Author: Dr. Jeremy Sharp

[00:00:00] Dr. Sharp: Hey everyone, this is Dr. Jeremy Sharp. This is The Testing Psychologist podcast 19.

Hey y’all, this is Jeremy. I know I don’t usually do a preroll like this, but I wanted to give you a heads-up that this podcast is a long podcast for me and there’s a good reason for that. Dr. Aimee Yermish talks to us about so many different aspects of building a practice and working with gifted and twice-exceptional kids. We pack a ton of information into this podcast so I invite you to take some time and stick with us to the end and I guarantee that you will learn a ton.

All right. Thanks. Now for the podcast.

Hey everybody. Welcome to another episode of The Testing Psychologist podcast. My guest today [00:01:00] is Dr. Aimee Yermish. I’m excited about our conversation today. We’re going to talk all about giftedness, twice exceptionality, and how Aimee built her practice around assessment with those kids and their families.

Aimee and I first made contact on the Minnesota Pediatric Neuropsychology Listserv, which some of you might be aware of, if not, it can be a nice resource for conversation and discussion around neuropsychological assessment. I noticed that Aimee was pretty active on the listserv and she had so much good information to share, particularly with kids who were on the gifted spectrum or twice-exceptional spectrum. And that caught my eye, so I reached out to Aimee to see if she’d be willing to come and talk with us about this kind of assessment practice. Luckily, she’d agreed.

So let me do a little introduction, Aimee, and then we can jump into our interview. Sound good?

Dr. Aimee: Sounds good. Thanks for inviting me.

Dr. Sharp: Yeah, of course. [00:02:00] Dr. Aimee Yermish is a clinical psychologist and educational therapist practicing in Stow, Massachusetts. She provides consultation, therapy, and assessment for clients who manifest giftedness or multiple exceptionality. Drawing on her analytical background as a scientist and practical background as a teacher, she focuses on building self-understanding, self-regulation, and range of choice in life. Her book on executive functioning coaching for smart people, If You’re So Smart, is in progress with Great Potential Press.

Aimee, welcome to the show.

Dr. Aimee: Hi, thanks so much.

Dr. Sharp: Welcome. I’m so glad to have you. I’ve been thinking about trying to talk with you for a long time, so I’m glad we could get it together and have you here.

Dr. Aimee: That sounds great.

Dr. Sharp: Yeah. I think based on our previous conversations, that we have a lot that we could dive into, so I’m just going to jump right to it. Let’s talk a little bit about giftedness and maybe talk about how [00:03:00] you would define giftedness. We can start there.

Dr. Aimee: It’s funny because that’s where everybody always starts. I did my dissertation research on the experiences gifted clients have in psychotherapy and every single one, what are you doing your work on? Oh, I’m doing the experiences of gifted clients. Oh, really, how are going to define giftedness? That was always the question.

The entire field of giftedness research has been going around and around in circles on the definition thing forever. I think it’s a waste of time. At one point during one of these conversations, I said, okay, look, how about you define African American for me and I’ll define gifted for you.

I was being a little cheeky about it because I was like, come on, not everything can be defined. The more I thought about it, the more I realized it’s true. We can do good research and have good clinical practice on a group, even when it has fuzzy and sometimes internally contradictory boundaries. [00:04:00] Lots of clinically important groups are like that.

Both in my dissertation and in my clinical practice, if someone wants to come to my office, I’m not going to tell them that they’re not smart enough to hire me. People tend to self-select, but they also do typically have very good reasons to think that they or their children, I work with adults as well as children, they have good reasons to think that they’re gifted or twice exceptional and they’ve often had trouble with other practitioners or they’ve been frustrated in school or in work or in the social world in ways that are pretty typical for gifted folks.

I have two clients who are pretty average in intelligence. They came to me because they were referred by another very happy client who said, you should work with Aimee. She’s great. I have turned down referrals for kids who are on the intellectually [00:05:00] disabled side of it because that’s an area of clinical competence I don’t have.

The thing that it helps is, what I found in my research was it makes sense to think of giftedness more as a cultural group. Yes, you have people who are very smart, they catch on to things quickly, they learn things quickly, they learn things well. They may learn things younger or better than other people might be able to but a lot of what we’re looking at is the cultural experience of it. And so then we think about it in terms of cultural competence, just as you would with veterans or Latinos or whatever.

Dr. Sharp: Okay, that’s fascinating. Is that a widespread belief in the field? I haven’t run across that. Are there standards of competence for working with gifted kids or anything like that?

Dr. Aimee: Part of what came out of my dissertation work was I came up with a set of provisional clinical guidelines for clinicians who want to work with the [00:06:00] gifted folks. Interestingly enough, I was able to base them very heavily on the, I was like, I don’t know how to write clinical guidelines, let me look at some. I looked at the guidelines for GLBTQ clients and I said, oh, this is a lot of the same issues. A lot of times, it functions culturally as a closeted minority or semi-closeted minority status.

This goes more towards questions of therapy than assessment but when I’m thinking about why am I good at this and why is this a good niche for me, a lot of it has to do with that notion of thinking of it in terms of culture.

Dr. Sharp: Okay. Just to maybe backtrack a little bit, that reminds me, it’d be important to probably talk about how you even became interested in this population and why this is so meaningful for you.

Dr. Aimee: Sure. I walked backwards into it. I’m a multiple time career changer. [00:07:00] I am a grown up gifted kid myself. I’d like to say there’s two kinds of gifted families; those who are shocked to find out that their kids are gifted and those who are shocked to find out that anyone could be shocked to find out that their kids are gifted.

I grew up in the latter kind of family where I was pretty socially isolated in a small school but my family not strongly valued education and there was a lot of support, everybody in the family is smart, there wasn’t a sense of surprise, I got a lot of support at home.

And then when I went to a very large public high school in a good district and then eventually to MIT, I was like, oh, well, here I’m totally normal and this is great. And that’s where most of my friends and also my husband we met, when I was an undergraduate. So there’s a community.

I trained originally to be a molecular biologist but in graduate school realized that I really [00:08:00] loved teaching far more than I loved research. I stepped back and said, you know what, I want to know why my undergraduate students don’t understand science. And so then I went into K-12 teaching. I taught biology, I taught physics, math. I started in high school and then I moved to middle school, picked up a teaching credential along the way.

One of the schools I taught at specialized in kids with learning disabilities and ADHD. A lot of them had ADHD. I found that I really enjoyed the shared puzzle solving, how do I help this particular kid wrap their mind around this particular concept? How do I get them on board with me to try? So that was like, oh, this is cool.

And then I taught at a school that specialized in gifted kids. And that brought up a whole new set of challenges. I had a lot of opportunity to be creative as a teacher and to enjoy middle schoolers. People always go, oh, you [00:09:00] poor dear, you taught middle school, what happened? Did you get last choice?

I’m like, no, middle schoolers are great. It’s all about niches. And for me, those young adolescents are, they have energy, they’re a little nutsy. So much is happening for them psychologically. There’s a lot of leverage. They’re trying to figure out who am I and developmentally, they start to want grownup help who aren’t their parents. So being able as both a teacher and a clinician, to do the object relations work of being an attachment figure outside the family who can say, hey, I can help you here, let’s walk together, that’s rewarding for me.

I eventually got tired of politics in school and so I went into private practice as a tutor. I could teach AP Biology and AP Calculus [00:10:00] and do it for kids with LDs. So that was a little specialized niche all by itself.

I got interested in testing and I took this certificate in educational therapy. It was not represented accurately to me when I took it. It was basically Boston Process Approach Neuropsychological Evaluation and Remediation specific to learning disabilities. So that’s how I got into testing.

And then over time, my clients got more and more unusual, more kids with psychological disorders, more kids with autism spectrum disorders, with trauma and kids who needed official diagnoses, which I couldn’t make. They needed a big doctor person to come in for their special education advocacy.

What was happening was, I was finding that I had to turn away more and more kids where I’d say, I can’t do what you need and at the same time, I had nobody to turn them [00:11:00] towards. So that’s what got me back into graduate school. I became a psychologist.

Part of what I liked about graduate school was that I was able to, I went to a professional school, which’s now called William James college, Massachusetts School of Professional Psychology was name at the time. They allowed me to tailor my clinical work to what I wanted to learn and also to do my dissertation work on, as I said, the topic that I was interested in.

My dissertation is free on my website. People read it. I will talk more about marketing later, but I have to tell you, having paid the extra $40 to ProQuest for the right to put my own dissertation up on my own website has paid off enormously because people read it and they go, oh, you get it.

Dr. Sharp: She gets it.

Dr. Aimee: And that’s [00:12:00] the thing, is that in the clinical where the gifted clients often say, well, we have to find therapists who get it, and most of them don’t.

Dr. Sharp: I was going to say, it sounds like that’s particularly important for this population because you have folks who actually would read a dissertation before coming to see you, right?

Dr. Aimee: Yes. It’s a qualitative dissertation. It’s very conversational. And the thing is that within the gifted community, people say, oh, you have to find a therapist who gets it and a lot of them don’t. A lot of people have had very bad experiences. A lot of people have a wonderful experience too, but they’ve had very bad experiences.

The problem is when I would explain this to clinicians, so often the response I would get was, well, there’s nothing to get. They’re all a bunch of narcissists who think they’re all so special.

Dr. Sharp: Oh, goodness.

Dr. Aimee: And the harshness of that. I was like, oh, little [00:13:00] unprocessed countertransference match. That was part of the thing, was realizing that, because a lot of the people who would say this were obviously themselves very intelligent, but it was like, this is part of that sense of you have to be comfortable with yourself. So yeah, people read it and they go, oh, this person gets it. I want to work with her.

Dr. Sharp: It’s funny, you had to think of that as an aspect of marketing in your practice, but I could totally see that. It’s an extended version of your biography that people […].

Dr. Aimee: And it’s also a service in and of itself. Sometimes I get thank you notes from people who write and they go, thank you so much for putting that. It was validating to know that I wasn’t the only person who had experienced these things. They don’t need therapy, they don’t need anything, they’re just [00:14:00] sending me a note.

Sometimes, at the urging of a friend, I put a tip jar there and occasionally somebody puts money in the tip jar. It’s because she said, I can’t believe you’re putting it out there for free, and I’m like, because I want to offer it, I want people to hear that they’re not alone. That their experiences are not, they’re not the only one. So there is this.

And part of this, there is this sense of mission for me. This isn’t just like, oh yeah, gifted people, they’re cash cows. No, this is actually much more a sense of purpose for me as a clinician.

Dr. Sharp: Oh, sure. It seems clear this is your life. This is what you’ve experienced personally and have managed to wrap it around in a professional way too. I think that is so important. I’ve talked on this podcast a fair bit about how testing a lot of people, I get these [00:15:00] questions of like, oh, how do I start testing my practice? What are the codes? How do I bill?

You got to walk that back and say, what do you really like to do and what are you passionate about? Because otherwise, it’s going to get real tough when you’re sitting down to write those 10, 15, 20-page reports and you don’t have that motivation to do it.

Dr. Aimee: Oh, yeah. I think every neuropsychologist I’ve ever talked to, we all go, oh God, the reports.

Dr. Sharp: Sure. Oh gosh.

Dr. Aimee: I’m sure we’ll get to this later in the hour about report writing for different clients, its own ball of wax, but if you’re going to be doing that work, you’ve got to. I think most people I know who have a niche area have some personal connection with it. You have to have metabolized that. You can’t be like, okay, I have to do this and I have to fix this.

If you’ve got too much of a drivenness, then [00:16:00] you’re working out your personal needs with the clients. I think you need to have done your own work so that that’s not what, you’re doing it for the clients, not for yourself, but to have it be this very authentic outgrowth of this is a population that I love to work with and a kind of work that I love to do. People can tell, and it’s easier for them then to hear you when you have to say things that are hard for them to know that there’s trust.

Dr. Sharp: Oh, that’s so important. I think you nailed it. Trust is the word. So let me maybe use that and transition a bit, did you go straight into private practice doing assessment and testing after graduate school then?

Dr. Aimee: Yeah, what had happened was I had had my educational therapy practice [00:17:00] where I was mostly doing, let’s say, glorified tutoring, special education consultation and advocacy with that. I did some intelligence testing. I did some LD testing, fairly limited in that because I needed to stay on the right side of the law. So I had been doing that.

And then over the course of my training, while I was in graduate school, I still maintained that practice. From a time perspective, I had to prioritize graduate school, but I continued to see clients as much as I could squeeze them in and to stay involved with the community and to continue doing all of the things that I had been doing that had built the educational therapy work. I continued to do those things.

And then as I became progressively more legal, as I [00:18:00] became more able to do the things that I wanted to do and that I was now competent to do, during my postdoc phase, I had an agreement with one of my former internship sites where I was then on staff as an employee. What happened was that people would come and they would come to me and I’d say, well, I can’t legally do this assessment, but I can have you go over to the clinic with me and I will be your assessor.

So the clinic was making money and I was making money and they were getting me to do their assessment and I was getting appropriate supervision. It was a win-win all the way around. It was a great experience for me. And then once I was independently licensed, then I started working independently.

It took a little bit to grow but it [00:19:00] grew quite quickly because it already existed and because of the, I don’t know what it would have been like had I not had the previous experience. I think it would have taken a little longer to establish myself.

Dr. Sharp: That makes sense. That is a natural extension of the work that you were already doing. It sounds like you were getting some of those calls beforehand in the tutoring practice but you rightfully said, no, I can’t do this but once you had your degree, it’s like, okay, yeah, the market is open.

I know we had some conversations earlier about insurance and cash pay and that sort of thing, have you ever taken insurance with these assessments?

Dr. Aimee: No.

Dr. Sharp: No. Okay.

Dr. Aimee: No. It was funny because one of my motivations was, oh, I would love to go and be a licensed professional and then I’ll be able to take insurance and then more people will be able to afford my services. And then I saw the dark underbelly of [00:20:00] the insurance system and I saw how little they pay for assessments and I went, I can’t feed my family on that.

I am basically a cash only practice. I do offer some pro bono work. There are times where somebody will call up and I’m like, all right, I can. If I choose to slide my scale or to offer pro bono stuff, I will do that but basically, it’s cash only. What I’ve done instead is I offer a range of services and that includes free information that is high quality, useful, take it to the bank, use it. You don’t need to pay me for it.

Information on my website and the blog that I don’t know… if I write up, oh, here’s the things that I usually recommend for people as far as how to help your middle schooler or your high schooler organize their stuff and get their homework done. [00:21:00] Well, that stuff’s for free on my blog. People call me and I say, you can do that for free.

And then I have a range of other services so that it’s not just the multi-thousand dollar assessments. There’s a range. I’m very clear with people around let’s find a service that works for you.

Dr. Sharp: So let’s say that someone calls and they want to go forward with an assessment and you’ve deemed that to be appropriate, how do you structure the pricing for that?

Dr. Aimee: What I do is I usually have them fill out a developmental history first. A lot of my clients have been assessed before, some of them many times. They’re often a lot of single discipline assessments or the schools have done, there’s a lot of little things and everybody’s like the blind men seeing the elephant that they’ve got, everybody’s got a little piece of the [00:22:00] picture.

I know, a lot of those kids are on the autism spectrum. That’s the most common when I see the giant pile of stuff. I know here’s where we’re going but I’m looking at the complexity of the case, I’m looking at what do we already know? What can I figure out so that I can try to create?

I don’t use the same testing plan for every kid so I plan out an approximate testing plan. I think, okay, how much time am I going to need for this? And then I quote people a flat fee up front. I’ll give them options. I’ll say, if you’d like me to include testing for dyslexia, then that’s how much it is. I’ll let them pick and choose.

