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  • 467 Transcript.

    [00:00:00] Dr. Sharp: Hello everyone and welcome to The Testing Psychologist podcast. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner and private practice coach.

    Many of y’all know that I have been using TherapyNotes as our practice EHR for over 10 years now. I’ve looked at others and I keep coming back to TherapyNotes because they do it all. If you’re interested in an EHR for your practice, you can get two free months of TherapyNotes by going to thetestingpsychologist.com/therapynotes and enter the code “testing”.

    This podcast is brought to you in part by PAR.

    Hey, guess what y’all, the BRIEF-A has been updated. The BRIEF2A is the latest update to the BRIEF2 family. Use the gold standard in executive functioning assessment to assess adult clients. You can preorder it now, visit parinc.com/products/brief2a.

    Hey, y’all. Welcome back [00:01:00] to The Testing Psychologist. Glad to be here with you. Thank you for tuning in as always to the podcast.

    This is a really cool episode. My guest, Dr. Tara Vossenkemper, is a practice consultant speaker and therapist specializing in group practice success. She has a healthy blend of depth irreverence, which you will hear on this podcast and a straightforward approach.

    Tara helps practice owners navigate the complexities of hiring team dynamics and organizational culture. She’s known for her candor insights and easy to implement strategies. She’s passionate about empowering practice leaders to build thriving and sustainable businesses.

    I had a lot of fun during this conversation. Tara is a new, but fast friend here in the consulting world. She reached out initially when I had made a post in a group about my recent downsizing or rightsizing of the practice. We connected pretty quickly on a variety of topics and here we are on the [00:02:00] podcast.

    I mentioned that Tara is relatively irreverent. You will hear that during the podcast. So if you have little ones in the car and you don’t want them to hear a little bit of profanity, then you might skip this one till you are listening by yourself, but that’s part of what I love about Tara, she is 100% herself and you’ll figure that out pretty quickly throughout our conversation.

    So we talk about “culture” and how it is such an important part of running a business although the word itself is getting a little overplayed and has almost become a cliche at this point. That’s why this is so cool to talk with Tara. We dig into a deeper idea of culture; what it is and how we define it in a mental health practice, how to create it, how we nurture it.

    I think this is a useful episode for anyone out there running a practice, whether it’s small or large or very large, or maybe you’re just solo and [00:03:00] you’re thinking about hiring. I think it’s important on many levels. So please enjoy this conversation with Dr. Tara Vossenkemper.

    Tara, hey, welcome to the podcast.

    Dr. Tara: Hi.

    Dr. Sharp: Good to have you.

    Dr. Tara: Thanks.

    Dr. Sharp: I’m glad that you’re here.

    Dr. Tara: It’s good to be here.

    Dr. Sharp: Good. I’m excited to chat with you about culture, people and this whole crazy journey of running a business and everything that goes into it, so thanks for your time.

    Dr. Tara: Mm-hmm.

    Dr. Sharp: Let’s start where we typically start on this podcast, which is, why this might be important to you? Of all the things that you could care about and spend time on and talk about on a [00:04:00] podcast, why are we talking about people and culture?

    Dr. Tara: Culture is important to me because I’ve worked at some really terrible places. I don’t know if this is just a me-thing, but I can’t imagine being somewhere that I would hate to be, like having to work somewhere that it wasn’t relatively pleasant to be at.

    I always think back from my very first job where the training was not very good and I was almost fired because I wasn’t trained well and then I ended up being great because I ended up figuring out what I was doing all the way through a more recent before I shifted into practice, a relatively recent, by recent I mean 10 years ago, but recentish for being an adult job where I remember they were hiring on adjunct faculty.

    It was at [00:05:00] a university and nobody was explaining to them what was expected of them. They were just told fill out this paperwork. Nobody told them you need to fill out, this is 99. Here’s what it is. This form, here’s what it’s for. And so I ended up like taking that on.

    I remember how toxic my boss was. I can’t imagine personally being in a place that I hate to be and I don’t want that for anybody. So even if my place isn’t for everybody, there’s got to be a place that’s for them. There could be a place where you love to go.

    That’s lame but my response is that I don’t want to be somewhere that sucks and I don’t want people to be places where they feel like it sucks and they’re dragging their feet to go in on a Monday and they’re dreading it on Friday evening because it’s going to be Sunday soon. All of that sounds awful.

    One more thing that I just realized, it’s probably [00:06:00] existential. I think everybody’s walking towards death actively, why are you wasting any time doing something that you’re not satisfied overall with doing? Do you know what I’m saying?

    Why would you ever spend time doing something? Where are your values? Do things that make you feel good knowing that some days are going to be hard, of course, but broadly speaking, surround yourself with people that you like, that support you and help you be better. Also do something that you mostly love to do and/or make sure you’re doing something that is speaking to a value that you have.

    I think that’s probably why, it’s funny to say out loud, it’s oh yeah, and we’re all dying. Let’s also make sure that we’re doing something we love in the process.

