Indiana University Students: Anxiety, Depression and Drug Use (and how to fix them)

Since moving to Bloomington, home of Indiana University, a few things have become clear. One – everyone here wears red clothing, drives a red car or paints a room in their house red. They don’t mess around with school pride.

Second thing I’ve noticed is the super-driven nature of IU students. They are high achievers and have big goals. Awesome. Big goals are great. Unfortunately, these same students are often not equipped for the challenges of living on their own and the intense academic load. Anxiety, depression and drug use are common here (as with most other big schools). Since there are so few counselors/psychotherapists in the area, I see a heavy load of students, especially when the pressure starts to creep in around mid-September. The partying picks up, parents are gone and classes start to dial-up intensity. It’s a toxic mix.

A great place to start is IU.

IU offers respite in the form of their counseling center (CAPS) but it’s a) triaging a problem, b) only short term and c) often doesn’t get to the underlying issues which are often years in the making. Don’t get me wrong, CAPS does a great job and the best they can considering how underfunded they are. The first two sessions for each semester are free. Each following session is $30. They generally have a waitlist so I recommend that students sign-up early.

CAPS also offers psychiatric care for those needing medical attention, like help or oversight with medication. The wait list is often even longer since there are fewer psychiatrists than counselors. Psychiatric visits are not covered under student health fees so insurance or out of pocket payment is expected.

For those struggling with more serious drug issues, IU offers OASIS/Journey. Students that sign-up for Journey get an assessment to determine the best level of care. Staff then decide between two evidence-based interventions in both group and individual settings, the Journey Program operates under 3 phases, designed to provide progressively more attention based on the student’s need.

Students referred from the Office of Student Ethics are charged $200. Alcohol and drug charges are applied separately. If a student was found responsible for both an alcohol and drug policy violation within the same incident, they get billed $400. For non-offense participants,they get charged a one-time fee of $25.00 after their first visit.

If IU doesn’t have the availability or discretion you and your family needs, reach out to me. If I can’t help, I’m happy to provide insight into other providers in the area who can.

The best thing for parents to do is start searching for professional support either through IU or the community in July and August. Getting appointments set and providers lined-up will be much easier when the semester has not started. Once the semester starts, a good counselor will work closely with parents and the school to ensure that everyone is aware of progress and prepared in case the students experiences more severe issues.

Hopefully, your son and daughter will not need any of this but if they do, act early and expect everyone to act as a team.

Insider’s Guide: Psychological Testing and Evaluations

Right after we moved to Indiana, something under the hood of our car started rattling loudly when it was first started-up each morning. I was sure the engine was failing and we’d either need a new car or, at minimum, a new engine. Fearing the worst, I took it to the dealership and tried my best to describe the noise. They took the car, hooked it up to their computer and ran diagnostics. Based on their findings, they adjusted some engine controls and replaced a sensor. Total cost was under $150 and about an hour of time. I was lucky it wasn’t more expensive. The technician said that if I had driven muh further, the engine would likely have overheated, blah, blah blah ….basically, bad things would have happened if I had not run the diagnositics. Money well spent.

My experience with our car reminded me of psychological evaluations and how often I talk with parents that want to wait a bit longer, save a bit more money or hold off until ‘things calm down’ before getting some diagnostics run. A shot engine would cost a few thousand dollars. Untreated behavioral health issues can cost tens of thousands of dollars and leave perminant scars. 

But when are things bad enough that you need to get a psychological evaluation? When is a car sounding bad enough to get diagnostics run? My definitive answer is this: When the symptoms are impacting a life domain (eg. school/work, relationships, family, activities) …and yes, this holds for both cars and people I believe. If things are bad enough to keep you up at night, it’s probably a good time to get evaluated.

The Basics

A psychological evaluation is a generic term used to describe a clinician’s use of tests, assessments and clinical interviews to determine a diagnostic presentation. Or, more simply put, what do all their symptoms add up to. There is no single test that makes up a psychological evaluation. A psychologist (often the most qualified type of behavioral health professional to administer testing), based on basic initial information about the client, chooses from a menu of tests and assessments all of which are evidence-based tests and procedures of assessing specific aspects of a person’s psychological profile. Some tests are used to determine IQ, some are to determine processing speed, others are used for personality, and still others for something else like depression or delusions.

Testing can be used to identify and sometimes determine the severity of just about any behavioral health disorder. Psychological testing is not definitive. While it can provide significant insight and give us a solid understanding of why someone is experiencing the symptoms they are, it can never provide certainty or causation. Clients can be found to ‘meet criteria for depression’ though, technically, we can never say without doubt they have depression. Sounds crazy but that’s how science and scientific testing works.

