86 Transcript

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Dr. Sharp: [00:00:00] Hey everyone, this is Dr. Jeremy Sharp and this is The Testing Psychologist podcast, episode 86.

Today is part 2 of a two-part series on Therapeutic Assessment. My interview with Dr. Raja David was a lengthy one and we broke it up into two parts. If you did not listen to part 1, please go back and do that. It will greatly help in following along and integrating the material that we have in today’s episode.

Part 1 was all about theory, logistics measures, billing, and all those practical pieces of Therapeutic Assessment. Part 2 today will really focus on a case study. So we spend the vast majority of the time applying all of that information from part 1 to an actual case. So like I said, go back and listen to part 1 if you haven’t already, and I think that will really help you out before this episode.

If you [00:01:00] deem any CE credits, that time is starting to come up. For us, it’s the end of the summer when our license is reset. If you need CE credits, I have partnered with athealth.com to offer current and past Testing Psychologist podcast episodes for CE credit. So check it out at athealth.com. You can just search for The Testing Psychologist and you can use the code “TTP 10” to get a discount on your entire purchase. So check that out.

All right, onto part 2 of my conversation with Dr. Raja David.

Hey everybody, welcome back to part 2 of my discussion with Dr. Raja David. We’re talking all about [00:02:00] Therapeutic Assessment. If you didn’t hear part 1 last week, please go back and check that out. We go over all the theory and the logistics: What is Therapeutic Assessment, what does it look like, what the measures are, and all the background information. And then this time, we are going to be diving into a case study, which is the first case study we’ve done here on the podcast.

So Raja, thanks for being willing to do something like this first of all.

Dr. Raja: Yeah, am excited.

Dr. Sharp: I’m really excited to see where this goes as well. So we’re talking before I started the recording, I said, I’m not really sure how to dive into this, so I think I’ll just turn it over to you and let you start from wherever you think is the beginning of this case study and we’ll just take it from there.

Dr. Raja: That sounds great, Jeremy.

Dr. Sharp: Great.

Dr. Raja: I will say just as well, one caveat, [00:03:00] this is a case study that’s based really on an amalgamation of a number of different clients because it was too tricky to just identify one person and have such personal information out there in the internet either for forever. And so, the caveat is if you harken back to graduate school, you remember when used to do role plays, and sometimes it’d be like, this doesn’t feel quite real. We might have a moment of that or two and we might have just bumped into the fictional aspects of this client. So bear with me if that occurs.

Dr. Sharp: Sure. It’s good to put that out there for confidentiality’s sake, I think we’re very modular.

Dr. Raja: Correct. This is really a very fictionalized client in almost all ways.

Dr. Sharp: Cool.

Dr. Raja: So let me tell you, as I’ll explain this client, I’ll also match through the steps that we covered in part 1 a little bit too, so you can see how they aligned and what it looked like for this client whose name is Sophie. She’s 24 years old, heterosexual, cis female. [00:04:00] She had been working with an individual therapist in the area named Lauren for about eight months. I will give you some background but just the more recent history as you come into the Therapeutic Assessment.

So Lauren and her were doing individual therapy that Lauren was providing targeting anxiety. Sophie essentially had graduated from a Master’s program in Public Health Administration about three months before I met her. And essentially at the tail end of graduate school, her anxiety became so pronounced and was so interfering with regards to her academics and what she had to get done that she sought out Lauren for help.

So Lauren and Sophie did a lot of really good work on the anxiety. She was having some almost panic attacks but not quite at one point and a lot of gastrointestinal issues relative to the anxiety. The work that they had done [00:05:00] had quieted that down. Sophie was able to graduate successfully and actually immediately was hired on into a role in a medical clinic. The anxiety went down symptom wise but both Lauren and Sophie felt like there’s still some anxiety around and they were having a hard time getting their heads around what else might be helpful for her and how to work with her.

So essentially when I met Sophie, she is three months into this new position as well. I had contact with Lauren before I had contact with Sophie and she scoped out, is this a good referral? Here’s what’s happening, what do you think? What would this look like? And so, she and I talked about it.

She also shared some of her hypotheses that part of what was happening is unresolved issues from Sophie’s childhood. The two of them had talked about some things and I’ll explain some of that background in a moment [00:06:00] but they hadn’t really gotten any traction on that and so she wondered about that.

Dr. Sharp: Okay.

Dr. Raja: And so the referral is essentially made in that way and that Lauren connected me with Sophie. I reached out to Sophie on the phone and connected just a really brief interview with her. In the Therapeutic Assessment model, as I said in part 1, we really want to decrease the power difference between ourselves and clients and be collaborative from the front end.

On that phone call, I started with, well, what are you hoping to get out of this process? What would be helpful to you? And from the get-go, Sophie was clearly a bright, energetic, and curious person which, as we know, is true for all therapies. When people have good insight and are curious about themselves and invested, one puts some energy towards it, that often is beneficial to their therapeutic process. And so she had that from the get-go, which really helped in our work together.

I just ask some of the preliminary questions I always ask people with one of them [00:07:00] being something we didn’t talk about in part 1 and that is, has she done psychological testing before or not? This question’s important for two reasons: one, quite frankly, logistical because if someone says, oh yeah, I just finished this evaluation somewhere and I’m going to use insurance, I’m thinking, oh, you probably blew through all your units, so I do not if this is going to work. I want to know that as well as I don’t want to repeat testing that was just done. Second, I want to find out if they’ve had testing before, what was their experience like, and was it a positive one or not a positive one.

And the reality is most people get therapy and never do any testing. There’s some group of people that do testing and some of that group don’t have good experiences with testing. If someone is coming to me and they’ve already had an experience with an evaluator that did not feel good to them, I want to know that at the front end so that I can help them see how our process is going to be different.

So I check that out. I also always want to check out, are [00:08:00] there other providers you’re working with because if people have multiple providers, I want to make sure we’re all on the same page before we step into a Therapeutic Assessment. And so in Sophie’s case, that was not happening. It was just Lauren. There’s no history of mental health services before Lauren. No history of any kind of psychiatric medications for Sophie.

So we had the phone call, we set up appointments and we had the first session. Again, as I talked about in the first episode here, Jeremy, that first session is really spent identifying questions that the client hopes to get answered through the testing. Sophie, I don’t want to say she bounded into the room, but she came into the room with a fair amount of energy. She was really ready to get going and really wanted to figure out something about her anxiety.

And so from the very beginning she had thrown out a question here, as I’m now trying to find it, that [00:09:00] eventually as we talked about turned into this; “I’ve been working in therapy and in other ways on trying to better control my anxiety but it is still around. What more can I learn about my anxiety and what might be beneficial in getting it under control?”

And so Sophie leads with, I’m trying to figure out my anxiety and we eventually get to a little bit more nuanced question, and for the first 25, 30 minutes of the session, this is where our focus lies. I’m just inquiring, well, what’s your anxiety-like and how do you know when it’s around? Have you noticed any patterns to it and how does it impact you? Does it seem to arise in certain situations or not arise in other situations and really trying to individualize and contextualize this issue for the client?