    Dr. Sharp: Right. Oh, I love this. We’re off to the races here. We’re already talking about the slow march to death that we’re all embarking on. This is [00:07:00] right up my alley.

    Dr. Tara: Perfect. I think about it way too much.

    Dr. Sharp: That’s a whole other conversation. I’m going to resist the urge to …

    Dr. Tara: Go down that route.

    Dr. Sharp: Dwell in our existential here, and we’re going to shift it into a discussion about culture at work, which is true though. People, we spend a lot of time in our workplace and the way you describe that experience just feels, I imagine a lot of people are resonating with that, working in a place that sucks and dragging their feet and just what that feels like.

    And so framing it that way totally makes sense to me. It is our job as business owners to actively work on creating a place that doesn’t suck.

    Dr. Tara: Yes. And being clear about what that is with people so they know what they’re stepping into.

    Dr. Sharp: Yeah.

    Dr. Tara: I think there’s a lot of bait and switch that happens. I don’t even know if it’s bait and switch on purpose, I think nobody actively talks about it in [00:08:00] a hiring process or the interview process, or nobody’s vetting with the current employees to see what’s it really like there. And so you join something, maybe thinking one thing, and then you realize this is not what I expected, I wish I wouldn’t have.

    Dr. Sharp: Yes. It’s funny, you bring that up. I was thinking about this question or concept as we were getting started and it’s presenting itself already, but I’m going to start with another question that goes off script, which is, what do you think is the role of self-awareness of a practice owner in developing culture.

    Dr. Tara: That’s so funny. I feel like I’ve hit up against this sometimes. I think that self-awareness needs to be relatively high and this, [00:09:00] I might get in trouble or I might get pushback from people in saying that I would speculate that people who don’t have very much or who have a lower ability to engage an accurate self-reflection are going to have more trouble with the people component of employing others and also with the culture of the practice.

    So I do think that self-awareness is a really important component to a healthy practice for the owner to be self-aware. I also think that, to me, that’s the beauty of therapy is that even.

    I’m thinking for myself, even in the past year and a half, I started a backup with therapy in February, 2023, before I had my third child. It was February, 2023 right after a move, right after a second location. It has just been such a helpful [00:10:00] experience and journey not only personally, of course, it’s therapy, but also I see it directly translate into my practice, I see it directly translate into the people who are a part of the practice and it’s like oh, interesting, something that I was wanting to happen was actually being bottled neck by my inability to do something.

    I would say unprocessed trauma is what it was, but by my inability to recognize this thing or do this thing a little bit differently, it was how I was showing up that was having this influence. I think self-awareness is really important.

    Dr. Sharp: I’m with you on that. Thinking back, just as we’re talking about this, I feel like some of the most difficult times in my practice, at least, have been times when I’ve been out of touch, like my perception of what was happening and how I was interacting and presenting at work was out of alignment with, I’d say, the majority [00:11:00] opinion of my employees.

    You’re talking about therapy, of course, that’s been a part of my life over the years, but I’ve also been fortunate to have two closer employees over the years who have taken the leap to pull me aside and be like, dude, I think we need to talk about this or things are going to go off the rails.

    They’ve been like, you got to look at things a little bit differently here. That’s been super valuable, but yeah, I agree, self-awareness is huge and it’s an ongoing journey for us.

    Dr. Tara: Just makes me think, my people know my love, I love the US version of The Office. One of my employees, she’ll say to me, I’ll be the Dwight to your Michael, she didn’t even watch the show, but she just says, I’m the Dwight to your Michael.

    She’ll send me gifts sometimes of the white. She’ll sometimes give [00:12:00] some feedback about stuff or in other cases, she might hear something happening and squelch it where she’s no, that’s not … I don’t want to say 5 battles because that seems like a really strong language, but she’s always good for giving a different perspective to people who might have …

    I think everybody is always going to have a variety of opinions about stuff. So it feels like if I stand in integrity with decisions that are being made in alignment with our core values and all of this stuff is true, how people receive it is not mine. That’s not my responsibility to bear.

    Of course, I try to make known the intention and how decisions are made and all of that, but it may or may not fall on deaf ears sometimes depending on what it is and what’s coming up for people, so it’s nice to have a Dwight to my Michael who might advocate for the practice or for me or for a leadership team behind the scenes.

    [00:13:00] Those people are invaluable. Those employees who know you, they see you a little more, they’re a little closer, they might see more clearly and stand up for you, so to speak.

    Dr. Sharp: Your champions of sorts.

    Dr. Tara: Your champions. I like that.

    Dr. Sharp: Yeah, that’s so true. Gosh, we could go so many different directions with this. Maybe we start and I feel like culture is overplayed a little bit. Even the word culture, nowadays, when I use it in interviews or something, I cringe a little bit inside, oh my God, please think of something, some other different word to use, but it’s important.

    Dr. Tara: You can say vibe.

