Mental Health Support on College Campuses: What Parents Need to Know

Most larger universities like Indiana University (close to where my office is located) have health programs called CAPS which stands for Counseling and Psychological Service. They are often staffed with licensed therapists/counselors and psychiatrists with a range of experience and expertise. Their primary goal is to act as a stabilizing resource for most mental/behavioral health or substance use issues. Many university CAPS typically offer individual, group and couples counseling along with occassional free workshops. Here’s the list from IU CAPS on what they typical help with:

  • Academic Concerns
  • Relationship Concerns
  • Stress Management
  • Power and Privilege
  • Time Management Help
  • Sleeping Issues
  • Adjusting to College Life
  • Anxiety
  • Depression
  • Substance Use
  • Body Image, Eating, and Exercise Concerns
  • Sexual Assault or Abuse

They have the same confidentiality requirements as counselors like me off campus but are limited in many ways. CAPS limits the number of unpaid sessions (IU CAPS allows for two) and mandates that a student must be working with one of their counselors if they want to meet with a psychiatrist for medication management/evaluation. Here’s a breakdown of IU CAPS fees:

COUNSELING  With IU Health Fee  W/O IU Health Fee
First two sessions (per semester) No charge $55 per session
Additional full sessions $30 per session $55 per session
Additional half sessions $20 per half session $35 per half session
Additional group counseling $15 per 60 min. session

$17 per 90 min. session

$29 per 60 min. session

$35 per 90 min. session

PSYCHIATRY
First visit $55 $105
Follow-up visit $30 per visit $55 per visit

IU CAPS does not accept insurance but does provide a super detailed invoice to be submitted to a student’s insurance company for reimbursement.
Over the last few years, I’ve noticed many CAPS programs around the country have had a huge increase in demand for their services while also having budget cuts or mediocre increases that leave them without the full team of professionals they need for each semester. At IU CAPS, every one counselor is responsible for 2,110 students (yikes!). This is not a new problem at IU and not isolated to IU.

So what can a parent or student do? If CAPS doesn’t seem like a good option, look for a therapist/counselor convenient to campus who specializes in college students. Therapists should be flexible to accommodate busy course loads and social events. In my practice, I have extended evening and weekend hours since many students a slammed with class 9-4pm most days. It’s also important that the therapist be willing to talk with parents and provide updates and suggestions. Parents can sometimes feel like their kids are a million miles away. A good therapist can often act as a bridge and lower the anxiety associated with having kids at school.

Finally, talk with CAPS (or encourage your son or daughter to) the first week of school. It’s easier to cancel an appointment than to stand in line after all the students are back on campus. The intake process should be thorough and your kid shoul feel like the therapist/counselor will really understand their issues and help.

Insider’s Guide: How to Pay for Therapeutic Boarding School (2017 UPDATE)

Before we dive into understanding the options for paying for a Therapeutic Boarding School, let’s quickly review what they are.

The Rise of Therapeutic Boarding Schools

Image result for boarding schoolAs public schools across the country have slowly been pruned back by state legislatures, funding for behavioral, emotional and academic support within schools have nearly dried up while public money is increasingly being used for private charter schools. Therefore, it’s not surprising private institutions that offer therapeutic (or quasi-therapeutic) environments like boarding schools and private schools have exploded. One of the fastest growing kinds of boarding schools is what’s called a Therapeutic Boarding School. Therapeutic boarding schools maintain the advantages of traditional boarding schools such as intimate class sizes, individual attention, great academics, developing student self-reliance, and the fun of living with peers in a completely “child-friendly” environment.

Some therapeutic boarding schools specialize in helping teens overcome certain psychological problems such as Attention Deficit Disorder, Bipolar, Asperger’s and even Depression. Others have programs for overcoming substance abuse problems or achieving weight loss. Some specialize in helping students who lack motivation get a fresh start in a nurturing environment. Most have some sort of family or parent involvement piece to ensure a team approach (ie. Weekly family therapy via phone or Skype).

