TTP 54

Dr. Jeremy Sharp Transcripts Leave a Comment

Dr. Sharp: [00:00:00] Hello and welcome to The Testing Psychologist podcast, episode 54. This is Dr. Jeremy Sharp.

Today’s guest, Cecilia Briseno, has shared so much with us, and I’m so excited for you to hear this conversation. Cecilia talks with us all about immigration and hardship evaluations, and it just became so clear through our conversation that this is a topic that’s dear to her heart and very personal. She gave us a lot of great information on how to conduct these evaluations. So I think you’re going to take a lot away.

Cecilia is a licensed clinical social worker. She is bilingual. She has a private practice, Brightside Family Therapy in Arlington, Texas. She has over 17 years of experience in social work in a variety of settings and she has done some doctoral study in marriage and family therapy as well.

Cecilia specializes in Solution Focused Therapy(SFT) and has a [00:01:00] dual niche in working with couples but also working with families navigating the immigration process. She specializes in these evaluations, explaining the hardships that families face when separated from their loved ones. She is now providing training in how to conduct these evaluations, a training for other clinicians which you’ll hear us talk about. So please welcome Cecilia Briseno to the podcast and enjoy our conversation.

Before we get to that, I want to give a shout-out to our sponsor Q-interactive. As you all know, they have been sponsoring the podcast for a few weeks now, and this will be the last month of sponsorship for Q-interactive. They are the digital platform for administering a lot of the common tests that we give in our evaluations. This system has really improved the efficiency in our practice and we find that kids love the iPads, and you can get a 45-day free trial of [00:02:00] Q-interactive at

All right, on to the interview with Cecilia Briseno.

Hey y’all, welcome to another episode of The Testing Psychologist podcast. I’m Dr. Jeremy Sharp. Today, I am here talking with Cecilia Briseno. Cecilia is a licensed clinical social worker in practice down in Arlington, Texas. She is the founder and owner of Brightside Family Therapy there.

We’re going to be talking all about immigration and hardship evaluations. This is an area that there’ve been a lot of questions about in the Facebook group and certainly, as far as [00:03:00] I know, a rising area of practice in the evaluation field. So I’m super excited to have you on the podcast today, Cecilia, welcome to The Testing Psychologist.

Cecilia: Thank you for having me. I’m excited to be here.

Dr. Sharp: Thank you so much for taking the time and being willing to talk through some of these evaluations with us. I know this is something that I’ve been approached to do by a retiring psychologist here in our community who I guess has a line on an attorney who refers for a lot of these evaluations. So this is very personally relevant for me but I know that a lot of folks out there are really interested in these types of evaluations as well. So I’m super excited.

Cecilia: Thanks. I’m excited too.

Dr. Sharp: Cool. Can we just start a little bit, I like to get some idea of who you are and what your practice looks like so can you just tell me a little bit about your training and how you got where you are now and [00:04:00] what now looks like in your practice? What are you doing these days?

Cecilia: Sure. I got my Master’s in Social Work and then eventually, just like everyone else, worked my way into private practice. I was doing it part-time for a while and working part-time also. And then just like everyone else I’m sure, just kind of killed myself for a while, was able to save some money and build up my clientele and I was like, okay, it’s time. So I have been doing my private practice alone for the last, going on two years in two months, wow.

Dr. Sharp: It goes fast.

Cecilia: Yeah, it does go really fast, but it’s exciting and I love it. Every day is an adventure and growing a practice, as you know, is a challenge, but it’s really fun and really rewarding. [00:05:00] I’m bilingual so my practice is about half and half, about 50% Spanish, 50% English.

Probably about half of my practices are these evaluations and then the other half is working with couples. Not at all what I anticipated when I thought of being in private practice but it’s worked out really well and I really enjoy it.

I just recently hired my first contract therapist, so that’s really exciting and that’s been really nice to be able to. She had a huge desire to learn about this immigration work and so she is helping primarily in that area because I was getting too many referrals. So that was nice and I was like, okay, time to hand some of that off. I [00:06:00] also do LCSW supervision. So social work supervision, I guess that’s mainly it.

Dr. Sharp: That’s all.

Cecilia: And then I have my kids.

Dr. Sharp: Sure. Right. Your second job.

Cecilia: Exactly.

Dr. Sharp: Did you say that you teach a little bit as well?