For her specifically, she’s saying to me, Raja, I’ve been working on this and I want to know what that is. And so we [00:10:00] spend some time also just discussing, well, what have you tried? What’s worked? What hasn’t worked? So I have some sense of what this client has already tried to do to help herself with regard to the anxiety.

Dr. Sharp: Okay. And how does she say, if you have this information, how the anxiety manifested? What did she notice? How did she know about it and so on?

Dr. Raja: Well, that’s part of the tale a little bit here, Jeremy, but what she would say at the very beginning was it’s just like everywhere, Raja. I feel it all the time. It’s really bad when I’m at work lately with my new job which some of it seemed normal new job anxiety to me also. We talked about how it had been around in graduate school and peaked and then got better with Lauren’s help. At some point, I reflected back and said, well, if I had met you in high school and I had asked you, how did you have trouble with anxiety? What do you think you would’ve said? What she said to me was, if you had met me in high school, I would’ve said, no, I [00:11:00] don’t have problems with anxiety but after talking to Lauren, I’ve come to realize I probably was pretty anxious back then too and I just didn’t know it.

Dr. Sharp: Got you. 

Dr. Raja: And so she’s got this question out there and I’m joining with her around it and I’m also instilling some hope. I’m going to say to her, I really think we can figure some stuff out about this, Sophie. I think we can answer this question.

Dr. Sharp: Nice.

Dr. Raja: I then transition because she did not have any other questions, which is a little atypical but sometimes you don’t get many questions. She said, this is what I want to figure out. I explored a few other parts of her life and she didn’t really say, yeah, I need to work on things like relationships or anything else. So I’d let it go. But meanwhile, Lauren had emailed me a question. Lauren again’s a therapist and her question that she emailed me was, are there unresolved issues from Sophie’s childhood that are still holding her back?

Dr. Sharp: All right.

Dr. Raja: And so I shared this question with Sophie and she knew that Lauren [00:12:00] was holding this question; this wasn’t new information to her. We started talking about it, and I wanted to get a sense of her interest in this question. In a nutshell, what she said was, it’s fine. I’m not that interested. I don’t think that’s something but if this will help Lauren help me, great. Let’s see and if we get anything we can figure out.

Dr. Sharp: Okay.

Dr. Raja: So now that this question’s out there, this allows me to open that door a little bit more to try and understand, well, what does Lauren know about this childhood and what might Sophie tell me about that? So after we talked about this question and where she’s at with it, I said to her, something akin to, well, tell me a bit about your childhood. What would you think would be helpful for me to know?

I’ll just hit some of the highlights here a little bit. So her biological parents were never married but they were in a committed relationship and very excited when Sophie was born. They were living together so it was the three of them for some period of time.[00:13:00] When Sophie was roughly around 4 years, somewhere around there, they had a second child, and not too soon after her biological father just left the family. Sophie has not had any contact with him since he left the family and she acknowledged she didn’t know all the details about that decision. What she alluded to is that her mother would say things like, well, he just couldn’t handle it. It was too much and he left.

So her mother is now with these two kids and without the financial support of the father. She quickly takes on two jobs. She had one job and she ramped it up and started working more intensely. She also rather quickly, I think, in hindsight here married a man and he had four children from a previous marriage. All of a sudden there were 6 children in the household with [00:14:00] Sophie being the oldest of those 6.

Dr. Sharp: Okay.

Dr. Raja: So you can hear even there some relatively quick changes for a young child: the loss of a father, a quick marriage, and a really big change in the family composition.

Dr. Sharp: True.

Dr. Raja: As I said, Sophie’s mother was consistently working these two jobs and was quite busy until Sophie became a teenager. So Sophie took on a lot of the responsibilities with the kids and sometimes that was very overt that she had to do certain things and sometimes less. Early on she struggled a little bit academically, in earlier years of elementary school until it was determined her reading and writing were a little bit off. She got some assistance about that and that seemed to be resolved.

And she was caught up by third grade, fourth grade, somewhere around there. And moving forward there, she was an academic superstar. She graduated at the top of her high school, went to a very prestigious undergraduate school, did well there academically, and got into this Master’s in [00:15:00] Public Health Administration program that was not easy to get into and did well academically there even with the anxiety.

Dr. Sharp: Great.

Dr. Raja: And so at the end of the first session, just to pull this together here, Jeremy, we’re wrapping these two questions together and I summarized them back to her and we both agreed that these were a good place to start. I let her know if she thought of another question after she left, we could always add it in. I was going to type them up and we’ll get going with testing next week.

Dr. Sharp: Cool.

Dr. Raja: So we have our questions. So in between sessions, I type them up. And then Sophie came back about a week later and I pull out the typed questions and I show them to her and basically say, how do these look to you? If you want to make any edits or additions or deletions, let me know. She was fine with how they were so we kept those.

Sophie did not do a ton of testing. She stepped into the MMPI-2 [00:16:00] next. I explained to her that she was going to take the MMPI and that, this is the most widely used personality test in the world, and it’ll be really helpful. And just understanding you very broadly and who you are as a person, your personality and it might give us some good sense about your anxiety and what that’s like.

Dr. Sharp: Can I ask you a question real quick?

Dr. Raja: Yeah.

Dr. Sharp: What makes you choose the MMPI-2 over the MMPI-2-RF or vice versa?

Dr. Raja: I go both ways actually lately, Jeremy. The MMPI-2-RF being new, we have a little bit of the same problem I think we have with the R-PAS being new in that we don’t have all these years of great articles and data about it. I think we’re still building some of that up. And so some of my favorite MMPI books don’t tackle the MMPI-2-RF, the Levak therapeutic book here, Therapeutic Feedback with the MMPI-2 [00:17:00] Siegel and Nichols. They really are just talking about the MMPI-2.

And so for me, the decision point might be relative to how many more underlying issues I think you can get out of the MMPI-2 that sometimes are harder to read in the MMPI-2-RF do I think I’m going to need in this situation versus is it going to be better for the client just to do something quicker, which the MMPI-2-RF obviously is, and easier for them to see things on the MMPI-2-RF. It’s easier to explain the MMPI-2-RF scales and the graphs to people than it is, I think, some of the MMPI-2 scales.

Dr. Sharp: That’s fair. And then continuing with that line, what would make you choose those over the MCMI or vice versa?

Dr. Raja: I know a lot of people in the field are a little leery about the Millon and we know the MCMI is designed for clinical population. [00:18:00] And so there are times when I have someone where I think this is a person in the clinical population, there’s likely a personality disorder here and so then that makes sense to me but there are other times I find it helpful but knowing that it might over pathologize them, but I’m going to use my critical thinking skills to figure out where do they really fall here or how do I make sense of this?

To me, the question comes sometimes honestly down to pragmatics a little bit, like how many testing units did I get for this person? How much time do we have? Do I feel like I’m going to need more testing versus less given who this person is, and someone like Sophie, that’s just going to give you a lot because her insight’s so good and she gets herself so well in many ways. Sometimes I don’t feel like I need as many tests.