    Dr. Sharp: Vibe, I can get hold of vibe.

    Dr. Tara: You can do the vibe.

    Dr. Sharp: Here’s the vibe. This is good. We can riff on culture synonyms. How do you [00:14:00] define it, though? As we frame the conversation, when we’re talking about culture, what does that even mean to you?

    Dr. Tara: This is where I’m sorry to keep it esoteric. It’s this phenomenological experience. It’s this perceptual filter for everything related to the practice. I also love Gottman methodology. I love John and Julie Gottman’s work at Julie Schwartz Gottman.

    On their sound relationship house, the positive perspective is sandwiched between conflict and above the friendship system. The craziest thing to me is that the perspective is a result of a friendship system and your ability to navigate conflict, but it’s really hard to work on directly. It’s something that you can’t quite capture exactly.

    I always think of it, what’s this phrase in [00:15:00] research? It’s like the latent variables. There’s all these little points around something that are like everything’s pointing to one concept but it’s hard to exactly say, this is the concept in this very clear structure.

    So when I think of culture, I think values, norms, traditions, the vibe of the practice, the essence of the practice. I was joking earlier, but those words are actually ways that I think about culture. When I walk into the space, how do I feel? Physiologically, what does it do for me? How do I feel when I interact with others?

    For me, everything about my experience with a place, including my own practice is reflective. I would say maybe 85%, a lot of my experience with the place is going to be reflective of the culture of that place.

    I feel like that’s a little bit like woo-woo maybe, but it is, it’s like the vibe. It can be practical. We’re talking about [00:16:00] traditions or norms or values or expectations or specific ways of interacting with each other can be reflective of culture but yeah, I would say it’s like the essence, the vibe of a place.

    Dr. Sharp: I think there’s something to that. It’s almost like the whole is greater than the sum of the parts, the mind versus the brain, there are lots of analogies to capture it.

    I’m curious, if you found this, I think I have, as I’m saying it out loud that there have been times when we’ve almost tried to engineer culture and it backfired, like when we were almost working too hard and then that somehow tipped the scales in the opposite direction to what we were going for. Has that ever happened in your practice? I’m working through this, like how much is [00:17:00] deliberate versus unintentional?

    Dr. Tara: Yeah, it makes me think of the point of diminishing returns; at what point is it actually too much? And then it starts to, or like too much anxiety is detrimental. A healthy amount of anxiety is good for performance, but too little or too much is not.

    I’m thinking of almost like fluidity, flexibility and adaptability. These phrases are coming to my mind. For me, I’m always interested in front-loading the work. I think probably because I’m a Kolbe Quick Start, I want to get shit done. Let’s go create something, do it and then let it work.

    And so I think the same thing with people, when you say the whole is greater than the sum of its parts, I’m thinking about the people are part of creating and maintaining culture. The [00:18:00] responsibility of every person at the practice is keeping this entity, which is the practice and the culture of the practice alive and healthy. It’s not just on me. It’s on every single person. I might have my finger on the pulse of it in a very different way, but everybody is involved in this.

    And so when I think about front-loading the work with culture, I think about hiring. Who are we bringing on? How are we making decisions about them through a culture focused lens? Because if they fit and they know what’s important to us, and they’re interested in this thing, then theoretically they’re going to be at least somewhat invested in keeping it alive in a healthy way.

    And then if we spend time, I don’t think it needs to be this every day, I’m sending out emails about live out the core values, do this thing but what I do know is that more often than not, [00:19:00] more clear messages about culture focus things are better. I don’t think that it means that you need to be doing these major giant gestures of moves like we’re revamping our culture.

    I don’t think it needs to be like this, but if you know what comprises your culture, if you say, I know my core values are really important in keeping my culture healthy, then I might highlight core values on a weekly basis and say, hey, I want to give a shout out to this person for living out this core value.

    Hey, #on your shit, good job so and so for doing blah, blah, blah. I might do things like that on a weekly basis. I know in our quarter meetings, our quarterly state of the practice meetings are about the vision, where we’re going, why we’re going that direction, whether or not leadership did what they said they would do over the previous quarter by completing our goals, what are the goals to get us to closer to our vision in the next quarter and what are our core values and how are we living them [00:20:00] out?

    We do things like that. I would say, for me, that’s not overkill. I don’t want to shove it down somebody’s throat. I’m not trying to like force feed people this stuff but there’s also this balance between if I don’t say it enough, they’re not going to be thinking about this. It’s not going to be top of mind for them.

    For me, it’s not set it and forget it, it’s bring on the right people and then consistently send messages about culture. Maybe not daily, you need to live this out not in a chastising way, in a celebratory way. I’m done. I’m just talking a lot. I’m good though. That’s it. I think I answered your question is what I’m trying to say, maybe.

    Dr. Sharp: Yeah. No, this is good. It’s bringing up these different points of where the culture can happen [00:21:00] and where we can be a little bit more deliberate about infusing the knowns of culture and maybe planting the seeds to let it grow organically and watering too, if we want to keep going with that metaphor.

