHR system, and other literature. It’s just one of those things that is important and contributes to the [00:29:00] whole vibe, I suppose, but I appreciate you calling attention to that.

Dr. Emily: Right.

Dr. Jae: There are places where this can be useful, but identify as, I think that when we’re talking about a cisgender person, we would never say they identify as a man, we would just say is a whatever year old man. I think that this is a way to minimize a person’s identity when we talk about them or write about them.

So I think that the term identify as, and what I’ve said to providers is, if you wouldn’t use the language in reference to cisgender patients in describing them, then don’t use it for a transgender patient.

Dr. Sharp: It’s a great way to put it. I feel like we could talk about just the language for an hour. There’s [00:30:00] just so many of these instances, but I appreciate y’all highlighting two of the bigger ones that also may fly under the radar because they masquerade. I’m just going to keep going even though I’m trying to stop myself, but I feel like they masquerade as affirming. I don’t know if that’s how it started or what, but we’re honoring “the preferred pronoun” or we’re naming how someone identifies, but then as we go along, it’s more like, well, it’s just another word of.

Dr. Emily: Then you recognize that you’re undercutting.

Dr. Sharp: Right.

Dr. Emily: Could you imagine saying, oh, that Emily, she identifies as white.

Dr. Sharp: There’s an ethnic-racial component to it.

Dr. Emily: You can just think of all different scenarios where you just don’t. So I think what Jae said is that at the very end of the day, would you do this with a heterosexual, cisgender, white person?

Dr. Sharp: Sure. [00:31:00] It’s a good lens to look through. Well, let’s dive into some of the practice, I suppose. Practice-wise, we get involved, at least assessment-wise. I feel like what gets a lot of headlines, so to speak, is supporting someone through the transition process. Maybe this is outdated, I don’t know, like writing the letter to help someone go through a medical process. I would love to hear from y’all, though, how we as neuropsychologists can truly and be involved in assessment with gender-diverse folks.

Dr. Jae: Broad strokes around the transition process, transitioning is; I think [00:32:00] that many cis people think it’s a demarcation of some medical process or procedure but there are different dimensions to transition. There’s medical which may or may not include surgical transition. It may exclusively include hormone replacement therapies. There is the legal aspect of transition, which includes changing documents, and then there’s a social aspect of transition, which may include changing presentation or use of different pronouns or community-orientedness and building.

I think that in Pop news and everywhere, the medical aspect is highlighted and it tends to be what people focus on and think about but for the purpose of neuropsychologists and more broadly psychologists, that social and political aspect is the place where we can have a role in supporting a person. Once a person is granted at the mental health license, they are emboldened to write these letters.

Jeremy, I wish this was an outdated process. I can tell you that [00:33:00] we aren’t prescribed a role as gatekeepers to this process, but we still are, particularly for surgeries. And so I think that when we’re conceptualizing a person for a neuropsychological evaluation, what Emily and I say is, think about what would impact the evaluation and the evaluation is the key component at the end of the day.

So anything that you’re asking about in terms of a transition or a process should be because it has clinical relevance to the assessment that’s being performed. But as an aside, any of us have the capacity to write these letters. I think that the social aspect also has the greatest impact on things mood or psychosocial support, which are the real considerations when we’re doing a neuropsychological assessment.

Dr. Sharp: Sure. This may be a super clumsy analogy and feel free to call me out if that’s the case. I wonder if this emerged, the [00:34:00] letter writing process, the gatekeeping process, I see some parallels between folks who are doing other things that should or could be under their own volition. I think of bariatric surgery or surrogacy evaluations that we do or things like that. I don’t know if that’s too much of a stretch or if that’s minimizing somehow on either side but I feel like there’s a precedent for this kind of thing in our field where we do gatekeep other things.

Dr. Emily: I think it’s rooted in these ideas that there’re somehow mental health issues that are causing someone to do something. Surrogacy; is someone fit to carry a child and then will they be psychologically able to give it up? [00:35:00] Bariatric surgery; does someone have some mental illness that’s the reason that they have a challenge with weight? Has that been addressed sufficiently already?

I think your perception is right on that there is a component of that. I don’t know how soon we’re going to get away from this outdated idea that someone’s gender not matching with what an ultrasound or a physician said their genitalia looked like at birth is somehow a mental problem but hopefully, we’re going to get there. Sorry, Jae, jump in.