Dr. Sharp: That’s fair. I was just curious. I know that’s always a raging debate.

Dr. Raja: It is.

Dr. Sharp: Yeah. Thanks for detouring for a second.

Dr. Raja: Yeah, no problem. So Sophie comes back, and she’s there for roughly [00:19:00] 75 minutes, completes the MMPI. I scheduled another appointment with her the following week and at this appointment, I scheduled for an hour and a half. And what we did essentially for the first 45 minutes or so is, I did what’s called the extended inquiry on the testing. So here’s where I’m exploring the test with her.

So I have her come in, I say, we’re going to first talk a little bit about the MMPI-2. I’m just curious, what was it like for you to take that test? Because I want to get some sense of her experience and quite frankly, if something strange happened during the test, let’s find that out now. She says, oh yeah, halfway through, this didn’t happen to Sophie, but oh my God halfway through, I got a text from my ex-boyfriend and I have totally freaked out the entire rest of the time. Like, if something like that happens, I want to know about it.

Dr. Sharp: Sure.

Dr. Raja: So I wanted to get some sense of that and just normalize that it’s not the most fun thing to take. It takes a while. It can get a little dull side. And then what I said to her is, the MMPI identifies some items [00:20:00] things. It’s helpful to review with clients. And so I’d like to take some time reviewing those with you. And so I’m now looking at the critical items with Sophie, and I’m just walking through some that seem relevant to me or ones that I feel like I need more information about.

And so, she said false for, I wake up fresh and rested most mornings. So I’d say so this item said, I wake up fresh and rested most mornings. You said false for that. Well, tell me about your sleep and tell me about what it’s like in the morning for you. I’m really trying to understand how these different items and then also what I’m seeing in the scales relate back to her and her life. Again, I’m inviting her to collaborate in the process of making sense of this test data together.

And so we would continue through probably some of the critical items or we did continue some of the critical items. I would essentially show her some of the content scales so she could see where she’s at. Just so you can get a sense, this was essentially a [00:21:00] 7-2 profile with the 2 not very highly elevated, the 7 a bit more but not super high but the 5 was also pretty high.

And so with that 5up a bit, we got this dutiful, responsible, serious person, the kind of person that’s going to take on many tasks and responsibilities but also probably pretty worrisome with that 7 trying to anticipate the worst. I’ve heard a great analogy of the 2-7-1-2. It’s like moving through the world with too many windows open on your computer and you’re just jumping from one thing to the other just to make sure. But with that 5, we can also see her energy and her commitment that got her through graduate school. She’s action-oriented and able to move forward on stuff.

And so I’m not going into deep interpretations with her at this point, Jeremy. We’re just talking about the test a little bit and how does this match up with your life? And so for example, sometimes when people are high like this, they often fear the [00:22:00] worst and they’re moving through life just worried about what next callam is going to happen. Does that resonate with you, Sophie? What do you think? And we would have a conversation about that.

Once we’re done with that, in this same, this is still the third session, I then transferred over to what’s called the Early Memories Procedure which I have to find here now, here it is. The Early Memory Procedure was developed by a psychologist named Arnold Bruhn. It’s essentially a booklet. You can have the client take it and fill it out or you can fill it out with the client, which is my preferred method. It’s basically a series of pages and it asks clients to essentially reflect back on their earliest memory and write in as much detail as possible. You’re supposed to think about memories that are one-time incidents, not things that you used to do over and over again, and just capture the experience.

And you essentially do that roughly [00:23:00] 5 times, and then on the 6th prompt, it says, beforehand you’ve thought about memories throughout from your early childhood but now think of a memory from your entire lifetime that is particularly vivid or especially important to you for whatever reason. And then has the person write that memory. There’s room for additional memories if the clinician chooses to do those or if the client wants to.

But then what happens is you go through and you rate each memory on two scales. One’s a scale of 1-7 for the emotional valence, so positive to negative. So 1 is very negative, 7 is very positive and the middle is neutral. The second is clarity of memory and this is 1 to 5. So 1 is like, it’s really fuzzy. I can barely remember anything. And 5 is like, it’s a movie, it’s like playing in my head. I can see everything very clearly.

I’m not going to share with you all of Sophie’s memories, but I want to share with you what really was her most important memory. And this was, I think, the [00:24:00] 2nd or 3rd memory that she came up with. I remember that I was at kindergarten or maybe it was preschool and it was the fall festival, kind of like a Halloween thing, but they wouldn’t let us call it Halloween. I was [..] from the backyard against, I think. I remember my mom came and I was so excited that she was at school with me, and I remember my dad was supposed to be there and he couldn’t make it. This was right before he left.

So that’s the description that she wrote. It then has a series of prompts. The first one is, what’s the clearest part of the memory? And Sophie had: standing near the playground, watching my mom and teacher talk. The next prompt is, what’s the strongest feeling in the memory? And Sophie said, excitement at first, but then I felt empty and hollow because my dad didn’t show up. There’s a third prompt, if you could change the memory in any way, what would that be? Sophie’s response was, have my dad be there. And lastly, it asked how old are you at the time. And she [00:25:00] thought she was about 4 or 5 years.

Dr. Sharp: Okay.

Dr. Raja: What the EMP is great at is bringing into the room what important experiences often for people are, as this one is. But even if they’re not as salient as this memory is, they often capture where the person is stuck. Bruhn who developed this theory is that whatever memory they rate as the most negative on that one to 1-7 scale, and the clearest on that 1 to 5 scale indicates where they’re stuck. Sophie rated this as a 4 on clarity and as a 2 on emotional valence. So almost the most negative but almost the most clear.

Dr. Sharp: Got you. Sure. Okay.

Dr. Raja: I did this with her and then we start talking about these experiences. It’s not uncommon after I do the EMP, I’ll explain people what I just explained you, Jeremy about this is how we make sense of this. What do you think? And this opens that [00:26:00] door because what does this memory really about? I was abandoned by my dad at an important time for me. It opens the door to conversation about that and I will now try to link that back here to Lauren’s question, do you think this is part of what maybe Lauren is trying to figure out that maybe there’s some stuff from your childhood that’s still sticking with you.

Dr. Sharp: Yeah. And would you do that right there in the moment as you get this information?

Dr. Raja: Yes, exactly.

Dr. Sharp: Nice.

Dr. Raja: And for Sophie, there’s certainly, it could be an emotional reaction to this. Even telling the story was difficult a little bit. And now that we’re talking through, what was it like to not have your dad around? She’s getting a little bit emotional. Let’s go back to the MMPI-2 profile. She’s got that 2-7 part that can suggest some fragility but the 5 is up too so she’s got some resilience to her too. So she can quickly pull it back together.

Dr. Sharp: Yeah, I see that.