    You mentioned hiring, to me, and it sounds like we maybe agree on this, that’s the first place that you start to build a sense of culture for the folks in your practice. What do you think about that?

    Dr. Tara: I absolutely unequivocally agree. Yes. Not only in our phone screen, I encourage anybody that works with me about hiring related things. They’re going to get a similar script.

    In our phone screen process, which is our first leg of hiring, we do two of things but in that phone screen process, my director of clinical operations, she has a list of core values or my integrator, depending on if we’re [00:22:00] hiring admin or clinical staff. She will basically ask them specific questions related to core values.

    So if one of our core values is own your shit, which that is one of our core values, so basically taking responsibility. If you know Gottman, you know that’s the antidote to defensiveness. So we’re also trying to not have any horsemen come traipsing through the practice. So own your shit.

    She might say, the question, it might be something like, tell me about the last time you messed up; what did you do and how did it go? What did you do to rectify that and what was the outcome? Tell me how it went.

    If people can’t come up with an example, to me, that indicates they probably aren’t actively taking ownership of what they need to be. If they tell a story about how they’ve been wronged, people are wronged. There are absolutely 100% victims in this world, not every [00:23:00] experience in every single person’s life is a 100% victim.

    There are moments where everybody messes up. Tell me about a time where you messed something up. If you can’t, that tells me something else. And so that for me is, right away, we’re asking, how are you living out our core values without directly asking this? That’s what we’re assessing in that phone screen. Give me these examples of how you’re living these things out.

    So right away, this is setting the stage for, I say setting the stage, maybe it’s like weeding out the wheat from the chaff; separating the wheat from the chaff. I don’t know what chaff is but it’s like separating these things. It’s something on a grain, it’s like the stock of wheat. It’s something.

    Dr. Sharp: Yeah.

    Okay. We got it.

    Context clues.

    Dr. Tara: It’s something like that. Context clues. It’s farming.

    Dr. Sharp: Something you don’t want. I don’t think we want chaff.

    Dr. Tara: We don’t want chaff. Maybe it’s used for something else, but [00:24:00] we’re going with planting seeds. We planted wheat, now we’re separating the wheat from the chaff. So right away, we’re doing this thing. And then later in that process, when we do something, we do a meet-and-greet as well. No leadership is included in the meet-and-greet, it’s just our hiring team, whoever is a part of it.

    Anybody can be a part. That’s not true, there’s only a certain amount of people at a time, but then they’re the ones who actively talk about the culture of the practice, their whole goal is you need to make sure this person is a culture fit and you want to make sure they feel like they’re a fit with us.

    So it’s like each party’s interviewing the other, but it’s we’re hanging out together and then they’re talking about the culture of the practice and what it’s like to be here. They’re answering questions. It’s this fluid experience. For me, right away, we are separating the wheat from the chaff, but we’re also starting to talk about culture in that same [00:25:00] process.

    I know at some point, I haven’t done this, my role is very different in the hiring process at this point, but we will actively say, the practice culture is very important. We are not willing to bring folks on who don’t fit or who don’t feel like they’re going to fit.

    It has to be not only clinically but also culturally; this is part of the deal. It’s not just you’re really good at this one thing, but you hate working with people and you keep everything to yourself. That’s not going to work. That’s not going to fit for us. It’s a very extreme example. We’ve never had that happen.

    Dr. Sharp: Sure.

    Dr. Tara: I think that answers your question maybe a little bit.

    Dr. Sharp: Oh, absolutely. I love those elements. We do that meet-and-greet as well in the hiring process and it’s great. People get to see what it’s like and see what the people are like too, and that’s a big component; am I going to get along with a lot of the folks [00:26:00] here?

    So hiring is one component. That’s where we’re planting these seeds of culture. Where else does it come up in your practice? Where do you see culture manifesting and being infused?

    Dr. Tara: I don’t mean to cop out. My thought is everywhere. It permeates every part of how we interact and exist with each other. And so when people are hired, for example, we right away get them personalized swag like personalized gifts because I want to create belonging with them right away if you’re hired even before you start.

    There’s been times where somebody has started right before our quarterly event or right before we have Christmas in July as like an event. Maybe their start date is right after, but they accept the offer before, guess [00:27:00] who’s invited? You’re invited, bring your family, come on and meet us, that sort of thing.

    If you’re here, you are one of us now. You get your little fancy picture taken. Of course, there’s marketing stuff and all that but also here’s a tumbler with your name on it. Here is this padfolio with your name lasered on it. Nice little things that are practice related but also personalized, unique to this person.

    In our onboarding process, we do 90 days of onboarding. I like to spread it out for a reason. We are very intentional with, we’re sharing information, there’s video trainings throughout, but also inviting questions, inviting feedback, what’s not going well for you.