Dr. Jae: I think it’s specific to working with a trans population. It deals with a mental health provider legitimizing a transgender person. [00:36:00] I think that has historically been what it is and those are its roots.

I think that we’re moving towards and I do an informed consent model, I do think that the challenge inherently with having to see a mental health provider for the purpose of attaining one of these letters, one is, it positions often a cisgender provider to make the decision of is this person trans enough or adjusted enough, which they themselves might not actually have a ton of knowledge on.

And then the other thing is we have to think that trans and gender-diverse people as a population, often have economic barriers. And so accessing a mental health professional, especially when there are requirements for treatment before getting a letter can be really hard.

So in general, I think that the movement has been towards an informed consent model, which I think is progress but I think it is still inherently flawed because there’s [00:37:00] difficulty gaining access to the people who would write these letters to begin with.

Dr. Emily: Especially those that have appropriate knowledge and background to understand the issues.

Dr. Sharp: Sure. I appreciate y’all commenting on that just for a bit. I would love to start to dive into some research stuff. We touched on that a bit ago, but I think that’s super important. Maybe we just start with research on binary sex differences that seems important in this whole discussion. What does that research look like, especially from a neuropsychological perspective? Feel free to take this whichever direction you would like.

Let’s take a break to hear from a featured partner.

Y’all know that I love TherapyNotes, but I am not the only one. They have a 4.9 out of 5-star rating on trustpilot.com and Google, which makes them the number one rated Electronic Health Record system [00:38:00] available for mental health folks today.

They make billing, scheduling, note-taking, and telehealth all incredibly easy. They also offer custom forms that you can send through the portal. For all the prescribers out there, TherapyNotes is proudly offering ePrescribe as well. Maybe the most important thing for me is that they have live telephone support seven days a week, so you can actually talk to a real person in a timely manner.

If you’re trying to switch from another EHR, the transition is incredibly easy. They’ll import your demographic data free of charge so you can get going right away. So if you’re curious or you want to switch or you need a new EHR, try TherapyNotes for two months, absolutely free. You can go to thetestingpsychologist.com/therapynotes and enter the code “testing”. Again, totally free. No strings attached. Check it out and see why everyone is switching to TherapyNotes.

The [00:39:00] SPECTRA: Indices of Psychopathology provides a hierarchical-dimensional look at adult psychopathology. Decades of research into psychiatric disorders have shown that most diagnoses can be integrated into a few broad dimensions. The SPECTRA measures 12 clinically important constructs of depression, anxiety, social anxiety, PTSD, alcohol problems, severe aggression, antisocial behavior, drug problems, psychosis, paranoid ideation, manic activation, and grandiose ideation. That’s a lot. It organizes them into three higher-order psychopathology; SPECTRA of Internalizing, Externalizing, and Reality Impairing. The SPECTRA is available for paper and pencil assessment or administration and scoring via PARiConnect. You can learn more at parinc.com/spectra.

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

Dr. Jae: This is [00:40:00] an area that is just so exciting for me; the concept of gender as a moderator of cognitive ability. I think that there has been this history in neuroscience and neuropsychology around sex-based performance, which is like there’s a male brain and that there’s a female brain and there are these distinct functional differences between these two types of people that will become evident during a neuropsychological assessment.

I’ve done a lot of reading and two things have become evident. One is that there’s a publication bias that naturally skews us towards literature that highlights differences. So historically, when we look at the difference between men and women or male and female, I hate those terms but when we look at those differences, I think that they’re especially illuminated in the research. I do think that type of publication bias tends to particularly [00:41:00] negatively impact marginalized demographics.

When we do comparisons based on gender or race or any of these other demographics, which represent marginalization, there are people who are potentially harmed by this research. So when it’s done, I think it needs to be done purposefully and carefully.

This is to say historically we have seen this inflation of difference based on sex. And in more recent years, the overarching theme is one, it is just so much more complex than that. So most of the research that exists is structural, not functional. So a lot of it is based on brain size or structural differences between brains, which is not a one-to-one relationship in what we see in terms of a neuropsychological assessment or cognitive ability.

So as far as neuropsychologists are concerned, we have limited available research on functional differences that are meaningful and recent.

And then the other thing is if you [00:42:00] look at research that is exclusive to a particular region of the brain, you’ll see these differences. But when you look at whole brains you start to look at many people because again, a lot of MRI researchers have whole samples. So when you look at meta-analysis or these larger-size studies, the differences between men and women start to dissolve. I think at this point, the understanding is and should more broadly be that it’s just so much more complex.