Dr. Raja: But now we can hold out this hypothesis a little bit with her. [00:27:00] I wonder if there’s some part of your sadness, your anxiety that’s connected to your dad not being around. And we don’t need to answer that now because we’re just in the second step really. I said to her something like, well, let’s see what else happens in the testing and see if we can get any more information about that. So then she comes back for another session…

Dr. Sharp: Sorry, could I have a backup just a little bit?

Dr. Raja: Please.

Dr. Sharp: So with that information, would you call that level 2 kind of information?

Dr. Raja: Yes. Thank you for saying that, Jeremy. So I guess for the audience, if you didn’t listen to part 1, go back now so you understand levels. But level 2 information’s going to be new ways of thinking about yourself that the client can hear and accept.

Dr. Sharp: Got you. Nice.

Dr. Raja: Yes. Spot on. We’ll make a TA out of you here, Jeremy.

Dr. Sharp: I’m on my way.

Dr. Raja: So the next test I did with her is [00:28:00] the Thurston Cradock Test of Shame. I also talked about this in the first podcast. This is a storytelling test designed to help identify shame and how clients respond to shame. I’m not going to get into all the scoring of that relative Sophie, but I just want to share with you one of the stories so you can hear a little bit of how we play with it.

And so she came back, this was again, appointment where I said to her we’ll probably meet like 75 minutes or so, somewhere in that range. And so she comes in. I always want to check in with people at the beginning but almost every testing situation because if I’m going to have them do something hard, as you can hear in that EMP discussion. Emotionally, this can get hard. I want to know where they’re at. I also want to reflect back on that last session and say, you know what, I’m wondering what that was like for you to talk about your dad not being there and were you thinking about it anymore afterward or [00:29:00] not? So get some sense of impact. Did she put it back away real quickly or did it percolate for her?

So she comes in, we check in. She’s in a good place. She’s buoyed again a little bit and I administer this test to her. I’ll try to describe what this one card looks like. It’s essentially an adult character; they can only see the back of them. And they’ve opened a door into what looks like a lunchroom at a business place and you can see your water cooler and a group of what looked like adult coworkers all standing together and one of them looks like they’re laughing, right?

Dr. Sharp: Got you, I’m with you. Yeah.

Dr. Raja: Picture the fear we all have of walking in and our coworkers laughing at us. That’s what this card is pulling for. And so here’s the story that Sophie created for this one. [00:30:00] This woman is at work and she walked into the lunchroom and all of her colleagues are talking about something, maybe her. They were laughing and stopped when she walked in and the boss said, let’s start our meeting.

I asked her, what are they thinking or feeling? She’s feeling dread because she knows she has to go into that meeting and talk about her current project and she feels nervous about what she’s doing and she’s thinking, great, they were just talking about how dumb I am and now I have to present. Pause, what happens next? I don’t really know. I think she goes to the bathroom and tries to get her act together. She sits in the stall and just works to make herself strong, and then she goes to the meeting and is firm and assertive. Anything else? No. So we have this story now in the room, right?

Dr. Sharp: Oh gosh. Yeah.

Dr. Raja: So again, there’s 10 cards to the test of shame. So I’m going to go through all of them because I’m going to follow my [00:31:00] standard administration and then I’m going to go into the extended inquiry, and I’m going to say, Sophie, what did you think of this test? I’m going to follow her lead initially and see where she goes. If that doesn’t go anywhere, I might say, well, were there cards you really liked or cards you didn’t like? Or maybe did any of them sound familiar to you at all?

Sophie clearly recognized this one as her. And so I said, oh, when I heard it, I was wondering the same thing because I know we were talking about your new job and how stressful it is and how you can get nervous there so I’m wondering if we could talk about that a little bit. And so I brought that story back up, if you will, and I gave her the card again and I read it back to her. We just spent time really going back and forth between talking about what’s in the story and what’s in her life as a way for me to understand what this experience is like for her.

So the story brings into the room [00:32:00] what we call her problem of living that occurs in this workplace. And now I’m just really in a kind of a playful, exploratory, curious way, trying to understand this with her. What was beneficial about this for Sophie and I eventually connected back to her question about anxiety, is we realized that a good part of her anxiety is connected to those moments when she really feels insecure about her intelligence.

Dr. Sharp: Oh, that makes sense.

Dr. Raja: And so here’s this moment where she’s got to go in and talk to these coworkers and present and demonstrate. Does she know what she’s doing or not? And they were laughing at her, maybe, maybe not. And so we started to then talk about that experience, what’s it like then when you’re worried about your intelligence and what that’s been like for her and tracing that all the way back.

So we talked about graduate school, as I mentioned, she struggled there for a little bit with anxiety. We talked about what that was like. And often I’ll ask a question, something like, [00:33:00] well; do you think the worry about intelligence was around when you were in elementary school, if I had met you in third grade? And what we started to realize a little bit was the impact of needing this extra help when she was a little behind on, on reading and writing and how that sat with her, combined with the fact that she’s got this busy mom and probably was not as attentive to what that was like for her and the dad was gone. And started to make sense of how, one of the things about her anxiety is it’s not necessarily omnipresent. There is anxiety at different times but it’s going to be probably strongest in moments where she’s concerned, what are people thinking about my intelligence.

Dr. Sharp: That fits, okay.

Dr. Raja: Questions about that, Jeremy?

Dr. Sharp: It makes sense to me. You’re explaining, I think you’re articulating it well. That’s a pretty clear example of how the card adds to your experience.

Dr. Raja: Yeah. Right. I’m just using the test data that’s [00:34:00] captured something about this client to explore really with the client these moments.

Dr. Sharp: Yeah. Okay, so far so good.

Dr. Raja: Okay. I’m not going to go through all the tests. I did a Rorschach with Sophie and it’s the same kind of procedure. We do the test. I administer in fashion. I do, again, the extended inquirer; we explore some of these responses. Rorschach response in particular often serve as metaphors for people’s lives. And so we talked about that and we’re starting to understand her more.

Eventually, I get to a place where I feel like we got enough data to answer the questions and I’ve got a good conceptualization of Sophie. I’m going to move into the assessment intervention session, which comes before the discussion session. In the first podcast, I had mentioned that this was a step in between testing and the discussion session, but I didn’t explain it. Allow me to just explain this really quickly.

Dr. Sharp: Great.

Dr. Raja: And I’m going to use an analogy to help you understand it. Imagine you’re a [00:35:00] biker and I own a bike shop and I’m a great bike coach. And you come to me and you say, Raja, I want to learn how to bike better. And I say, all right, Jeremy, let’s figure some things out. I sit down with you and I ask you a bunch of questions about your bike. And maybe I have you take bike tests, like go take these tests about biking and why don’t you go bike and take a journal with you, log what you notice about biking and bring all that back and let’s talk about it.

So we could do that but quite frankly, if you wanted to get better at biking, what would be more beneficial if I said to you, all right, Jeremy, how about Saturday? Let’s go biking and I’ll follow behind you and I’ll watch you and let’s see what happens because I can see it in the moment to understand what’s exactly occurring.

Dr. Sharp: Yeah, sure.