    That’s one of my favorite questions is not to ask, hey, how are things going but what’s not working? Tell me what’s going wrong. [00:28:00] Because if I’m inviting negative feedback, what I’m doing is I’m actively seeking out authenticity and candor, which is also one of our values. I am also indirectly forcing vulnerability, which is really healthy for a workplace.

    If I can also say, hey, I messed this up in your process. I should have done this. It might not feel vulnerable to do, but to be someone higher up saying I messed up, you’re modeling vulnerability for a person who’s new and doesn’t know you at all.

    You’re saying, hey, it’s okay to make mistakes. That’s not only owning your shit, which is a value, that’s also vulnerability and safety, which is, I love The Culture Code from a Daniel Coyle perspective. Those are two very important components.

    In the beginning, whenever someone comes on, we say, look, this is where we’re going. This is our vision. That’s purpose. We’re [00:29:00] here to do these things together. This is who we are. This is what we do.

    You’re setting the stage for vision and forward momentum, and we’re doing this together. All of those things are ways of not only creating culture but ensuring that people know what it’s like to be here and know what it’s like to be a part of this special group and to move together.

    So for me, like I said, it’s everywhere, when we do consultations, when we highlight people. When we review people, we’re reviewing people based on values. I do annual reviews, which isn’t very much but we do big… we always have feedback going.

    There’s always open dialogue around metrics and numbers and hey, this is a struggle. What’s going on? You need some help. Okay. Meet with your clinical team lead. Let’s process through this thing, whatever.

    On a twice a year [00:30:00] basis, operations team and clinical team, there’s two big reviews. Even those reviews are about core values and practice culture. They’re not about performance because we’re doing performance all the time.

    I don’t give a fuck about performance right now. You’re literally doing this all the time. I want to know how you feel about being here. I want to know what see as your future for the practice. What are your goals in life outside of our practice? How do we help make that happen for you? What role can we play to facilitate what you want out of your life? For me, that’s all culture related.

    It’s funny because I like people a lot. I’m not very sociable, so if you invited me to a party, I probably wouldn’t want to go, but if I was there, I would really like the people and then I would just be done like, all right, peace out. Thanks.

    Do the old good old Irish goodbye, walk out the door, but I [00:31:00] love people. I’m interested in them. I want to know more about them. I want to know about how they think and why they feel the way that they feel, how they feel and all those things.

    And so I think that some of this was born out of that; I don’t want to sit and tell somebody what they’re doing right or wrong, I want to embed feedback in everything we’re doing so that if we get to that place where we’re having a serious discussion, none of it’s new, you know where we are.

    For me, the annual review, I wanted it to be more culture and people focused because all the other stuff was already taking place so it felt like a waste of time. If we’re doing performance stuff all the time, why am I going to sit with you once a year and tell you about your performance? We can talk about how you feel about how things are going instead. Does that make sense?

    Dr. Sharp: It does. It mirrors what we do in our practice as well. I know we’re both EOS driven [00:32:00] and so that’s probably a lot of coincidence. I like that model so much better where your “performance evaluations” are alignment with values and how things are going in the practice.

    We have a question on our evaluations which is something like, what is one thing that we could do from a leadership standpoint to make this a better place to work? What’s one thing that could take this to the next level for you?

    The answers have ranged from, could I get a new chair to can we have better retirement matching, it goes all over the place. It’s nice to solicit that feedback and create more of a collaborative environment.

    Dr. Tara: And even with that, I’m so sorry, I think I cut you off.

    Dr. Sharp: You’re good.

    Dr. Tara: My thought is, even with that, I knew at the very beginning, I remember teaching [00:33:00] before I started the practice, I taught some community mental health program or course for master’s program back in St. Louis.

    It’s somewhere in the book. I just remember feeling so validated reading this and then it has come up for me since. It was something about if you’re doing anything in community mental health, you need the buy-in of the community, which is a fucking duh, of course, but you need the buy-in. Any ideas you have; people want a say in what’s happening.

    Every time I think about the practice, we’ve done some version of meet-and-greets from the very inception. Before I had this thorough hiring process, I knew I wanted people involved because a person was joining our team. It’s not, they’re joining me, they’re joining the team.

    And that the team at the time was a lot of interns and supervisees. And so it was like, I want their buy-in [00:34:00] too. I knew that if people were involved in the process, they would feel more invested and bought into the process, which might sound gross and manipulative. That’s not the intention.

    The thought was, I want them to feel as invested as possible. Of course, no one’s going to be as invested as I am, but I want people’s involvement and influence because they are here and they are important to the team and to the practice. And so what they need and what they want is a value.

    It’s almost feels like it’s not just me, the practice is this vessel or this entity that’s reflective of all the people, everybody makes this up. It’s not just Tara’s practice. Logistically, it is, but in terms of a culture wise, it’s not just my practice, it’s verybody, we’re all here doing this together.

    Dr. Sharp: Yeah. Let me ask a potentially difficult question, something I’ve wrestled with so it’s as a selfish question, like many of my questions.