Cecilia: Oh, yeah, I do that as well. I’m an adjunct professor at UT Arlington where I’m actually an alumni. It’s in the same city that I’m in so it’s pretty convenient. I just started doing that this semester. So I’m wrapping up my first semester and it’s going well. It’s been a different kind of challenge but it’s good. I’ve always wanted to do it so it’s nice to see all the different things that I’ve had a passion for come together in this year. It’s been awesome.

Dr. Sharp: Sure. [00:07:00] It sounds like you’ve really created a practice and a lifestyle that really works for you, that brings in a lot of pieces that you care about.

Cecilia: Yes, absolutely.

Dr. Sharp: Very cool. You said that this is not where you planned to end up in your practice. How did you get into doing these immigration evaluations?

Cecilia: When I was an LMSW, licensed master social worker, you can’t have your own practice. And so I coaxed a colleague of mine who had an office space that was empty. When I found out, I was like, no, you have to start a practice. So I helped her with all the paperwork and all the different steps to starting a practice so that she could see clients there but also so that I could see clients under her practice. So I have [00:08:00] been in private practice ever since, before I was able to, I was doing it.

During that time, I was approached by an attorney that was just two blocks from me wanting to send someone to me to earn an immigration evaluation and I was like, I don’t really know what that is. So he explained it to me and as a social worker, I’d done a million assessments before. And so I told him, well, I don’t really know but based off what you’re telling me, I can try.

He sent that client to me and I tried and he was like, yeah, this is great. I was just like, okay, well, I guess I’ll do it. He continued sending clients to me. It’s been about 10 years now with just, no, maybe about [00:09:00] nine. So it’s crazy to think about that because it feels like it happened in the snap of a finger but once I started doing it for him, he was sending more and then over time, people would just call me and ask me, if this something that you do. Of course I did. And then they would be working with different attorneys and once they saw my evaluation, they would send their other clients to me.

I haven’t really marketed, maybe once or twice, I’ve sent out an email. I think when I first was just doing my practice on my own and I was gung-ho and had time, I went to two attorney’s offices and handed my cards out but other than that, it’s all just been through word of mouth [00:10:00] and then also obviously now I have it online that this is something, a service that I provide.

It’s grown and like I said, now I have a contract therapist that’s helping me almost solely with these evaluations. Didn’t know that this was how it would be but I’ve enjoyed it. I have a personal passion for this immigration issue and so it’s worked out really well.

Dr. Sharp: It certainly sounds like it. I wonder if we could maybe dig into that a little bit because the evaluations we do; I think we all have a personal investment in evaluations for some reason. I have little kids right now so evaluating kids is close to my heart, I think is part of it. I think a lot of folks maybe have parents who’ve aged into dementia and things like that. There’s usually a personal reason. [00:11:00] I’m curious about that for you. I’m trying to think how to ask this question but it seems like the immigration evaluations or maybe even like more politically charged almost, and maybe that’s an assumption. I don’t know if that’s actually true. I’m not sure what my question is here but I’m trying to stumble into …

Cecilia: I am getting the gist.

Dr. Sharp: Why is this important? Is there truly a political piece to it or what?

Cecilia: Yes, I think I understand your question. For me, it absolutely is something that’s very personal to me and has helped me in my work. I’m Mexican-American and my parents both grew up in El Paso, Texas, [00:12:00 that’s right on the border of Juarez and so like right on the border of Mexico. There are a lot of immigrants there.

So back when my parents were there, my dad actually where he grew up, my dad came from a family of 19 kids and actually they adopted one so there’s 20. They lived across the street from a church and they actually helped to build that church. My grandparents like raised funds for it and were there building it and so wonderful people.

I only met my grandfather two times, he passed away when I was four. I didn’t know them personally but just from the stories I’ve heard. They were also across the street from the Mexican border.

Being that they were right by church, [00:13:00] people would cross over and back then it wasn’t the same as it is now. It was just like you could literally just cross over a fence and you were on the American side. And so they would see the cross on the church and they would naturally just go to the church or they would stop and ask someone and someone would say, well, across the street from the church, there’s a house there and they help immigrants.

And so immigrants from far would come to my grandparents’ house and even though they had a two-bedroom house and 20 kids, they had a closet that would have all kinds of clothes and shoes. They had a bed, they would say, go take a nap, go sleep and then the next morning, they would have them shower, give them clean clothes and shoes, and then they would give them a [00:14:00] mug with food in it. And so then they would go on their way and continue their journey. And so a lot of people would come back and visit my grandparents.