I’m very collaborative with the client around defining what are the referral question? What do you already know? What do you suspect? Who’s the audience? If you need me to make this clear so that you can advocate for an IEP, [00:23:00] that’s a different set of clarity than if I’m working with a homeschooler who says, I need to know the answer but I don’t need to be able to prove it to anybody else.

And also what was in the range of services is needed, sometimes it’s just a consultation. They just come in for two hours. There’s no testing. I play with the kid. We talk, we have fun. I talk with the parent at the same time and I can give them a lot of the same advice for a lot less money. So I give them their options.

Obviously, there’s richer information when I test and more certainty. I frequently with consultations, I don’t make a diagnosis but some people don’t want the evaluation in part because they don’t want the diagnosis. I try to lay out their options but I quote them a flat fee and the reason I do that is because I know some people like to work hourly; the problem is with gifted kids, some of them go [00:24:00] for a really long time into those tests. And with the WISC, you can’t adjust the start points. It takes forever.

I’m very nice because I’m like, I’m really sorry, I have to give you these really easy questions first, just bear with me, it’ll get more interesting soon. They’ll keep going and a lot of gifted folks are perfectionists and persistent and they will work really hard.

I used to do it hourly and I would tell people, okay, this testing, it’s typically four hours of testing and then I had this one mom where I told her it was going to be four hours of testing and the kid took six. I felt horrible because people need to be able to budget. And so I said, I don’t want this to ever feel like a bait and switch. There’s a flat [00:25:00] fee that includes everything I’m going to do, that includes feedback, the report, more conversations. I am extremely generous with my time because I want them to feel that they’ve gotten their questions answered.

Dr. Sharp: Got you.

Dr. Aimee: And so I just sit there and I go, all right, I set up, I say, this is what, this is going to be for this. I tell them, I don’t want to be in a position of having to come back to you in the middle of the testing to say, oh, actually, I want to do something else.

Dr. Sharp: So how do you structure that just from a business perspective? How does that flat fee correspond or not correspond to your hourly rate and how do you come up with that budgeting for all these factors?

Dr. Aimee: Some of it is related to my hourly rate. There is no way I could charge for the hourly time I spend writing reports, I just can’t. And that’s my perfectionism and I don’t believe in punishing other people for my perfectionism.

[00:26:00] A lot of it is based on what’s the going rate around here. I do charge a bit more than the going rate around here, but not ridiculously much more. In any time, you’re setting prices for any service, it doesn’t matter what industry you’re in, it comes down to a question of what value do I provide and what do I feel comfortable being paid for this? Is it so much that I can’t look at myself in the mirror? Is it so little that I resent it?

I end up with an approximate that most of them come out and around the same point, but it really is this sense of, I know how much work this is going to involve and here’s what I think is a fair price. If somebody says, I can’t afford that, then I go, okay, let’s talk about a different service that you could afford. [00:27:00] In some cases, for some services, I’ll say, well, then I think you should go to somebody else because it’ll be less good service but it’ll answer your question. I am enthusiastic about recommending my colleagues.

Dr. Sharp: Got you. Just a nuts and bolts question, are you doing all of this during, you call it a consultation, but is that like an intake interview? Do people fill out that developmental questionnaire ahead of time and then you talk with them on the phone before they even come in or how does that work when you’re deciding with them what’s the best?

Dr. Aimee: I started doing the consultations as almost a diversionary service. The thing is that I’m only one person and I’m a perfectionist writer myself, the limiting reagent was how many reports can I write? And that’s a piece of business decision around, is [00:28:00] there a way I can hire an assistant of some kind who could help me, who would still do the quality work? I haven’t figured that out yet. That’s not something I’ve solved right now but I would get way more people asking for testing than I could possibly test.

And very often what I would see is, I know what I’m going to tell them. I would look at the history and I go, I already know what this is going to probably be. I know what to tell them, maybe not in as much detail, maybe not as perfect as I could do it if I actually had all the testing data. But if I know that a kid is clearly struggling with social cognition, then I actually already know what I’m going to recommend for them for a lot of things. And once I meet the kid, I get a lot more information just from meeting them.

So it was partially because I don’t have the bandwidth and partially because it lets [00:29:00] me serve more people and save them money and stuff. If somebody comes in and they say, I know that I want to do an assessment, then what I do is I have them fill out the developmental history and send me all of that pile of paperwork, every previous test, current special education records if you’ve got them, current school records if you’ve got them. And then I usually say, anything else you think would help orient me.

I do say all prior evaluations even if you think they weren’t very good or you disagree with them because people will try to edit what they give me. I’ve seen that. I’ve been on both sides of that coin where people have edited or wanted to suppress or edit my report and then give it to somebody else. I’m like, I’m not going to edit my reports in any case.

So I’m getting this pile of paper on the person. [00:30:00] Usually within that, I can say, okay, if they know they want an assessment, I will be able to figure out from that what I want to do. And so I’ll be able to give them a quote, we can schedule the assessment directly. They’ll come in and I orient the kid and I do an assessment and then we do feedback pretty typically.

I can tell you a little bit more about that process but it’s more when I’m trying to do the consultation to head off the need for assessment. There’s a lot of mythology in the gifted community around, well, you’re a bad parent if you haven’t had your kid tested. And I’m like, no, you don’t need to get your kids tested, you test when you have a question that testing will answer and when you have an audience that’s interested in the answer.

A lot of what I’m doing is educating them about, you don’t have to do testing if you don’t want to or if you don’t need to. Sometimes the consult is as a [00:31:00] prelude to maybe doing testing. So then that’s part of the question that we’re doing in the consultation is figuring out whether they now know what to do or whether they do want to have an evaluation. What’ll happen is they filled out all the paper beforehand.

I always tell people it’s not strictly required, but I do find that it lets people give me a lot of information quickly so that we can make best use of our time together. I read faster than they talk so it’s better if I already know that stuff.

I do do consults over video chat also and there’s obviously, I’m not going to play with the kid. But for testing, I’ll be playing with the kid and I’m taking notes on how they do playing board games or what they’re doing in the sand tray or whatever, that ends up getting rolled into the evaluation report [00:32:00] if they go forward with it.

I’m trying to help them. I’m trying to answer their questions. They’re getting a chance to scope me out. I’m getting a chance to scope them out. There’s definitely trying to get a sense of personal fit. Sometimes I will get a really strong sense that this family is not ready to hear the news.

Dr. Sharp: Interesting. What might give you that impression?

Dr. Aimee: They’ll be very explicit about it. Oh, we don’t really believe in diagnosis or we don’t want our child to be labeled. We don’t want that. And I have answers for those things. I believe them. I talk about it. I believe that self-knowledge is always better than not. Once you know something about yourself, you can then decide what to do with it.

Dr. Sharp: I would agree.

Dr. Aimee: These are the same answers I would give; these are not gifted specific answers. Although gifted clients can often do really well with that self-knowledge. [00:33:00] It becomes then part of the grist for your problem solving. Oh, well, here’s what I’m really good at and here’s what’s harder for me, I’m going to approach this difficult task.

The labeling thing, I say that the issue is that everybody’s always being labeled. What we’re working for is labels that are accurate and compassionate. When a kid is rude or thoughtless or a jerk or what, I’d much rather be able to explain why this kid is having trouble managing the expectations of the social world or whatever.

I try to work with them around that but sometimes it’s very clear that they’re not comfortable with that or what they really want is a much more limited assessment that is not designed to be diagnostic. They want something that’s more aimed for advocacy [00:34:00] purposes and it’s more focused on identifying strengths.

I write in the report that this was not designed as a diagnostic assessment and can’t answer a diagnostic question. That’s fine. I try to be clear with them that if you come in for a multi-day full neuropsychological assessment, the usual practice in that is that in that report, I am either going to make a diagnosis and explain why I’ve made it or I’m going to explain very clearly why I think no diagnosis is warranted.

Usually if you’re in a situation where you’re thinking about a full assessment, that’s a large investment of time and money, usually there’s a problem so there’s usually going to be something diagnosable. So sometimes what it is, is that they’re able to get the help that they need. They’re able to take in the idea of, for instance, the kids with the autism spectrum disorders are probably the hardest in terms of getting [00:35:00] families on board. I could spend a whole hour talking about that.

Dr. Sharp: Can I jump in there real quick? Because I would imagine some people might be saying, and I’m thinking, is there truly any relevant or documented comorbidity between giftedness and autism spectrum?

Dr. Aimee: The issue is that the autism spectrum is very broad. It’s not even a single spectrum, it’s a large multi-dimensional space. I don’t think there’s any support for the idea that giftedness causes autism. Sometimes what you’ll see is that kids who are quite bright when they’re very young and they’re autistic, and they learn to read early, and they read and they score, so they gather lots of [00:36:00] information, and they score very high on measures of crystallized intelligence because they’re five and most of the kids in the norming sample don’t have access to the sources of information they do.

As soon as you’ll get these very high scores on IQ tests at quite young ages with autistic kids where it’ll tail off if you see the same kid come back. Remember, I’m often seeing reports where I’m seeing, oh, here’s the report from when they were five, here’s the report from when they were 10, here now they’re 15, now it’s your turn and I’ll see changes over time. Sometimes those scores hold up, sometimes they don’t.

One of the common experiences that a lot of gifted folks have is social isolation and social mismatch. You’re the normal kid, you’re going to school, school’s not built for you. Most kids have the experience of going to school and [00:37:00] having lots of kids around who are basically like them and having most of the things the teachers ask you to do to be reasonably challenging but doable. That’s what schools is for most people.

For a lot of gifted kids, there’s nobody around who’s like you and of course, schools often systematically isolate them. They parcel them out as thinly as possible across all classrooms. Research suggests putting them together in clusters, it’s actually better for all the kids and it gives them friends. It gives them a group that’s easier to make friends with, gives the teacher a constituency, so it’s not just like the one kid.

That’s again, topic for another podcast, but so a lot of gifted kids have limited access to the peer groups and the peer experiences that allow them to develop social skills. So a lot of times people think that a kid [00:38:00] who’s really smart must be on the spectrum because they’re a little bit geeky and they have deep passionate interests that are not necessarily typical for children their age or they’re extremely articulate. They have very big vocabularies and they are more comfortable working with older people or even with adults. And so these are features of giftedness that can masquerade as autistic stuff.

There are also sometimes features of autism and so I don’t think that it is true that gifted people are more likely to be autistic or autistic people are more likely to be gifted. But it’s certainly of the things I see, when people come into my office with a lot of distress, the main things I see are autism spectrum disorders, ADHD, learning disabilities, anxiety disorders, mood disorders.

Everything else in its normal thing, I’ve worked [00:39:00] with kids who are developing psychosis and things like that, but those are rare because that’s rare. It’s mostly the more common stuff.

Dr. Sharp: Got you. Okay. I want to get into the nuances of testing with gifted kids but I do want to ask one question about, it seems clear that you have a really busy practice to the point that you you’re using your intake as a diversion, which is funny.

Dr. Aimee: I know. I have to find some way to find an associate, but there’s so much around, I need to find somebody who would be able to do what I do.

Dr. Sharp: Sure. Oh gosh, I know that challenge. Let me ask you then about marketing or whatever you might call marketing. How did you build such a busy practice?

Dr. Aimee: It’s funny, I don’t market per se. I’m very much part of the online gifted community. There used to be a number [00:40:00] of mailing lists, they’re less active now in the day of Facebook. There’s now very active stuff on Facebook. It doesn’t have the same intimacy as it used to be but I am very much part of the community.

I’m a participant observer. I present at conferences that are aimed at parents of gifted kids as well as for my professional colleagues. I answer questions. Honestly, the way I built my practice first was just by hanging out in mailing lists, this was before social media and being knowledgeable and helpful in answering people’s questions and doing it out in public.

And the people would be like, oh is it okay if I ask you to, I’d like to pay you for some of your time, are you willing to do that? I’m like, yes, [00:41:00] that’s what I do for a living. The vibe when I’m doing it is not, oh, but if you come in for a consult with me, then I’ll answer your question. I don’t do that.

If I’m going to answer somebody’s question in public, I’m answering somebody’s question in public with the full knowledge that I’m giving something away. What it’s doing is it’s letting people see how I think. So people who see how I think, then say, oh, I’d like to work with her.

The most useful thing I do is I do public speaking. I always joke, I used to do public speaking six times a day for hostile audiences because I taught middle school. They will let you know if you’re boring. So what I learned how to do and I make funny PowerPoints. I’m good at that.

I found that by giving talks in places where [00:42:00] parents, I include adult work too, but places where people who might be interested in hiring me might hang out. For instance, at MIT, there is a weekend once a year where high school students come from literally all over. They get like 2,500 kids coming from all over the place. And like anybody in the community teaches anything for free, if it’s $40 for the whole weekend for the kid, it’s ridiculously cheap.

So the kids are in this giant learning playground. There’s no rules about who can come, but it attracts curious smart people. And so now we have all their parents who are now hanging around with nothing to do. So the organizers set up a little parent program. I always speak at that parent program.

Dr. Sharp: Oh, okay. That’s perfect.

Dr. Aimee: It’s perfect. I always tell us, put me before lunch because what’s going to happen is that I’m going to give my talk and then people are not going to stop [00:43:00] asking me questions. And so put me before the lunch break so that then we have time.

And then I usually end up just sitting out in the parent lounge area for hours afterwards. People are continuing to ask me questions. I am so essentially doing what I do in public and letting people see how I think, letting people see how I approach cases and they’re getting to see me as a person.

Dr. Sharp: Absolutely.

Dr. Aimee: It’s great because it’s always been, by being part of the community, that has also really helped me that I can tell you when I was in dissertation how:

a) I had no trouble getting subjects.

b) I had people chilling for me. I provided posts to Facebook, oh my God, another 3000 words. They’d be like, hey, go, go.

It’s like the kid from the small rural village who goes off to college to become a doctor and then comes back and sets [00:44:00] up a medical clinic for the community. It’s been part of why it works. So I think that the marketing is very much being out there, being helpful and knowledgeable, letting people see how I do it, how I think.

I am a member of the appropriate professional and parent organizations and so for instance, my state association for gifted education, I talked to them and I said, you guys should have a professional membership. They said, really? I said, yes, I would happily pay you more money every year for the right to have a listing on your website as a professional member. They’re not endorsing me, they’re just saying I’m a member and I’m a professional and I’m on their website. I have the same thing with [00:45:00] SENG.

That means that people who are looking for an evaluator, and they go, oh, gifted, Massachusetts, let me see what I find, they find me. I also have nice relationships with, there are a few schools around here that require IQ testing for admissions. That’s very easy testing. And so I’m on their webpages too. But mostly it’s word of mouth being part of the community, that’s where it goes.

Dr. Sharp: Just thinking about specifics, are there any particular conferences or websites or groups that you would recommend for anybody else who is interested in getting into this community?

Dr. Aimee: What I would recommend is if you go to the blog that I never have a chance to update, part is because I’ve been working on writing the book, I write long blog posts and it’s too much. It was like I’d write something, I go, [00:46:00] oh, I should put this out where people can see it. So that’s what the blog is. I had two sticky posts there. One of them is called, oh no, my kid might be gifted, where do I start?

Dr. Sharp: Oh, perfect. Okay.

Dr. Aimee: I update the post rather than posting new things. I just go, oh, there’s a new edition of this. I’ll put that up there. And that gives good stuff.

I don’t know if the misdiagnosis book saying is called Supporting the Emotional Needs of the Gifted. That’s a really good organization. It’s primarily for families and gifted people themselves, but there are professionals in it. Again, you can be a professional member. I think you do have to establish that you’re not just some carpetbagger. I have to say, people are often very suspicious around that; [00:47:00] who are you?