The other thing is that the human brain is not immune to psychosocial influence. There is this idea that I think is very interesting, which is the gender role mediation hypothesis, which describes how over a lifetime, men and women have different abilities cultivated and that will lead to the differences that we see in functionally and cognitive performance.

So a lot of this research has been done in academic settings where they look at [00:43:00] math and reading or writing abilities in boys and girls that are school-aged. One of the interesting things that we’ve seen is that that is culturally bound. The cultures that have less of an idea of differences don’t see the same differences in performance on academic achievement tests.

The other interesting thing is that as we’ve started to dissolve these ideas that are largely sexist in nature around ability level, over time, we’ve also seen a decrease in the difference in ability between math and reading; boys being better at math and girls be better at verbal ability. So we know that overall, there is some aspect of cultural influence and social influence and what it is that a person can cultivate over a lifetime that produces what we see in terms of cognitive ability in adults.

Dr. Sharp: Well said.

Dr. Emily: I’ll also add [00:44:00] that Jae’s referencing a forward-thinking set of body of research. If you go and look at older cognitive and brain anatomy research, it’s deeply flawed. Many of those types of studies persist today.

Just think about the typical recruitment flyer for a study. We’re recruiting men to look at this or we’re recruiting older adults over age 50, here’s all of our exclusionary criteria. Oh yeah, we’re going to do your physical exam as part of it. Do you know who’s never going to even walk in the door for that?

I think those types of studies, especially ones that already tout themselves as looking at “sex, gender differences”, they’re biased recruiting toward those extremes of masculine and feminine, that anyone who’s not fitting that [00:45:00] box is highly unlikely to be included.

And that leads me to commenting on feeling like as much as I appreciate the rich normative data that have been developed by neuropsychologists and others over the decades, it’s important to remember that that recruitment flaw and data flaw exists in those studies as well, and in those published sources that we often feel really good using to help us identify what’s impaired, what’s not impaired. We try to use cutoffs and we’re trying to fit people into boxes that don’t exist in that sample.

Dr. Sharp: Sure.

Dr. Jae: Gender as a moderator is just oddly more individualistic, more nuanced, and less important than neuropsychologists often hold it to be.

Dr. Sharp: Well, yeah, I think that’s true. [00:46:00] At least when I went through graduate school, which was a long time ago at this point, this is still a thing that we talked about a lot, is the male, female brain. It’s a hard idea to shake. I feel like it’s baked into everything we do. Even in our day-in and day-out work, there are male and female norms in the vast majority of measures we’re doing. Even if there’s no difference between the two, it’s still right there. It’s binary classified and …

Dr. Emily: We have to repick, when you open up the norms book, what section are you going to do after you’ve gotten your scaled score to go get your t-score? Some of these demographics, I work in aging. I would like to think that age doesn’t matter and I think in many ways that it doesn’t but that does seem to be [00:47:00] a more, it’s a safer thing to go with. Again, the goal is to not marginalize or be pejorative to someone. So you’re trying to have them look their best. So making an age adjustment has more basis.

Maybe education, although we all know years of education is a proxy for so many other things and it can be quality or not quality. So that also has a lot of flaws. And then as we’re talking about gender is often awful to be using as a demographic factor for normative data, just like race is often really difficult.

Dr. Jae: If I may, just as this pertains to transgender people in particular, right now there’s very minimal research on functional changes in trans people, as it pertains to gender. [00:48:00] When you look through the research, it’s really hard to get good information about, okay, if there are these normative gender differences, how do trans people fit into all of this?

Generally, what I’ve seen is that for people who have not had exposure to hormone replacement therapy, the research varies. A lot of it tends to suggest that trans people have a unique cognitive pattern that doesn’t correspond to, basically, we look different than cisgender people of either gender.

There is also research that suggests that the more time that a person has been on hormone replacement therapy, the more they begin to approximate their gender in terms of cognitive performance. But again, a lot of this research that’s been done has been a small sample. It has not been long-term research which has [00:49:00] exclusively looked at binary trans people, trans men, and trans women. So as far as neuropsychologists are concerned, there isn’t a clear-cut answer in terms of how this all shakes out as it as it affects trans people

Dr. Sharp: Well, you’re anticipating some of my next questions, which are, what does the future look like, essentially, for trans folks in the neuropsychological literature? Will there ever be a day where we have trans norms? Is that even something to be considerate? Where does it go from here?