While this all may sound great, there are definitely some risks and downsides (beyond the financial cost) of sending a kiddo off to therapeutic boarding school. I address those issues in great detail in another blog post. For now, let’s revisit the financial aspects…

Expense or Investment?

Parents often find themselves in a desperate situation with a troubled teenager. Their daughter runs away from home again, gets caught with the dealer down the street, crashes another car, and has yet another arrest. Parents become afraid for their teen’s lives as their teen’s risk-taking and lifestyle keeps becoming more extreme as the parents’ ability to set boundaries and expectations seemingly erodes.

It’s hard to think clearly and find solutions at times like this. Therapeutic boarding schools and therapeutic wilderness programs can provide answers, but they come at a price, with some programs running upwards of $50,000 a year.

But cost doesn’t have to be an insurmountable obstacle in getting your teen the help they need. We have helped countless parents in similar situations come up with creative ways to finance therapeutic boarding school, knowing that their child desperately needs an intervention. Therapeutic boarding schools are no longer exclusively the domain of the wealthy.

Top 10 Ways to Pay for Therapeutic Boarding School

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Here are 10 ways families just like yours found to finance their teen’s therapeutic program:

1.   Hire a Consultant: Say what? More money? Yes, but trust me, this really will have super high ROI. Also referred to as case managers, therapeutic placement consultants or educational consultants, a good one is worth their weight in gold (a bad one is expensive and makes bad treatment recommendations). Make sure they are UNAFFILIATED with any program and have the clinical expertise to help advise and guide your family through the whole process. Some clinical educational consultants that specialize are able to handle this. A great case manager will be able to create a treatment plan, explain the process for getting a comprehensive psychological evaluation, walk with you through the intake process, support you while your teen is in the therapeutic boarding school, and coordinate discharge planning to ensure a seamless transition back to home or college. The last piece is essential – making sure your teen has everything they need to succeed after they return. Great case managers also know how to secure reimbursement from insurance providers for teens that attend therapeutic boarding schools. There are definitely some tricks (eg. Hire a case manager that’s also a licensed professional counselor and much of their work could be paid for by insurance) and inside knowledge necessary to make this happen.

Typical cost: $95 – 350/hr (some charge a flat fee of several thousand). 

2. Find the Program’s Financial Aid Officer: The private school or wilderness program should have a financial aid officer who can advise you about how to finance your child’s education. You should ask this person what programs, loans, discounts, or financial aid the school offers. Find out exactly what is included in the tuition and board bills, and if there are additional expenses such as buying uniforms or paying special fees for sports.

Typical Cost: Nothing – programs provide this to try to entice you into signing up. Beware of anything that sounds too good to be true – verify any claims they make about coverage from insurance, student grants/scholarships or loans. 

3.  Public School Funding: You may qualify for a loan through a kindergarten through 12th grade educational loan program. These loans work the same way as college loans, in that you pay what you can while your child is enrolled in the private school, and pay the rest off later. The terms of some loans let you spread out payments over 10 or 20 years. Your credit history will be a factor in securing a loan. Your school’s financial aid officer should be able to help you find such a loan.

Typical Cost: Your sanity – they will drive you crazy with the bureaucracy and take loads of time during your work day since everything in public school shuts down by 3:30pm. 

4.  Discounts for Upfront Payment: Some schools offer discounts if you pay by the year, instead of by the month. The average student stays at a therapeutic boarding school for less than two years, and wilderness programs are even shorter. A good therapeutic placement consultant/educational consultant will save you thousands of dollars by negotiating these discounts.

Typical Cost: More money upfront but no other associated costs. 

5. Tap 529: Consider using your child’s college fund first. Think of the therapeutic program as a way to get your child back on the right path toward college. Without intervention, she won’t have the grades or motivation to get through college and use her fund.

Typical Cost: Make sure there are no withdrawal penalties for use for therapeutic boarding school. 