I go to the SENG conference. There’s a New England Conference on Gifted and Talented, whenever it occurs, I present at it. Locally, we have a little tiny thing happening this weekend called Beyond IQ. It’s mostly like a family reunion more than anything else.

Essentially, I’m a member of the National Association for Gifted Children. You identify with the things. I’m also connected with the Davidson Institute for Talent Development. They serve kids who are at 3 standard deviations above the mean. I’ve done seminars for them. I’ve presented at their annual conference.

They’re actually going again this summer. They have an annual gathering and they’ve invited me as a speaker. It’s a win-win. They get a great talk for their people and I get to be in front of people who don’t know me yet.

Dr. Sharp: Sure. That’s [00:48:00] fantastic. Thanks for those resources. We’ll put all of those into the show notes so that folks can check those out when they are ready. So let’s transition, you’ve been so generous with your time. I really want to …

Dr. Aimee: I talk too much, but yeah.

Dr. Sharp: well, this is all good. You have a lot of valuable things to say, so this works well. Let’s transition into the actual assessment process. I would imagine people are really curious. Does assessment with gifted kids differ from other kids in terms of measures you might choose, the process of testing, how do you approach that?

Dr. Aimee: Sure. Some of it has to do with managing anxiety because sometimes they’re coming in because I want to get my kid into the following school. So there’s often a lot of parental anxiety. I have had to warn parents, do not go looking for how do I [00:49:00] do test preparation. I tell the parents, the only preparation you’re allowed to do, and I want you to do this, a kid has to have a good night’s sleep and a good breakfast the morning of and the parent needs to relax as well because the kids can read the parental anxiety and then the kid’s going to get anxious. So there’s a lot of stuff around that.

Sometimes, a lot of parents will say, oh, let’s go to take the kid to my friend and we’ll play some games with them. The gifted kids usually can tell that you’re lying to them. Why are you so anxious that I have a good night’s sleep before we go play with your friend? I don’t get it. They’re not dumb.

It’s funny, I remember one particular case where the parent insisted I was not allowed to use the Word test.

[00:50:00] And you know what, it was a mistake because the kid was more anxious because she didn’t know what was going on. Why is this so serious if we’re playing games? Why can’t we agree to change the rules of the game, if it’s a game?

I think the problem is they also start worrying what’s wrong with me. No matter what’s going on, these are kids who crave knowing and it’s a different experience. So I am very honest with them. I say, I am a psychologist.

If it’s a little kid and they don’t know what a psychologist is, I say, I’m a thoughts and feelings doctor. I help people who are frustrated in school. I think about what’s the kid’s reason for referral. I help people who are really bored in school, or I help people who are trying to have more friends. Whatever it is that the kid would identify as their reason for referral.

I try to solicit that when I’m talking [00:51:00] with kids. What would you like to know about yourself? Recently, I was sitting with a parent and the parent had pretty typical, we’re pretty sure we know what the diagnosis is, but we need updated testing and we’re trying to get guidance on where to put the kid in school.

And the kid says to me, I want the following career. I’m not going to say it because I don’t want to be mad, but here’s the career I want. It’s a little bit impractical but not totally. I said, this this career, I can tell you, I want to be a race car driver.

Dr. Sharp: No.

Dr. Aimee: I said, okay, well, being the actual driver might be unrealistic because very few people can have that and he understood me. But then I said, but we can think together and we absolutely can use the testing to help you think about what you can do now in school that might help you get a job in the larger field of race car stuff. Maybe you’re going to end up [00:52:00] as an engineer, maybe as a broadcaster, maybe as a mechanic, there’s lots of things and the testing will help us figure out how to help direct you now that might help you.

I said, that’s actually a really good reason for referral. It can really help. And that also helps bring the kid into the process because if you don’t get them in on the game, oppositional kids don’t test or you don’t validate it, and that’s true for everybody. So I do that.

The other thing I have to really do is I have to normalize for kids the experience of what testing is going to be like, because a lot of these kids, first I explain, we’re going to do lots and lots of different things. I talk with them. If they play sports or music or something, I’ll say, oh, how is this sport different from that in terms of what you have to be good at. You have to run fast or jump high or if you’re really strong, or you can go all day. [00:53:00] Sports are different.

Different kids have different strengths and weaknesses so I’m going to normalize that we’re going to do lots of different testing and some things are going to be really easy for you, and some things are going to be really hard for you. And that’s okay. These are kids who normally don’t get anything wrong in school very commonly.

The other thing I have to explain to them that the tests work on the Goldilocks Principle. It’s going to start really easy and then it’s going to get harder and harder and then it’s going to get too hard. And it’s okay that it’s going to get too hard. It’s okay that you’re going to get things wrong. That’s my job, is to find the things you can’t do.

And I tell them, I say, these tests are normed all the way up for big kids or adults or whatever. I say that I guarantee you there are going to be things that I ask you to do that you don’t know how to do. And that’s okay and that’s good.

I give them a little bit of a quiz, as long as I keep asking you to do things, you’re probably [00:54:00] doing better than you think you are. One mistake doesn’t end it so I want you to stay in there with me. I don’t know silly answers when it’s too easy. Give me good effort when it’s hard and that’s okay but I need to give them that normalize thing.

Sometimes when the kid is particularly anxious, I’ll use that consultation beforehand so they can meet me, that’s why we’re doing a consultation ahead of time, it lets them play with me. It lets them be okay. She’s not from the black lagoon or something like that. It lets me do some play based evaluation.

I don’t find that most gifted kids do not do well on do I get to earn stickers by doing subtest. Some of them do, it’s not particularly motivating. The thing that tends to motivate them is the idea that we’re going to learn something about you and I’m going to include them [00:55:00] in the process. I often do create a checklist so that they can, okay, I’ll write the things I’m going to do that day and then we’ll check them off so they can see where we’re going.

Sometimes gifted kids have trouble accepting the role of the authority, like I’m setting the rules here now and you’re not. I will tell them, I have to follow the rules of the test too, because I can’t … Sometimes they’ll try to control the book, try to try to turn the pages and things like that. Sometimes they don’t, they want to look at my side of the easel.

I think a lot of kids do that and it’s anxiety. I want to see the answers. Maybe you’ll tell me the answers. I try to give the kids as much autonomy as I can. Every once in a while, I’ll get a kid who wants to make a test for me and I let them do that. That’s fine.

I [00:56:00] want them to understand what we’re doing and to understand that the failures that they’re going to experience are totally fine and normal. It’s information. It’s not like at school where you generally know everything.

Dr. Sharp: I think that’s so important yet to normalize that because I think most people come into it thinking, oh, this is a test, I can maybe get 100%. I’m going to be graded. And just to say like, hey, this isn’t

how it works.

Dr. Aimee: Not how it works. Sometimes kids will have done a thing in science class where they get a piece of tin foil and they have to make a boat. I used to talk about building balsa wood bridges and then you would find out which bridge was the strongest by seeing how much weight it could hold, but the problem is with that you end up crushing the bridge. And I said, I know that’s not a nice image.

Because I talked about the tinfoil boat and if we wanted to know which boat could hold the most weight, then we’re going to keep putting pennies in all the boats and we’re going to see which one sinks first [00:57:00] and then we know, oh, it can hold that many pennies minus one. It doesn’t mean the boat was a bad boat, it means that that’s how many pennies it could hold before it sank.

Dr. Sharp: That makes sense.

Dr. Aimee: It’s something that kids have often seen something like that. I try to leverage their curiosity.

Dr. Sharp: Good. You have to enroll them in such a lengthy process, I think.

Dr. Aimee: Yeah.

Dr. Sharp: So then once you get into it, what measures are you selecting? We got standard, Wechsler scales, are there different measures that are better for gifted kids or?

Dr. Aimee: It’s an interesting thing. A part of what I’m looking at is who’s the audience. Generally, if it’s school admission stuff, most of the private schools want the Wechsler. So I’ll do that. The Wechsler is a fine test. I like the new edition because the splitting up of fluid reasoning away from visual spatial, [00:58:00] both fits better with research and also tends to be more relevant.

I’ll often see kids where they’re very strong in fluid reasoning and their visual spatial is good but nothing fabulous and I like to be able to see those as two separate factors.

Dr. Sharp: Hey, can I ask you? Sorry to interrupt you. I’m just very curious, I like to get people’s perspective. How do you explain how fluid reasoning is relevant in everyday life to parents?

Dr. Aimee: I usually talk about it in terms, I say intelligence is made up of a lot of different things but one of the biggest splits, this is actually how I usually start my feedback sessions, is between stuff you know and your ability to figure out new things. Stuff you know and familiar situations for most of the time with the gifted kids, the verbal Comprehension Index is usually functioning more as a crystallized intelligence. It’s [00:59:00] measuring their experience in the world.

So fluid reasoning is about coming into a new situation, figuring out what to do when you’re not sure what to do. I also talk about how the two intertwine because one of the best things to have when you’re coming into a novel situation is to have a good pile of existing knowledge about, oh, but other problems similar to this were solved this way, so that’s crystallized intelligence about problem solving.

And when you’re trying to learn something new, you’re trying to build your crystallized intelligence focusing on how does this fit in with what I already know, and how do I connect this, how to make sense, that’s a problem solving technique. So they tend to intertwine, but I think of it in terms of figuring out what to do when you don’t know what to do.

[01:00:00] Dr. Sharp: Okay. Thanks for indulging me there. I was just curious. That’s something that I think about sometimes, so measure selection.

Dr. Aimee: The other thing I happen to like about the Wechsler, if I think that autism spectrum disorder is on the table as part of the differential, I usually do the whole test minus the reading stuff at the end but the balance between the information and the comprehension subtest, often with the gifted kids on the autism spectrum, we will see 18 on information and nine on comprehension. You see huge split between those two subtests because it represents the difference between book learning and social learning.

Dr. Sharp: Sure.

Dr. Aimee: It doesn’t prove anything by itself, but a lot of times I’m looking for like, oh, I just need a little, sometimes if I’ve used a different IQ measure, I’ll often just do those two subtests as a [01:01:00] supplemental piece.

I really like the DAS. I like it better than the Wechsler for a lot of things. I like the fact that the fluid reasoning tasks are not confounded with time, with speed.

Dr. Sharp: Oh my gosh.

Dr. Aimee: It gives you time to think. I like the fact that I can put the start point anywhere I want to; I don’t have to do the easy stuff. In fact, you can administer stuff out of level. Some stuff has to be administered, so if I have a four-year-old, there are some five-year-old stuff I can give them and there are still norms for it. If I have a five-year-old or if I have a gifted five-year-old on the Wechsler, they’re on the WPPSI, which means they’re going to ceiling stuff and I’m going to have ceiling effects. It’s a big issue.

Whereas on the DAS, I can give them the school age battery [01:02:00] which is designed for six and up, but it has norms for five year olds. Sometimes the cute things with the little pictures for the little kids is actually confusing and they’re like, why are you telling me this? Whereas the stuff that says Scott Squares and Circles on it, is easier for that. They’re like, oh, okay. I see what you want me to do. You want to figure out the rule. Oh, I can figure out the rule. So I like the DAS a lot.

I don’t care for the Stanford-Binet. I find that it doesn’t have enough granularity because there’s just not enough items at any given level and the instructions are very confusing in some places for the kids. I’m like, I don’t want this to be about, could you understand the instructions?

Dr. Sharp: Oh, of course.

Dr. Aimee: I’ve used other tests, mostly I use the DAS and the WISC. Those are my favorites. And then I use the [01:03:00] Woodcock-Johnson, not as an overall IQ measure, but it is my best source of little diagnostic bits and pieces in the cognitive realm.

And then I use all the same things you would use for a lot of other stuff. If I’m doing dyslexia, I’m going to be using like a CTOPP and a PAT and a GORT and things like that. I’m going to be using stuff that’s aimed at the particular question I’m asking.

The biggest issue that I have is that most tests of social cognition are much too easy for the gifted kids and they just ace them no matter how much trouble they’re having. The thing that I’ve found thus far that has been the most sensitive has been the Social Language Development Test. It has picture items and verbal items, and a lot of times the kids can answer the verbal items reasonably correctly.

Although they might have trouble with the, well, I can know the right thing to [01:04:00] say in a social situation as long as it doesn’t upset me but when you’re actually asking them to look at pictures and say, what’s this person thinking and why, it’s often much harder for them.

Sometimes that also gives me a source of very clear information I can show to a parent. I can show them a picture. There’s one item on SLDT that has this kid who looks furious and he’s got his hand up in the universal stop, get away from me gesture. If I show that to the parent and I say, I want you to know your kid looked at this picture and he said, I’m five years old. It’s vivid.

Dr. Sharp: That’s so big.

Dr. Aimee: They can see that. They go, okay, that kid is not correctly interpreting social signals. There’s two pictures on that test that adults in these scolding [01:05:00] things, like they’re warning you, like it’s the teacher giving you the look. I can show them, I say, if this kid can’t understand what this look means, they’re going to get in trouble a lot because they got the warning, but they didn’t see the warning. So they don’t know why they’re getting in trouble, but the teacher thinks she warned them. I like that test in particular.

I have heard really good things about the RESCA and I haven’t gotten it yet.

Dr. Sharp: Oh yeah, I’ve seen that one going around on the listserv as well.

Dr. Aimee: It’s being discussed. I’m likely to check that out. A lot of what I’m looking for, for the gifted kids in the neuropsychological realm is I’m looking for difficult tasks. I don’t get as much information out of something like Trails and Verbal Fluency. I usually administer them because they’re easy and fast and stuff, but oftentimes, they don’t give me a whole lot. But tests like the Tower of Hanoi or the Tower Test on the D-KEFS, [01:06:00] the tower on the D-KEFS is great because I can watch them try to learn from experience.

Dr. Sharp: Yeah, sure.

Dr. Aimee: It starts with; can they figure things out? How do they approach it? Do they just dive right in and do 100,000,000 moves? It gives me a sense of how they are, similarly, the Sorting Task, what do they do when they run out of easy answers?

A lot of times it’s the qualitative stuff. With gifted kids, it’s often hard to find tasks that are actually hard for them. Frequently, even in their areas of most profound weakness, twice exceptional kids will give you average scores because nobody told them they’re supposed to do badly on it. So they’re compensating. They’re doing everything they can to try to get the answer and they can muddle through.

Dr. Sharp: So you’re looking at scores that are in the average range or maybe even above [01:07:00] average technically but still are significant weaknesses for these kids and have to mindful of.

Dr. Aimee: Yeah. I care much more about the within kid differences. And that also is reflected in their grades. That sometimes the kids, they’ll be like, well, but he’s getting B’s in reading, I don’t know what the problem is. The school’s like, well, he’s getting B’s in reading. I’m like, well, yes, but he can actually barely read. It’s taking an immense amount of effort. This is not fluent, comfortable reading.

Oftentimes, that becomes a thing that’s a little more sensitive because they can do it if you give them time but if you force them to do it immediately, they have a harder time.

Dr. Sharp: That’s tough. Yes. So once you have all of that results, then I am curious, just to wrap the process, how do you structure the feedback session and write the report? Do [01:08:00] those differ with gifted kids versus neurotypical kids?

Dr. Aimee: Yeah, one of the big things where I don’t know that many people do this for more typically average intelligence kids, I virtually always include kids in the feedback process.

Dr. Sharp: Okay, at all ages?