And so hearing this, I get really emotional talking about it, but hearing this growing up was so powerful for me. Obviously, times have changed. I have little children and I live in the middle of the city and so I’m not able to do this exact work, but this is my way of continuing my Geez boys, continuing this legacy.

My dad was very similar. My dad passed away nine years ago but he didn’t do that either. He helped in his own way, he would go to city council meetings and he would [00:15:00] petition for sidewalks to be put in poor neighborhoods that we didn’t even live in and so a lot of different things that my dad did that I saw that everyone has their own way of giving back and so this has been my way to help immigrants that are coming over and help to push this issue a little bit more.

I’m not a super political person. I do have my own beliefs about how we should be handling immigration in this country. Just because of my own personal views, but this is one thing that I definitely feel very passionate about and I love that I’m able to incorporate this passion of mine into my work because I’ve been trained, I’m licensed, now I’m able to help [00:16:00] on a different level.

Dr. Sharp: That’s such a powerful story. It sounds like you have this legacy to bring forward, for helping folks and giving back, like you said. That’s pretty incredible.

Cecilia: Thanks, definitely keeps me going and it’s something that I want to pass on to my children. I hope that as they get older, they’re little right now, that they’ll see, okay, my great grandparents did this, my grandparents, and now my mom. And so I want for them to also continue that legacy. That’s what we do when we’re parents is we hope that we do enough that are our children will catch on and continue it for us. So we’ll see.

Dr. Sharp: Yeah, you’re so right. My gosh. I think the work itself is, [00:17:00] it’s very important, very powerful. I’d love to hear more about that. I’m going to ask some dumb questions here because to be honest, I don’t know why people come for immigration evaluations. I don’t know what they’re about. I don’t know what you’re trying to do with them or assess exactly. Can you give me a little bit of background in terms of what is even happening here in these evaluations when people are referred to you? What questions are you trying to answer? What do they need? Anything like that.

Cecilia: Sure. So most people that come are trying to get an I-601 extreme hardship waiver. What that means is, basically, if I were married, well, I’m married, that is factual but for example, if my husband were here and he were [00:18:00] undocumented, and so most of the time they have to go through a process and obviously to get papers or to become legal, they have to go through a process. Part of that is they have to have a consequence for coming over without papers, and a lot of times that means that they have to go back to their home country for up to 10 years.

And so with this waiver, if it’s approved, that waives them having to do that. They still have to go through the whole process but they’re able to stay here during that time. Then the extreme hardship part of it is that I would have to prove through the help of this immigration evaluation and the attorneys [00:19:00] to prove that it would create too much hardship on me for my husband to be gone.

So if I’m home with little kids and I don’t have any work experience and my husband is the sole provider, that would be an extreme hardship for me. That is a factor. It’s not a strong of a factor as if like I had a child with a disability, or if I had cancer, or if I was disabled in some way. There’s different situations that would make my case stronger that I would experience extreme hardship without my husband.

So that’s what I as a therapist, I am working for trying to figure out in the [00:20:00] interview is trying to find out what that hardship is. A lot of times, just going through this process and having this immigration case already creates a lot of hardship and so I discuss that and delve into that as much as possible and see how has it already affected you in your life and then I try to link that and also any kind of trauma or any type of hardship or whatever. I’m seeing if there’s a link between that and then what they would face if their husband or their spouse is gone. Does that make sense?

Dr. Sharp: Yeah, it does. I just want to make sure that I’m on the same page with you. Are there more than one type of evaluation, are you evaluating the individual who [00:21:00] might have to return to their home country or just their spouse and family members?

Cecilia: It’s whoever is requesting the waiver on behalf of the other person. I am doing the evaluation on the U. S. citizen or the person who has residence here. A lot of times people think it’s for the undocumented person. It’s actually for the citizen or resident. It’s on behalf of the resident or citizen and then for based on their spouse.

It’s usually a spouse. It can also be children. That’s typically, and I tend to talk in this way because that’s just general. I think it’s different in different areas but typically here [00:22:00] it is like a wife requesting for her husband so I tend to go back to that. It can be either way around, obviously but for an undocumented husband, because a lot of times it’s the men that come over to work and then end up getting married here, whatever, settling down. It could also be sometimes both of the parents are undocumented and so it can be also a child or children that are requesting on behalf of their mother or their father.

Dr. Sharp: So then would you be doing the evaluation on adult children or adolescents or what?

