PTSD

What happens in a psychological evaluation?

If you are thinking about psychological testing you probably want to know what an evaluation will look like.

You are nervous about making an appointment. What will happen? What will we talk about? Will it even make sense to me? What if they don’t answer the questions I have? How long will it last?

I’ve done enough evaluations to lose count so I know what method works for me and the people who like to work with me. I’ll break down what I usually do so by the end you’ll feel less scared about making that appointment (everyone has at least a little worry about these things!)

Most psychological evaluations involve talking to the psychologist about yourself and symptoms such as anxiety and trouble sleeping in an interview, doing some questionnaires about yourself, and possibly some activities that look at how your brain is working. By the end, you should be given feedback. Professionals sometimes have different workflows, but I can tell you how I do it here in Boise. (P.S. This starts after the process of seeing if I’m the right person for you and making an appointment.)

Sun setting at Canyonlands National Park

Sun setting at Canyonlands National Park

Psychological Interview

First, you come in to talk with me about your concerns and share important background information. Depending on the questions we have, this interview will take between one and two hours. If you have trouble talking about yourself (maybe speech or memory is one of your concerns), I will ask your permission to talk to someone who knows you well to make sure we are getting good information and not missing anything important. Honestly, I like to do this even when you can talk about yourself all day - it always helps to get another perspective! If you are still worried about exactly what we’ll talk about, here is a list of things I ask about and a short explanation for why I ask them.

Your current concerns

I hope it is obvious that I care about what is bothering you, and there might also be concerns that others have for you – these could be things like worrying too much, never feeling happy, always being on-edge, trouble sleeping, feeling distant from others, having trouble with relationships, struggling to cope with stress or other problems.

Medical

There are a lot of reasons this is important; so many medicines and hormones can impact how you are feeling, head injuries can change us, and there are a surprising amount of medical concerns that can cause psychological symptoms. It is also helpful to know what medications you’ve tried (if any) and how they have worked (or not).

Education and Work

This gives me information about how concerns might be impacting these areas of your life

Substance Use

I know this is scary but some of this information can tell me things like how you cope and if using a substance or withdrawal might be impacting how you are doing. It is super common for people with mental health concerns, especially trauma, to also use substances so I always ask. Which leads me to…

Trauma

You can see my last post for an explanation of trauma. I find that people don’t talk about it unless asked; which means it gets overlooked. Trauma leads to a lot of things in different people – anger problems, relationship issues, depression, anxiety, the list goes on. I can’t make the best recommendations for you if I don’t know whether or not trauma happened and how it might impact you.

Current Potential Symptoms

These are things like how you are feeling, what you are doing/not doing, sleep concerns, eating and appetite problems, thoughts of hurting yourself or others, and unusual experiences like seeing or hearing things that other people don’t see or hear. I always ask about everything because people sometimes don’t share unless asked directly.

Current Life

This is basics like who you live with, who you talk to, how you spend your free time, and who you are in a relationship with. I also ask about what parts of your identity are important to you (and how much detail you want me to know), such as sexual orientation, gender identity, religious beliefs, race, ethnicity, language preferences, immigration status – context can be really important to understanding the big picture!

This list is not exhaustive, but hits some of the big points. Each interview I do is a little bit different based on you and your concerns 😊 You might hope after talking about all that, we don’t just jump right into testing. I think it makes for a very draining day for some folks, so lucky for you - I don’t.

Canyonlands National Park arch with blue sky

Canyonlands National Park arch with blue sky

Psychological Testing

After the interview, I will plan what questionnaires and activities we should do to answer our questions. You’ll know the general things I want to look at more closely before you leave my office after the first interview. If there are any questionnaires that you or people you give permission for to answer online, I will send those out shortly after your interview. The rest of the questionnaires and activities we’ll complete at my office 1 week after your interview. In between these meetings I’ll be trying to contact anyone you gave me permission to talk to (such as a counselor, doctor, lawyer, or someone else who we think needs some input into your evaluation).

The assessments (and how much time they take) will be different depending on your questions . If you are worried about how your brain is working (like memory, attention, or concerns about your brain working too slow) I’ll likely do an intelligence (IQ) test with you and maybe one for executive functioning (this is basically your ability to plan, organize, and monitor your thoughts and behavior). I would also have you or someone who knows you well to do some questionnaires about your ability to function in the world and take care of yourself (also called adaptive skills) and your executive functioning (it is better to have more than 1 source of information when I can get it!).