6. Put it On Plastic: When you enroll your child in these therapeutic programs, there will be upfront expenses such as processing fees and deposits. Some parents borrow these initial payments from credit cards, especially ones that offer “frequent flier” miles. This way their child is immediately enrolled. They use their free mileage for transportation to and from the school.

Typical Cost: Beware of high interest rates if you don’t pay off your balance in full. 

7. Angel Investing: Some parents borrow the necessary funds from employers or relatives, and pay them back after securing educational loans or home equity loans.

Typical Cost: If you go through a peer-to-peer or crowdfunding site like The Lending Club or Kickstarter, count on a 5% fee for total amount funded. 

8. Health Insurance Reimbursement: Your health insurance policy may cover part of the cost of a therapeutic program as a medical expense. When you hire a case manager, they will be able to tell you how to file the paperwork and what you need from the program to ensure a speedy reimbursement.

Typical Cost: Sanity… totally lost if your insurer are jerks that don’t reimburse when and how they should. You are attempting to pull money from their cold, dead hands. Expect a fight.

9. Consult Your CPA: Some expenses for therapeutic schools and wilderness programs can be deducted from your income tax return as medical expenses. If you own your own business, you likely have WAY more creative options for deducting medical expenses.

Typical Cost: $200/hr for a good CPA to walk you through if and how to deduct from taxes.

10. Tap Home Equity: Parents have taken out second mortgages or home equity loans and then deducted their interest payments on their income tax returns.

Typical Cost: Fees, closing costs total 2-6%. It also bumps the timeframe for paying off that home back several years.

11. Public School Funding: We lied – there turns out to be 11 ways to pay for therapeutic boarding school. Is your child enrolled in public special education classes because of problems like attention deficit disorder and learning disabilities? Does your child have an “Individual Education Plan” at a public school? Do you suspect your child has learning problems that the public school cannot address? In certain cases, public school districts have to reimburse parents for private school tuitions. The Supreme Court ruled on June 22, 2009, that an Oregon school district had to reimburse a family for private school costs because the child in question could not achieve a free and appropriate education within the district. The child had not been enrolled in special education classes but was diagnosed later with attention deficit disorder.

When it comes to what matters most parents are unstoppable in finding ways to get the services and support they need. Don’t let cost be the determining factor. If your teen needs help, speak with a case manager, your trusted CPA as well as a therapeutic boarding school you’re considering and work together to find a way to get your teen back on track.

How to Prepare Your College Student for the Semester

Holy moly, it’s almost August again and classes are just around the corner. Time to dust off the ‘how to’ guides for parents. Here are a few favorite tips from the last few years that parents have found helpful.

Image result for college

  1. Organization. Organization is a concept, not a tool. Identify tools they can and will use. Make sure they are using the calendar app on their phone. Have them figure out the best use of online tools the school provides. Many students need the help of a counselor they see 1-2x per month to help oversee their organization habits and tools. Get this all figured out before the car is packed.
  2. GPA. Talk about what, if any, expectations you have for overall as well as per-course GPA. It’s a bit late to tell them at Thanksgiving dinner you wanted to see a 3.75 GPA for the semester. Best to discuss this in July and August. Make it realistic but also challenging. They are not going on vacation. They are coming to school to earn a degree and have some fun (after the work is done).
  3. Appointments. What ever appointments need to happen leading up to or during the school year, have your little college kid get them setup and on the calendar now. It’s not too early to get the dentist appointment scheduled. If they take any type of medication, do not assume they can just have a walk-in appointment for a refill. Get this scheduled now (especially if they need to find and work with a psychiatrist for antidepressants or antianxiety meds).
  4. Contact. How long is too long before you start to worry? Make it clear that if you text/call them, you expect a response (even a lame one) within XX hours. Stick to it. We all know they will get busy (or sleepy or drunk or distracted) but having you worry day after day is unnecessary if they simply check in regularly.
  5. Scheduling. Kind of along the same line as appointments above, one of the most powerful sessions I have with students leading up to classes cranking is sitting down with their schedule and putting EVERY assignment, test, meeting, etc. into their calendar. Most professors post their syllabus on the school’s intranet and every student has access. Every syllabus is required to have all dates/times of classes as well as assignments and tests.
    But wait, there’s more!
    After we plug in all the items from the syllabus, we reverse-engineer. For example, if Mary has a test September 18 for Calc, we schedule back one week for studying (start September 11). For each day, we carve out 1 hour for studying (eg. Mon, Sept 11 3:00pm-4:00pm Review Calc). This makes it so each study session is a known, expected quantity with a specific day and time.For more insider tips, tricks and ways to support your college kid, contact me

