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Green Tara

complete psych evaluation

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My current (for now) therapist has suddenly suggested that, in order to get to the root cause of my issues or how best to treat them, I need to have a complete psychological evaluation. I've never had one before. I'm guessing that sort of thing will be expensive and will not be covered by my insurance. Or rather, will be one of those things that is covered but applied toward my deductible, which is my husband's goal in life to never approach meeting - so I do what I can to help out...like maintain substandard mental health care for myself. Oh, but I digress.

Do we think that this is something that would be worthwhile toward finding the appropriate type of therapy or approach that would best help me or is it a time and money suckage? I apologize if that's an obtuse question but I'm quite a babe in the woods when it comes to this sort of thing. She said that it would be an indicator as to what type of help I needed and even though I asked for a more expansive explanation, that's pretty much all I got. I never knew that I needed any particular type of help. The only reason I have to be wonder is that she might be trying to send me to her husband, who is a psychologist...so it did give me pause. She did mention him in our conversation, in any case.

I'm sure it couldn't hurt to have more insight into myself (if they even tell me the results), but is it really necessary for my continued success in therapy? Thoughts? Comments? As always, thanks.

Tara

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"Complete psychological evaluation" has no meaning to me. Never heard of it.

What is it that she proposes? What is the focus/purpose of such an examination? What type of evaluations? Who will perform them? What are their qualifications? How much will it cost?

What does your Pdoc say about this?

Does your therapist have some disagreement with your Pdoc's diagnosis?

What kind of therapy are you recieving? Is there a treatment plan? Does your Pdoc agree with it?

What are your therapists qualifications? Counselor, LCSW, MS in psychology, PhD in psych?

Tons of questions I know, but you are already concerned whether this is appropriate.

a.m.

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Complete psychological evaluation is ambigous. Most likely it is a combination of tests, written or self-answer, and maybe some interactive/subjective tests. Examples may be the MMPI II, some type of IQ test, a symptoms checklist, and the more subjective and oral answered tests such as the Thematic Apperception Test, even a Rohrshach -- some folks still give this -- the battery of tests would depend on what sort of information your therapist thinks may be helpful.

What degree/qualifications does your therapist have? Is she a social worker, counselor, psychologist, or are you referring to your pdoc as your therapist? What are your therapsit's qualifications for reading/interpreting the psychological evaluation report? Perhaps most importantly, it sounds like your therapist thinks the evaluation would be helpful to her in order to provide a proper or more specialized form of treatment. But do you know what kind of treatment would be the most beneficial for you? You don't mention your diagnosis(es), if you have ever been told or given a diagnosis, do you have your own thoughts as to your Dx?

As per some of your questions and concerns: Do you think collecting additional information would be helpful to you (or has mentioned above more useful to your therapist)?, and useful for you to make progress in therapy? Psychological testing only aids in suggesting diagnoses not confirming a Dx, and thus may suggest some forms of therapy may be more useful or helpul given your diagnosis and what therapy may be best for a specific Dx as well as best suited to your personality. Correct administration and interpretation of the tests is the key. Testing sessions costs can vary widely according to who performs the tests and how many tests and/or sessions it will take to complete the tests.

If tdoc is suggesting you be tested by her husband, there may be a conflict of interest, or it may be that they do work as team? Does hubby also see patients or only perform testing? Insurance coverage, of course, will be according to your coverge and how the testing session is billed.

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At PDoc and TDoc's suggestion, dd had a psychological evaluation done by a licensed psychologist. As someone else explained, it's a series of tests that, in combination, provide pretty conclusive evidence of "what's going on". The reason for so many tests is that, as was explained to us, "you can fake a test some of the time but you can't fake all of the tests all of the time". The tests are designed to derive certain bits of information but each test does it a little differently. I'd have to look back at dd's written results to give you the correct verbage on this, but once you've done all the tests your dr. will "scale" the results indiicating things like how delusional you might be, what your tendencies for schizoprehnia might be, whether you reflect any personality disorders, etc.

In our case, this was very conclusive. First of all, the results that the tests yielded were, for the most part, things I could concur with from being on the outside looking in. The test did a very good job of identifying my daughter, her thought processes, her personality, etc. Her I.Q. test results were considerably lower than the results from two previous school tests.....maybe her concussions played into that, maybe medication, maybe whatever. Those tests were used primarily to help the psychologist evaluate dd's ability to understand and answer questions. Oh, what was helpful was that the testing helped determine some of her strengths and weaknesses i.e. dd, apprently, isn't very detail oriented when looking at things, including problems in her life. In our case, dd was a minor. The psychologist not only gave us the same written report that was given to dd's doctors, she met with us and explained everything in detail. At that time she said dd should never know the specific results of her testing. Not because it was so horrible (although parts were), but that dd wasn't ready or capable of dealing with some of the results (i.e. dd's resistance to accept that the abuse from childhood continues to deeply affect her). I don't know what happens with an adult except I would imagine you have a right to the results. I'll reiterate that the doctors don't sugar-coat this and I think the patient should really be in a position to accept the information as a positive approach to treatment. The psychologist did meet with dd and gave her what I'd call a more positive overview of the situation and suggestions for treatment options, etc.