Dr. Aimee: Yeah, I can explain the normal curve to a smart four-year-old. They don’t understand it as well as their parents do. They’re usually curious, they want to know. What I always explain to parents is, it’s like sex, I don’t want them to get their information on the street. I want them to get their information from me because I’m a reliable source.

Sometimes parents don’t want me to give numbers during the feedback session, and I’ll respect that because I don’t want the kid to go to school and go, I got a 137 on my IQ. I will talk with kids [01:09:00] about how do you talk with people about this and how not. It’s like bragging about your income; we don’t do that.

But even pretty young kids, what I usually explain is I say, well, for anything we ask you to do, there’s going to be lots of different things that affect how well you can do on it and some of that is who your parents are and what you had for breakfast that morning and what I had for breakfast that morning. So there’s going to be lots of different things that affect it.

Most of the time, the things that help you about counterbalance the things that hurt you and so you end up in the middle. And sometimes, it’s more unusual, you have more things that help you and other things that hurt you and so then that gives me the hand wavy explanation of why a normal curve looks like it does.

I draw a normal curve and I put little smiley faces on the normal curve to say, okay, so when we’re in the world of knowing things, you do a lot better than most kids and I draw a little [01:10:00] smiley face up here. And over here, when it comes to keeping track of what you’re thinking about and holding lots of information in your head at once, you’re much more like most kids there, or that’s a lot harder for you and I put the smiley face someplace else. I build up this color coded thing so that they can see the score splits. When I have that kind of a split, we’ll say, oh, and I try to tie it to their experience.

People who have this often have the feeling of I feel like I have all these ideas and I can’t remember them all. And the kid will go, oh yeah. I’m like, well, that’s where we saw that on that score. So I’m trying to tie it to them.

The language, we’re going to keep it nonjudgmental. You know a lot of stuff, here’s what’s harder for you. It can be hard for you to do easy things quickly without getting bogged down. I go back to the kid’s reason for referral.

A [01:11:00] part of why I want to keep the kids in this is because if we don’t tell them, besides the fact that they’re going to get information off the internet or their friends or whatever, they’re going to get a lot of wisdom, they will tend to assume there’s something deeply wrong with them. There’s a lot of shame.

If there is something that’s diagnosably wrong, I want to be able to frame that in terms of, it’s not a death sentence, it’s this year’s, here’s what are the good aspects of this. Here’s what are the more troublesome aspects of this. Here’s how you can use your strengths to compensate for your weaknesses. Here’s some things you can do to help yourself.

I have to get to report writing. The other thing is that I leave a ton of feedback at a time. If it’s just an uncomplicated IQ test, I will allot an hour but if it goes a little over, I won’t get upset. If it’s a full evaluation, [01:12:00] I try to get it done in two hours, but sometimes parents aren’t done. Sometimes they’re not done, especially if there’s a developmental diagnosis on the table.

Gifted kids tend to have gifted parents and they are also used to knowing a lot and understanding a lot. They don’t want me to just say, here’s the answer. They want to know, how’d you get there? What exactly was that test? No, that can’t be right.

Usually, I don’t get outright arguments, but I get a lot of curiosity and a lot of debate. I accept that asking questions, it’s how I learned. I ask a lot of questions when I’m a student too. So I don’t get upset by the lots of questions. I’m like, I need to prove my case. I need to show them the data.

Oftentimes I’ll pull out the rag. I’ll show them, I say, here, this is the Rey complex figure. And they go, that’s a complex figure. I say, yes, that’s a complex figure. And [01:13:00] I say, what do you notice about it? They’ll tell me different things. I’ll say, okay, so now I’m going to show you, the first thing I asked you to do was to copy it. And I’ll say, we noticed and they’ll see like, wow, the kid missed a lot of the important details even though it was right in front of them or wow, they’re seeing all the pieces, but they really don’t see how it all fits together.

If I had only one traditional neuropsychological test, the Rey would be the thing. I find that it usually gives me a lot of information. I hate to say this in front of a lot of neuropsychologists, but the Rorschach is my favorite of tests. It gives me a ton of useful information. It’s really good. You can hate on me for it if you want, but it’s very helpful. I would never diagnose anything on the basis of the Rorschach alone, but it gives very rich information.

To go back to Rey, I’ll show them, they’ll be able to see, wow, this kid can see all these details, but they don’t see how they [01:14:00] fit together. I can also use that to build empathy. For a lot of folks with autism, it’s like every detail in the world is exactly as important as every other detail in the world. And that makes them really observant, but it also gets them overwhelmed.

It’s hard for them to fit it into a coherent whole, and you can see that here. They can see that on the thing. And then I can show them the recall copies. I say, and here’s what they internalized from it when I asked them to do it from memory. You’ll see details randomly scattered on the page or whatever, or the kid with ADHD where they’ve got the basic idea, but everything’s just missing and it’s very sloppy. The point is I show the parents primary data so that they can see where I’m coming from.

There’s a lot of family therapy [01:15:00] involved. There’s often oh yeah, my brother’s just like that too, or my spouse is just like that, or I’m just like that. I think that’s certainly not specific to gifted kids but doing that family work around acceptance is important.

My number one rule is; I don’t want my reports to be used as fish wrap. If they’re rejecting the report, if they go, I paid all this money and she’s wrong, then I haven’t been able to help this person. So I do try to accept that it’s going to take longer. I want them to feel that they’ve had their questions answered.

Sometimes they’ll send me emails later with other questions. What I do is I take notes during feedback and I make a point of making whatever I told them, I make sure I incorporate those questions into the report as well and make sure that that information goes in. [01:16:00] It’s long but it’s worth it because ultimately, if I’ve gone to all this trouble to do the report and then they don’t believe me, then I’m not helping anybody.

Dr. Sharp: Right. Believing comes through educating and just walking them through. I don’t know about you, Aimee, but I find those feedback sessions fun if somebody is asking nuanced questions like what’s the difference between rote memory and working memory? Why can they do this but not that? That’s fun for me. I’m like, okay, we can talk about this.

Dr. Aimee: I’m trying to tie it to their everyday experience too. What’s always amazing is when I’ll tell them something like, oh, I’ve noticed that you come up with a million ideas but then you struggle to get them all out before you’ve forgotten them. And they go, how did you [01:17:00] know? It was something they hadn’t told me. If they had noticed it and crystallized it, they probably would have told me but they didn’t realize it.

And so I’m able to show them things and then they go, oh yeah, that is like me, or that is like my kid, that explains it. And so I’m helping them build. I always say, I do diagnosis because the universe demands diagnosis, but I care about case formulation. I want to build a coherent understanding; why does this person have the dilemmas and struggles they do? What can we do about it?

The goal is for it to be really empowering. A lot of times, it helps people build compassion for themselves and for their kids and it helps them build a sense of hope that I’m not stupid. Kids tend to globalize because people tend to globalize. [01:18:00] It’s like, you’re not stupid at all. Here are the things that you’re super good at and here are the things that are a lot harder for you. And it is normal to not be good at everything.

Here’s why you like the things you like and here’s why the things that are hard for you are hard for you, and here’s what you can do. Ideally, it’s a joyful process. It’s not always, it can be hard.

Dr. Sharp: Of course.

Dr. Aimee: Is a grieving process often. There’s that sense of the death of the ideal child in mind.

Dr. Sharp: Oh yeah. Of course.

Dr. Aimee: I’m a therapist in addition to it. I know that some people who do testing, they’re testers. That’s what they like. I’m a therapist at heart. In some cases, for adults, I’ll do a formal therapeutic assessment where the [01:19:00] report writing looks completely different. Are you familiar with Steven Finn’s work?

Dr. Sharp: Yeah, I interviewed a psychologist, Dr. Megan Warner, who’s also over on the East Coast. She’s over near Yale. We did a whole episode on therapeutic assessment, I think it was episode 10.

Dr. Aimee: I think both formal therapeutic assessment where you’re going towards a letter or a personal fable or something like that, I love doing that with people, folks, because you can leverage somebody’s imagination, develop a story.

For a lot of the adults who come in, it’s like, I can’t keep a job. What is wrong with me? Or I’m struggling to deal with personal dilemmas. My father is dying or whatever, the things that people deal with and using the testing as extended therapeutic session. Having them join in the process of interpretation with [01:20:00] you, it’s really good for them. It leverages their strengths.

They’ll often come up with ideas that, oh, I’m not really sure. I might have an idea but I’m not sure and they’ll go, no, it’s this. I’m like, oh, yes, now I see it. I do share the process as much as I can with them.

Even when I’m going to be writing a formal report because there’s an audience out there or I need to, I still try to keep to the idea of keeping them as a partner in the process.

Dr. Sharp: I think that’s a great perspective just to have with assessment in general. It’s strength-based and you’re trying to enroll the person and ultimately they’re the ones who benefit, hopefully. Well, this is great, Aimee. I feel like we have packed so much helpful information.

Dr. Aimee: I talk too much.

Dr. Sharp: No, this is fantastic. You basically walked us through from start to finish how [01:21:00] to develop and run and the structure of practice aimed at gifted and twice-exceptional kids and young adults, of course. This is amazing.

Dr. Aimee: And adults. There are people out there who do a lot of work with adults. I have adults in my therapy case where I have quite a number of adults.

Dr. Sharp: Well, it’s a needed service. It sounds like you’re doing a great job.

Dr. Aimee: Yeah. It’s one of my goals in life is to teach more people. One of the other sticky things on my blog is, I was helped finding a therapist for a gifted client and people write to me, do you know anybody in lower Townsville? And I’m like, no, I don’t. I would love to have a broader network of people who are culturally competent with this group both for therapy and for testing and do a good job.

Dr. Sharp: Just to bring it full [01:22:00] circle, we started talking about how working with gifted individuals is maybe a cultural competence and it helps to view it that way. Do you have any parting words or resources for psychologists who might want to learn more about working with gifted individuals or testing with gifted individuals, anything like that?

Dr. Aimee: I think there’s two things. One is, I mentioned that, oh no, my kid might be gifted. That’ll enter you into a lot of the main resources; go to Hoagies’ website, see what’s going on. There’s part of that you need to educate yourself.

There is a book, they’ve just had a new edition of it called The Misdiagnosis and Dual Diagnosis of Gifted Individuals. It’s a lot of clinical lore, but it’s quite useful in orienting, because there’s issues with both over diagnosis, under diagnosis, and misdiagnosis.

There’s a lot of [01:23:00] times where people want to explain away very pathological behavior on the logic that, oh, that must be because they’re so smart. There’s times where we don’t see how much they’re struggling because they’re so smart and they’re working hard at it, and there are times where we misattribute.

So like I got this one little boy. He was adorable. Both of his parents had doctorates in mathematics and he had memorized the entire public transit schedule of the Greater Boston area.

Dr. Sharp: Oh, goodness.

Dr. Aimee: Okay. You’re, the kid must be on the spectrum. I always use memorizing train schedules as the everybody’s idea of what autism is, like, oh yeah, that’s what they do. And I said, most of them don’t do that. This one did.

I tested him and I played with him and I talked to him, no, he was a little boy who lives in the big city and his parents don’t own a car. [01:24:00] It was interesting and it became like this fun family thing and he really does love public transit. It’s really interesting. Maybe he’ll become a civil engineer or something like that or a city planner or something someday.

It was just interesting and fun. It gets him out in the world and it orients him, I feel safe. I know what bus that is that’s coming because it’s this time of day and I’m on this street, so I know what bus that is. Both in how he interacted with me and how he did on the various tests, I was like, no, he is just anxious. It had more of an OCD flavor than autism stuff.

So people will miss, that’s the kind of thing where somebody would take that and go, oh, well, obviously, and you’re like, no. So it’s really important to be aware that you can make mistakes in all those directions. That book’s a good place. It is written for clinicians.

[01:25:00] Steven Feifer has some stuff. The AP does have a book on the psychology of giftedness. Most of the stuff is focused around kids in school with adjustment disorders.

The other piece that I would want to say is most of the psychologists that I know are pretty smart. You have to be pretty smart to get into the field, especially if you like doing testing because to do the coursework to do that, to do the training to do that, so chances are good that you are smart yourself. I think it’s important to work through what that has meant to you and to get comfortable within yourself.

When I think of it in terms of cultural development, we talk about the notion of developing a multicultural self.

To really know, what is this to me? I see myself [01:26:00] as an ambassador between these two cultures. The problem is that what you have, it’s just like anything else, what you haven’t metabolized, what you haven’t processed, you’re going to act out.

When people talk to me about painful experiences that they’ve had, it often has that flare of somebody trying to cut you down a notch, you’re not so smart, you’re trying to stop being so oppositional, you think you know everything or whatever. And so you need to get comfortable with your own intelligence and accept what it means to you, what it’s been.

It may have affected your life; it may not have affected your life. How it feels to know that there are people out there, no matter who you are, I guarantee you there are people who are smarter than you, and there are people who are better than you at everything and what that’s like? Because if you haven’t thought it through, you will act it out with your clients, and that’s not okay. [01:27:00] It’s just like any other countertransference reaction.

Dr. Sharp: Yeah, but one that we don’t talk about. This is literally the first time I’ve heard anyone mention that as an identity to be aware of as you’re working with folks. I think that’s super valuable. My brain is spinning, all these experiences over the year, okay. This is great.

Well, Aimee, I so appreciate all the time that you spent with me this morning and I think that people are going to find this really helpful.

Dr. Aimee: I’m glad. It was great fun.

Dr. Sharp: Good. If folks want to get in touch with you or follow up for any reason; what’s the best way to contact you?

Dr. Aimee: Usually email. My website is www.davincilearning.org. My email is aimee@davincilearning.org. [01:28:00] That’s usually the easiest way to set things up. I do consultations, for quick questions, I often answer them and if people want me to actually sit down and do a consult with a case with you, we do that hourly. I absolutely do that too.

Sometimes people are really struggling with that, oh, I’ve got this tricky, not sure what to do with, I’m happy to help out with those because very often it is a pattern that I’ve seen, you may not have seen it a lot because this is who I work with, I probably have seen that pattern before.

Dr. Sharp: Great. That sounds awesome. We’ll put all that information in the show notes too, so that folks can get in touch with you if they want to. Well, thank you again. This is great. I appreciate your time, Aimee.

Dr. Aimee: Great. Thank you.

Dr. Sharp: Take care.

Dr. Aimee: All right. Take care.

Dr. Sharp: Bye-bye.

Dr. Aimee: Bye.

Dr. Sharp: Hey y’all. Thanks again for tuning in to my interview with Dr. Aimee Yermish. Usually, I like to do a little recap of the important things from the interview, but to be honest, there was just [01:29:00] so much good information there that I am having a hard time summing it all up.

Two things that did jump out at me though, were Aimee’s view of giftedness as a cultural competence issue. I like how she framed it that way and emphasized that it’s something that you need to know about and need to have done your own work around perhaps being a bright individual and that there’s a lot to know about working with the gifted population.

Luckily, she gave us plenty of resources to learn more. You can find those in the show notes as always. And like Aimee said, sounds like she is generous enough to do some consultation as well. If any of you are doing some testing with gifted individuals and have some questions, sounds like she would be willing to talk with you. So that’s fantastic.

Thanks as always for supporting the podcast. It’s great to see the community grow. If you’d like more information, you can go to the website, which is thetestingpsychologist.com. You can check out the [01:30:00] Facebook group there. You can also learn a little more about testing and consulting, if you’re interested in that, in building your practice, there’s some great resources there on the website.

If you’d like, and if you feel compelled, please feel free to support the podcast any way you want to. You can share it on Facebook. You can share it on your own website or on your own podcast, and you can tell your colleagues.