Dr. Raja: When we’re doing a TA with people, one of their goals is can we bring their problems of living into the room for them to be present with us so that the client and us can explore that together and contrast [00:36:00] this to intellectually handing something down to someone. I’ll just use a simple example here. It’s one thing to explain to someone, well, I think you have abandonment fears. Part of what’s going on is when you fear they’re going to be abandoned, you get really anxious and then you engage in these behaviors.

It’s going to be a very different experience if I can do something to bring their abandonment fear into the room that it’s present for both of us together and we can identify what’s happening there and make sense of it together. Lived experience.

Dr. Sharp: And in that example, how would you go about that?

Dr. Raja: That is a great question. I will say of all the steps in the model, the assessment intervention session’s the hardest one for people to get their head around but we tap into other tests or aspects of art therapy or drama therapy or even some of the family therapy approaches to try to do something that’s going to bring the problem [00:37:00] of living into the room.

Dr. Sharp: Oh.

Dr. Raja: The number one thing that people do is actually use the storytelling cards, and they select cards that pull for the issues that they think are what’s unresolved for that person.

Dr. Sharp: Okay, are these new cards that haven’t…?

Dr. Raja: Yeah, so I gave her the test of shame already, so I wouldn’t give her a new test of shame card, and I’m going to tell you what I did do with her in a second, but I would find other cards that I think are going to help bring into the room what’s going on.

Dr. Sharp: Okay. Fair enough. I’m curious to see where this goes.

Dr. Raja: Okay. So let me give the example and then we’ll come back and make sure we got our heads around it because as I said it, often, people are like, wait, what, when it comes to the assessment intervention session.

Dr. Sharp: Okay.

Dr. Raja: A little bit of what happens there is similar to the extended inquiry, what we just saw, right? But in the extended inquiry, we’re working on the fly because it’s like, oh, there’s something, let’s see what we can do with it. Let’s explore.

[00:38:00] In the assessment intervention session, the first thing that’s really important is I want to have a solid conceptualization with a client before I design my plan. And so for Sophie, based on what I’ve seen in the test data and based on what she’s told me, my conceptualization at this point would be that she’s got unresolved sadness and grief about her father’s absence, her mother not being there as much as she would’ve liked, given how busy she was. And all of that’s contributed to what we’re seeing the anxiety and some of this depression, as well as the questioning of herself.

She managed all that by learning to be really independent in her problem-solving. And that has led to difficulties depending on others. So she’s got this headstrong and this is the good of it. It got her through high school really successfully and then a really tough undergraduate program and a really tough graduate program. But she’s so independent on her problem solving. She doesn’t always connect well and with [00:39:00] others because she has a hard time relying on others or depending on others. And this unresolved grief is still there.

So what I wanted to do was see if we could do something that would bring sadness into the room particularly potentially sadness related to parent figures and to see if we could start to identify that together. So what I said to Sophie, I had said, okay, we’ve now done four or five days of testing over maybe four or five weeks. I said, why don’t you come back, we’re going to do some other types of testing together, and my hope today is that we can figure out some of the answers to your questions together in the moment.

Dr. Sharp: Okay.

Dr. Raja: And so as far as she knows, this is like the other testing sessions. She doesn’t know it’s different in that way. I would then pick, or I did pick cards that matched what I thought might bring her problem of living into the room. When I do this, I usually start with a card that’s a little more [00:40:00] neutral just to warm them up. Given she’d already done the test of shame; she was familiar with the storytelling test procedure, so it didn’t take much.

But essentially I gave her a card that’s from the Adolescent Apperception Test, which I’m sure not many people are totally familiar with but if you can picture the TAT card, I think it’s 13MF. It’s the depression error card of the boy who’s sitting in the house and it looks like out in the Dust Bowl and it’s like a six-year-old boy just sitting in the door, well, all by himself. And it pulls for this alone child.

And what happens? In the Adolescent Apperception Test, there’s a similar picture with regard to pull. It’s a bit of a street scene and there’s this girl sitting at the curb and there’s a house behind her. And she’s looking down into her hands and holding her hands together. It looks like she’s looking into her hands and it’s got that same quality. She’s the only character in the story. [00:41:00] That pulls for this alone child and what’s going to happen for this kid. You with me, Jeremy?

Dr. Sharp: I’m with you.

Dr. Raja: Okay. So here’s the story that Sophie tells for that card. This girl appears to be very sad and she’s looking at her hands and maybe wondering what she can do to make things better. She appears to be crying. Maybe something just happened in the house to parents or her siblings and she walked out to the curb to get some air and get away. So I asked her, well, what happens next? She picks up and goes about her day because she knows life must go on and hard things only make you stronger.

So here again, we can see the independent problem solving approach showing its full colors. You have this child who’s minimally stressed or sad, crying. And how does she manage that? She doesn’t reach out to attachment figures or peers, anyone else. She solves it herself with this kind of mental, [00:42:00] it’s going to be okay, pick yourself up attitude. In this assessment intervention session, she told stories to a few cards but this one stuck with me because it pulled for the issue with the parents and the sadness that I believe she had as well as the independent problem-solving.

So now I’m going to do something that’s really unique to the model. We’re going to play with this test a little bit. And so she did about four stories and then we talked to her, what was that like for you? What did you find interesting? I follow her lead. And then I said, I’m curious about this card with the girl, do you think we could talk about it a little bit? She said, sure, Raja. So I hand her back that card and I read her the story back. So it’s in the air with us again. And then I say to her, you know what, I’m curious about this story, and I’m wondering if you could tell the same story with the same beginning but instead of the ending, she picks up and goes about her day that part before you [00:43:00] do that, I’m wondering if you can just have someone come out and join her.

And in my mind, I’m thinking, what would happen for Sophie if somebody comes to this child in a moment of distress and let’s see what’s going to happen next. And I’m specifically, Jeremy choosing the word, just someone at this point because I really want to scaffold her tours. What I really am curious about her mom and dad but let’s just start with someone and see where she goes.

So she says, sure. So she says so this girl, let’s call her Megan. She sits on the curb and then her little sister comes out and says, what’s the matter?And Megan says nothing. And then Megan takes her back inside and gets her ready for school. So she tells that story, again, I stop and say, well, what do you think of this? And we kind of talked through it. To me, what I’m noting is really interesting, is who did she choose to have come out? A younger child.

Dr. Sharp: Of course, yeah.

Dr. Raja: So much safer from a [00:44:00] relationship standpoint than a peer or the parent. And again, here we see her being the older sibling, again and so we talk about that a little bit. So now I shift it a little bit. I’m going to scaffold her toward more of what I’m looking for. And so after we talk through that a bit, I say I wonder if we could try this again. Let’s pick it up from the same place. And this time we’re going to have someone come out, but this time can you have a parent that comes out to her and pick it up from there?

And this is what she says, Jeremy. She says, oh, sure, I can. And then there’s this pause, and then she says, wait, what am I supposed to do? And so I lean back in and say, just pick up the story from here. And a parent comes out and she says, okay. So Megan sits there and then her dad comes out and starts to now, well maybe her mom comes out and there’s this [00:45:00] big sigh. I don’t know. I just don’t know what would happen next. I just simply can’t imagine that.