    Dr. Tara: No, [00:35:00] do it.

    Dr. Sharp: I’m curious how you approach and balance this dynamic of helping folks feel involved, part of the process, collaborative and so forth like you’re describing and retaining the, I still make the decision aspect of it. If that’s the direction you go maybe you don’t, I don’t know.

    Dr. Tara: No, that is definitely the direction I go.

    Dr. Sharp: Let’s take a break to hear from our featured partner.

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    So if you’re curious or you want to switch or you need a new EHR, try TherapyNotes for two [00:37:00] months, absolutely free. You can go to thetestingpsychologist.com/therapynotes and enter the code “testing”. Again, totally free, no strings attached. Check it out and see why everyone is switching to TherapyNotes.

    Let’s get back to the podcast

    Dr. Tara: Carefully, the answer is carefully. I tried lightly. I don’t know if it’s tried lightly, there’s this constant internal of like the bottom of the triangle, not a pyramid, I guess it would have to be some sort of a pyramid, but a three systems scale, not the scales of justice, but a scale with three balances, if that makes sense.

    Dr. Sharp: Yes.

    Dr. Tara: Okay. Thanks. You know what I’m trying to say, right?

    Dr. Sharp: Yeah.

    Dr. Tara: Autonomy is definitely one. I do not ever want people to feel like they have no [00:38:00] autonomy. The Structure of the business is another. There has to be structure in place for us to do things streamlined and uniform. And then the sustainability and longevity of the business is the third.

    I’ve shared this openly with people. If my team ever heard, this wouldn’t be new. Maybe the way I’m talking about it might feel new, but I’m constantly balancing the practice financial health with the structure to make it flow healthy, effectively, efficiently for clients, for the team, for me, for operations team, for everybody, and then also autonomy for clinicians.

    And so I think with vision decisions are not the team is to make. There’s limits where it’s like no, where we’re going is not, you all don’t see the horizon in the same way that I do and so it doesn’t make sense to me that I would task you or ask you [00:39:00] to make this decision or to even have a say in this decision when you don’t have the same view that I have.

    Whilst if you are interested in niching down, you’re interested in supervision, you’re interested in growing a certain type of, you want to do something new or slightly different, walk and talk therapy is not something, that’s a silly example, but a clinician came to me and said, I want to do that. It was like, cool, let’s get the right documents on file and fucking make it happen. Have fun.

    Somebody else came to me and said, I want to create this track within the practice. That sounds awesome. It’s not only in alignment with where we’re going, but you are interested in doing this.

    So those are the sorts of things where it’s like people have space to grow and evolve within the practice, but the parameters of the practice are relatively the same. They will grow and evolve. [00:40:00] As we do, opportunities will also grow and evolve. I say carefully, people have autonomy but it’s within the confines of this structure that we have in place right now at its current capacity, knowing it’s going to get bigger as we go.

    I had someone the other day say they would love to do a podcast, that’d be awesome. We’ve had a recent discussion about podcasting so, of course, I’m thinking about our discussion and the intention of doing that from a practice perspective. I’m thinking about marketing, I’m thinking about financially, how would that make sense? I’m running through all of this stuff, knowing we’ve wanted to do a podcast for the practice for a long time, is this something I could make happen now?

    My feedback to this person was that’s been on the docket for a long time. I am not saying no; I’m not saying yes right now. Let me think about it. Let me figure out if this is something we can do and how it might happen. Thanks for letting me know this.

    [00:41:00] I will absolutely consider this and probably take it to leadership and discuss, and then go back to the person and let them know, here’s what we think, here’s what was decided.

    Carefully was a flippant answer, but it does feel careful. I can’t ever let people be further than where we are because then that disrupts the flow and the structure of things. And also if I’m eating into profitability, then I’m fucking everybody over, not just myself, everybody is messed up.

    Everybody gets fucked over if the profitability of the practice is not healthy, because then if the practice goes under, everyone’s gone.

    Dr. Sharp: It’s so true.

    Dr. Tara: I think carefully is accurate, carefully and then those are the things that I’m constantly seeking to balance.

    Dr. Sharp: I like the way that you conceptualize it as this three-legged stool situation or three-legged scale. [00:42:00] That makes sense to me.

    It is a component, and folks feeling some agency and autonomy. We know that’s a big part of workplace satisfaction, is having control over what you do, what’s happening in your environment and having that be a component, and it’s got a balance with these other components that are equally important.

    Dr. Tara: Yeah. Because you’re part of something. If you’re a solo practitioner and you want to do a podcast, more power to you, have fun, do it. It’s your own time. It’s your own money. It’s your own energy. It’s your own investment. It’s all on you.

    When you’re doing that as part of a larger system, nobody at the practice exists in a silo, and so I hate busy work, it enrages me to do things that don’t need to be done, but we’re just doing them because we’ve always done it. No, I feel like Michael, [00:43:00] no, God, no, I’m not going to do that.