Cecilia: Yeah, it can be either. I’ve only had those two times in the nine years that I’ve done it, but yes, that is also possible.

Dr. Sharp: Okay. Got you. [00:23:00] Thank you, like I said, for bearing with that dumb question and actually explaining what is going on here but that’s super helpful. I didn’t know if we were working with the undocumented person or the resident or what?

Cecilia: Really quick, I want to add to that. It can also be an adult child who’s married, could be with children that is requesting for their mother or father. So if there’s something going on between them, maybe they’re sick or, I’m not sure but there could be other situations, so that would create hardship on an adult child. That’s also a situation that doesn’t happen very often but that’s also possible. Something else that you said, I was going to respond to that. I don’t remember but I’m sure it’ll come up.

[00:24:00] Dr. Sharp: Sure, we’ll see if it comes back. So let’s start back in the beginning, where do you get referrals for these evaluations? I know you mentioned a lot of word of mouth but are there other, like for people who are maybe trying to start a practice like this, where would you go look for referrals?

Cecilia: I would definitely start with attorneys because there are a lot of attorneys that are specific immigration attorneys, that’s their focus. A lot of times when I have talked to a new attorney or they’ve sent someone to me and then I call them just to touch base and to introduce myself and all that, they’ll say, we’ve been looking for someone that does these evaluations and we can’t find anyone so I’m so glad to know that you do this. So definitely, I would start with immigration [00:25:00] attorneys.

There’s different organizations, nonprofits and things like that that do help undocumented immigrants with their papers, with the whole process and so you could go that route. I’ve really found that with the attorneys, that’s the best way. That’s the most consistent form of referrals for me. And then also word of mouth because usually if I work with someone here, they usually will have a brother or sister or a cousin or friends that are also in similar types of situations. And so it’s not at all uncommon for me to get phone calls and say, oh, my co-worker referred me to you because they knew I was going through this process and they’ve already worked with you, or [00:26:00] my sister came to see you or whatever. To me, those are the primary sources of referrals that I receive.

Dr. Sharp: Got you. And then once the individual gets in touch with you, walk me through the process from there. What’s the first point of contact in the evaluation.

Cecilia: So whenever they call me, there’s quite a bit of information that I try to gather so that I can know how to help them. Depending on the attorney, some of them will explain it a little bit more and some of them just say, you need to go to therapy, call this person, they’ll explain it to you. That’s not uncommon at all.

I tell them, and everyone does it differently. I’ve heard of a number of different ways that people have done it. I’ll explain the way that I do it and explain why. [00:27:00] When they call me, I explain to them that first of all, who the actual client is, because a lot of time that’s not very clear so they can understand that because they just think okay, well, my spouse who’s undocumented needs to go and see, and I’m like, not really.

This is actually what I was going to tell you earlier that even though the resident or citizen is my client, I still meet with the undocumented spouse and the children. Anyone that’s living in their home, basically. I can go into that a little bit further but I explain that also in that phone call.

I tell them I have to see them at least three times for three different sessions. Each session is about an hour. That’s so that I can get all the information that I need and also so I can have a really good understanding as to what their situation is [00:28:00] so that when I’m doing the evaluation, I can obviously speak to that pain and that hardship.

I could get all the information but if I don’t really understand or have a good knowledge as to what their situation looks like, it’s not going to be as strong because it’s those things that each family specifically deals with that I want to be able to key in on or point out in the evaluation. Sometimes I say evaluation and sometimes I say letter, it’s in the form of a letter but it’s an evaluation. I’m meaning the same thing if go back and forth.

Dr. Sharp: Okay. Why do you do three separate hours versus one three-hour session?

Cecilia: I do it that way because a lot of times they’re looking for an established [00:29:00] relationship with a therapist. I know of other psychologists and other therapists that will just do the one-hour session and do the evaluation right in front of them and then they’re done. I don’t do it that way because I want for whoever is reviewing their case to see that they do have a more established relationship with me.

So depending on the timeframe, I usually we will do it within a month. If they’re like, okay, we need it now, gotten to the point with a lot of the attorneys that they’re, as soon as a client contacts them and says, okay, we’re going to request this or we’re going to apply for this waiver, they’ll tell them, okay, call this therapist. We still have some time but start seeing her now [00:30:00] because it shows, instead of having one month of a relationship, we’ll have a six-month long relationship. So by the time I’m providing the evaluation, that shows a lot more of an established relationship.