Most insurances do not pay for this testing and it's very expensive - check first! In our case, the testing took dd about 10 hours total and the psychologist needed 6 (maybe 8?) additional hours to grade the tests, make comparisons, and come up with results and a report. At 150.00/hour that is pretty darn expensive (our insurance paid most of it). Having gone through it, I honestly would have dug into our savings to do this if the insurance hadn't paid for it but prior to the testing I didn't have the confidence in the accuracy of the results to make that decision and probably would have declined the testing.

The results are used assist TDoc in determining the direction of therapy and PDoc in a diagnosis and treatment.

I'd make very sure you use someone who does this a lot (and not just your TDoc's husband). I would imagine that experience pays off here. We live in a large metro area and our PDoc gave me names of people who only do this and that's the only people I called. I really don't regret it. Good luck to you. My suggestion, if your insurance will pay for it then why not give it a go? At the very least it's another tool to help your docs help you, right?

I just re-read your post and thought, if you don't mind, to add another comment from our experience. Yes, this can be enormously helpful in continuation and success of therapy. In our case, as I stated, dd was (and still is) refusing to even acknowledge the abuse as a factor in what is going on but since most of her subjective test results showed a tendency towards viewing things in a very sexually violent way....well, you know what I mean - it's definitely impacting her. There's other things that came out which showed that where dd was in the acceptance of everything related to what was happening to her - including the hallucinations (which is a whole other story that still baffles me). It really helped the TDoc to know where she was even though she couldn't provide that information to him herself (and it's not that she didn't want to, she couldn't because she doesn't see it).

Edited by DMF

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Wow. Such a lot of good questions and a lot of information to digest. First, I hope no one minds me responding in this format, but I want to get to a lot of the salient points/questions raised.

Air Marshall: I don't know exactly what she proposes or what type of evaluations. I asked directly and couldn't get a direct answer. She just assumes I've never heard of the tests in question, which is irritating and probably untrue as I have a pretty broad general knowledge.

She mentioned that a psychologist would perform them after she speaks to my pdoc for some or other reason. That will be the first he's heard of it. He's extremely laid back and will most likely go along with it.

I have no idea how much it costs. That was one of my questions for her. I know my friend just had a so called and court ordered "psych evaluation" done for his daughter due to a child custody case and it was to the tune of $1500.

My pdoc's dx is BPII and my t's office, who is a LCSW has me down on their books as BPI. I don't know how they ended up dropping a I but I've never had a manic episode so...I don't know about any treatment plan in existance. I just go in there and talk for the most part. My suspicion is that she wants to rule out a personality disorder; which I think is more than a little far fetched. Then again, she doesn't know me like I know me.

Batou: I think the answers to your questions are above and yeah, that's what I thought as well. These tests would be great for suggesting a diagnosis. Trouble is, I'm already quite happy with the one I've got. Wait, that didn't sound right. ;) Anyway, that's what I think I'll tell her on Monday. Thanks to everyone who articulatied that fact so I can use it when I get into her office. Between the meds and the hard sell, I tend to get a trifle discombobulated when I get in front of her at times.

DMF: Thank you for taking the time to share the story of your daughter with me. I can see how it would be a very useful tool in guiding someone toward the proper path in therapy. I just don't think this battery of tests is right for me at this time. Now if it were paid for by insurance then I'd say, Sure, Why not?, because gods know we pay enough into that policy. While it would be nice to have greater insight into my old brainbox, I don't think I need to go shopping for a new dx, which is what she wants to do, and possibly give her husband some business in the meantime. I suppose I'll wait and make my final decision after I find out about the cost/coverage and then choose who administers the test(s) myself.

Thanks again for all your input and help with this question and decision for me. It's difficult to go to friends with certain mental health questions and my husband already thinks I'm a second full time job, I'm sure! You guys have a great weekend!

Tara

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first- just want to express some concern about tdoc not being willing and/or able to give you thr info you requested.

there's something about that and my impression that you didn't feel you could push it- this raises red flags to me about trust and communication.

also sounds like you don't feel respected- that you know a lot and tdoc assumes you don't. ( even if you don't here's where you could learn- by asking questions and tdoc answering-

i would reccommend following up on this communication problem FIRST! overall this could have more impact on you tx success than all the tests in the world)

also- seems you have questions about her motives-is this really useful or business for her hubby or do they often work together in this way? You have a right to ask all these questions and have them answered to your satisfaction!!!