Insider’s Guide: Creating and Maintaining Boundaries

The small college I graduated from had a working farm in a beautiful valley with a river flowing through the middle. Students worked on the farm 15-20 hours per week planting corn, fixing tractors, and cleaning out the pig stalls. Our farm had a herd of cows that loved to poop, eat grass, drink from the streams and get into trouble. The college hired a farm manager who decided our primary focus should be keeping the cows out of trouble by fixing existing fences and building new ones with high-tensile wire (electric fencing) with solar chargers.

After months of slow progress, the cows were fenced-in and safe from their naughty excursions. But they continued trying to bust out of the new fancy fences so the farm manager said out next job was to create a ‘salad bar’ in each pasture. We removed massive thistles, dug up weeds, and filled in mysterious holes. We planted clover, fescues and other plants cows love. After a full season of work, the cows no longer tried to bust out.

They had a) strong fences and b) healthy pasture. The perfect combination of keeping cattle happy and in a good spot.

Image result for cows

Humans can be like those cows, especially young humans (teens and young adults). If we don’t build boundaries around them, they wonder-off into the world. We don’t want the boundaries too tight or they suffocate and don’t learn how to handle freedom. If the boundaries are inconsistent and full of gaps, they don’t have structure to lean on when the world gets hostile. Boundaries, like fences, require maintenance. Talking about your limits and the consequences if they are unmet is maintenance. Telling your son or daughter you are appreciative they came home by curphew last night is maintenance. Keep the fence maintained and it will be easier than looking for cows at 2:00am (I’ve done that before).

It’s also important to create that healthy pasture for kids. Create positive experiences at home, provide healthy food and love and attention. Give opportunities for engagement, ownership and rebounding from screw-ups. This is the healthy pasture for kids. Pastures also need maintenance. Checking in with kids and revisiting what you are providing as a homebase is essential. What sort of place is your home? Safe and welcoming or something to be avoided? Talk this out, don’t make assumptions.

Healthy fencing plus healthy pasture equals healthy cows. A simple experience I had which holds true today for families I work with.

 

How to Pivot

I’ve been working on a project that just is not working. There are so many reasons, some of which are my fault, many of which are out of my control. But let’s move on. I need to pivot. It’s time to do something differently. Pivoting with this means to end that project, change the people involved, 10x my behavior with obsessive focus or something entirely different. There are probably a hundred other possibilities of ways to pivot out of the current trajectory. I am emotionally and financially in the middle of it so I can’t see all the options. I also don’t have an outside mentor or family member or consultant to provide that outsider perspective.

Everyone has stuff they get stuck in. Sometimes it’s really important to suck it up, dial-up your grit and just get through it. We are often pretty whiny and complain about how hard stuff is.
But when is it the right time to quit? When is it time to pivot? This is what I’ve been looking for since so many clients I work with (eg. parents, college kids, entrepreneurs) really struggle with this. I struggle with this.

Here are some observations. There are other times in life when pivoting is important, essential or just part of the game. People pivot playing basketball looking to pass or avoid defense. People pivot when mountain biking – an unexpected downed-tree or squirrel in the way dramatically changes things. People pivot when driving – I’m thinking of all the shredded truck tires I used to dodge when driving on I-40 around Raleigh-Durham. No time to think, just move or risk the car, bike or losing the ball.
What’s the take-home? In those instances, pivoting is reactive, requiring instinct rather than careful planning.