Hope everyone’s doing well. Enjoy the springtime turning into summer very quickly. Hopefully, that’s happening wherever you are. I know it certainly is here and we’ll talk to you next week. Bye bye. [01:31:00]

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[00:00:00] Dr. Sharp: This is Dr. Jeremy Sharp. Welcome to The Testing Psychologist podcast, episode 18.

Hey, welcome everybody to another episode of The Testing Psychologist podcast. I’m Dr. Jeremy Sharp. Today, I’m talking with Allison Puryear. I got introduced to Allison through our mutual connection Joe Sanok, who I’ve talked about on the podcast before.

I did some consulting with Joe over the last several months and he is understandably well-connected in the mental health consulting world. He hooked me up with Allison, and we had a good conversation two weeks ago. I’m thankful that she is going to spend some time with us on the podcast today to talk about all sorts of things that I think will be helpful for [00:01:00] y’all.

So I’ll do a brief introduction and then we can just dive into it.

Allison Puryear is an LCSW with a nearly diagnosable obsession with business development. She started practices in three different states and would like you to know that building a private practice is shockingly doable when you have a plan and support, which we’ll talk a lot about. Allison has a private practice and she also does consulting through her consulting business, Abundance Practice Building.

Allison, welcome to The Testing Psychologist.

Allison: Thanks so much for having me, Jeremy.

Dr. Sharp: Great to have you. I’m excited to talk with you. We have any number of things we could get into, but the thing that jumps out right away is, and I’ve heard you talk about this on other podcasts and whatnot, but you have started over in your private practice three different times, at least that I know [00:02:00] of. Is that right?

Allison: That’s true, plus two maternity leaves.

Dr. Sharp: Plus two maternity leaves. Okay. My admiration for you just went through the roof.

Allison: Thanks.

Dr. Sharp: Yeah, for sure. I think that just gives me chills and terrors to think about starting my private practice over. Maybe let’s just talk about that. That’s a good place to start.

Allison: Sounds good.

Dr. Sharp: So why did you have to do that and how did you do that? Let’s just go there.

Allison: I guess we’ll start chronologically. My husband and I were living in Athens, Georgia. I’d been working for the university there and also had a private practice on the side. I needed to get out of my full-time job but my husband was interviewing all over the country for PA school.

He ended up getting in at the University of Washington, which was [00:03:00] our top choice. And so instead of quitting my job and going whole hog into this private practice for like six months and then moving, I maintained the small private practice and continued to try not to get super burned out in my full-time job. I did this part-time practice, full-time job thing for five years, which looking back on that, I’m like, what, Allison, why did you do that? But I did love my full-time job for a long time. It was just at the end that it was not so great.

By the time we moved to Seattle, I was at the end of my agency rope. I was not going to work for another bureaucracy. I’d had really bad experiences working in agencies, despite being pretty easily managed. I’m a good employee and I’m a people pleaser which I’m working on, but it’s not that I was the rebellious employee who didn’t like authority. I love authority. Please give me some rules and boundaries, but I just worked for [00:04:00] some toxic agencies.

As we were preparing to move to Seattle, I was like, babe, I know you’re not going to be able to work while you’re in school because his program was 80 hours a week but I absolutely can’t do this agency thing. So I’m going to try to do full-time private practice and I promise I’ll get a job if money is running low, but deep down inside, there is no chance I was going to let that happen.

So we moved to this brand new city where I didn’t know anybody and I decided to throw myself in it as hard and as fast as I could. I’m a tenacious person, so I just used every single ounce of that that I had in me and it was great. I had an incredible time building in Seattle. It was incredibly empowering. It was totally scary. There are some rose-colored glasses going on, I’m sure, but overall, I felt [00:05:00] like I stepped into myself as a powerful woman for the first time in my life.

Dr. Sharp: Oh, that’s interesting. What do you think you learned about yourself during that time in Seattle when you were building your practice?

Allison: I think moving across the country where I didn’t know anybody was already a big leap. I’m very community-oriented and had lived in one place for most of 13 years. So I had a very tight secure network of friends.

And so I think recognizing that, oh, I can make friends anywhere. This is nice. I can build this business and be far more emotionally satisfied and financially comfortable than I ever thought possible as a therapist, because I was trained as a social worker and my program had a lot of emphasis on like, you’ll do really good work in the world, just don’t expect to make money.

So it was nice [00:06:00] to bust through the ceiling I thought that existed that didn’t and find my work so fulfilling. It was a powerful experience for me and I think it helped me fall in love with private practice just the way everything fell together.

Dr. Sharp: That sounds like a really amazing experience. Did you have to do a lot of that when you built your practice on the side back in Georgia?

Allison: I didn’t. It was a small city. I had a sought-after niche. I was known in the community already as somebody who provided this. So clients came easily. I never had to work for it, honestly. I just had to let people know that were already in my social network and professional network that I was doing it.

It was also a nice wake-up call to go from being super well connected, very easy start to a private practice to the early days of Seattle where I would lie if I was not saying, [00:07:00] I was sitting on the floor crying probably two times a week early on. So let’s keep it real, right?

Dr. Sharp: Yeah, I appreciate that. No, those early days are really hard for a number of reasons, but certainly moving to a place where you don’t know anyone, that’s extra hard.

Allison: Yeah.

Dr. Sharp: Goodness. But then you did it again.

Allison: Yeah. So my mother-in-law was sick and so we needed to move back across the country to the Southeast so we could be closer. So we moved here to Asheville, North Carolina. I was building my practice and it was going well and it was building up pretty quickly and I knew we were putting roots down here and I started getting sad that this was going to be my last practice that I would build, that once I got it up and running, it would be self-sustaining and I wouldn’t do this marketing stuff anymore.

I was sad about it. I thought, well, [00:08:00] that’s interesting. Am I crazy? What’s going on? And that’s a piece of what ended up having me create Abundance Practice Building, in helping other people build, I get to live vicariously through other people as they build their practice while also all the marketing efforts that go into an online business.

Dr. Sharp: Right. That’s an interesting way to look at it, that you’re living vicariously through these other folks who you consult with. I could totally get that, it’s not feasible to just keep moving across the country and starting practices.

Allison: I think I’m not enough of a gypsy soul for that.

Dr. Sharp: Got you.

Allison: I’d like to claim it.

Dr. Sharp: Right. Have you always been what I would call an extrovert or someone, I perceive you to be an extrovert just by virtue of the way you’ve built these practices. I assume it takes some of that, but I don’t know if that’s true or not.

[00:09:00] Allison: Yeah. I say I’ve been an extrovert and outgoing most of my life. I went through a shy period, but I’m pretty outgoing and pretty extroverted. So it worked for me to use networking as a primary means of building my business because then when I’m in a new city all by myself, whether it’s Seattle or Asheville, it was a way to meet new people. It was a way to get my need for connection met and it made it fun and helped me learn cities. So that was fun.

Dr. Sharp: Absolutely. That’s cool. It sounds like you came by this consulting niche because I would say I’ve always heard marketing and reaching out and networking is your niche within consulting even, it seems like you came by that pretty honestly and it’s something that you enjoy.

Allison: Yeah. I think it’s possible for almost anybody to enjoy networking with enough reframing and training. [00:10:00] So that’s one thing I love doing.

Dr. Sharp: Well, I’d like to talk with you about some of that. Maybe we could jump into that. I think that’s a big leap for a lot of folks. I don’t know if I’m generalizing here, I’m sure I’m generalizing, but folks who do a lot of testing or assessment tend to be fairly data-driven and maybe more prone to staying in their offices and looking at data and writing reports and that sort of thing, so I wonder if it might be a little tougher for testing folks to get out and do this marketing, networking kind of thing.

Allison: Yeah, I can totally see that.

Dr. Sharp: I know you talk with a lot of folks in your consulting, have you seen folks who are building practices around testing or assessment?

Allison: Primarily, it’s usually counseling, though I have some people who do assessment as a part of their practice, but not the primary [00:11:00] means.

Dr. Sharp: Yeah, certainly. So through that experience, have you seen any concerns or issues that are specific around the testing, like how you market that stuff or how you reach out and network with folks? Has that come up at all?

Allison: I think of testing as such a nice, natural, beautiful niche that makes marketing easier, actually.

Dr. Sharp: Ah, I like that. Beautiful niche. That’s great. I’m going to take that. Talk to me about that, what makes it easier, you think?

Allison: Especially if you look at the assessments you enjoy doing, so if you enjoy ADHD testing in children, for instance, that’s like who to network with on a silver platter. You’ve got pediatricians, you have family doctors, you have therapists who treat families, therapists who treat kids, therapists who treat frustrated parents. So you have all of these different people, dieticians who might be helping families work with [00:12:00] different dietary means to help their kid calm down.

So you have all of these people you can reach out to and let them know what you’re doing and you are helping them. I think that’s one of the things that we have to keep in mind around networking is it’s not about going and selling yourself to someone because I would hate networking if that’s what it’s about. That would feel creepy. What it’s about is letting people know what you can offer that will help them.

Dr. Sharp: How do you do that without seeming creepy and pushy?

Allison: Therapists are a good example. They’re, I would say, the starter package for networking because we tend to, like most people we meet, that’s a generalization, we might be interested in people a little bit more than the average person. And so I always say with networking, especially if you’re reticent to start easy, you don’t have to be a hero. Find some therapists you’ve heard good things about, or [00:13:00] maybe you’re friends with some friends of yours, the low-hanging fruit, find them, reach out.

I usually send an email because, at 37, maybe I’m on the edge of the generation where the phone feels a little too intimate for a first conversation. I am more comfortable reaching out to strangers via email. So I email.

I usually have a subject line of I’d like to connect and that way they’re clear it’s probably not a client but it’s also interesting to click on. Then I usually say what I have in contact with or in common with them. So it might be like, oh, we’re both friends with Jane Doe. I’ve heard good things about your work. I’d really love to get together for coffee in order to learn more about you and your business.

Sometimes they reply, sometimes they don’t. And that’s one thing to note that if you’re sending out one email at a time and expecting a response, you’re going to be waiting for a while. So go ahead and scatter shots, send out [00:14:00] five and you’ll probably get two or three back.

And then if you’re an introvert, maybe schedule one, maybe two networking events per week, but just try to get it consistent where it’s a part of your week and it’s not something you binge on in a week. Let’s keep it low-key and easy.

If you’re like me and you’re extroverted and you like any excuse to get together with strangers, I’m so weird in that way, then sure, book five in a week, do whatever. When you get together with them, just talk to them like human beings. We’re good at connecting.

If you’re doing assessments, then you’re good at connecting enough that people are giving you responses. They’re not just staring at you with their mouth agape. So talk to them like you’re wanting to get to know them as a person. Do ask them about their business but the conversation doesn’t have to focus on their business. You guys will get to that, it’s the thing you have in common, [00:15:00] so it’ll come about naturally and you don’t have to push it.

Dr. Sharp: Yeah. I think that’s so true. I’ve talked about networking more in the sense of just building relationships more than anything else. If I think back to all my conversations with folks, there are some, depending on the frame where we’ll talk about business stuff pretty quickly and that’s that but most of them, we just ended up talking about all sorts of things; our kids or the South where I’m also from or college football, whatever it might be, and then the conversation will find its way back to the business but you got to get comfortable first, I think.

Allison: And I hear a lot of people say like, oh, but I hate small talk. I can understand that, most of us, we like to go deep. It’s part of our training and part of what attracted us to the field potentially but you can’t go deep without knowing a little bit about [00:16:00] somebody.

So to think about it as laying the groundwork for those kinds of conversations that you might want to have with them later and knowing who felt like a nice, easy connection and nurturing that connection. I don’t think that you need to have a second networking date with somebody where it was awkward and uncomfortable and you could not wait to leave, just leave it be. They probably had the same experience.

Dr. Sharp: That’s a great point. Don’t force it.

Allison: Yeah.

Dr. Sharp: Do you have anything that you found that makes it easier for folks who might be a little more introverted to get through that 15, 20, 30 minutes when you meet with someone for the first time and are trying to do that small talk thing? How do you approach that?

Allison: I think first it’s looking at what are you most comfortable doing. Usually, introverts are much more comfortable asking questions about the other person and letting that other person take the stage. [00:17:00] And then it’s just using the social skills that you have, shy, introvert or not, you have the social skills most likely to leapfrog questions after what they say.

I’ve talked to people for a long time about quilting and I don’t know the first thing about quilting because I would be like, tell me more about that. Where did you learn to do that? So using the part of you that’s really interested in other people, using that skill set to get to know this person. You don’t have to save it for the assessment or the counseling room.

Dr. Sharp: And that seems easy. When you say that, it’s like, oh yeah, I know how to do that. I can answer questions. I do that all the time.

Allison: Totally. I’ve had this conversation with my partner. He’s a mountain biker and he’ll go on and on about this mountain bike he’s looking at. I can sit there and be like, uh, uh or I can ask him questions like, tell [00:18:00] me more about that dropper post, that sounds fascinating. How does that work and why? In that way, we’re having a better time talking. I’m less bored and more engaged. It doesn’t mean I am interested in mountain biking, but he loves it so I’ll join him with it conversationally, at least.

Dr. Sharp: Right. That’s great. You’re right, that makes the conversation better for everybody if you’re engaged to some degree. So the therapists, it sounds like is low-hanging fruit, which I would agree with. That seems pretty easy.

The thing with testing is that we are often trying to network and maybe garner referrals from folks who are traditionally hard to talk with. Physicians, of course, school counselors, psychologists, and attorneys, I think about are big referral sources for us a lot [00:19:00] of the time. So I wonder what some of your thoughts might be on getting in and having some of those harder conversations that might be tougher to land, so to speak.

Allison: So the thing about therapists is we’ll run on and on. If we have a lunch hour, we’ll talk the whole time. You’re not going to get the lunch hour of an attorney or a doctor most likely. So you have to get in and get out quickly to make it loaded with good information that’s going to make it easy for them to refer to you and to remember if you’re getting intimidated, that you were making their lives easier.

When my husband was in family practice, he was clear that 15 minutes for his clients who had some mental health issues was not even close to adequate to helping them. He could prescribe medication, but he knows that’s not solving the problem.

So he was always really happy to find good therapists to refer people to because he cared that his patients got what they needed. [00:20:00] And so in that way, even though he was crazy busy when people would come by to network with him, it was the sense of like, oh, thank God, I’ve got somebody to refer to.

So I think staying in this mindset because I think many of us can get intimidated by physicians and attorneys, staying in the mindset that we are helping them do their job better. We have a skill set they don’t have and we’re making their lives easier.

And being tenacious, not taking it personally if the front desk staff doesn’t want you to do a little talk because that’s one thing you might do is offer a talk about how to get somebody in for testing or how to recognize the unseen signs of whatever diagnostic criteria that the doctor might not know about that you’re seeing it, you’re testing.

So you can do little talks. Most likely the doctors are going to come in and grab whatever food you brought and leave, but the nurses are there and the [00:21:00] nurses have a lot of power. They’re often the drivers of referrals. So that’s one way.

Dr. Sharp: Sure. Just a practical question with that, say you’re able to land a talk and you mentioned the food thing, I know a lot of people who have agonized over what kind of food to bring and do you bring anything else? Do you bring healthy food? Do you not? All of that. Have you found anything that works in those situations or how to approach that?

Allison: I’d ask the front desk. Ask them, say like, what do you guys want? And then you’re bringing them something different than from what the drug representative bought them yesterday, and it’s maybe something across town that they never get that they really want. So they may think even more positively about you because you fed them well.

Dr. Sharp: Oh, yeah. I think that makes a big difference.

[00:22:00] Allison: Yeah.