    So anything that we do, I’m constantly thinking, this is no stone left unturned to call it neuroses, it’s probably some compulsion. Why are we doing it this way? Do we actually need to do that extra step? What’s the function of this thing?

    And if there’s no function for it, I’m going to flick it out of the process like okay, it doesn’t exist. We don’t need to do something that doesn’t have a purpose. And so I think nobody exists in a silo. If somebody wants to do something, we have to figure out how it fits in everywhere. We have to find out how it fits in everywhere.

    And then conversely, if we go to do something and we stumble across something that’s not functional, we’re just going to get rid of it. I’m not going to keep something, I started talking about this for a different reason. I forgot why. So I will just stop talking at this point. Thanks.

    Dr. Sharp: It still ended up in a good [00:44:00] direction. I love this. I feel like we’re living parallel lives in so many ways. Even this topic of efficiency and not taking extra steps in your processes and systems and all of that. We could totally go down that path.

    I am curious, just a little bit of a sidebar, because you’ve mentioned two of your values now that match very closely to two of our values. So now I want to hear your other values and see how close they are to ours.

    Dr. Tara: The first is authenticity and candor; be authentic and candid, they’re all the same tense. The next is have depth and fun. It’s not just depth, we don’t need to walk around, you know the episode of South Park where Wendy Testaburger breaks up with Stan, and he turns Goth or Emo or something, and then Butter’s little Raisins girlfriend dumps him. He’s like, oh, it’s a beautiful kind of sadness, but Stan’s all like Moby and Goth.

    [00:45:00] We don’t need to be Stan. It doesn’t always have to be, oh gosh, I could talk all day about this. Life is deep. We’re marching to death. I cannot extricate myself from being a meaning making creature in a meaningless life.

    So the creation of meaning and living a deep life and purpose and intention, all of that is great, but also I’m going to fucking laugh at a fart joke. I’m going to make them. I’m going to laugh at them. I’m going to watch silly videos.

    For me, it’s the combo of the both. I might be crying and laughing, not labile, but crying about something meaningful and giggling next. This is so ridiculous, I just put my dog down and I’m laughing at the fact that the lady down the hallway is calling her to follow her.

    I’m like, she’s deaf. It’s like God, up here we are. It was so sad, but also I’m giggling, she’s deaf. [00:46:00] She’s not going to hear you. Oh, anyway, the absurdity of all is funny. So be authentic and candid, have depth and fun, be excellence oriented and growth centric.

    So you’re not always going to be excellent, but strive for excellence and growth centricity, own your shit. And the other is embrace interdependence. What’s funny about this is we got rid of somebody who wanted to exist in a silo. We didn’t get rid of them, they left and it was a good departure. It was a good leave. The conversation after was like something was not fitting. They wanted to exist in a vacuum.

    I had a former client say to me once, this is all happening at the same time, a former client said to me something about [00:47:00] all hands on deck was one of the values of maybe the Navy. I don’t remember. Some form of armed forces, all hands on deck, no, many hands make light work.

    I felt like I’m my mind blown in that moment, that’s exactly the thing, that’s exactly it. And so this embrace interdependence came as a result of this employee leaving who wanted to exist in a vacuum and the realization we need to know that people know that they’re a part of something that’s very interconnected.

    The practice’s of spider web of roles, systems and processes. Every little move you make has ramifications for the entire rest of the system. So if you want to go rogue, you’re going to fuck somebody else over in the process. Somebody else is going to bear the weight of what just happened because you did something that was not what was discussed or had planned, or that’s for me, [00:48:00] the structure of the business piece.

    The autonomy pieces follow the process with the forms and whatnot. You have to get an ROI on file to do this thing. That’s an ethical example. Let’s say, we want this form on process to do walk and talk therapy, instead, you did walk and talk therapy and your person fell and now we’re being sued.

    You just messed up a lot. A lot of other people are now bearing the weight of this thing that if you just want to did what we asked, so that’s the structure plus the autonomy. We want you to be able to do this thing, but we also know the safety of the practice, I don’t feel like that’s the exact right word, but the structure is important. So I keep going back to that.

    Those are the values; have depth and fun, authenticity and candor, excellence oriented and growth centric, own your shit, which is my favorite and the embracing interdependence.

    Dr. Sharp: I love it.

    Dr. Tara: Thanks.

    [00:49:00] Dr. Sharp: This is good. We have a lot of overlap. We have fewer but the umbrellas are maybe a little bigger. So ours are, get after it, which encompasses the own your shit, get your shit done, always be getting better.

    We have get after it. We have keep it real, which is very much like your candor and authenticity. We have conversations when we need to. That’s part of growing. That’s part of getting better. We have balance we with me, we default to supporting one another.

    That’s the go to mentality is that we’re there for one another. This is a group collaborative thing and never to the point of being a martyr and or getting resentful and that kind of thing. So like that autonomy versus group. And then our last one is be active allies, which is the [00:50:00] social just to see component. It’s the affirmation of different groups and all that kind of stuff.