Dr. Emily: I’m sorry, I’m shaking my head, which of course in a podcast, you can’t see me doing that. In my journey, I and the folks that I wrote the first paper with, we started off with this goal, as soon as we were getting into publishing it, that we were going to reach out. [00:50:00] We had a community of folks across the country at different VAs, and we were going to collect trans norms.

And then you start looking at what that would be like and you realize that you, at best, would have an end of one for all the different variables. And it goes to what Jae was saying and that this isn’t about, at the end of the day, the medical piece of it:

1. It’s so individual.

2. It’s not even in existent for some people.

It’s not the right goal. I don’t think. What I think, this is my opinion, is that what we need are nonbinary norms that I could trust have been inclusive in their recruitment to cover a full continuum of, not just a continuum, but all dimensions of sex and gender.

[00:51:00] Folks who are intersex are not represented in any of this stuff either, and that’s 1.7% of the population has variable sex characteristics, chromosomal differences that are not just your basic XY, XX pairs. So that’s where I would hope we could get is to have rich norms that are inclusive.

But you know what? Nobody wants to pay neuropsychologists to collect these data. That’s a challenge. That’s a whole different podcast, who makes the money and who pays people to collect norms?

Dr. Sharp: Sure.

Dr. Emily: Sorry. Go ahead, Jae. Were you going to comment there?

Dr. Jae: No, I’m excited about that question. I don’t know that I’ve ever been asked. I think that there’s two directions I think about, one, I do agree with Emily in terms of where neuropsychology could go. If you tried to do brands norms in particular, it would still be hard to [00:52:00] do a one-to-one when you’re sitting with the patient in front of you, because there’s so much nuance to a person’s gender or experience.

I think that even if that was done, it would fall short in terms of clinical utility, but using collapse norms that encompass people not just cisgender men and cisgender women but encompass a range of genders so that you could have collapsed norms that are less binary or homogenous. I think that that could be the way to go for sure.

And then I also think, a lot of the research that exists on trans people is not, I think there’s minimal clinical utility. I think a lot of people have looked at how are trans people different or how are trans people similar. A lot of it seems to be rooted in wanting to validate or not a trans person in their experience.

So I think that in terms of the [00:53:00] general neuroscience or psychological literature, I think that we need to be thinking about how does it serve the population that’s being studied. If you were going to look up information about how to do an assessment or a trans person with a particular disorder, there would be nothing, but there’s a lot comparing trans and cis people, is there gender in the brain somewhere? So I also think that the direction needs to go in clinical utility and that serves the community.

Dr. Sharp: That makes sense. Maybe to clarify and as always put me on the right path if I’m going down the wrong path, but it sounds like both of you are advocating in some sense for combined norms, just norms, not male, female, trans, just good norms.

Dr. Emily: That included folks that don’t fit just [00:54:00] that cis binary.

Dr. Sharp: Right.

Dr. Emily: The same way that we would say that a normative data set that’s just a bunch of white males from Minnesota may not be the best to apply to someone from a different group, it’s not that different.

Dr. Sharp: Yes. I’m just laughing. It’s always just white males from Minnesota, I feel like.

Dr. Emily: I’m from Michigan, we always call out. We like to think it’s more Northern than us but they’re not.

Dr. Sharp: Sure. That leads me to the question then of like, where do we stand now with trans folks and gender-diverse folks with testing and norms? This question comes up a lot, for better, for worse, but it comes up a lot day to day and in the groups and whatever, on the listservs, what norms do we use when we’re giving these measures that demand [00:55:00] that we choose norms?

Dr. Emily: Can I just start by jumping in and saying that I, with the first person I worked with, used the test?

I knew I was working with a trans woman and I used my standard test battery. I hadn’t maybe read the chart carefully enough, but even then, I don’t even think I knew to ask questions ahead of time. I just went in with a sense of, okay, well, this is new and I used my standard battery.

It was a particular verbal memory test, the List Learning test, that is very popular. At that time, that version of it, it had binary gender dorms, and I hit that moment like, oh, crap, which norms do I use? And looking back, I’ll tell you what, I would never, ever use that test again for, I frankly don’t use it as a regular part of my evaluations anymore at all and I definitely would not use it in that population. The same way [00:56:00] again, if you have someone coming in and there’s no good norms for that population, don’t use that test.