And at this point, the tears are starting to come, Jeremy. And so I’m right there validating and supporting and talking about the sadness and helping her identify it. What’s happening for you right now, Sophie? Help me understand what you’re feeling. And really just staying with the emotion and validating the sadness connected back to these experiences of not having her parents there. And we stick with that emotion. This approach has really got that emotion-focused therapy component and we want to stay with that before going to the logical explanation part.

And I’m going to be very careful at this point because I’m going to work under a bit of assumption that shame’s going to arise relative to the [00:46:00] sadness as what was the case with Sophie because somewhere in this conversation, there was a sentence essentially like when I was little was hard, but I should be over it by now. I shouldn’t be feeling these things right now. So dampening down her emotional experience and feeling shame about still being sad. I’m coming from a place of normalizing the experience and helping her understand why it makes sense that she didn’t grieve, think about what I said about the family background, there was no time to grieve. The dad’s gone. The mom’s now super busy. The mom’s onto somebody else. The household’s got some level of chaos with all these people in it. There’s no room for grief and no one that was really attentive to her grief needs relative to her dad not being there.

Dr. Sharp: Sure. Wow. It’s a powerful example.

Dr. Raja: Yeah. And you can see, Jeremy, how the test brings it in. And because it’s a lived experience in the moment there, [00:47:00] it’s so different than me saying to her at a discussion session, well, I think part of what’s going on based on the testing is that you have unresolved grief about your dad.

Dr. Sharp: Oh, yeah. Totally different, right?

Dr. Raja: Right.

Dr. Sharp: Are you always going for that sadness, a shame combination or are those specific to this case or…?

Dr. Raja: That a good question. We had talked about the different levels of information, for Sophie, this is level 3 information. Reality is some people have level 10 information. That some of this is really, they’re just not ready to address and it’s really quite unconscious. What I’m always going for in an assessment intervention session is what Finn would call a little bit of the low-hanging fruit. What do I think they can gain some more [00:48:00] awareness about that’s not going to be so hard for them to gain awareness about, that they’re just going to not be able to accept it.

Dr. Sharp: I see.

Dr. Raja: Because reality, I think the sadness for Sophie, we obviously got to that place and she could experience it and recognize it. What I think would’ve been even harder is the anger.

Dr. Sharp: Yeah, that’s the next level.

Dr. Raja: Like, yeah, mom, where were you when I needed you? And dad, what the hell? Where’d you go? That would’ve been a harder thing to go after, I think, in an assessment intervention session.

Dr. Sharp: Okay. Fair enough.

Dr. Raja: So I’m obviously truncating a very longer experience with more emotion and there’s a lot of support by me through this process and helping her regroup and lead feeling okay. I’m not just opening you up as you… it’s just like a therapy session. I’m not just going to open you up and then okay, session is over.

Dr. Sharp: Right. Well, and that leads to another [00:49:00] question is, I guess, what’s the intent here? What are you going for in this session? What happens after this emotion comes up?

Dr. Raja: What my hope is through the assessment intervention session some of the level 3 information that might be rebuffed still during the discussion session becomes more palatable because of this experience. Now for Sophie’s case, it came roaring in the door for us, so we could see it in and experience it. You can imagine someone who maybe was more defended about this or felt maybe even less secure with me about it, and they didn’t quite get there but at least we’ve planted a seed on it and when I come into the discussion session and I talk about it again with them, maybe then it’s going to be even more palatable and not just something that’s going to be hard for them to look at.

Dr. Sharp: Okay. So I just want to make sure I’m following you, it’s like you have this [00:50:00] idea from the testing and the interviewing and the interactions up to that point of things that might be particularly salient for them or emotion, connections, experiences that you’ll likely deliver those things in the discussion and maybe the wrap-up letter but in order to do that, you need to have this assessment intervention session to really make them, I don’t know, more real or more meaningful or personal…

Dr. Raja: And I think maybe understanding why Finn developed this helps little, Jeremy because they were doing all that testing and that extended inquiry that we were talking about. They were going into the discussion session and realizing people are still not able to take in the level 3 information. So then the idea was can we do something as, is an in-between step, that more real for them because you can imagine now what’s next is the discussion session?

And so when I [00:51:00] say to Sophie, as we talked about last time and as I think you figured out, there’s some unresolved grief for you here relative to your dad leaving the family and your mom not being there the way you needed. She’s going to be more in a place of being able to say, yeah. And two parts there, Jeremy. More of like, yeah, I can get that and I’ve had this experience with Raja where I can talk about it and it was okay. I’m setting the stage for Lauren to pick up that piece and keep going with it.

Dr. Sharp: Yeah, I get that. I see what you’re saying. This is really interesting. I’m just thinking through and again, you can see my face, the listeners cant, but I’m clearly working on this really hard in my mind. I’m just thinking of how this seems like there’s a parallel between sending someone off to do like a little bit of VMDR or something or some other different [00:52:00] therapeutic approach that accelerates the process and then you take that back to your therapist and it enriches that experience.

Dr. Raja: That’s very well put, Jeremy. It’s an intensive short-term psychotherapy.

Dr. Sharp: Yeah. Okay. This is a great case.

Dr. Raja: So next, and I’ll go into a little less detail here because as far as a case study and explaining it on a podcast doesn’t work so well. But the next step is we’d have the discussion session. So that would be at Lauren’s office. I would be there and I would orient as to how it’s going to go. That I’m going to be here for the first part and then we’ll answer the questions. And then I’m going to step out and let you two talk a little bit too, so you have a chance for some alone time without me there.

I always let clients know, I think we’ll probably get through most of what we need to get through today but if you leave here today and you’re like, I want to know more than [00:53:00] what we talked about, we can arrange more times to meet. I’ve had some clients where the discussion session was five sessions long because that was the pace that they needed given who they were and how much they really could take in. Now, I couldn’t always get the therapist there for all five of those sessions. That’s the hard part but the client and I were able to meet.

And so in that session, the discussion session, I’m just answering the questions and so I’m talking now about some of this test data that Sophie and I had already looked at and helping Lauren understand what we figured out relative to the social anxiety specifically and how intelligence or concerns about how people are perceiving their intelligence is such a big part of that. And then talking through some of that test data. I’ll often bring back into the room either a Rorschach response or a TAT response or one of the Early Memory Procedure memories that feels to really capture this person.[00:54:00]

And so in Sophie’s case, we were talking, I’d share, and I’m sorry, I should also add one more important step here, Jeremy. You’re going into the discussion session off of the assessment intervention session which can be powerful, so I always want to check in on that too. How have you been doing since I last saw you because I know what we figured out was heavy and make sure they’re, figure out what that was like for them.

Dr. Sharp: Yeah, I hear that.