Pivoting in larger life issues maybe requires long-range thinking like how will this impact my family, finances, etc. I think it also requires an outside perspective (new information into the system). Pivot is moving in a different direction based off this new information (…or perspective or paradigm or assumption).

But, research is here to challenge the assumption we need to think through all big pivots.

Researchers, studying choices and life satisfaction found that people were often more satisfied and happier if they committed to making a big decision based on a coin flip.
Yes, a coin flip. A coin flip for quiting a job, ending a relationship, getting married, having kids, etc. Heads….or…..tails.

What? How the…? A coin flip takes the thinking, second-guessing, planning, sleepless nights and hands all of it over to chance. It becomes externalized, kind of like believing that God controls mudslides, getting a promotion, and whether a kid gets into Harvard. It’s no longer mine (internalized) and within my control. It’s up to something or someone else (coin or God).

So, if you need to make a hard decision, flip a coin.

If you need to pivot out of a messy situation or something complicated, get outside information from a counselor, consultant or super smart family friend.
Tomorrow – I’m finally meeting with someone to give me perspective on my pivot. Better late than never.

How to Overcome Suffering

Suffering is the gap between what we expect and what our reality is.

If I expect to have a Tesla Model 3 (sooo sweet) but instead have a first generation Prius that smells like dog, I might be pretty miserable. If, on the other hand, I’d love to have a Tesla Model 3 but change my expectation to having a reliable vehicle regardless of flashy eco-cred, I shrink the gap between what I want and what I have. Harder said than done but no less true.

 

 

 

 

 

 

 

 

 

 

 

 

This also happens to be the foundation of non attachment. When we are attached to an outcome (eg. our kids will get an ‘A’ on their Calc test) we create an expectation. If our expectation is not met (eg. ‘A’) we suffer (eg. or get really pissed because we know they are totally smart and capable but probably didn’t study enough….). When we suffer we try to change our reality to fit our expectation (eg. ‘Study harder next time!’).

Peace (not happiness) comes from changing the expectation, not the reality. Having goals is super important. But goals are not the same as expectations. Goals are things we are working towards. Expectations are assumptions we make about the future.

Next time you get angry (or anxious or depressed), ask yourself what your expectation is compared to your reality and observe the gap between the two. Try changing the expectation just a bit.

Spring Semester Planning for Kids Returning to College

You made it! The kids made it home, the in-laws were tolerable and there weren’t a ton of gifts that needed returning. Now that everyone is headed back to campus, it’s time to either let that old anxiety creep in or spend some time on the front end helping your son or daughter develop a plan to be successful for Spring Semester.

Money

If you have not learned by now, discuss how much you are giving to your kid and when you’ll give it to them. You don’t want to find yourself in a defensive position Sunday night while your son is blowing up your phone begging for their regular spending money to be put into their account early. I recommend putting money into the account 2x/month. Put it on them to create a budget which factors in their books, fun money and any other expenses. I also recommend a limit is set for any credit cards and deciding who and when it will be paid off.

Organization

Talk about starting the semester off with everything in it’s place – clothing, car, computer. Let’s make sure everything is reviewed, updated and ready to go. While we’re at it, let’s pull up the calendar and start looking into the future to see when things will need to be re-updated. Get the oil change scheduled, even if it’s two months out. Get the printer cartridge in your Amazon Wish List so that you can move it to the cart quickly when your printer gives you a frowny face.

Scheduling

Speaking of calendars, let’s go ahead and talk scheduling more in-depth. I recommend to every college student they use the following strategy: Get all your syllabi, Put all dates for tests, papers, office hours, etc on your calendar. For tests, count back from the test date one week and put schedule study times (no longer than 90 min). Do the same for papers. Break down writing the paper into reasonable and realistic chunks of time and put them on your calendar. Theme: Put everything on your calendar, everything. If your son or daughter are in greek life, there are a ton of events that can be put on the calendar. Same with internships or study abroad – break down all the details so that you can see things from 10,000 ft.

