Feb | 2022

20th

Sunday

Great psychological assessment goes far beyond diagnosis

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In the field of medicine, a diagnosis typically leads to a clear treatment plan.  Not so in the field of psychology. Understanding the significant difference between medicine and psychology is critical if you want to obtain the very best psychological evaluation, whether you are an elite athlete, parent, student or adult.  

Because human anatomy and physiology across billions of humans is relatively consistent, the same medical diagnosis made on 100 people with the same condition leads to a highly similar treatment plan. 

Example: A severed patella tendon in the knee of a middle-aged adult, no matter what their life experience has been, will require a specific type of surgery to reattach the tendon. The medical treatment plan usually does not depend on the patient’s temperament, level of motivation, perceptual style, coping style, lineage of life experiences, or many other variables contained within human personality. 

In psychology, when 100 people are diagnosed with the same condition, it most often means the need for 100 different treatment plans. The human personality (psychology) is staggeringly diversified. No two people have the same personality. In fact, it is fair to say that the distance between each human and every other human is huge. Everyone experiences, expresses, and tries to control psychological problems in ways completely unique to their personality. Even identical twins have highly diversified ways of manifesting the same psychological condition, such as ADHD.      

I am highly critical of most of psychological assessment because it tends to pretend that the diagnosis — in and of itself — determines what needs to be done. Nothing could be further from the truth. When 100 different people are diagnosed with ADHD, there needs to be 100 different types of treatment plans. Yes, there will be some overlap with the specific recommendations. However, so much of effective psychological treatment is driven by variables far outside of the diagnosis. 

For example, the way each symptom — and groups of symptoms — affects each person dramatically differs. The way ADHD affects a Type A athlete is very different from the way it impairs an unmotivated college student. There are very different treatment challenges with each of these unique people.

This huge distance between each person’s psychological profile and every other person’s profile is the size of the Grand Canyon. Ultimately, there is no one “type” of ADHD. There is just a personalized form of ADHD in each person.

This is why good, effective psychological assessment, while it includes diagnosis, goes far beyond diagnosis. In psychology, an effective treatment plan cannot be created unless the key factors affecting the presenting problems are identified. A short list of the key factors that need to be considered include low self-esteem, trauma, extraversion, intelligence, motivation, level of psychological insight, level of social support, history of psychological issues, and temperament. These all factor into effective psychological treatment planning.     

Why You Need a Psychological Road Map

Psychological road maps go far beyond diagnoses

As a Tucson-based psychologist with an expertise in assessment, I create a cognitive map for each client after I conduct an assessment. I map out on a sheet of paper all of the key factors that are connected to the problems to be addressed. Each factor becomes a circle, and I create a Venn diagram with arrows connecting the visualized circle factors. These arrows allow the person being evaluated to “see” how various factors relate to each other, and 90% of these factors are not captured by the diagnosis.

How to Find a Reliable Psychological Evaluation

Let’s say you’re looking for a reliable psychological evaluation. Maybe you want to lead your company more effectively or enhance your athletic performance. Perhaps you want to increase your self-knowledge, learn more effectively, or solve a puzzling question you have about yourself, or treat a problem. You need to find a professional who can prove to you that they do not practice with a narrow, diagnostically focused mindset. 

If you have a severed patella tendon, the medical model is usually sufficient to diagnose and treat the problem. However, this medical model of diagnosis and treatment doesn’t work when you need to thoroughly assess a psychological issue like ADHD or anxiety.

To obtain a return on your investment in a psychological assessment, you’ll want someone who provides you with powerful, useful information. You’ll benefit from seeing a cognitive map that identifies all of those hidden factors that easily escape diagnostic categories. 

Too many behavioral health assessments — whether conducted by pediatricians, psychiatrists, psychologists, social workers, or counselors — look like what I call a “drive by”: a superficial evaluation that diagnoses a person with no real in-depth evaluation. You deserve an evaluation that gives you a functionally precise feel for how the key factors on the cognitive map relate to each other.  Anything less than this will not create sustainable improvement. 

In psychology, a mountain of studies shows that whether or not someone gets better is not primarily driven by the accuracy of the diagnosis. Rather it depends on how well the treatment plan is contoured to each individual’s personality characteristics. In fact, Dr. Larry Beutler, Ph.D. clinical psychologist, wrote the brilliant book Prescriptive Psychotherapy. It has become one of my desk references, and his approach has become an official evidence-based treatment.  But his approach is more than just another treatment. It is a critical guide to crafting effective assessment. Beutler reviewed more than 30 years of social science studies and created a guiding treatment plan model that shows regardless of diagnosis how the treatment approach needs to account for a large group of non-diagnostic factors.

Most of the patterns impairing people are not captured by diagnoses

Questions to Ask Any Potential Evaluator

  • How do you go about identifying how psychological problems function within my unique personality?
  • How do you go beyond diagnosis to find the roots of my problems?
  • What kind of techniques do you use to capture dynamics and/or factors that lie outside the diagnostic system?
  • What factors do you assess for, aside from diagnosis, that will guide your treatment plan?
  • To what degree will your recommendations go beyond diagnoses, and lay out a roadmap to overcome critical non-diagnostic factors?

 


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