( also - i had what they called "a battery " of psych testing when i was first inpatient. i think then the tests were helpful because i was so completely unable to talk about anything. primarily i think it told them that i had some psychotic features ( so APs might help) and that i was way suicidal (so i guess they got an idea of how carefully to watch me.) i believe some testing can also be neurological- to see if ther is an underlying medical problem causing symptoms.)

usually the only professionals trained to administer these tests are psychologists- (PhD or PsyD.)

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Tara,

Ok, thats some helpful information.

Ok, I'm going to lay out my opinion on this..

- An LCSW, even one with a BA in psychology, should not be doing any diagnosis (so its good that she is suggesting eval other places), but even at that, if she has concerns, she should be consulting and advising your Pdoc, who IS qualified to evaluate and diagnose MI's.

I am not impressed by this suddenly coming up, and her only mention of your Pdoc is that the therapist will call the Pdoc to confirm/coordinate. If your therapist has had significant concerns she should have been consulting with your Pdoc regularly either in person, by phone or by letter.

Before she sends you off for thousands of dollars worth of testing, I would expect the therapist to clearly communicate in writing, to your Pdoc what her concerns and questions are about your mental status and diagnoses. Ideally, you should be told at least in general terms what the concerns are. However, I personaly could accept not being told immediately, if my Pdoc felt it would aid diagnosing.

Now, the next most logical step would be to arrange for some long lenght appointments with your Pdoc for him/her to do evaluation. Remember, your Pdoc IS fully trained and qualified to eval and dx. The advantages are, that he already knows you, won't be starting cold trying to figure out your history, and a couple hours with your Pdoc is going to be a helluva lot cheaper than a battery of standardized tests.

At this point your Pdoc should be able to give you a very good idea of either any new dx's or areas of concern that might require more office work, or some formal testing. Also, your pdoc may only require one or two or three standardized tests, instead of a whole battery, by having already ruled out non-applicable illnesses.

If you do decide to go for a full battery of testing, I would almost NOT be willing to go see the therapists husband, just on general principles. Look for full time licensed professionals at major hospitals or universities.

Just to emphasize, my point is don't get stampeded into spending thousands on tests, without having a simple and clear explanation of why you need this testing, and don't do it without agreement from your Pdoc that you need it.

BTW, my therapist is a LCSW, and I have been through a general neuro-psych battery about 15 years ago, albeit for neuro problems.

Best, a.m.

Edited by AirMarshall

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all on my own (sort-of, complicated, but not reccomended by current tdoc) i decided i "needed" a complete psych evaluation. and it was a pain in my ass and told me what i already know: that i am depressed, anxious, and have "unresoved issues from childhood." all of these things my current tdoc figured out in during the first session. i don't think it was the most usefull thing i've ever done, to say the least.

which is not to say that psych tests have no use, they do.

but i'd push harder to understand why your therapist thinks this would be useful and what tests. the MMPI isn't an obscure test that no one has heard of and the tester will tell you what test you're taking (plus things are labeled) so it's not like it's a big secret. (well, other than the tests themselves are secret, but so that they are accurate. wouldn't work if you'd already read all the questions and knew how it was scored.) all the testing in the world won't help if you don't have a good relationship with your therapist, and i'd think that asking what tests should be a question to answer. and i certainly wouldn't pay my therapists husband to give me a series of tests without an explanation of which tests and why. i wouldn't let my therapists husband do it even if i was told what and why. a lot of people get dx'd without tests, and tests aren't the only way to rule out a personality disorder. just my opinion, of course.

good luck with whatever you do.

penny

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These are good responses and I would like to reiterate the relationship between the TDoc and PDoc. First, my insurance wouldn't pay for it without the PDoc recommendation AND providing the criteria necessary for approval (not just "we think it would be helpful"). However, it was something that came out in therapy that alerted the TDoc that there may be some things that haven't quite surfaced that might be contributing to the situation. Before we even had an idea this was a possibility, TDoc called and conferenced with the PDoc who then set up an appt. with us to discuss the situation and make his own evaluation of the need for the testing. AirMarshall said there should be an ongoing dialogue going on between PDoc and TDoc - if that's not happening then it's time to find a new one or the other. TDoc should not be railroading this is basically what I'm getting at.

Also, you really don't sound like this is something you want and YOU get to make the decisions. Go with your gut instinct and if it's no today you can always change your mind down the road.

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Just want to respond to AM's comment about social workers. there are different levels of SW training and liscensing. this varies state by state.my home state allows a social worker with a Masters degree and 2+ years of clinical experience to recieve 3rd party payment for services ( some states will only have insurance reimbursment for therapy for an MD or Phd.

my point is that in orer to bill insurance- an independent clinical social worker is required to make diagnoses- and by this point in training, is in fact, well qualified to do so.