Dr. Sharp: That sounds good. Okay, I like that piece about you doing them a favor, which I think is totally true. And especially, at least here, I know that that’s a big deal. I get referrals from folks who I’ve never actually met in person but they have our information and have seen reports over the years. They need something quickly and easily and someone they know they can rely on.

Let me switch gears just a little bit. I’ve heard you talk on your own podcast, which is great by the way. It’s called the Abundant Practice podcast. I’ll put in a little plug because I think you do a cool format with your podcast. Allison does this thing where on Mondays she’ll talk with someone who has a very specific consulting issue and they’ll chat. Then she’ll bring in another consultant on Wednesday to go back over and add any thoughts [00:23:00] or brainstorm and flesh it out a little bit more. And then on Friday you come back and circle around and give a clear action item for people to act on.

It works really well and it’s cool. Your podcasts aren’t super long. I can listen to them really quickly and yet there’s a lot of helpful information.

Allison: Thanks.

Dr. Sharp: Yeah, of course. I thought I would throw that out there. I’ve been listening lately. One thing I heard you talk about though, here recently has been money mindset stuff. I think that is really important for us, particularly with testing.

Insurance is one thing and that’s a whole other deal with insurance and testing but a lot of folks are just trying to establish fee for service testing practices and I think it can be tough because when clients call, that initial conversation about what are your fees, it [00:24:00] goes from, well, I charge $150 an hour up to maybe I charge $2,000 for an evaluation or $3,000 or even $1500. We’re throwing out pretty big sums of money right off the bat and I think that’s hard for a lot of folks to figure out how to do that and how to be comfortable with that.

And so I was wanting to talk with you a little bit about the money mindset and getting comfortable with having fees like that and talking with people about it. I wonder, do you have ideas or thoughts or even resources around wrapping your mind around charging a full fee like that and getting comfortable with taking that much money from folks?

Allison: Yeah. First, it’s thinking not about the time that you’re spending with the person as much as what you’re providing for them. Like you are ruling in or ruling out a [00:25:00] diagnostic issue that could drastically change their treatment, change their life, you can’t put a sum on that.

Someone being able to be clear like you’re on the autism spectrum and in here or now, with this diagnosis, you now have all of these resources available to you. We have best practices we can follow that without that diagnostic, you wouldn’t be able to either access or know where to go with it.

So I think it’s looking at what you’re providing with people and valuing that. It’s like with networking, you were making people’s lives better. It’s not that you’re giving them news they want to hear all the time but you are bringing clarity that they need or they wouldn’t be sitting in your office.

So I think rooting into that and looking at your why, like why do you do what you [00:26:00] do? Why did you choose this out of all the other professions you could have chosen? Because you have to be pretty freaking smart to do this.

And knowing that that is worth, not just what you’re doing but the reason that you’re doing it, those things are worth being paid a good living. There’s a lot of school that you have to go through for that. There’s a lot of heart that you’ve had to put into learning everything that you’ve needed to learn.

Dr. Sharp: I think that’s so true.

Allison: I’d say that first. And then I’d also say to look at, what was my other point? Just flew out of my head. Being clear, we’ve all got money stuff.

One of the groups in my Practice Building Group, it’s a three-month thing that I do. The third one is all about money. I’ve had people in my group who grew up in multimillionaire households. I’ve had people in group who’ve grown up in [00:27:00] poverty and I’m entirely clear, none of us gets out of or gets into adulthood without some money stuff. And it’s so rooted in security and self-worth.

If we can be curious about that and keep looking instead of buying into the shame that might come up when we say the number and practicing saying the number. I know it sounds silly, but like when you’re washing your hair in the shower, say, oh, this assessment costs $3,500, when you’re driving down the road in your car, practicing, this assessment is $1495, and just practicing saying it out loud, because you might get comfortable with it in your head, but the first time you say it out loud to a client, you might trip over it because it feels different when you’re saying it.

Dr. Sharp: Absolutely. You said a minute ago that a lot of the difficulty with the money conversation is wrapped up in self-worth. Is [00:28:00] that right?

Allison: Oh yeah.

Dr. Sharp: Can you say more about that at all?

Allison: I’ve seen it in a few different ways. Having run these groups for a few years, I get this nice overview of people who grew up in many different ways. I grew up working class personally, so I had this mindset, I still have to work on it. It’s not like I’m done with it, but I’m certainly farther than I was, of I have to work hard to earn the money that I make, if I don’t work hard, then somehow I’m a jerk or I’m not worthy.

So for mine, my proletariat upbringing, where working hard is the most important thing, it’s really hard for me to take it easy and not push the limits all the time. I’ve seen some of my clients who grew up with more money who [00:29:00] have almost like a survivor’s guilt around it. And the sense of like I was born on third base. I didn’t hit this home run, it’s not fair for me to make a good living.

And then a lot of our educational experiences going through our programs, there was often an emphasis on you need to treat the underserved. You need to not charge a lot. You need to take what you can get and you need to not complain about money because you’re doing this as a heart-centered practice and not to be greedy. I’m clear that doing great work, loving what you do, and enjoying making a good living, those things don’t have to be mutually exclusive.

Dr. Sharp: I think it’s so important to hear that over and over. We get that message so much in graduate school and beyond. I think a lot of folks doing testing too tend to maybe work primarily in [00:30:00] hospitals and settings where there’s not a whole lot of talk about taking money from folks and charging and it can be a leap to get into private practice and realize that, yeah, you do need to be comfortable with that.

Allison: Yeah. And that can bring us full circle to the networking thing because if you are charging a rate that someone can’t afford or won’t afford, depending, it’s important to have referral sources that you trust that may be able to accommodate what they can pay or will pay. That’s one thing that keeps me from feeling like I have to treat all the people with eating disorders in my city because that’s my specialty. I have great referral sources, people I would trust with my friends and family, and I feel good referring to them when I’m full or someone can’t pay my full fee or needs to use insurance.

Dr. Sharp: And maybe this is what you meant, but I could see that being a good way to reach out to other [00:31:00] folks who’re doing the same thing that you’re doing just to say like, hey, I need referral sources and I’d love to connect with you. And then it’s almost like you’re giving them something or helping them.

Allison: Absolutely.

Dr. Sharp: Which is always nice. I know that there’s so much that we could get into with money and networking and niching and all of that kind of stuff but I think this has been great just to touch on some of these things and start to be thinking about how these come into play as we’re building our practices. Before I let you go, two things, any parting thoughts around networking or practice building for folks who are doing testing in particular, I know I’ll put you on the spot here.

Allison: No, it’s good. I think one thing that I try to emphasize with people and we’ve touched on it,[00:32:00] not just testing in particular, but in any way going into business for yourself can feel scary and hard. And so if you’re building your testing practice and you’re starting to feel like a failure, it actually might mean you’re on the right track. We’ve all been through that fire, in order to get successful, you have to keep working a plan to get there.

And that’s when hiring someone like Jeremy can help if you need some guidance or getting your support systems around you so that you feel buoyed and supported in those times when you want to be sitting on the floor crying that it’s hard work emotionally more so than practically, and it’s totally worth it.

Dr. Sharp: I like that. I would agree with you. If people want to learn more about you or about your consulting or your podcast or anything, what’s the best way to get in touch with you?

Allison: Sure. My website is [00:33:00] abundancepracticebuilding.com got a lot of free resources on there. I also have a Facebook group that’s a lot of fun where people are loving and generous with their ideas and support.

Dr. Sharp: Oh, that sounds great. Well, thank you so much for taking the time to come and chat with me here for a little while about what I think is some really important stuff here in building practices. It’s been really great.

Allison: Thanks for having me.

Dr. Sharp: Yeah. Take care.

Allison: You too.

Dr. Sharp: Hey y’all. Thanks again for listening to my interview with Allison Puryear. Allison has a lot to say about building a practice and networking. She’s done it so many times in different cities and after coming back from maternity leave and I hope you found our conversation helpful.

Two things that jumped out to me were her reframe of networking and what that looks like specifically with doctors and [00:34:00] attorneys and folks where it might be tough to get in with them, but reframing it like you are providing a service and doing those folks a favor by giving them great referral sources rather than having it be something that’s intimidating or judgmental or anything like that.

So that was one piece that I took away and something that I found has been relevant for me too. Just last week I was at a pediatrician group’s office and they were like, oh, we’re so glad to have met you, we’re so glad to know this resource’s out there and it really was cool.

I will say, just to get to her piece about what kind of food to bring, I totally used her advice and contacted the front office staff and they told me exactly what to get those physicians that they hadn’t had a note, they wanted that day. So that was super helpful too.

The other piece that Allison brought up that I think is pretty relevant is [00:35:00] how we need to shift our mindset around money and how we charge for our services. A big part of that gets back to self-worth and knowing that the services we offer are valuable. And yes, they do cost a fair amount of money and these are life-changing services that many people really need, and we have the training to do that.

So if you haven’t done any amount of work on self-worth and money mindset and that kind of stuff, I definitely put in a plug to think about exploring that for yourself and I’ll put some resources in the show notes to help with that as well.

So thank you as always for listening to the podcast. As I’ve said, it’s so exciting to see things grow and see people continue to join our community. If you’d like more resources or do want to join the conversation on Facebook, first, you could go to the website, which is thetestingpsychologist.com. There you can find [00:36:00] links to articles and past podcast episodes, and you can also find a link to the Facebook community, which is The Testing Psychologist community. We’d be happy to have you there and happy to have you join the discussion.

I look forward to next week. I will be having a great conversation with Dr. Aimee Yermish, who is a psychologist on the East Coast. She specializes in assessment, therapy, and coaching with gifted and twice-exceptional kids and young adults. This podcast is super long, I’ll give you a warning, but there’s so much good information packed into this podcast.

She walks us through from the beginning to where she’s at now, how to build a thriving practice assessing kids with giftedness and young adults with giftedness and twice exceptional abilities. So definitely tune in for that and take care in the meantime. Bye [00:37:00] bye.

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[00:00:00] Hey everybody. This is Dr. Jeremy Sharp. Welcome to The Testing Psychologist podcast, episode 15.

Hey, y’all. This is Dr. Jeremy Sharp again. Welcome back to another episode of The Testing Psychologist podcast.  I’m sitting here looking out of my window on a beautiful spring day here in Fort Collins. We had a little run of cold weather last week, but we are definitely getting into the spring/summertime, which is great news for me. I think I mentioned that I’ve grown up in the south and I’m definitely used to more heat and humidity. So that kind of thing just feels like home, but we are getting there here in Fort Collins. So I’m super excited about that.

Today is a little bit of a different episode. To be honest, I really [00:01:00] considered just not even publishing anything this week, but I decided to just go for it and put something together real quick.

I was out of town last Thursday, Friday, and all through the weekend. Typically, the weekend or Thursdays and Fridays is when I work on my podcast. I got back to town on Monday and I was feeling all this pressure to get the podcast out. Honestly, some other things came up here in the practice where I’m our clinical director. I’ve been working on handling some of that and just making sure that things are running smoothly here.

What happened was I got into this place of… that old perfectionistic stuff started to kick up, and I just said, rather than release an unfinished episode or a short episode, I think I’ll just skip it this week, wait [00:02:00] and hone the episode for next week and release it back on Monday again. But then I got to thinking, okay, this is probably good practice, some exposure to not give into that perfectionism and need to do everything exactly right every single time. I also had some really cool experiences while I was out of town, and that got me thinking about some things that I think are relevant to talk about here on the podcast.

So I’ve decided here for today, I am just winging it. I don’t have any notes typed up or guidelines or anything like that. I just wanted to share some thoughts from my weekend trip and some things that have been going on here in the practice.

One big thing that came out of my weekend trip, and there are really two things I’m going to touch on today. One was the value of actually taking some time [00:03:00] to go out of town and take a little bit of time away from the practice, slow down a little bit, and be very deliberate with reflection. I do not do this very often, to be honest. This was a little bit of work for me. It’s much easier for me to stay here and work on the practice, work on my reports, and just constantly be doing, doing, doing. And there are any number of distractions here from day to day and week to week. So this is a big deal.

I took some time off to go out and spend some time with good friends but also got to hang out with Connor McClenahanfrom Cupla Media. If you haven’t looked those guys up, you should. They’re great. They do video marketing for therapists. I got to have a really cool meeting with him. We talked about video marketing for therapists, our practices, and that kind of thing.

Generally, this trip was really [00:04:00] just to give me some time to get away. And what it ended up turning into, this wasn’t deliberate necessarily, but when I found myself with some free time, and really, this was just two hours on the plane ride out, and then maybe 2,3,4 hours each day on Thursday and Friday, that’s all that it took for me to just to step away.

I could have worked on reports and business stuff, but I didn’t. I was able to let go of some of that anxiety and just having little small windows like that where I went on some walks. I sat out in the sun. I was in Los Angeles.

It was nice and sunny and easy to spend some time outside. And I just spent some time thinking about the business, our assessment process, our staff, and [00:05:00] needs in the community.

It was really nice to just take a little bit of time away. I was struck by how little time it took to really gain some clarity around some of these fairly big issues that have been going on here in the practice, big picture stuff that I lose track of and don’t work on as much as I should because I’m wrapped up in the day to day in the clinical work.

That’s one piece I wanted to speak briefly to the value. If you’re not doing that, it’s not like you have to take a trip and get out of town necessarily, but even taking a half day where you’re out of the office every other week, or if you can do a two-day trip, that can be really helpful for your business development and for your own mental health too. I came back so refreshed, recharged, and excited to get back in and really work. So that was super helpful.

If you’re looking to do that in a really structured way, [00:06:00] something that I have signed up for for the summer is Joe Sanok’s Slow Down School, which is a, I guess you call it a conference, but I almost think of it as like a retreat opportunity. It’s a week-long event where there’s really deliberate slowing down and days of doing nothing, but then I’m going to be paired with some pretty structured coaching for building your practice, building your business, things like that. So I’m going to be there. It’d be great to see some listeners there too if that kind of thing sounds appealing to you.

So just a brief plug, like I said, getting away, slowing down, reflecting on your processes. That was super helpful for me.

Then the second component that I really wanted to speak to today, again, just briefly, is just some thoughts on not having to do things perfectly. I mentioned that at the beginning that this [00:07:00] podcast, I almost didn’t record it just by virtue of not having a really well thought out, put-together podcast, but then I thought, okay, there’s a little something to say here. Let me just go for it.

And I think that this is a good metaphor to keep in mind or an idea to keep in mind just for our practices. I see this coming up a lot, day to day. Particularly for me, I have trouble with getting reports absolutely perfect. I can just comb over and over and over my reports, writing the interpretation exactly right, including every big bit of information that I think I need to, and really speaking to what the parents or the client needs to hear in this assessment.

I think that 90% of that is probably really good, and part of what sets us apart with our evaluations, and that last 10% is maybe going above and beyond what actually needs to get done, and in fact, just wastes time [00:08:00] that I don’t need to spend on reports. And so, like I said, this is a little bit of practice for me just in another context to let go of the perfectionism a little bit.

I see that coming up in reports. I see that with tools that I’m researching for our business or ways of doing things. I can often get lost in the research and lost in finding exactly the right way to do things. That ends up just taking more time, and of course, it’s time that I’m not necessarily getting paid for. And often the outcome does not justify the time spent on it. So that incremental increase in accuracy or effectiveness or whatever the metric might be usually doesn’t justify the time.

So, just two thoughts on that. I’m sure that a lot of you’re familiar with perfectionism and wanting to do things [00:09:00] right. I think to some degree that’s really valuable. And it’s always worth coming back to, revisiting, and maybe even practicing not doing things absolutely perfectly once or twice and seeing how that goes.