Here are the steps you should expect for the evaluation:

  1. Initial Intake: Initial intake appointment gathering basic background, symptoms and goals (1 hr)
  2. Testing: Psychological testing (1-6hrs)
  3. Write-Up: Psychologist writes-up the results (2 weeks)
  4. Results Session: Review of results and recommendations for treatment

Initial Intake and Testing

Let’s drill down into the details of testing. Once the tests are chosen, the evaluation is typically done in a formal manner by a licensed psychologist or therapist in their office. Depending upon what kind of testing is being done, it can last anywhere from 1 hour to a full day and consists largely of computer and paper-and-pencil tests.

There are generally four categories of tests:

  • Clinical Interview. The clinical interview is a core component of any psychological testing. Some people know the clinical interview as an “intake interview”, “admission interview” or “diagnostic interview” (although technically these are often very different things). Clinical interviews typically last from 1 to 2 hours in length, and occur most often in a clinician’s office. Many types of mental health professionals can conduct a clinical interview — psychologists, psychiatrists, licensed counselors, clinical social workers, and psychiatric nurses.
  • IQ. The most commonly administered IQ test is called the Wechsler Adult Intelligence Scale—Fourth Edition (WAIS-IV). It generally takes anywhere from an hour to an hour and a half to administer, and is appropriate for any individual aged 16 or older to take. (Children can be administered an IQ test especially designed for them called the Wechsler Intelligence Scale for Children – Fourth Edition, or the WISC-IV).
  • Personality Assessment. Personality assessment is designed to help a professional better understand an individual’s personality. Personality is a complex combination of factors that has been developed over a person’s entire childhood and young adulthood. There are multiple variables that influence our personality such as genetic, environmental and social components. Personality tests take this into account. There are two primary types of personality tests 1) objective, by far the most commonly used today, and 2) projective. Objective tests include things like the Minnesota Multiphasic Personality Inventory (MMPI-2), the 16PF, and the Millon Clinical Multiaxial Inventory-III (MCMI-III). Projective tests include the Rorschach Inkblot Test, the Thematic Apperception Test (TAT), and the Draw-a-Person test.
  • Behavioral Assessment. Behavioral assessment is the process of observing or measuring a person’s actual behavior to try and better understand the behavior and the thoughts behind it, and determine possible reinforcing components or triggers for the behavior. Through the process of behavioral assessment, a person — and/or a professional — can track behaviors and help change them.

In addition to these primary types, other kinds of psychological tests are available for specific areas, such as aptitude or achievement in school, career counseling, management skills, and career planning. For instance, in our Kentucky office, we provide neuropsychological testing for head trauma, sports injuries, pre-employment and a bunch of other neuropsychologically-related areas. 

Results Session – What Next?

At the results session, you will meet with the psychologist and go over the results. You should get a copy of the full psychological evaluation (typically 5-20 pages). It should be broken down into the following format (or something very similar):

  1. Basic Demographic Information
  2. Reason for Referral
  3. Names of Tests Administered
  4. Data from Each Test
  5. Results (Diagnoses)
  6. Recommendations
  7. Signature and Title of Psychologist

A good psychologist will go through the entire document, explain the tests used and results fully. He or she will also review all the recommendations which will likely include one or more treatments like outpatient therapy, medication evaluation with a psychiatrist or placement in residential treament. The most important sections are the Results and Recommendations. The Results are the psychologist’s list of diagnoses that were supported from testing and observation. The Recommendations is the ‘what now’ piece where you understand your options for treatment based on the results. If you don’t understand something, ask. They should completely answer any questions you have.

A great psychologist will either offer a list of specific providers who offer the type of intervention or care recommended or refer you to a therapeutic placement consultant or educational consultant who can help with treatment placement.

Cost

If you are paying out of pocket, expect to pay $500-$2500 for the entire evaluation service. If you have insurance, contact the insurance company before scheduling an evaluation and ask what their coverage is for outpatient therapy and what your copay will be.

FAQ

Q: What if I disagree with the results or think the psychologist did a bad job?

A: During the final session when results are discussed, present your concerns and be a specific and factual as possible. Psychologists can only test based on information they have. If the psychologist had all the information but ignored important pieces, discuss this and, if necessary, make sure they do retesting to capture what they missed.

Q: Our daughter needs testing for an IEP at school. Is there a difference between psychological testing and testing at her school?

A: The testing you need is referred to as psychoeducation testing and often includes IQ testing. Testing for an IEP within a school system is not supposed to be used for diagnoses, only determining elegibility for an IEP or 504.

Q: How do we find a psychologist to do an evaluation?

A: If you are working with a therapist, start by asking if they have any recommendations of someone they trust and have worked with. If you are flying solo and have no one in your corner yet, check out Psychology Today (https://therapists.psychologytoday.com) > Type your Zip code into the search box > Under the Treatment Orientation on the left side, choose Psychological Testing and Evaluation. You should get a list of providers that conduct evaluations.