It just depends on the situation. I do get calls and they’re like, I need the letter by five days. And so you do what you can and you have different ways of working around that but most of the time I try to, and I explain to them, we have to do at least three sessions.

If you can come for more, I know that cost is also an issue and time and distance because there’s not very many people that do these and so a lot of times people are traveling from really far. [00:31:00] I have people that drive four or five hours to come and see me, and I don’t even know that until I see them and then I’ll start looking over the paperwork and I’m like, where are you from? Where do you live? And I’m like, oh my goodness, I had no idea. I’m so sorry if you had to drive so far. And they’re like, oh, it’s okay. There’s a lot of different factors that go into it, but typically we’ll do the three and if we can do more then we will do more sessions.

Dr. Sharp: Sure. So you have that initial phone call and explain the process. It sounds like triage a bit and make sure they’re an appropriate fit.

Cecilia: Exactly.

Dr. Sharp: Okay, so then do you move to the interview portion or the sessions.

Cecilia: Yes. When they come, we have a lot of paperwork. I have them fill out my regular consent forms. I actually have another [00:32:00] form, an agreement that explains this process a little bit more clearly as far as what they can expect. I can’t guarantee that they will get this approved because of my evaluation, I’ll do my best.

I tell them it has to be a minimum of three sessions but if I think, based on their situation, if they have a lot going on, then it could turn into a minimum of four or five sessions just because of their situation.

Typically, I can get everything done in three but if there’s going to be more than I put in there, that I’ll let them know as soon as possible. I also have a discounted rate if they pay upfront and so I explain that in there. You can do payments and this is how much it costs. If you [00:33:00] pay upfront, then it’s a discount. I have them sign which one they want to do, different things like that. So just kind of the expectations for this process, because it is different than a regular therapy session.

Dr. Sharp: Sure. And as far as the payment and the billing, is that out of pocket? Is it insurance? How do people typically pay?

Cecilia: People typically or always for me because I only accept private pay, but they pay cash or a credit card. I don’t almost ever get any questions about insurance. I don’t know if it’s just because of the types of jobs that they have or what, or because going through this process, they’re having to pay cash for all of it so I think that’s just the expectation that it’d be the same for this.

I can probably, [00:34:00] honestly, in the nine years I’ve been doing this, I’ve probably had that question come up maybe five times about insurance. It’s not even in question. I don’t even think about it. So it is private pay.

Dr. Sharp: And do they pay you directly or does that come through the attorney or …?

Cecilia: No, it’s directly to me. I accept payments here at my office.

Dr. Sharp: I was just going to ask; do you just charge your hourly rate for each hour that you spend or do you have a flat rate now for the entire package? How does that work?

Cecilia: It varies a little bit because if we do more than the three sessions, then obviously it’s more, but I do charge less than my hourly rate and that’s because I know [00:35:00] that the people going through this process are usually struggling financially and have had to pay thousands upon thousands of dollars for their attorney and all the different fees related to the immigration case and so I do charge less.

Now that I have a contract therapist, I’m raising my rates but for her, she’s going to take on the rates that I’ve had for quite a while. I’m happy to share that with you. Give me just 1 second so I can take a drink of water.

Dr. Sharp: Oh, yeah, no problem. Maybe you could share it because I know that rates vary across the country, hourly rates are different but do you have a sense of maybe what percentage less you would charge for this whole package, how much of a deduction you take off of your hourly rate to put this package together?

Cecilia: Probably about [00:36:00] 1/3 less.

Dr. Sharp: Oh, okay. That’s substantial.

Cecilia: Maybe 25% to 35% less but it does range so much. It ranges even here, where I’m from, a lot of times people will come to me because they’re like, you’re a lot more cost-effective than some of the other clinicians that do these evaluations because not usually whenever they get a referral specifically from their family member, a friend or an attorney, they almost immediately call and schedule an appointment, no matter how much it costs, but if they’re like found me on the internet, then they’re shopping around. And then they’ll usually come back to me because my rates are pretty reasonable compared to some of the other ones.

Some of the people that even just do that one session, [00:37:00] maybe one to two-hour evaluation charge more than what I do for the three hours and then the letter. I charge $100 a session and then $200 for the evaluation, the way I came up with that $200 is just because it usually takes about two hours. To start off with, I’m sure it took longer. I know it took longer but at this point, after doing them for nine years, I could probably do them on my sleep.