Just thinking back, I’m sure this podcast is not one of the best ones necessarily, but hopefully worthwhile just to get a few thoughts out there about slowing down and maybe not being quite so hard on yourself to do things absolutely right every single time.

I appreciate it as always. It is really cool to see our listening community continue to grow and to see the Facebook community continue to grow. If you have not joined the Facebook community, you can definitely check us out. You can search for the Testing Psychologist Community on Facebook at that search bar at the top. You can also go to the [00:10:00] website, which is thetestingpsychologist.com. There you can find articles, a link to the Facebook group, and information about building your testing services via articles, past podcast episodes, and things like that.

Thanks to all of you who continue to listen and pass along the podcast to your friends. It’s really amazing to see things continue to grow and spread the word about testing and the business side of things.

Stay tuned. I have some really great interviews coming up over the next few weeks. I’ve got Kelly Higdon and Allison Puryear who are both, I would say superstars in the mental health consulting world. We have some really good conversations about building your ideal practice, about money mindset, how to talk about charging big fees for testing, wrapping your mind around that, and how to create the practice that you really want.

Also, [00:11:00] I’m speaking with two psychologists with some really interesting specialty areas within testing. So, I’m talking with Dr. Erika Martinez about how to apply neuropsychology training to more of a therapeutic assessment model, and helping millennials and young adults be successful. And then I also hope to be talking soon with Dr. Aimee Yermish who specializes in assessment with gifted and twice-exceptional kids. She has a really cool practice going on over on the East Coast.

So keep your eyes out for future episodes. I think we’ve got some cool stuff coming up. In the meantime, feel free to pass this along and share it on your own Facebook group or with friends or on your blog, or wherever you might pass along information to other folks.

Thanks as always. I will catch you next time. Take care.

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[00:00:00] Dr. Sharp: Hey everybody, this is Dr. Jeremy Sharp. Welcome to The Testing Psychologist podcast, episode 14.

Welcome everybody to another episode of The Testing Psychologist podcast. This is Dr. Jeremy Sharp. Today, I’m excited about my guest, Dr. Maelisa Hall. Maelisa and I were originally introduced through Kelly Higdon, who will also be on the podcast here in a few weeks, but Kelly is a private practice consultant here based out of California and she consults with a lot of really cool folks.

And when I got in touch with her, Kelly said, you have got to talk with Maelisa. Maelisa has this awesome business going on and you two would be a great fit. I reached out to Maelisa and it was a great connection.

And so [00:01:00] I invited her to come here on the podcast to talk with us about all sorts of things but we’ll focus probably on her two main businesses, which are QA Prep, which helps therapists get all the paperwork in order and documentation. And then she also has a private practice, but you’ll hear plenty about that as we go along.

So Maelisa, just briefly, welcome to the podcast.

Dr. Maelisa: Thanks for having me. I’m excited to be here.

Dr. Sharp: Absolutely. Let me read your official bio here and then we will just dive into it, okay?

Dr. Maelisa: Cool.

Dr. Sharp: Great. Dr. Maelisa Hall is a licensed psychologist and serial entrepreneur living in Southern California. She loves talking about productivity, time management, business, and online marketing. Maelisa pays the bills with her two psychology-related passion projects, QA Prep, and Hall coaching group.

Maelisa, can you tell us a little bit more about each of those [00:02:00] businesses and what you’re up to these days?

Dr. Maelisa: Yeah. So definitely keeping busy with both of those. QA Prep is an online business that I’ve had for almost three years now. With QA Prep, I help other therapists with their documentation. So I offer training and webinars, CE classes, all kinds of things, free blogs, and everything related to how to make your documentation more simple, easier, and more meaningful. That’s my big focus with QA Prep is how can you enjoy your documentation a little bit so that it’s not this boring task or this dark cloud that’s always hanging over your head.

Dr. Sharp: Wow. Enjoy your documentation, is that a paradox or what?

Dr. Maelisa: It’s possible or at the very least, not hate it.

[00:03:00] Dr. Sharp: I’ll take that. No, I trust you. If you say you can help enjoy your paperwork, I totally believe you and look forward to talking about all that.

Dr. Maelisa: Like with anything, when you can find some meaning in it, then you can figure out how to motivate yourself to get it done and you can start to enjoy it a little bit more or see the value in it at the very least. And then with my private practice, I do counseling online and I also have an office and I offer assessments. I do a career assessment and ADHD testing with adults. So two really specific testing areas.

Dr. Sharp: Absolutely. I would love to talk with you about both of those and how you set those up in your practice. Maybe we [00:04:00] can save that for a little bit later though, because something you said just about QA Prep and the paperwork jumped out to me already.

You said that you have to find some meaning in it to make it enjoyable or a passion for you. Could you talk a little bit about how you came to start QA Prep and what led you to that? Paperwork, people wouldn’t think paperwork, that’s my passion. So I’m really curious how it became yours.

Dr. Maelisa: Absolutely. I started out from the very beginning, my first practicum doing testing. And so everything that I was doing with the field of psychology was very paperwork-heavy and detail-heavy. It’s important that you’re accurate when you’re doing testing and that you’re making sure to cross all your T’s and dot your I’s, et cetera, and report writing and all of that.

I found that [00:05:00] I enjoyed testing a lot. And so I think that helped me with the paperwork part of it, too, because I saw how valuable the testing reports were to people and how much meaning they could provide. And then I took that with me as I moved more into providing psychotherapy at the end of my internships and then after I graduated from graduate school.

I worked in an agency where, LA County is infamous for their documentation practices related to Medi-Cal, which is everywhere else, it’s called Medicaid, but here in California, we call it Medi-Cal. The paperwork is just crazy. It’s mountains and mountains of paperwork that you have to do in order to provide psychotherapy to people.

It wasn’t a big problem for me because I do [00:06:00] tend to be a good writer and I was able to use that as a time to reflect. So that’s one of the suggestions I offer people is when I was writing my notes, I was making sure to take the time to think about the sessions. It was almost like I was processing the sessions myself as I was writing the notes.

Not that I’m this perfect person who did that every single time, sometimes I had to get a note done, but for me, it offered me that respite from what was a fairly stressful job. I also was thrown into this position where I had to do a lot of intake assessments and the intake assessments were really long. They were typically two to three hours long and pretty intense, pretty severe clients and we had this huge waiting list.

And so I had to learn very [00:07:00] early on how to manage that and how to manage my time or that would have gotten completely out of hand because there’s so much paperwork with an intake assessment and so much documentation that you have to do right away or you’ll forget a lot of really valuable information.

So I think between those two things, I learned to manage the paperwork well, and it never became a huge issue for me. We all get behind our paperwork every once in a while, and that did happen to me, but for the most part, I was able to manage it fairly well, and I was able to catch up very quickly when I did fall behind.

So fast forward, a few years, and did other things. And then I found a job, actually working at that same agency, I went back to them, doing quality improvement. And so that was training therapists at the agency on how to do the documentation. And then actually going in and [00:08:00] auditing charts, which wasn’t my favorite part of the job.

Even with that, it was auditing charts and then providing the program director’s reports and information on what pieces were missing, what they needed help with, how to improve, and then creating training that was specialized to each program to help them overcome whatever struggles they had, each program would tend to have different weaknesses.

As I started doing that, I got all this feedback that people were like, oh, this training is so helpful. We never got anything like this in graduate school. I kept hearing the same thing over and over again. And then I started helping people who were in private practice because I had all this information about insurance and general documentation and realized that nobody in private practice has anything like this.

There is very little training in this area. So I decided to start QA Prep and offer that [00:09:00] training. And that’s what I’ve been doing ever since.

Dr. Sharp: Good for you. You’re so right. I remember back when I was getting started and probably for years after that, the process of finding guidelines for how to do all of the paperwork, especially with insurance was really hard. I feel like it’s gotten maybe a little easier over the past two years, but maybe that’s due in part to some of your materials that are out there and helping guide people.

Dr. Maelisa: Thanks. Honestly, I don’t have a lot of competition. In regards to insurance, there’s one or two other people who offer some information, but even without insurance, if you’re a private practitioner, there are very few guidelines.

One of the things that I do in my training is I start off with the general ethical guidelines related to documentation. I give the actual description from APA and [00:10:00] AAMFT and these different national associations. They all just say you have to document, but they don’t say how, so we get very little guidance.

Dr. Sharp: That’s a great question. So how did you fill in the gaps there in the guidelines? How did you know what to put in your policies?

Dr. Maelisa: That’s where the auditing has come in handy. Being someone who has gone into other people’s practices, and read other people’s notes and their client files, you start to see a lot of the same things come up over and over again. It becomes very obvious what people are missing.

So with documentation in general, one of the things I talk about is having a story and that’s what your client’s file is, is a story, whether you’re in private practice [00:11:00] doing testing or doing therapy or whatever. It’s the story that you have of your treatment with them.

When you’re looking at a file and you’ve never seen this client, you don’t know anything about them at all. And so I would go in and do this objective audit. It becomes very obvious where the holes in that story are.

For example, a really common thing that people miss, that people don’t think about is making little notes on things like rescheduling or when the next appointment is, or like a vacation. I might be reading a file and then there are three weeks that are completely missing. I’m like, well, what happened here? There’s three weeks that are just gone and that could be anything, it could be somebody lost their notes. It could be they never wrote the notes or it could be the client was on vacation for three weeks so they didn’t come back. If you don’t write that down, then nobody who’s looking through the file knows what happened.

Dr. Sharp: Oh, that’s [00:12:00] interesting. Sorry to interrupt you, even right off the bat, that’s something that is relatively new to me. Typically, in the past when I was doing more therapy, if clients went on vacation or took a little break for whatever reason, that’s just what happened. I don’t know that I necessarily documented that clearly.

Dr. Maelisa: It doesn’t have to be a big deal. It could just be like at the end of one session note, maybe in the plan section, you just write client will be on vacation for the next three weeks and return on XYZ date for the next session. But even adding a little thing like that closes that gap. So that’s a basic example of things that you learn as you spend time reading other people’s notes.

I think another thing is one of the exercises I have people do in workshops and in training, especially early on when [00:13:00] I was learning how to do training was that I have people write notes together as a group. So we give an example client, everyone writes a note as if they did a psychotherapy session with them. And then we compare notes.

In the beginning, it can be really scary. Everybody’s like, oh my gosh, I got to read my note aloud. Everybody’s going to think my note is horrible but you find that everyone tends to write very similar things and we are covering the same thing, maybe saying it a little bit differently.

Of course, there are exceptions and there are times when people might leave out something that was important or add things that aren’t important, but in general, you find those guidelines, which you would find from maybe doing consultation with people, things like that. That’s one of the things I offer too, is just ideas for people of how do you find what that [00:14:00] norm is for your profession?

Dr. Sharp: Something I run into a lot and I think I hear on Facebook groups and message boards and things like that is how much do you include in your notes, especially when you’re dealing with the insurance? Can you speak to that at all?

Dr. Maelisa: Yeah. Most of my answers with documentation are usually it depends, which everybody hates, but that’s because it really does depend on the situation. So with insurance, it’s not about length. So it’s never about how long your note is or how much you write in a note, regardless of whether it’s insurance or private pay, whatever. What matters is the information that’s in there.

So with insurance, things that you want to make sure that you include are what progress the client is making because insurance companies don’t want to pay for a service that isn’t working and they won’t eventually. [00:15:00] If they saw that you were doing therapy for 12 weeks and you said that the client is still so impaired, they need so much help and you didn’t talk at all about any progress that was made, they’re going to say, okay, well, that was great. It was a trial and it didn’t help at all. We’re done.

So it’s balancing identifying that progress with also identifying that need because on the other side of the coin is the fact that this person has made some progress but they still need this service and why. So it’s making sure to identify those two things. I recommend people put one sentence that has both of those things in there in every note. In that way, it reminds you to address those two key points every time you’re writing a note that relates to insurance.

Now there are more specific things depending on who you’re billing to, for [00:16:00] example, Medicare and Medicaid or Medi-Cal do tend to be more stringent and you might want to put in some extra things like making sure that you identify specific interventions and making sure that you have enough information to justify the amount of time you bill is the biggest thing.

But generally, for most private insurance companies, it’s not that dramatic, but you want to identify those two key points; what’s the progress being made and what is the ongoing need? And then talk about what you did. You simply just talk about what you did in your session.

Dr. Sharp: Sure. I know that a lot of folks are using EHR systems these days. There’s SimplePractice, TheraNest, and TherapyNotes and there are any number of solutions out there. Have you checked any of those out and from a documentation standpoint, do you have any thoughts on which of those might have advantages over another or [00:17:00] are they all pretty good or what?

Dr. Maelisa: Yes, what a timely question. I’m interviewing quite a few of them and putting together what I hope will be an epic blog post highlighting how you write notes within the different EHRs. I do hope to have that out in two weeks. I’m not sure when this interview will be airing but hopefully, it’ll come out around the same time. So you can check that out on my blog.

Dr. Sharp: Oh, that’d be great. And while I’m thinking about it, what’s the address of your blog or website?

Dr. Maelisa: qaprep.com.

Dr. Sharp: Okay. Perfect.

Dr. Maelisa: Pretty easy to remember. Part of the reason I’m reaching out to them is because I know this is a big issue. What you bring up is what people are thinking of. As far as notes go, I would say that a lot of the EHRs are pretty similar and you’re writing your note.

The [00:18:00] big difference is whether or not you can customize your note template. For some people, that’s more important than it is for others. For me, honestly, it’s not a huge deal because I’m pretty comfortable writing freeform or I can use a structured template. One of the things I am not a huge fan of is pre-populated check boxes.

I know a lot of people want to have notes where like, oh, okay, I just check off interventions that I do, or I just check off ways in which the client presented. And that I think can be helpful but only after you have written your own notes for a while because what a lot of people do is they get all these check boxes and then they’re making things up. They’re checking them off because they have to [00:19:00] whereas if you write your notes, let’s say using a template like DAP or SOAP or some of these common templates, which I also talk about on my blog, and I have a free crash course people can sign up for, and I talk about all that stuff more in-depth, and do give some samples too.

When you’re looking at that, you then get used to writing, and you notice what are the phrases that you use because the type of therapy you do might be very different from the type of therapy I do, or the type of clients you see might be very different. If I give people a list of checkboxes, it’s not going to be individualized to their clients or to what they provide and they’re going to start overlooking a lot of the things because it doesn’t apply to them.

So if you write your own notes for maybe six months and then go through and do a review of your notes and pick out the things you find [00:20:00] yourself writing over and over again and then create your own checkboxes, your own template, that’s totally different because that’s going to be a really meaningful, really powerful tool for you to use that will save you time and still provide that meaning and still be very individualized to what you do.

Dr. Sharp: That’s a great tip. It’s funny, as you were talking, I was glancing over at my EHR to see if that’s doable. I use TherapyNotes, I’ve talked about that on the podcast before and it does have the capability to write in custom interventions. You can tailor it to your specific approach. That’s a great idea.

Dr. Maelisa: And that’s one of the biggest things. Most of the EHRs offer a free trial. I tell people, just sign up for two of them and see what you like because you might like one that I don’t like. There are so [00:21:00] many things within an EHR. Personally, I use CounSol. I would actually say their notes are not my favorite. They have two different forms of notes, and so I use the freeform one. Their more formalized note process is not customizable, and it has a lot of those check boxes that I don’t like, so it’s not my favorite.

However, everything else with the EHR is exactly what I wanted. It has everything I wanted except that. So for me, it’s ironic, one of my big focus with QA Prep is notes, but in my own private practice, that’s the least favorite part of my EHR.