We can talk about what do you do when you end up in the position I ended up in but the best, what’s the expression? The best offense is good, I don’t know. If I had just thought ahead of time, I would have used a different battery and I would have done better. There are tons of List Learning tasks out there. I did not need to use that one though.

Dr. Sharp: Now that sends me down this whole path of affirming assessment measures, that’d be a list I would like to see, if it exists.

Dr. Emily: Jae has a list. Jae, do we have it just in our talks or do we have it in a paper at any point?

Dr. Jae: We don’t have it in a paper yet but [00:57:00] I’m happy to send it over to you as well because it’s a nice shorthand. And also to respond to this, there’s four basic approaches to take to norming. You can choose norms according to a person’s sex assigned at birth, you can choose norms according to a person’s gender if binary. You can use and choose tests that include collapsed norms or you can double score using male and female norms and compare to see if there are any clinical differences between those two.

Personally, I would say, the research doesn’t support using sex as a group for this population. I also think it’s an anti-affirmative stance and those things fortunately in line, so I would never take the first one.

In terms of the second, using a person’s gender, I think it depends on, are there tests that I really need to give and only have [00:58:00] binary norms? What’s the clinical utility in choosing a test where I’m going to have to choose gender?

And then if we’re thinking about gender as a far as norms are concerned as a compound construct, there’s socialization, people have gone into the hormonal aspect of things or the chromosomal aspects. We have all these different aspects of what winds up for cisgender people aligned very neatly, for transgender people don’t.

And when we’re thinking about the compound construct of gender, all of these different individual components, would I choose gender norms for a trans person? Maybe, if I really needed the test and if they had a binary identity and it’s something that had been long established, my default would always be to use tests and choose tests with collapsed norms.

I don’t see any real value in double-scoring and doing both. Other than that most of the [00:59:00] time, a provider would find that even if there’s minor numerical differences between scores, there’s not really any clinical difference. It doesn’t change the range in which somebody is performing most of the time.

Dr. Sharp: Yeah, I would agree with that. Right, in the majority of cases.

Dr. Emily: For that person that I worked with, her scores were hitting that mild cognitive impairment mark for verbal memory tests and I didn’t put it in the report, but I’ll just admit back it was, I can’t remember exactly what year, but it’s more than 10 years ago. I did look up the not appropriate gender norms, just out of curiosity. Then I had a conversation with her at feedback about how I was leaning toward a mild cognitive impairment diagnosis because of weaknesses in verbal learning and memory, and frankly, it matched with her

[01:00:00] perception of what had been going on for her. And so we had a discussion around that and then I wrote the report.

So there was transparency. That’s another thing, if you’re going to do something like double score or use the wrong norms, sex assigned at birth, you better darn well, if you want to be ethical, be having a really clear conversation and explanation for why you would do that. I don’t know.

Dr. Sharp: That’s a great point.

Dr. Emily: Again, we’re talking about adults, kids are tricky. I can’t imagine being a pediatric neuropsychologist. It would be so much harder.

Dr. Sharp: It’s so funny, I think the exact opposite, we can agree to disagree.

Dr. Emily: I’ve had many people say that because I deal with dementia and I’m getting really, those diagnoses are not easy.

Dr. Sharp: Sure. Jae, were you [01:01:00] going to …?

Dr. Jae: Yeah, as an aside, I do want to make note that whatever norms a person chooses to use, especially working with a trans patient, the provider should note that so that if a person is retested, those can be, and hopefully they choose collapsed norms based on this podcast or are thoughtful in their approach but I think it’s important to document what norms you’re choosing to use so that the test can be done again, because I don’t think another provider would naturally do what you’ve done on a test for a trans patient.

Dr. Sharp: That’s such a good point. We’re certainly talking about a lot of the practicalities of testing. I’m curious, what else, what we might want to be thinking of in terms of the other aspects of the evaluation; maybe the interview, maybe the report writing. Could we dive into either of those areas?

Dr. Jae: Emily, I’m [00:02:00] going to call out some of our conversations yesterday.

Dr. Emily: Oh, sure. Yeah.

Dr. Jae: Emily and I just had a conversation yesterday about how marginalized people, when we’re working with majority population, we are often unconsciously looking for cues that signal to us whether we can be safe or comfortable. And this comes up also very frequently when people reach health care professionals. There’s a history of mistreatment for many populations. So I think that the first thing when working with a trans patient is to cue them to let them know that you are a person who’s hopefully knowledgeable and coming from an affirmative perspective.

