The Ins and Outs of Psychoeducational Testing

Upon becoming licensed ten years ago, I began scampering around in search of “gigs” to supplement the meager income I was making as a part-time community-mental health therapist and college lecturer. It was my good fortune to land a two-year position with Teri Solochek, an educational consultant in the San Fernando Valley who was well known for conducting psychoeducational testing with the wayward children of the upper-strata and placing them in high-end therapeutic boarding schools around the country.  I nodded politely and disguised my ignorance when she spoke of psychoeducational testing, assuming it was a of hybridization of the more regal psychodiagnostic testing that we are all trained to do in graduate school. Indeed, my stint with Teri Solochek proved to be auspicious and I incorporated psychoeducational testing as a dimension of my own private practice.

So, what is psychoeducational testing (PET) and how does it differ from psychodiagnostic testing (PDT)? Generally speaking, PET is conducted primarily for the benefit of parents and the school (although it may also be forwarded to an outside mental-health professional for medication-related reasons or to embolden therapeutic work), and the report that is generated is utilized by parents and educators to implement any school-based accommodations and home-based adjustments that might maximize a child’s learning.

If the child is in private school, at the request of parents, the psychologist may consider consulting directly with the school to share findings, identify favorable classroom accommodations, and advocate for the child. Since the psychologist serves as an ambassador for the child and his or her parents, diplomacy, discretion and sensitivity need to prevail in the psychologist’s dealings with school personnel. If the child is in public school, the PET report can be used by parents to secure special-education services (mostly as a prelude to a school psychologist conducting a formal Individualized Education Program (IEP) assessment); or, when the issues are less severe, to request a 504 plan, whereby the child can remain in a regular classroom, yet still access accommodations.

Typical accommodations include: use of a laptop or tape recorder in the classroom; access to a printed outline of lecture content; a change of seating arrangement; extra time on tests, untimed versions of tests, or take-home tests; or, a reduced work load. Such accommodations would depend on the presence of learning deficits. We all know the “usual suspects” of a reading (formerly dyslexia)  or mathematics disorder, where the child’s performance on a standardized test in any of these domains lags significantly behind his or her overall intellectual expectancy. Less well known, but equally as debilitating, are impediments in grapho-motor speed (output of paper-and-pencil skills), visual and auditory processing.  A typical battery I employ is either the Wechsler Intelligence Scale for Children—IV, or the Woodcock Johnson Tests of Cognitive Ability (my preference because it generates more information), the Woodcock Johnson Tests of Achievement, the Bender-Gestalt, and the Gray Oral Reading Test—4th Edition.

If psychosocial vulnerabilities appear to co-exist with, or potentially trump, learning impediments, PET then includes standard psychological tests such as the Draw-A-Person Test, Sentence Completion Test, Roberts Apperception Test for Children, Achenbach Behavior Checklists, and in the case of teenagers, the Millon Adolescent Clinical Inventory and/or the Minnesota Multiphasic Personality Inventory—Adolescent version. The psychosocial testing findings and any diagnostic conclusions arrived may or may not be shared with the school depending on whether the parents and psychologist reach a consensus regarding the perceived beneficiality for the child of the school receiving such findings.

The report can also be a constructive jumping-off point in discussing with parents their child’s learning style, intellectual potential, optimal school-child or teacher-child fit, unmet emotional needs, interpersonal style, and other factors that have implications for alterations in school placement, parenting styles, and family lifestyles. Any need for outside educational therapy, tutoring, or vision therapy can be addressed in feed-back consultations with parents.

PDT usually is far narrower than this, serving to clarify diagnoses for medication or legal purposes, and any report generated is primarily for outside mental health professionals.

I would extol early-career professionals interested in branching into PET to follow the ethical rubric that I subscribe to: Tailor the testing to the presenting problems and administer the fewest tests necessary to shed light on such problems, adding tests if ambiguity persists. In my estimation, the “one-size-fits-all” approach, whereby a fixed, extensive battery of tests is employed regardless of the presenting problems leads to PET being overpriced, and the lack of parsimony here may raise ethical questions. Also, preserve a normative developmental perspective in the assessment of children, since delayed development in the socio-emotional realm, not uncommonly, is mistaken for psychopathology, and when formally documented in this manner, can stay in a child’s school record, with deleterious effects.