If you have questions about why you are sad, worried, fearful, have intense up and down emotions, or keep getting into bad relationships then we’ll probably just do some questionnaires; some of those have to be done in my office. The questionnaires will ask a lot of questions and look at your personality and symptoms to make sure we aren’t missing anything. Common questionnaires I use are the MMPI-2-rf, PAI, and TSI-2. For people who speak Spanish many of the scales I use also are available in Spanish (hooray!) and when they are not available I try to find a good alternative.

Understanding your Results

Within 1-2 weeks after completing the assessments and questionnaires I’ll have your report completed and you’ll come to my office for 1 hour so you will feel clear about the results and confident in your next steps.

I do my best to answer all your questions during our feedback session. If I think counseling will be helpful I will give you specific recommendations for the type of treatments that are likely to work and if I know of anyone will include specific people. I also give you strategies that you can use at home, work, or school. If you find books or apps helpful I can usually recommend a few of those as well. You’ll get an electronic copy of the report (pdf) so you can share it with whomever you think makes sense (like your doctor or psychiatrist if you see one) and so you don’t have to remember everything we talk about in the feedback session.

Occasionally, the problem you have is something I have specialty in treating (anxiety or trauma) AND you really want to use me as your counselor. If I have any openings and we all agree it is a good fit, I am happy to do that.

Whew! I know that was a lot of information. But you’ve made it this far; you’ve got answers about the process.

Are you ready to get some answers about yourself?

Click to schedule a free 15 minute call with me to figure out if I’m the right person to help you and book your appointment. If I’m not your person, I’m happy to help point you in the right direction!




PTSD Awareness Month

Did you know June is national PTSD awareness month? It is also Pride Month! And Men’s Health Month! And National Safety Month! (and probably more that I don’t know about!)

The one I want to talk about today is PTSD awareness, not because it is more important than any of the others, but because PTSD (or at least trauma) is part of almost all of my work.

Actually, there is tons of overlap between PTSD and LGTBQ folk, men, and safety.  For example, LGBTQ youth experience higher rates of trauma (such as bullying, harassment, traumatic loss, physical and sexual abuse, and societal stigma, bias, and rejection) than their peers. And while women are more likely to be diagnosed with PTSD, men are more likely to experience a trauma and are less likely to get counseling in general. Also, trauma seriously impacts our ability to feel safe.

So what is PTSD? Good question, since I keep using that acronym, let’s start there - the long term for it is Posttraumatic Stress Disorder.

People might develop PTSD after experiencing something awful or tragic, where their life or someone else’s life or well-being is threatened; we call this a trauma. Sadly, trauma is super common in our world. About 6 of every 10 men (or 60%) and 5 of every 10 women (or 50%) experience at least one trauma in their lives according to the VA. Some examples of trauma are sexual assault, child sexual abuse, serious accidents, physical assault, combat, disaster, or witnessing death or injury. Others that are less physical in nature still have a strong impact, and I would argue the impact is often deeper or more complex; examples include things like childhood neglect (not getting your basic physical, emotional, or social needs met), verbal abuse, stalking, social rejection (of yourself or your community), and hearing about the details of trauma that happen to others.

Experiencing a trauma does not automatically mean you will have PTSD. Although you might still have some reactions that relate to what you experienced, and those reactions might pop up at any time. If you have PTSD you will have symptoms across multiple categories in addition to having witnessed or experienced a trauma.

The easiest way to explain PTSD it to describe it as a disorder of being stuck in the trauma.

People have different ways of being stuck in bad experiences. It can look like frequently reliving or re-experiencing things related to the trauma. You might be avoiding memories and reminders of what happened. You may notice changes in your thoughts and feelings that are directly related to what you experienced. And you might find yourself being highly reactive or on-guard. If this paragraphs sounds familiar to you, you probably have been feeling lonely too. Please know that you aren’t, 70% of adults in the U.S. have experienced trauma and up to 20% of those people go on to develop PTSD; that means literally millions of people are experiencing this. The good news is there is effective counseling for PTSD such as cognitive processing therapy (CPT) and trauma-focused cognitive behavioral therapy (tf-cbt). There is also growing evidence for EMDR.

Discovering if you have PTSD is the first step towards getting getting over it (and yes, research supports effective treatment for both adults and kids!) A psychologist can diagnose PTSD - if you are worried you might have it, schedule a free 15 minute chat with me to see if testing or counseling might be right for you. You don’t have to be stuck forever!

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