( will now step down from MSW soapbox)

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Just want to respond to AM's comment about social workers. there are different levels of SW training and liscensing. this varies state by state.my home state allows a social worker with a Masters degree and 2+ years of clinical experience to recieve 3rd party payment for services ( some states will only have insurance reimbursment for therapy for an MD or Phd.

my point is that in orer to bill insurance- an independent clinical social worker is required to make diagnoses- and by this point in training, is in fact, well qualified to do so.

( will now step down from MSW soapbox)

- States don't tell insurance companies who they can contract with or pay. Insurance companies determine what treatments will be covered, and who they will contract with as providers and what their qualifications will be.

Umm, ok I didn't really know what it took to be a social worker, so I've been reading up.

I can now firmly state that in general, social workers have NO formal education or training to be making diagnoses or even major judgements about psychiatric illnesses or their treatment. Having checked the bachelors and masters programs at Maryland, Illinois, Texas A&M, USC and UCLA, none of them require more than TWO (2) psychology classes all the way thru to an MSW. (hey, I had psych 101 too. I'm half way there.)

Now, social workers can be great counselors, with insight and experience into people. But that is not a substitute for an MS or PhD in psychology or an MD in psychiatry.

a.m.

Edited by AirMarshall

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Among other things, DMF makes the very valid observation about the possibility that the test results could be disturbing (or delivered in a disturbing manner).. Otherwise I have pretty strong, if provisional opinions on the advisability of accepting this therapist

Edited by realitytest

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Heya,

An aunt of mine whom I absolutely respect is an MSW.

My therapist who made fun of my diagnosis and said psychiatrists were useless was an MSW.

Like us MDs,

You can't tell always by the letters.

--ncc--

Just want to respond to AM's comment about social workers. there are different levels of SW training and liscensing. this varies state by state.my home state allows a social worker with a Masters degree and 2+ years of clinical experience to recieve 3rd party payment for services ( some states will only have insurance reimbursment for therapy for an MD or Phd.

my point is that in orer to bill insurance- an independent clinical social worker is required to make diagnoses- and by this point in training, is in fact, well qualified to do so.

( will now step down from MSW soapbox)

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I had a complete mental exam-my insurance covered it, which is a damn good thing-2100$! My pschy eval. was done by a neuropsych. who is also my therapist. The tests totally sucked. The 9 page eval. makes me sound like a hopeless case and a freak. IMHO, it was a total waste of time and $$. It confirmed what I had already been dx'd-BP2, MDD w/ dysthmia, GAD w/ PD, and a little touch of BPD. Also, all my life, I had tested high on IQ tests and their IQ tests put me in the avg. range for some areas, superior range for others, and low on memory/cognitive- I wonder about the accuracy considering the amount of meds I'm on. whatever. mel1

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This post is probably going to get me flamed to hell by the offended or disagreeable; but, I still think it's a legit point to bring up:

Do not ever trust any kind of social worker to diagnose your neurochemistry. They are not adequately trained. They are not clueful. They do not possess the scientific or mathematical training, or, in many cases, aptitude. They are amateurs.

I once had a social worker assigned to me when I went to a state "community" clinic for meds management. I was a Medicaid case then; and I think that was a factor. I think they get increased funding for complex cases (much like the public schools with the standardized testing failures), and have a tendency to trump up lots of "alphabet soup" co-diagnoses to increase the cha-ching. But, in any case, I was a clear-cut case of uncomplicated, lifelong OCD. What I needed was prompt access to a shrink and a CBT therapist. In the meantime, though, I was required to go through her. Here's what I got:

She tried to dual-diagnose me with BP and binge alcoholism.

The evidence? She did a general self-report questionnaire about my lifestyle, and I'd admitted that, once as a college-aged kiddo, I tried to experiment with peppermint Schnapps, had way too much, and passed out on my apartment couch. Also, I had insomnia when my obsessions spiked.

I shit you not.

Apparently, that alone was grounds for trying to declare me a ZOMG bipolar alcoholic in need of ZOMG crisis intervention.

Riiight. A quick complaint to the actual doctor in charge of the clinic prevented that silliness from going down on my records, and also got me into proper care. Yep, you guessed it- MD care, Luvox and CBT, which is what they wouldn't let me demand right from the start, because mental patients couldn't possibly know their own needs.

Social workers are, for the most part, either morons, dangerously fucked up, themselves, or both of the above. Be afraid. Be very afraid. ;)

Have only the qualified do any exhaustive, $2,000 evaluation work-ups you're thinking of doing.

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*snip snotty little patronizing spiel*

Um...did it ever occur to you that, yes, I have dealt with a large sample of them, and had merely chosen this one as one of the more extreme examples of what I'm talking about?

Exit high horse. Remove foot from mouth. Run along.

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