Promoting Emoti…

Aside

Promoting Emotional Literacy in Kids

To correctly label an emotion is to have mastery over it. Kids who are skilled at using words to express feelings are less likely to become overwhelmed in emotionally charged situations. Studies show that children as young as two, when shown facial expressions, are capable of discerning and naming the six basic emotions—happiness, sadness, anger, surprise, fear and disgust. Kids who have access to a variety of words for identifying these basic emotions, and are skilled at verbally elaborating upon them, experience a general sense of emotional control.

Emotion Words and Social Goals

When kids struggle to choose the right emotion-words to bring about desired social outcomes they are on their way to greater emotional literacy. For example, 4 year-old Lindsey may be happily playing alone and become irate because her 7 year-old sister Tonya has entered her play space. She may want Tonya to leave so she can resume playing alone. If Lindsey curtly yells at Tonya, “Go away, you’re nasty,” Tonya may start crying and linger around, or even advance on her in anger. Neither of these outcomes matches Lindsey’s desired one, which is to be left alone to play. However, saying, “Right now I want to play alone. I’m happy playing by myself,” in a bold but reasonable tone of voice increases Lindsey’s chances of having her wish met

Freezing up Emotionally

Over-reactions and conflicts are less frequent with kids who are able to finesse their emotion-word choices. But, adeptness at using words to identify and express feelings can also prevent a kid from “under-reacting” in emotionally charged situations. When confronted with others’ excitement, distress, or anger, kids sometimes cope by emotionally disconnecting. “Freezing up,” or muting their emotional reactions in this way can disable their receptivity to share in others’ delight, empathize with others in moments of distress, and protect themselves from others’ anger.  Good emotional literacy simply lessens the chances that kids will not shut down in response to others’ emotions.

Words that Show Feelings Come and Go

Learning to express feelings to reflect their transitory nature also enhances emotional literacy. The kid who can actually express the fact that feelings come and go—and  that new feelings often take their place—is  not likely to be overwhelmed by his or her own emotionality or that of others. Young children’s immature cognitive and linguistic development predisposes them to make overgeneralizations. To adults, their emotional statements sound absolute and permanent: “I hate you. You’re not my friend:” “I never do anything right. I’m a loser;” “You’re always mad at me. You don’t love me.” Acquiring expressions that capture the transitory nature of feelings is one of the challenging tasks of young childhood, and it takes a lot of practice for kids to master the nuances: “I’m mad at you right now. You took my doll without asking”; “I’m in a grumpy mood this morning;” “I don’t like you when you scream. You’re a fun friend when you don’t scream.”

Steps for Parents to Take

  • Model use of non-absolutist language and “qualifiers” when expressing strong emotions: “Sometimes I get frustrated when you don’t listen to me” not “You never listen”; “When you use a calm voice I get less frustrated with you” not “You always yell and it makes me so mad”; “It’s easier for me to be kind and generous when you ask before you take things” not “Don’t you have any manners? I’m mad because you’re turning into a selfish kid.”
  • Model use of language that captures the transitory nature of feelings: “Right now I’m angry with you because you hit your sister. I know I won’t stay angry with you. But, that’s how I’m feeling right this minute” not “You’re always so rough with your sister. Go to your room, I can’t deal with you”; “I’m sad hearing about you getting a detention at school. I’ll need some time to get over it. You’ve had such a good week and I have been so pleased. I’m sure I’ll get back to feeling pleased, but for now, honestly, I’m sad about it all” not “What got into you? I’m very disappointed!”
  • Coax kids to rephrase global emotional expressions and prompt them to be more specific: “You say that your teacher hates you, when last Monday I saw her hug you when you arrived for school. Was there something that happened today making your teacher disappointed with your behavior? Was there something she said or did that bothered you?”
  • Discourage use of absolutist words like “always” and “never,” and provide alternative tempered word choices: “You honestly think I never take your side and always take your brother’s side, and because of this I’m a lousy dad? I know you’re mad at me right now, but “never” take your side? Maybe, it’s more like you feel I don’t take your side enough of the time, or too much of the time?
  • Mirror your kid’s feelings and softly provide suitable emotion-word choices: “I can see you’re hiding your face with your hands. Maybe this is your way of telling me you’re embarrassed? Or, feelings shy?” “You’re jumping up and down with such joy, but I can’t get what you’re telling me. Are you really, really happy because you crossed the monkey bars on your own? Is it more than really, really happy and more like super excited?