Dr. Raja: But in Sophie’s case, we were talking about the grief and she was able to speak to some of that even without me saying it because she was in that room as we talked about it. And then I said to her, is it okay if I share with Lauren the memory from kindergarten or preschool? And so I read it again and of course, Lauren was just deeply touched by it as was I and she just started crying again right there in the moment.

Dr. Sharp: Oh gosh.

Dr. Raja: And we sat there with her and we just supported her through that grief again. And having those two people there just saying, we understand, we get it. [00:55:00] And so that in itself is powerful and healing for her but also is beneficial because remember what we also said about her, she tended to be an independent problem solver. And so here’s this moment of having a different experience of working through a difficulty with two people supporting you. And then how does that translate into how she moves out in the world now that she’s been able to have this as far as sharing more with others and being a more emotive which I think was getting in the way of some of her relationship-building.

Dr. Sharp: Absolutely. Yes. Okay.

Dr. Raja: So that’s the discussion and then there’s a letter that comes, we talked about that in much more detail in the first one. And then if Sophie did not come for a follow-up session as I explained typically happens but she could have. I followed up with Lauren afterward because, to me, this is the other benefit of these. In Sophie’s case, she was able to take a lot of this in and see the residents for her [00:56:00] life.

It’s sometimes the case; you’ll go into a discussion session. Just to use her example, I might say to someone, well, it seems like there’s still unresolved grief and that person might not be a place where they can hear it yet. And if they say, Raja, I don’t think that’s true. I think the tests are wrong on this one. I’m going to be respectful of that and say, okay, but I’m not going to totally let it drop.

So in the letter, I might still write something like, I know when we talked about this in the discussion session, it seemed like you didn’t think unresolved grief was part of the picture but as I said to you, it seemed like the testing was suggesting that and I’d encourage you and your therapist to keep exploring that. Because now the therapist can hold that bit of the client and what you’d expect is these parts of people tend to pop up again in therapy and so when they pop up, it’s a chance for the therapist to be like, I wonder if this is what Raja was talking about with their grief.

Dr. Sharp: Yeah, sure. I would imagine that some clients, it can be [00:57:00] fairly heavy and they aren’t able to take everything in at that point. They’re just not ready but putting it out there and they’ll have that letter always.

Dr. Raja: Yes. And one of the interesting things just come back to the research, Jeremy, the research suggests the benefits to people and when it occurs is variable. So we see people have changes even after the first session, after that discussion session. And sometimes still not sometime after that, maybe like six months later really occurs. And I think the thinking there is still that small changes are happening.

And so you think about even someone like Sophie, if she now can move into the world and be a little more open with her emotions, how does that then change her relationships? And then how do they respond to her in probably a more supportive way. And if the relationships build, what does that do to the anxiety and the depression? We’d hope it would drop. And so these small things can cascade into really important changes for people.

Dr. Sharp: Yes. [00:58:00] I’m just taking note of all the… there’s a lot of layers here in this process and I have a lot of appreciation for pulling all those skills together on the clinician side. You have to have your test administration and interpretation skills, but then of course, being able to deal with these heavy emotional situations and then how to integrate that with another person and then pull it together in written format.

Dr. Raja: And that is one of the challenges, and I’ll be honest with you, I sometimes blow this one because I’m bouncing back and forth really, bouncing is too strong a word, but assessor and therapist. And so there’s sometimes where someone’s saying something and I’m so busy in my assessor role, I’m writing everything down because I want to make sure I lose it. And meanwhile, I’ve lost the fact that they’re like crying.

Conversely, there’s other times where I’ve gotten so lost in the conversation, I’m supportive that I haven’t been able to capture some really good stuff that I wish [00:59:00] I had. That becomes a really tricky line that we wind up walking in this model. But again, I’m up for those challenges or I appreciate those kinds of challenges and work; it keeps it fresh for me.

Dr. Sharp: That’s a good point. I’m mindful of how a lot of folks will feel like they have to make that choice between therapy and assessment and go one direction or the other and this certainly marries the two.

Dr. Raja: Exactly.

Dr. Sharp: I wonder about that actually. You do more formal assessment as well or information-gathering assessment too.

Dr. Raja: I do.

Dr. Sharp: How do you find this fits for you in terms of burnout or feeling energized?

Dr. Raja: People in the TA world will talk about the need for connection with others that are doing this because it can be, if you’re really [01:00:00] doing this, you’re really connecting with people at a really deep level. And we know as therapists that that can be just challenging for ourselves. And so I try to stay connected with others that I know are doing the model or learning the model is one way to help myself. I probably could take on, well, I don’t know, whatever number of traditional evaluations I could take on, I probably can only take on half as many of these evaluations, just emotionally it’s that much more work.

Dr. Sharp: I got you. And are there people out there that make an entire practice out of Therapeutic Assessment?

Dr. Raja: Yes.

Dr. Sharp: Okay, great.

Dr. Raja: Yes, and I bet many of them also have a number of therapy clients so that they’re not just doing that, I guess would be the better answer, Jeremy.

Dr. Sharp: Sure. Yeah, I’m really thinking through a lot of the pieces of this and how it might fit into a practice. It seems like, and this could be, I’m sure there’s a lot of variation out there, but I would almost see, [01:01:00] if a clinician is doing a lot of Therapeutic Assessment, they’d be more likely to have therapy as an adjunct service than formal neuropsychological testing as their adjunct service in the practice. I don’t know if that’s right or not.

Dr. Raja: No, I think that makes sense.

Dr. Sharp: Yeah, interesting. Gosh, any wrap-up with Sophie or follow up with her before?

Dr. Raja: No, what I would say about Sophie and that case is she got a lot out of it. I go a little bit to where I started, she came into it motivated, she’s a bright individual. She had good psychological insight. She was already curious about herself. And that really helps in this process for people with what they can get out of it.

Dr. Sharp: Okay. Fantastic. Is there anyone on the flip side, who is not appropriate for a Therapeutic Assessment?

Dr. Raja: Realistically I wouldn’t say there [01:02:00] is because there are all sorts of studies and case studies of it being used with a variety of types of folks in different settings with various levels of psychopathology. The one area that I try to be or there’s two areas really I try to be careful about. One is people who are in chronic crisis because we can’t wait for the people who are in chronic crisis but the people who are in acute crisis and that’s atypical for them, this might be too much for them. And if I met with someone that I would hopefully recognize some of that and maybe the level of depth that we’re talking about we don’t go to, to help them stay functional and void.

The other part that is always part of what I’m trying to figure out is where is this going with regards to other providers or services this person needs. Because reality is for most of these people that are doing this approach that are like Sophie’s, this [01:03:00] letter went back to Lauren and it went to Sophie and nobody else needed it. And so as long as it was helpful to Sophie, that’s all I really care about. If I had someone again, where I thought, this person could go to residential or this person’s going to need something different given how that system works, I might do something different, at least from the writing standpoint.

Dr. Sharp: I could see that. And then would you create two separate letters?