But everything else, like with the intake paperwork was huge and it offers online sessions within the system for me, that was important to have one place to go for everything for myself and for the clients. So you just have to try them [00:22:00] out and see what works best for your practice.

Dr. Sharp: Sure. That’s great. Well, let me switch gears just a little bit and ask you about documentation for testing and assessment in particular. Do you have thoughts on that? Any special considerations for those of us who are doing a lot of testing and evaluation; what to consider? What to keep in mind? That kind of thing.

Dr. Maelisa: Yeah, I think one of the big things starting from the beginning is informed consent and making sure that your consent forms are customized for testing. I do have a paperwork packet for sale and I have a testing add-on form, I call it because I do think that reviewing with clients how psychological testing or any kind of testing is different from therapy and what it adds to the process and how that might change the relationship you have with them and who is going to receive the results. Those are all [00:23:00] really important things to review at the beginning.

I think in a similar way to therapy, we can’t guarantee the outcome. I think this is something that a lot of people actually miss reviewing with clients at the beginning of psychotherapy as well and it’s maybe a little bit easier to do with testing is even if someone calls me for ADHD assessments, for example, I typically can tell whether or not they’re going to have a diagnosis based on that initial conversation with them because, with that, it tends to be fairly specific.

I do testing with adults and so they’ve typically done a lot of their own research and put a lot of thought into the process before coming to me. So it’s usually just a confirmation of what they already thought, but it’s important for me to tell people, I can’t guarantee you’re going to have this diagnosis. I can’t guarantee what’s going to happen.

The point of testing is to gather [00:24:00] information. And so we’re going to gather lots of information. We’re going to look at everything we can and regardless of what results may come, I will be able to give you a lot of information about yourself and hopefully, you’ll be able to get a lot of insight.

Regardless, we’ll be able to go through some recommendations for what you’re struggling with because typically people aren’t coming to testing because everything’s going perfectly fine in their life. They think something is wrong either with themselves or with maybe their child. And so they want help and they want some guidance as to how to deal with whatever’s going on. And that’s what the testing can offer. And that we can provide regardless of what the results are, right?

Dr. Sharp: Sure. Do you include all of that in that paperwork packet; making it pretty explicit, everything that you just said about the uncertainty of results and whatnot?

Dr. Maelisa: It’s not quite as detailed in there on the paperwork packet. I don’t remember the exact language I [00:25:00] have right now, but it’s more about the difference between psychotherapy and the fact that you can’t guarantee results and the potential benefits and drawbacks.

I think it’s important to review with people too, that they may or may not be happy with the results and that results aren’t always easy to digest, and that’s hopefully where, as clinicians, we do a good job of providing that feedback to people and in a compassionate way, but sometimes it’s hard information to hear.

Sometimes people are really happy to get a diagnosis or find out certain information because they’re like, thank God I’m not, that term lazy, crazy, or stupid. This gives me an explanation for what’s been going on. Other times people are upset and they say, well, what does this mean? Does this limit me? Does this mean I can’t do this? Does this mean I have to change my plans? [00:26:00] So it’s important to make sure that people understand it’s not always this happy-go-lucky thing in the beginning.

It also makes me think about one big thing that I talk about with informed consent, and this applies to testing or psychotherapy, is that it’s a conversation, it’s not a form that you have people fill out. It’s a process. None of our ethical guidelines say that informed consent is a document. It’s something that you review with your clients and then our forms are legal and paper or electronic representation of the fact that we did review that with them. So it’s important that we have the conversation.

So while I do have clients fill out forms and obviously sign the forms, it’s a talk that I’m having with them and I’m making sure that they have looked through it and that they understand all those things.

Dr. Sharp: That’s such a good point. That’s interesting. I’ve never [00:27:00] heard anyone phrase it that way but when you say that, that totally makes sense. We have people sign the paperwork that says that they are consenting to treatment but how we present that is, there’s a lot of variation and responsibility on us to go through it appropriately and have that conversation like you said.

Dr. Maelisa: Yeah, I find that actually some people get a little bit annoyed with doing intake paperwork because it can be time-consuming and you feel like, oh, we have to go through all these forms and I’m not going through my forms in depth with people or going through everything line by line. I wouldn’t recommend doing that, but I would definitely recommend making sure you highlight those key points with people and have that conversation, I’ve never had anyone be annoyed that we talked about that part of it.

Dr. Sharp: Yeah, that’s interesting. The last episode that I did was [00:28:00] all about the vulnerability of coming in for testing and going through that process. I talk about how I restructured my initial interviews to be two hours long, in large part so that I could spend the time that I needed to at the beginning, to talk them through the process and orient them to testing and I think talk through a lot of these things that you’re mentioning.

Dr. Maelisa: Yeah. I heard that episode and I thought it was a great point because you want to make sure, and sometimes people have more questions than you think they’re going to have and you want to make sure people have the space to get all of that answered.

Dr. Sharp: Absolutely. So what are some other things that folks who focus on testing might want to keep in mind from a documentation standpoint?

Dr. Maelisa: I think the other big thing, what comes up with testing a lot more than with psychotherapy is sharing of documentation. And so making sure you have that identified ahead [00:29:00] of time.

All of the ADHD assessments I’ve done up to this point, actually, and I just started doing assessments in my private practice in the last two months but all of them have been referrals from other therapists or, actually, there were two people who came in, but they all were in their own psychotherapy. So I knew right off the bat that they were going to be sharing this report with somebody else and that it would be beneficial for them to do that with their ongoing therapist.

So that’s something you want to think about; is it going to a school? Is it something that they’ll want to hang on to and keep for a long time? And so you want to consider that when you’re writing your report, obviously, but also when you talk about authorizations to release information and making sure that you do have authorizations.

Sometimes that can get a little bit tricky because we’ll do a lot of treatment planning type stuff and [00:30:00] working with other practitioners and I think that’s a great thing. I think that we as therapists get a little too scared sometimes to share information and it can be really helpful for our clients, but just making sure you have your legal documents in a row as far as that goes.

And then also considering storage of records. I think you talked about this in one of your podcasts about, like if you store your records electronically, are you scanning the protocols into your EHR or are you just keeping the paper copies locked up in a separate file? Those are things you want to consider that I think are a little bit different with testing because it’s not something that you are directly entering into the EHR. You are going to have all these separate forms that you’re going to have to figure out what to do with.

Dr. Sharp: Yeah. Do you have thoughts on what you would do with all that?

Dr. Maelisa: I like scanning everything in. I think that’s what you do too. Is that correct?

Dr. Sharp: We do.

Dr. Maelisa: Just [00:31:00] because it’s easier to have everything in one place and the point to me in having an EHR so I don’t have to worry about having things locked up in separate cabinets and carry them around for the next seven years. If that’s not something you want to do, it’s perfectly acceptable to keep the protocols in a separate file.

I do always make sure that the report is definitely uploaded into the EHR and I give clients copies of the report. I want to make sure that is a little bit more open access for them to have.

Dr. Sharp: Got you. That makes sense. Going back to the consent to release information piece, I think that’s really important. What I run into a lot is parents will come in, we work with kids primarily so I have a lot of kids that are under 15, which is the age of consent for treatment here in Colorado. [00:32:00] They’ll always have questions about; do we release it to the school. Do we send it to the physician?

In many cases, they’ll say we want to release part of it to the school and the full report to the physician and some of it to the therapist and things like that. It can get tricky with the actual consent form. Speaking very frankly, I don’t think my consent form probably specifies all of those different ways to release it like it should, does that make sense?

Dr. Maelisa: Yeah. On the consent form that I have, I leave it blank for the ongoing form and then I’ll write in or type in what it is that I’m releasing to each person. So that’s what I would recommend is you personalize it based on what you’re releasing because parents and [00:33:00] individuals very well may want different information released to different places.

Dr. Sharp: That makes sense. Got you. Can you speak to anything with regard to the other end of the spectrum with teenagers and those who fall above the age of consent but lower than 18, or the age when most kids move out of the house?

I find that gets tricky sometimes with documentation in that, this is a lengthy explanation, so bear with me here, where parents will come in, seek the evaluation, the adolescent will sign the consent form and consent to treatment but then inevitably something will come up during the course of the evaluation. They’ll mention, let’s say, drug use or alcohol use or something that has some bearing on the diagnostic picture but then they say, don’t tell my parents. And so I am curious, from a [00:34:00] documentation standpoint and testing-wise, how you might handle something like that. I’m going to totally put you on the spot here.

Dr. Maelisa: I know, and that’s a good one. Well, thankfully, I can cop out a little bit and say that I don’t work with teens right now but this actually is something that is a little bit different in every state. So I would encourage people to make sure you know the guidelines for your state regarding adolescence and whether or not they can choose not to have their certain information released to their parents because in some circumstances, you can say, well, this report is going to the kid and it’s up to them to determine if they want to share it. Obviously, that gets tricky because it’s typically not the teen that’s paying for it, and all that stuff.

I think the big thing is knowing what your state guidelines are as far as that rule, and then making sure that you’re very clear with the parents and with the adolescent [00:35:00] upfront about those things. I used to work with adolescents a lot more and I would give very specific examples like that and tell people ahead of time.

Typically, let’s say an adolescent said that they were smoking marijuana. That’s not, for me, going to be one of the big deal things that I’m going to say, okay, well, remember when we had that conversation in the beginning about something was really harmful to you, I might have to tell your parents. That’s not usually going to be the thing that I’m going to be like, oh, I have to bring Mom in now and have a whole conversation with her.

However, with testing, it can be really important to the information, because if they say that they got high this morning and you’re testing them right now, that’s going to impact your results. So with testing, I think it actually can be a lot more important. And so I think it’s important that you talk with [00:36:00] the adolescent ahead of time about that stuff and make sure that they know that they need to avoid doing those things the day before testing and the day of testing and that kind of stuff.

Dr. Sharp: Of course. That makes sense. Do you happen to know, you mentioned checking your state guidelines, I know in some regards there are lists of state-by-state guidelines for certain practices, do you know if there’s anything like that for mental health or psychologists, anyone aggregate website that people could check?

Dr. Maelisa: Not for releasing records. I know there is one. There is a law group who put one together for online counseling guidelines and that’s really helpful. So they may be someone to check out and see if they have anything that could be similar to releasing records because typically states take their direction from HIPAA, [00:37:00] but then some states are more stringent than HIPAA and some states are less stringent than HIPAA. So that’s where you have to determine, okay, what’s the state, what’s HIPAA and how do they play together?

Dr. Sharp: Sure. That makes sense. Okay. I’ll do a little research and maybe try to throw that information in the show notes if I can find it.

Dr. Maelisa: Usually that’s one of those things where people who have recently graduated know more about it than us because they’ve been sitting for state licensing exams. I think most of us on our state licensing exam, that’s one of the questions or one of the topics you have to study. So that’s another area you could check out.

Dr. Sharp: That sounds good. This has been great. We’ve talked for quite a while and I still feel like we’re barely scratching the surface with paperwork and documentation. [00:38:00] Two things, before we totally wrap up, are there other things at all that you feel like would be important for folks to know, especially doing testing and thinking about documentation or insurance before we wrap up.

Dr. Maelisa: That’s a good point. I think with insurance, it’s really important in that first note that you write to make sure that you’re justifying why the testing is medically necessary and that’s going to be different for every insurance company. One of the things I recommend people do is simply google whatever insurance company you contract with and then medical necessity guidelines. So like, Magellan’s psychological testing medical necessity.

If you google that, you should be able to find whatever their guidelines are and that way you’ll have a clear understanding of when they think it is necessary and when it’s not, so when it’ll be approved, and then make sure that you specifically speak to those points in your notes, [00:39:00] which may never be reviewed. It may not be a big deal, but just in case, that way you have it and you don’t have to worry about it. That’s one of the biggest things.

And then to document what you’re doing. I think with testing, sometimes too, we think, we’re not doing psychotherapy and we’re going to write up this big report and so we may want to write a little bit less in our notes and at least, document what behavioral observations you saw. Anything of note or of importance that wasn’t specifically a result on the test and then document what tests you gave for each session

Dr. Sharp: Sure. That makes sense. Again, depending on your EHR, I know that TherapyNotes is really good about that. That’s one of the reasons that I chose them is they are pretty specific with forcing you to document all of the testing that you do and separate them out; how much time you spend on each one, [00:40:00] that kind of thing.

Dr. Maelisa: Yeah. I think it’s a little bit easier if you’re testing to create a template for yourself. You have a fairly standard battery that you give and it makes it a little bit easier for note writing, but make sure that you do include that personalized part because the way each person presents during a testing session is totally different.

Dr. Sharp: Absolutely. This is great. Maelisa, you mentioned a lot of resources over the course of the podcast that I would think would be pretty interesting to folks with paperwork and documentation. Can you just say again, how people could get in touch with you if they wanted to find some of these resources?

Dr. Maelisa: Sure. They can go to qaprep.com. I have a pretty extensive blog. I may have to preen that a little bit over the next year or so to organize things over the past few years, but there’s a lot of stuff in there you can [00:41:00] read. I also have a free crash course, so you can just click on get the free crash course or something like that on the website.

In there, I go through all the different forms you need in your private practice, how to do treatment planning, how to write notes, and give a bunch of different types of templates that you can use, including my templates that I created called meaningful templates. Especially if you struggle with what to write, that’s why I created those. They’re discussion prompts for you about what to include in your session notes. So that’s always a free resource for people too.

Dr. Sharp: That’s fantastic. I can vouch for your website and your blog. I’ve been on there. Maybe you say you need to preen it but there is a ton of good information on there about things that, well, with notes and paperwork in general, it’s easy to just let [00:42:00] that stuff slide and get into habits that may or may not be appropriate, so the information you have on there gets into the nuts and bolts of how to do documentation and it’s awesome. So definitely recommend that people check that out.

Dr. Maelisa: Awesome. Thanks.

Dr. Sharp: Oh yeah, absolutely. Well, thank you so much for your time. This went by really quickly and who knows, maybe down the road we’ll have part two of the paperwork and documentation but in the meantime, it was really great to talk with you and I appreciate you coming on The Testing Psychologist podcast.

Dr. Maelisa: I appreciate you having me and thanks to everybody for listening.

Dr. Sharp: Yeah. Take care of Maelisa.

Dr. Maelisa: All right.

Dr. Sharp: Hey, thanks everybody for listening to that episode with Dr. Maelisa Hall. I hope you learned something from my conversation with her. I know that I sure did. After we had that podcast, I went and checked out all sorts of resources. I mean it when I say that her website [00:43:00] is comprehensive and her blog has some cool stuff on it that helps us address some of those mundane things that are easy to overlook but not so easy to get out of trouble if you happen to get audited or something. So definitely check out her website. That information is in the show notes.

Thanks as always for listening. It is great to see the community continue to grow and see the downloads go up and just know that more folks are jumping on board with learning about testing and growing and starting testing services in their practices. So if you enjoy the podcast, do me a big favor; you can share it on social media, you can share it on your blog, you can write a review, you can rate the podcast in iTunes, any number of things, and share it with your colleagues. All of those are helpful.

If you do want to join our community and have some conversation with other folks who are doing testing in their practices; you [00:44:00] can check that out at Facebook, The Testing Psychologist community. If you want more information or want to read some articles or check out more information, you can go to the website, which is thetestingpsychologist.com.

I hope to catch you next week. I am going to be talking with Kelly Higdon, one of the premier private practice consultants. I can just say as a little teaser that my conversation with Kelly had me walking away rethinking how I might structure my practice. She has some powerful things to say for us. So hope to see you next week. Take care in the meantime. Bye bye.

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