I don’t think that visible signals like a pride flag in the office is great but Emily has beautifully said that can be undone in a single sentence during a clinical interview. So [00:03:00] putting these kinds of cues is fine. I think that some of the best things for providers to do is, one, have forms and documents that are inclusive so that a person could fill in their gender and not just circle MRF.

I think during the clinical interview for, I’m speaking largely to cisgender clinicians, asking questions that are important about language, about a person’s experience, not asking things that could be considered medical voyeurism. The question that should be on the forefront of any neuropsychologist’s mind during the interview is, is what I’m about to ask relevant to the assessment that I’m doing? The trap that says providers can fall into is the medical voyeurism or curiosity of a transgender person. So I think that keeping that in the forefront of our minds or your minds is really important.

And then I also think Letting a person know your [00:04:00] limitations, transparency; if you have to ask personal questions, giving a caveat before and going, I know this might be personal to you, here’s why I’m asking it or here are my limitations, I’m not sure how to refer to you in this way, can you tell me how to refer to you, write this report?

I think that for most transgender people, seeing that intentionality behind interacting with us is going to build rapport inherently even if you don’t know everything. I think that most psychologists who are not in the community will never know everything. Faux pas are going to happen but being clear about the intention that you’re coming in with, being able to admit mistakes or course correct when necessary, those are all the things that build the initial rapport and signal to the transgender person in front of you, this is a safe person to work with. I can actually talk to him about what’s going on. I can work with this person. I’ll do an evaluation with this person.

Dr. Sharp: Sure. You used that term medical [00:05:00] voyeurism. I don’t know that I’ve heard it before, but it totally resonates. I’m curious, off the top of your heads, I’m just thinking about myself, I probably err on the side of gathering too much information than less, and so I’m just thinking through, how could I trust myself as a provider not to inadvertently ask questions that aren’t relevant or might be perceived as medical voyeurism, if that makes sense?

I wonder if y’all have examples from cases in the past or even once, if you can think of them just off the top of your head, things that we probably don’t need to be asking about in most cases if we’re working with transgender folks.

Dr. Jae: I think where this is going to come up most is around medical and surgical history during the interview. I think that the approach in that area [00:06:00] maybe is to clarify why these questions are being asked and then ask questions that we would ask any patient about their medical conditions. Have they had any surgeries? What were the nature of the surgeries? If that’s relevant but also not get into the details.

I think the biggest thing is to veer away from curiosity about a transgender person’s body. I think that that’s where the voyeurism really becomes illuminated. We see this in pop culture also; curiosity around surgeries or medical procedures with this idea of what has a person done or how have they changed their body as a curiosity.

And so I think when asking, especially around the medical and surgical history, it should be limited to what’s going to affect the assessment. And if there are details about a person’s transition that aren’t going to have any impact on their cognition or what’s going on right now, then it doesn’t need to be asked.

Dr. Emily: Yeah, you wouldn’t ask a cisgender [00:07:00] woman if she’s had a breast augmentation in a neuropsychological evaluation, and you wouldn’t ask that same cisgender woman if she had a double mastectomy in her 20s and you’re seeing her in her 50s for a cognitive evaluation, were you going to ask about that like it’s important for the evaluation? Maybe the history of cancer is important. Is she still on tamoxifen or something?

So the point is, it’s tricky. It’s very easy to make a mistake. And as Jae said, being transparent, I’m like, okay, so I may make a stumble here. I’m in for EOI, I agree with you, Jeremy, I work hard. I’d always rather gather more data. Sometimes my patients come in from really far away and a lot of them don’t do great on the telephone so calling later to gather something I missed is not my goal.

On the other hand, be a little knowledgeable, [00:08:00] do some reading and have a sense of like, okay, well, what are the types of hormone therapies? Is it possible that in the first two months of initiation of a certain type of hormone therapy, could that have someone not performing at their cognitive best? And so there could be some legitimate questions for timing of certain things.

As Jae’s been educating me, hormone replacement therapy, there’s microdosing. There’s all sorts of variables there that it isn’t even just like, oh, I went on hormones and now I’m on this then I do the exact same thing every day for the whole rest of my life.