The Ordinariness of Good Psychotherapy

In the frenzy to establish and distinguish ourselves as psychotherapists, whether it be  acquiring a specialty in working with a newly-minted psychological condition, or becoming more fastidious practitioners of our chosen therapeutic paradigm, we overlook the ordinariness of what constitutes good psychotherapy.

Often it is out of a sense of real responsibility to the client, or to the interaction with the client, that our own need to be clever is overridden and we return to time-honored human virtues such as forbearance, sensitivity, tact, even-mindedness, honesty, and courage in our approach. There is the nagging suspicion that perhaps our own need to be clever arises from the client’s repetitiousness, and its unbearable effects, as if change could and should happen faster, catalyzed by a more sophisticated interpretation or skillful application of technique. Taking clients at their word, truly entering and residing in the manifest content of their narratives, the warp and woof of their everyday lives, what they feel actually matters, requires that we give ourselves over to the ordinary.   Sometimes our need to be clever is rooted in our own disfavor with giving ourselves over to the ordinary, and our interpretations and interventions become disguised ways of coaxing the client to talk about what should actually matter, to justify the potency of our education and training, or simply to stave off boredom. Which is not to say that clients do not need, yet resist, deeper meaningful linkages.

Often much of the salutary relational unlearning and re-learning that occurs in therapy remains implicit, embedded in moment-to-moment client-therapist interactions, in the form of mutually coordinated eye contact, speech prosody, voice cadence, and other rudimentary forms of human interaction. A smile, a sincere frown, or merely countenancing the calm demeanor of the therapist at the right moment, when the client expected disapproval, can have liberating effects, no matter how imperceptive. Contrary to the Freudian dictum, not all experiences have to be made conscious in order for them to have transformative effects.  Robust fees can rightfully be charged for having the presence of mind to be mindfully present, rather than being a masterful decoder of meaning.

So what are we offering to clients when we offer psychotherapy? And, if good psychotherapy is a more concentrated and specialized form of actual human relating, rather than something categorically different, ought we to even use words like treatment, intervention, and technique?

Yet, when we draw from our own humanity to help clients, desiring to act naturally, valuing transparency over mystification, common speech over clinical jargon,  tact over tactics,  and an awareness of mutual influence, many thorny ethical and professional issues arise. What separates psychotherapy from a form of therapeutic companionship? For that matter, under these conditions how are we to define professionalism? Appropriate training and education?  The role of clinical theory and technique? Arguably, somehow the line between implementing a technique and being a real person in the room has to be a permeable one, and acting authentically professional, as well as professionally authentic, an achievable way of being.

Likewise, a life of depth and dimensionality surely improves the relational goodness-of-fit that a therapist might have with an array of clients, across a variety of problems in living. It is probably more true than untrue that our clients covertly scan our faces for physiognomic signs of similarity between the life we have lived and live, and the life they desire to live. And yet, graduate schools are rightly not in the business of prescribing lifestyles, and it would be unthinkable of a supervisor to advise a beginning therapist to go out and get his or her heart broken, or to break someone else’s heart.

Lastly, rather than mimic the field of medicine and hotly pursue cutting-edge techniques and technology for his or her professional advancement, arguably the diligent therapist needs to assume greater stewardship for his or her own self-care out of the office in ways that allow for finessing his or her humanness in the office with clients.