Travel/Visiting Home

Plan out whatever travel including home visits your kid will have mor might have. If travel plans are only possible and not 100%, put a question mark after it so at least everyone knows that period of time is possibly accounted for.

GPA 

If your kid’s GPA got beatin up a bit in the Fall, it’s probably a good idea to identify a reasonable expectation for the Spring. If your son or daughter limped home with C’s and D’s, ask what is a realistic GPA for which to aim. Talk about it but make it clear there needs to be something concrete. . Along with identifying a GPA to aim for, talk about specific strategies that will be used to support them. All colleges have student support and academic support options. For instance, here in Bloomington, Indiana University has a solid Academic Support Center with a ton of resources that work well for thousands of students struggling academically.

Graduation/End of Semester

Part of that schedule should also have details that show your finals and last day of classes. Put details about studying for finals, having family in town, etc. If your son or daughter is graduating, figure out details early in the semester since 1) things get crazy busy/expensive during graduation and 2) hotel rooms get sold-out.

On Campus Help

Besides hooking up with academic support, it’s not a bad idea to find a counselor/life coach that can act as liaison between home and school. This professional should provide regular updates to parents, meet and be available as often as needed. They should be well-versed in young adult issues like anxiety, depression and ADHD. Universities often have counseling centers on campus that provide individual counseling for about six sessions and then they refer to a community professional. They might have ideas about professionals near your kid’s school that can offer support.

Final bit of advice – trust your kids and trust the process. With a bit of planning, your kid’s semester will have highs and lows but ultimately, they’ll finish the semester better than they started it.

Trump Presidency: What this Means for Your Mental Health Care

 

I’m going to touch upon a few things with some educated guessing since at this point we have no information on any strategy for changing the healthcare system, including the Affordable Healthcare Act (aka. Obamacare).

Medications

Big Pharma may be big winners in this election. There is a good chance regulation will decrease which means drugs will be pushed through the regulatory process. There is also a very good chance your medications will get more expensive Obamacare will be directly targeted for dismantling. At this point, the federal government has some impact on what drug makers charge (at least for Medicare, Tricare and Medicaid clients). There is a very real fear that whenever there is a conflict between industry and clients/customers, the Trump administration may very well choose big business.

Affordable Health Care Act – Obamacare

This was one of Trump’s big targets and will likely be a focal point as the Trump administration sharpens its agenda in 2017. One big problem with Trump’s over simplistic promise to ‘get rid of Obamacare’ is that it took years and years to recalibrate and organize healthcare at the federal, state and corporate levels. Billions of dollars went into this law. Changing the law will take years and years and more billions. Insurance rates have gone up for many people and that hurts. But, the dismantling of Obamacare will likely have a dramatic and catastrophic effect on providers, clients and hospitals. The prediction at this point is that while the current system is experiencing growing pains, the replacement will likely compromise the little leverage we have over insurance companies meaning they will go back to charging whatever they want and having pre existing conditions the hallmark of how they keep people from needed care.

Mental Health Parity and Addiction Equity Act (MHPAEA)

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law that generally prevents group health plans and health insurance issuers that provide mental health or substance use disorder benefits from imposing less favorable benefit limitations on those benefits than on medical benefits. With the Trump administration taking the reigns in a few months, there is the possibility the act could be dismantled in favor of insurance companies, most of which have fought, lied and deceived policyholders from the very beginning of the law in 2009. What this means for you: Insurers may no longer be required to pay for comparable level of mental health and substance abuse treatment as you have within your medical policy.

I will continue to monitor Trump policy changes and post again soon. Till then, take a deep breath, stock up on canned goods and sweep out your bomb shelter. We’re likely in for a wild ride.

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.  

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