Dr. Jae: What we know of HRT and cognition or what I know of HRT and cognition is there’s no direct detrimental impact. There might be a slight enhancing effect for some trans people on hormones, which is [00:09:00] interesting but I think that the relevance of starting HRT, that time might demarcate a particularly challenging or fluctuating time in a person’s life. So I think about psychosocial circumstances as the mediator between hormones or hormone initiation and is this a good time to test or not?

Dr. Sharp: Okay. Can you say a little more about that? Can you give me any more thoughts, any more details there?

Dr. Jae: On HRT and cognition?

Dr. Sharp: Well, more the second part of what you said as far as the timing and psychosocial impacts and how we might think about that as people come to us for evaluations.

Dr. Emily: We write reports all the time about how psychosocial stressors could be having an impact. Those can go in a positive direction, they can go in a negative direction, and frankly, change, even if it’s like for one’s like desired [00:10:00] change; brand new job, moved somewhere you’ve always wanted to move, there’s just still effects.

I don’t think that fully encompasses what you’re getting at, but it’s important to think of it in that way. Sleep sometime, sleep’s far more indicative if someone’s been getting regular sleep versus dramatically affected sleep on how they’re testing, or if they’ve had a period of depression and you’re testing them during that instead of when they’re euthymic. That I would say is much more likely.

I work with a lot of veterans who have a chronic post-traumatic stress disorder, and I would not interpret data from an evaluation without considering what their current ratings are of not just like some other clinician, but what they tell me that day their last week has been like in terms of their symptomatology. [00:11:00] And that’s got to be incorporated.

Dr. Jae: Yeah, I think what Emily said, it may be a big life event for a person. Also, it might not be. Somebody might be like; I’ve been out for a long time. I just started microdosing testosterone and it’s not that big of a deal, though there can be mood changes in response to starting hormones. So that’s also one of the psychological aspects of that period of a person’s life, but I think of it the same way, it may be a big change time in a person’s life.

Dr. Sharp: Yes.

Dr. Emily: So maybe getting the information, but then asking the follow-up questions of like, well, what has that been like for you? How are you feeling? Are you noticing it? Not in a voyeuristic way but like, are there effects in terms of your mood or energy or sleep?

Dr. Sharp: Absolutely. [00:12:00] All those questions we would likely ask other CONSORTs, right?

Dr. Emily: Exactly.

Dr. Sharp: Yes. I would actually double-click on that point about hormone replacement therapy and cognition, that was interesting. You said that to your knowledge, there is nothing around detrimental effects necessarily, but there may be a slight enhanced enhancement of cognitive?

Dr. Jae: Yeah, there’s a study I saw recently where there was an enhanced visual-spatial ability as a person’s been on HRT for a while, both masculinizing and feminizing hormones, which I don’t understand anyway. I’m not an expert on it, but what we know is that in terms of direct effects, a person’s memory or attention is not going to drop on an account of starting HRT. None of those are concerns. There may be other mediating effects, long term, like changes in health that might impact a person’s [00:13:00] cognition but there are no direct or immediate negative effects of HRT on cognition.

So if a person’s just started two months ago, a neuropsychologist does not need to be concerned that if a low score is evident and that it’s because of this. I think that is just like that.

Dr. Sharp: I got you. That makes sense.

Dr. Emily: Unless they tell you they haven’t been sleeping and because they’re having night sweats and you know what I mean? You have to fill in the whole picture.

Dr. Sharp: Yes. I’m getting a theme here. Thanks, Emily. It’s the other fact, psychosocial factors are important, we should ask about them.

Well, I know there’s no way to capture all of this in one-hour-long discussion so I’m not going to try, but I feel like we’ve covered a lot of ground. I appreciate everything that y’all are sharing. [00:14:00] Well, two questions just to start to wrap up:

1. The general question of, is there anything huge that we missed that you want to make sure to get out there before we wrap up?

2. Resources for folks who want to get better at this, want to learn more, want to do better work.

Dr. Emily: Jae, we haven’t brought up intersectionality at all.

Dr. Jae: Yeah, intersectionality, when we’re talking about being trans or gender-diverse or gender overall, it doesn’t exist isolated from other aspects of marginalization, which can be confounding and exponential. I think that the big takeaway is in interacting with a trans person, there’s a level of base knowledge that a person should self-educate.

And then when you’re with a person, there’s a lot of individualism. Even all of the training that you can get on trans people might not be applicable when you’re sitting down with a patient in the room. So I think that the big takeaway I would love for providers to have is to be [00:15:00] thinking about gender and working with trans people in a way that is thoughtful, self-aware, and nuanced.