Dr. Raja: Yeah, potentially. That’s what some people are doing out there. At the front end I thought, this is going to be better served by a traditional approach with collaborative elements. I’ll go that path because as I said, and then the first one, there’s ways to implement some of this without dramatically changing what you do and without maybe going for this more in-depth repair and these attachment disruptions and the shame. [01:04:00] These would be two things to take away people, even that act, and I know people do this, but that time spent figuring out, well, what do you hope to figure out in these testing? Develop some questions. You’re going to increase engagement by doing that.

And even that act of afterwards, they’ve completed a test and as it makes sense, as we talked about last time, exploring what was that test like for you, I think it conveys to people that this is about you and open for you and help me make sense of this with you. We never do that and reality is there’s sometimes stuff happens and we interpret it one way when reality is, it could have been something totally different that we just didn’t even realize right?

Dr. Sharp: Oh yeah, absolutely.

Dr. Raja: Like they start bombing on a WISC task and we never stop and ask but then if we do, we find out, oh yeah, I got through the fourth test and I realized I was about to have diarrhea, but I just kept it together and it’s like, I’ll…

Dr. Sharp: Like, that’s good.

Dr. Raja: I wish I had known that, right?

Dr. Sharp: Oh, sure. Oh [01:05:00] gosh, that’s got me thinking of all the poor kids who have held in bowel movements.

Dr. Raja: Mm-hmm.

Dr. Sharp: Any other takeaways or things you really…

Dr. Raja: Yeah, well, if you want to learn more about it, there is the Therapeutic Assessment Institute as a website, therapeuticassessment.com. Anyone can join the Therapeutic Assessment Institute. It’s relatively cost efficient to be a part of that which allows you to get discounts to their trainings. They’re doing the major trainings on the Therapeutic Assessment models. And then the other great organization, the Society for Personality Assessment, SPA. Their journal and their conference probably has more TA-related articles and presentations than anywhere else. They still only $125 for professional membership, which is like…

Dr. Sharp: That’s wild.

Dr. Raja: It’s great. I just keep thinking at some point they’re going to raise it but hopefully not. [01:06:00] We’ll see. And in next June will be the third annual or maybe it’s biannual at this point, International Collaborative Therapeutic Assessment Conference at the Therapeutic Assessment Institute. I’m host. It’s actually be out in your neck of the woods in Denver, Jeremy. They’ve done them in Austin historically, but Austin’s becoming, I guess, cost-prohibitive so it’ll be out in Denver June 2020. Well, that’s another way for people to learn. And I’m certainly open to consulting with others as well. People can contact me through my website which will be connected here to the podcast.

Dr. Sharp: Right. Yes, I’ve already got that in the show notes. And I’ve been listing all these other resources that you’ve mentioned as well. So folks can go check those out.

Dr. Raja: Great.

Dr. Sharp: And just as a matter of [01:07:00] logistics on my end, I will likely have the same show notes for both parts of our podcast. So part 1 and part 2 will have all the same resources and notes. Let’s see, anything else?

Dr. Raja: One last, we didn’t talk about this at all but there’s actually four models. I explained the adult model. There’s a child model which is really built around changing the parent’s narrative about the child that’s contributing to whatever’s going on. There’s an adolescent model, which actually is the one I probably have done the most of. What’s really cool about the adolescent model, just real quick, is the adolescent gets their own questions. They can keep private if they so choose. So we want to respect their virgining independence.

And often in the adolescent model and the child model, people do this sometimes too, I’ll have the parents do testing also. And so if I get a question like, how can mom and dad best help Billy, [01:08:00] then I’ll say, you know what would be really helpful if we could have some testing done on you also, which is usually just an MMPI. And then we can really understand who the three of you are and how that might be contributing some to the dynamics that are occurring.

Dr. Sharp: Yeah. That’s fascinating. I’ve said so many times, I wish we could personality test parents when I’m doing neuropsychological testing with kids. Well, there it is. People are doing.

Dr. Raja: Yeah. And it winds up becoming a great intervention because again, what we know oftentimes these parents are having their own difficulties and I’m still a kid therapist but kid therapists talk about, I keep trying to talk to this mom or dad about getting their own therapist and they’re dragging their feet or it’s too hard for them to do. But when you sit down with a parent, you say, let me explain to you what this MMPI says about you and depression or you and anxiety, it’s so much more salient for them that I find a follow through on them getting more help from themselves is much better.

Dr. Sharp: Yeah. [01:09:00] I totally could see that.

Dr. Raja: Yeah. And then the last model is a couple’s model. So for couples that are in trouble, and essentially you come up with questions about your couplehood or about yourself, each person does their own testing and they do their own assessment intervention session and then come together for a couple’s assessment intervention session. That one I have not done. It’s got more complicated parts to it as you’re trying to navigate think clinically, logistically but that also is an option.

Dr. Sharp: Okay. I could see that being very powerful as well. Wow, I feel like we’ve covered a lot of ground in our time together and I really like that we’re able to dive into an actual case and have some of this come alive a bit more.

Dr. Raja: Yeah, me too, Jeremy. Appreciate the opportunity.

Dr. Sharp: Oh gosh. Yeah. No, I really appreciate your time. Like I said, at the beginning of the first [01:10:00] part, the fact that you reached out and were willing to initiate this process, I’m just very grateful for that.

Dr. Raja: No, you’re welcome.

Dr. Sharp: Turned out well. Well, we have a lot of resources for folks to check out. I would imagine they’ve learned a lot between these two sections of our podcast. If anybody does want to reach out to you, what’s the best way to do that? Is that just on your website?

Dr. Raja: Yeah, there’s a contact place on my website or my email address is raja@mnccta.com. So it’s Minnesota Center for Collaborative Therapeutic Assessment.

Dr. Sharp: Got you. Sounds good. Well, Raja, once again, thank you so much for taking the time to do this. I hope that we might talk again soon in some form or fashion.

Dr. Raja: That’d be great, Jeremy. Appreciate the good work you’re doing.

Dr. Sharp: Thank you.

Dr. Raja: All right. Take care. [00:11:00]

Dr. Sharp: Okay, everyone, thank you for tuning in to this episode, this case study on Therapeutic Assessment. Like I said at the beginning, if you somehow missed it, this was part 2 of a very lengthy interview, and part 1 has a lot of great information on the basics of Therapeutic Assessment and actually a lot of details around Therapeutic Assessment. So go back and listen to that if you haven’t already.

If you have not subscribed to the podcast, I would invite you to do so. You can do that in your podcast app usually pretty easily. There should be a button that just says subscribe and that will make sure that you do not miss any future downloads. I’m also happy to announce that the podcast is now available on Spotify, so if you are like me and you Spotify as your main mode of listening to music, you can now get the podcast there too. Again, you can search for it on Spotify, just search The Testing Psychologist and it should come up pretty [00:12:00] easily.

Okay, y’all. That’s all I’ve got for today. I hope you enjoyed this two-part series. We will be moving on to future interviews in the next few weeks and I’ve got some fantastic guests coming up, so stay tuned. Take care in the meantime, bye-bye.

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