Sometimes it’s even less, sometimes it’s an hour and a half, but it’s typically about two hours. So it’s $200 for the evaluation. In total, everything comes to $500 with the typical pace, and then if they pay upfront, then it’s $450. So it’s a savings of $50, which isn’t much, but almost, I would say, 75% of the time they go ahead and do that.

Dr. Sharp: That’s [00:38:00] great. So you do these three sessions, give or take. Is there a structured interview form that you’re using or a specific measure or is it something you’ve developed or what?

Cecilia: No, I follow a certain structure. I don’t have anything that’s like a worksheet that are like an evaluation and I fill everything out. I know what I ask and I ask it just like I do everyone else. Now I’m training other clinicians on how to do these evaluations because that was one of the things that I wish that I had had as I was starting this process. And so I have created more of a guide for that.

I know what I ask and when I ask it and I have gone through the same process. I know the [00:39:00] first session I usually interview my client. So that’s the resident citizen about their background and about their marriage. That’s basically the first session.

The second session I usually will interview the undocumented spouse and talk to them about their background and then also what their life would look like if they had to go back to their home country. Would they work? Would they have a place to stay? The cost of living, would they access to medical care there? What is the situation like? Is it dangerous there and what does that look like? Those types of questions.

Usually, when they come the first time, I give them a financial form and have them fill it out as far as [00:40:00] their bills and then some other questions like how much have you already spent on the case? How much do you anticipate that you’re still going to have to spend on it, to kind of get an idea as to the financial portion of it.

And then if you were to go and visit your spouse in their home country, around how much would that cost? And two other questions about the financial portion of it and what that looks like for them so that I can explain that in the evaluation as well.

So we’ll go over that in the second session as well. Then the last session, I will interview the children. Sometimes depending on their age, if they’re younger, I’m just going to talk to them about their family and their interests and things like that because [00:41:00] I have a family systems background so I feel like it’s really important that whoever is reviewing their case see that they are a family just like I have my family and they have their family. And so that’s one of the ways that I go about that is talking to the children and giving their perspective a little bit.

If they’re a little bit older and they know about the case, because sometimes the parents choose not to talk to them about it because they don’t want to worry them, sometimes I won’t mention it but if they do know about it, I’ll talk to them about it and what impact it has been having on their life already and how it would affect their lives if their parent was no longer here.

I do that and then [00:42:00] I interview my client again about that hardship portion and get really in detail about how it affects them on a daily basis as far as like they’re sleeping and they’re eating and physically and emotionally, like what that looks like for them, that hardship. I go pretty in depth on that and that’s it.

That’s pretty much the gist of what we talk about, of course, it ranges and sometimes they have other different circumstances or other things that have happened in their lives that I will definitely tie into this because it’s an important part of what they’re dealing with. Typically, that’s the structure of it.

Dr. Sharp: Got you. Okay. It sounds [00:43:00] like it’s largely a very extended interview. Do you administer any standardized assessment measures or checklists or anything like that or is it mostly interview?

Cecilia: No, I have in the past and I didn’t see that it was in my situation or my circumstance with the attorneys that I was working with, I didn’t see a huge difference when I when I stopped doing it. I used Beck’s Depression Inventory and then I just stopped for some reason and I didn’t really notice a difference and my attorneys didn’t notice a difference so I haven’t done it since.

If they have a prior diagnosis, I definitely will include that but typically I don’t include that in [00:44:00] there. I’m sure that there’s others that do. That’s just another one of my personal beliefs. I did some doctoral work in marriage and family therapy, as you know is very systems-oriented and not so much focused on diagnosis. I have got away from that and so I don’t typically include that.

Dr. Sharp: Got you. Okay. And then what does the written report look like or letter? You said it’s a letter.

Cecilia: It is. It’s in the form of a letter. Basically, I start off with a little introduction of who they are, what they’re seeing me for and typically I’ll put the number of sessions that they had and the dates. [00:45:00] If we weren’t able to meet over an extended period of time, then I’ll usually just say, okay, they came in for three hours and then I’ll just say something like below is the information that I gathered during our sessions.

And so then I’ll go into the background, the interviews is somewhat of the same structure. I’ll go into the background of my client, background of the spouse and then about their marriage and then I’ll talk about the financial portion of it, or I’ll go into education and employment. So talk about the history for both of them in there and then the financial portion and that’s usually a big concern for my client. At times they’re going to be going from either two incomes to one income [00:46:00] or one income to zero income. So it’s a huge factor.