The big recommendations that I would have is a one-on-one. WPATH is one of the organizations that sets the standards of care for working with trans people. They’re more medically oriented, but I think that they have a lot of good resources. It’s also good to get acquainted with them as an organization.

And then APA did put out a paper on general guidelines for working with trans people that I read through and was pretty good. I think they did a pretty good job. So I think that’s also a great general starting point. And also Emily has done a lot of great work with a lot of great people. Sorry, I can’t do this to you, Emily. I would also [00:16:00] read some of the work that Emily has done specific to the field of neuropsychology.

Dr. Emily: I would stick with the most recent article that was from 2022 that is about affirmative care and was pretty equally in authorship for cis and trans voices. That original fledgling article feels very cringy now.

I wanted to mention, I had Testa in my mind and that is who it is, from 2015 is a key article that is on the development of the gender minority stress and resilience measure and a model for taking the minority stress model a step further and appreciating how that could be slightly more nuanced when the stress and trauma could be due to being in the gender minority/being marginalized. So it’s Testa and colleagues.

[00:17:00] Dr. Sharp: Great. There are links in the show notes for all those resources that y’all are mentioning.

Dr. Jae: And if somebody wants to do a deep dive, there’s a book called Trans Bodies, Trans Selves that really gets into, it’s predominantly worked on by trans people, and there’s also quotes directly from trans people on their experiences in health care and other things but if a person wanted to do a deeper dive on understanding working with trans people, I think that’s a fantastic book.

Dr. Emily: I have another one too. Sorry, I can’t believe we didn’t bring up the Queer Neuropsychological Society, QNS. Is a somewhat young but now getting quite well-established identity organization as there are others, Hispanic Neuropsychological Society, ANA et cetera. They not only have wonderful resources, you can get involved with QNS [00:18:00] but they also have a consultation option to set up and meet with folks and get peer support because not everybody may be in an environment where they have colleagues with whom to work and who have more expertise. So I highly recommend the plug for QNS, Queer Neuropsychological Society.

Dr. Sharp: That’s great. These are fantastic resources.

Dr. Jae: I think we’re done now.

Dr. Sharp: You don’t have to be done. We can keep going.

Dr. Emily: Oh, no, you’ll have to cut us off. If Jae and I get going, it’s … Come join us at AACN for our three-hour workshop.

Dr. Sharp: Yeah, that’s right. So just in the event, I’m thinking about time and timing and this is a dumb question again, will that be available after the fact as a recording for folks who can’t be there in person or listen to this after the [00:19:00] presentation?

Dr. Emily: It is. We did the virtual recording over a month ago. It will not be nearly as fun and dynamic as us in person. We bemoaned the loss of the interactive component. We have that with you here. This is why podcasts are awesome. The contents will be available.

There’s other recordings available as well. We have spoken for QNS, there was a NAN workshop that I believe was recorded. I might be wrong about that, but there are some things out there as well.

Dr. Sharp: Well, yeah, people know where to find you and hopefully they will dive into a lot of these resources and information that y’all are putting out there as well. It’s clear that you know a lot and have lived a lot [00:20:00] about this area and just super grateful that you’re willing to come on and chat with me for a little while. So thank you. Thanks for being here.

Dr. Emily: Thank you.

Dr. Sharp: All right, y’all. Thank you so much for tuning into this episode. Always grateful to have you here. I hope that you take away some information that you can implement in your practice and in your life. Any resources that we mentioned during the episode will be listed in the show notes, so make sure to check those out.

If you like what you hear on the podcast, I would be so grateful if you left a review on iTunes or Spotify or wherever you listen to your podcasts.

And if you’re a practice owner or aspiring practice owner, I’d invite you to check out The Testing Psychologist mastermind groups. I have mastermind groups at every stage of practice development; beginner, intermediate, and advanced. We have homework, we have accountability, we have support, we have resources. These groups are amazing. We do a lot of work and a lot of connecting. If [00:21:00] that sounds interesting to you, you can check out the details at thetestingpsychologist.com/consulting. You can sign up for a pre-group phone call and we will chat and figure out if a group could be a good fit for you. Thanks so much.

The information contained in this podcast and on The Testing Psychologist website are 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 [00:22:00] formed between the host or guests of this podcast and listeners of this podcast. If you need the qualified advice of 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.

Click here to listen instead!

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.