And so I’ll discuss that and then I’ll go into the health and emotional status and talk about how it’s been affecting them and then their concerns. And so that’s where I’ll include also the portion about what it would look like for the spouse if they had to go back to their country because obviously all of those things are stressors or creates stress on the spouse who stays here.

And so that’s actually something that I also address in the evaluation is, typically, when I ask them, okay, if your spouse has to go back for an [00:47:00] extended period of time, would you go with him? Would the whole family go or would your spouse go alone and then y’all stay here, the rest of the family stay here? A lot of times they say they don’t know, that they’ve gone back and forth, and they just don’t know what would be best.

And so typically in that situation, I like to put that there’s no good option. And so with that, I then go into if they all go back as a family, what that would look like and the stressors that that would create for them. And then if they stay here and the spouse goes back alone, then what that would look like and the hardship that that would create. I like to do that because it shows both situations and that there’s really no good option for them.

[00:48:00] I go through that in that area then I go into the children, talk about the children and then I have the summary and recommendations and that’s it.

Dr. Sharp: Okay. How long do these letters typically end up?

Cecilia: Typically, about four to five pages. I’ve had some clients who I have been working with on this for years and then when they say they’re ready for it, I’m like, oh goodness, this is forever to write, they’ve gone up to seven or eight pages. I think on how long I’ve been seeing them and what their situation is. It just depends but typically, about four or five pages.

Dr. Sharp: Okay. That sounds good. Do you use templates or [00:49:00] pre-populated letters or do you write them off from scratch or what?

Cecilia: I do a mixture of using a past letter and if I can remember a client who had a very similar situation, I might use it and then change it, changing it means go through the whole thing and change it. At this point, I know the verbiage I use most of the time, even not looking at the old letters, I can just from memory, write what I typically write.

So it’s kind of a mixture of those two, but I don’t have a template or anything like that. That would be awesome. I’ve thought about trying to create that but I have not had the time to do that.

Dr. Sharp: I know that problem. That could flow really well into your training. That would [00:50:00] be an excellent piece of software or …

Cecilia: Yes, it would. That’s something I would love to create. I actually talked to someone who does a lot of testing also, actually, you were just talking, Megan. I think it was her that was recommending using, oh, no, it was someone else, doing it through dictation and using that software. I would like to try that. I’ve just done it like this for so long. I forget that I should even try something different just because I’ve just been doing it like this forever but no, typically I just type it out.

Dr. Sharp: Sure. Got you. I know that we’re getting close timewise and I so appreciate all of this, I feel like this is super informative. Before we totally wrap up, [00:51:00] let’s talk a little bit about your training and what you’re doing with that.

Cecilia: Yes. I have since the beginning of the year started to train clinicians across the country on how to do these evaluations because I think there’s a huge need. For a while now, I’ve seen an increase in the number of referrals from my practice, so I would imagine it’s the same thing just with the political situation the way it is.

I think it’s for a while there and I saw a decrease, I think people were nervous to make any kind of move. Now, I would say in the last maybe three to four months, I’ve seen quite a big increase in those referrals. So [00:52:00] I think it’s definitely, if it’s necessary here, I’m sure it’s necessary in other areas, especially areas where there’s a large immigrant population. So if that’s an area that you live in, I would recommend you do some research and see if there’s anyone providing these evaluations and you’ll probably see that there’s not or there’s very few.

Anyway, yes, I’ve started to provide training for clinicians that are wanting to do these evaluations. I typically get the question; do you have to be bilingual? You don’t have to be bilingual. Most of the time when people do these evaluations, they just interview the resident or citizen.

They don’t usually incorporate the spouse and the children. And so definitely, if that’s the way that you plan to structure it, [00:53:00] the resident or citizen almost always speaks English so I think it would be absolutely fine for someone who’s not bilingual to learn how to do these and to be able to offer it in their practice. I think that would be a huge service to a lot of people, even if you’re not bilingual.

So I’ve started to train on this, before I was doing it through a Webinar type of format or we would meet online with the group and do the training and I am making a little bit of a shift. I’ve created a video series of the training and so now it’s something that will be, if you purchase the package or whatever, then it’ll be available to you along with [00:54:00] some other extra information like the paperwork that I use, that’s something that I have available and then a first session checklist and then a sample evaluation. That’s been a huge one for a lot of people. They want to see how it works and what it looks like.

And then as part of this new package with this change then I’m doing access to a monthly Facebook Q&A session. So you would be part of this Facebook group and once a month, you get on there and if you have any questions or have anything come up, then I would be available to answer any questions. And obviously, I’m always welcome to, people can email me or call me or whatever. Some of my past trainees have done that and I’m always happy to help any way that I can, but [00:55:00] that’s just a nice way to have it be something regular that they know that they can come and ask questions there.

I’m doing that training now. It’s $1,650 for the package. For the listeners, if they are interested then I’m happy to, I’m going to be taking $250 off, so it’ll come down to $1,400, which you can easily make back with just two clients. I want it to be something that will benefit y’all as the clinicians but I think that you’ll get a lot of information that you’ll need from it. So I’m excited.

Dr. Sharp: That’s awesome. That’s fantastic. I can tell so clearly that this is just dear to you and I think that makes a huge difference in the work that we do and how we teach others, [00:56:00] It’s not just sterile material, there’s some power behind it.

Cecilia: Absolutely. If you grow to, or I have, I’ll say this, I’ve grown to love my clients. I ask them, please, let me know when you hear back. I’m a religious person, in the interview, I typically find out if they’re religious at all or spiritual and so will tell them, I pray for you and I hope that this is helpful to you in your case, please let me know how this works out for you.

And so I do, not a lot. I’m happy to know that whenever they get their waiver approved, that they just go on, they just forget everything that they’ve already been through and they just want to move on and I understand that. Sometimes, the attorneys will let me know [00:57:00] when they’ve been approved or whatever. I’m not super helpful and sometimes I hear from them and that’s awesome. I’d love to hear back from my clients.

It’s definitely wonderful work to be doing. If you have any kind of a passion for this issue or this population, then I definitely encourage that you make this something that’s available to clients in your area because it is a huge service to them.

Dr. Sharp: That’s awesome. If people want to get in touch with you to learn more about this or to maybe pursue that training, what’s the best way to get in touch or learn more about it?

Cecilia: They can go to There’s information there and it’ll show you where to sign up and let me know that you heard about me [00:58:00] from The Testing Psychologist and I’m happy to give that discount.

Dr. Sharp: Fantastic. Thank you. I imagine that a lot of folks will be interested. I know that I learned a ton today and I just so appreciate your time and your willingness to share some of your story with us and share the clinical pieces too. I think this is such a valuable service for so many folks. I feel lucky to have had you here to talk to us.

Cecilia: Thanks for having me on. I loved it. I love talking about this. It’s weird because I’ve been so used to just doing it in my own little office for so long. It’s really nice to share it now and to be helping other clinicians that have wanted to do this and just didn’t know how. It totally fell in my lap and it’s something that grew and I’ve loved and I have a huge passion for and so I’m hoping that this is something that will grow because there’s so many people that need this service.

Dr. Sharp: Absolutely. Well, Cecilia, thank you so [00:59:00] much. We really appreciate it and take care.

Cecilia: Thank you so much. I appreciate you having me on.

Dr. Sharp: All right, y’all. Thanks so much for listening to that episode with Cecilia. I hope that you, like myself, took a lot away from that. As you could tell, I was asking some dumb questions and sometimes didn’t know how to get at some of these powerful experiences that she was describing but she bore with me and gave us a lot of great information about how to conduct these types of evaluations.

So if you’re interested, definitely check out Cecilia’s training. Like she said, there is a discount for Testing Psychologist listeners. If you’re interested, give her a shout and check that out.

I’ll give one more shout-out to our sponsor Q-interactive, the digital platform for administering many of the measures that we give in our assessments. Saves you a lot of time, can definitely save you money depending on how many assessments you’re doing [01:00:00] and you can check them out at

As always, if you have not joined us in the Facebook group, I would love to have you there. It’s called The Testing Psychologist community, and you can search for that on Facebook. We’d be happy to have you. We do a lot of talking about the business side of testing and the clinical side of testing. There’s a little something for everybody in that group.

If you’re moving along with your testing practice or thinking about starting a private practice and you’re not sure what to do or you want to tweak your systems and make sure you’re doing everything the right way, reach out to me. I would love to help guide you on that journey. We can talk for 20 or 30 minutes complimentary and just figure out if consulting is the right choice for you. You can also learn a little bit more at my website, which is I would love to chat with you.

All right, that’s it for this week. [01:01:00] Y’all take care. I’ll talk to you next time. Bye bye.

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