    That’s so interesting. It’s really cool to hear this. I don’t think I’ve talked with any other EOS practice owners about all the values, where they came from, what they mean and stuff. Thanks for going down that path for a second.

    Dr. Tara: Yeah. Cool. Thanks for asking. It’s funny, when I consult with people, values always come up because they, I had someone ask me just the other day, here’s a situation, how do I handle it? It was something happened with an employee. I was like, what do your values say? How would you be living them out or not if you did or didn’t engage in that discussion?

    Dr. Sharp: Yes.

    Dr. Tara: For me, it’s always like they actively answer problems. Anytime we’ve run into issues, because our values have evolved over the years as well. What they started [00:51:00] with, some have remained basically the same, but they’ve evolved.

    We used to have a striving for multicultural and social justice competence, and then we collectively decided that it was more of a, I really like the alley, the way that you language yours, though, but it was like if this is pay to play as part of the profession, then would it make more sense for it to be? It was a long discussion on, should we keep this one?

    Dr. Sharp: That’s so interesting. We had the same process with that value. We were like, is this table stakes or is this actually a value that goes beyond what’s just expected in this field? I’m right with you.

    Dr. Tara: It’s a discussion. It was a hard decision. It was a hard discussion. Some of the value changes have been a result of people issues. And so it’s interesting to me also, we’re running into this people problem. We’ve done this values analysis. And [00:52:00] for me, that’s like, what are we missing in our core values that’s not addressing the thing that I’m seeing right here?

    Something’s happening. We have a hole; we have a gap somewhere. And so as they stand now, our values, I always think of it like paper mache in this balloon. They cover the entire space of the balloon, from my perspective, currently.

    When something else happens, they might evolve, but they’ve been pretty steady for, I’m going to say a year and a half or something. It hasn’t been a crazy amount of time, but it’s like, I don’t know, every quarter, we look at the values and we grapple with them and say, are these still it? Is this exactly what we want it to be? Is this who we are? Is this how we want to exist together? Is this how we want to engage and operate?

    The answer for a few quarters now has been, yeah, these are spot on, [00:53:00] and they have been. When we do values analysis for analyses or a values analysis for a person or values analyses for people, they get at everything we want them to get at.

    Dr. Sharp: Yeah. I like that you’re bringing that up. It is cool and it is an evolving process. I think that’s easy to forget sometimes. When we set values for our practice, it feels really exciting the first time around and affirming and oh, we’ve nailed it. This is what we’re all about.

    Dr. Tara: This is so great.

    Dr. Sharp: It’s so great. I’m guilty of this too. I like to land on things and then stick to them, but they do have to evolve when you run into situations over time; both positive and negative where there are teaching moments and there are affirming moments of what your values are.

    I’d like that we’re coming back to this. I feel like a lot of the culture does come from values because [00:54:00] values are reflection of beliefs, which drive behavior, which creates that intangible stuff that just percolates through your practice. That’s all the parts thing, and they provide an anchor for what you do then.

    Dr. Tara: Yes. They feel like the thing that’s easiest to say, like if you’re living this out, tell me how you’re living this out. If we see own your shit and someone comes to me and says, I messed this up, then it’s obvious. Thanks for telling me. Cool. How do we fix it? What do we need to do?

    That may or may not require me to be involved. That usually does not, at this point, which is great because I’ve people in place to help deal with some of the issues that come up, but without values, it’s like, how do you say what you want?

    [00:55:00] A value is subjective. Like you’re saying, I want this thing and it can look any number of ways, but when I can see something happen and I can say, oh, that’s evidence of this value being lived out, in my mind, it’s like that shifts to objectivity; that’s an objective point of data.

    And so when I go to do something like an annual review, or I’m asking somebody to reflect on their own how they’re living out the values, which is something I have people do, then they can make it objective. It’s like, oh damn, I am not really living this one out. I’m really not doing this.

    I’m definitely doing this one, here’s how and why. I think it makes it much more tangible for every single person. I’m just reiterating what you just said. So I agree with you. I agree with that. Thank you, Jeremy.

    There’s two more things too actually that I’m just thinking of. [00:56:00] Of course, The Culture Code, I already said this. I love Daniel Coyle. He might be the only person I’ve written fan mail to. I wrote him an email and he’s from St. Louis too, which is cool because I’m from St. Louis.

    Dr. Sharp: That was cool. That’s the only book, by the way, that I have listened to twice all the way through; full audio book two times through. It was so good.

    Dr. Tara: So good. I always think of Papa bitch. Oh my God, I think of the examples from that book, how Tylenol handled the arsenic.

    Dr. Sharp: Yeah.

    Dr. Tara: God, incredible with their manifesto or their creed or the credo, I think. So good. The bad apple experiment, the kindergarten experiment. All of his examples are incredible.

    I wrote up an email, I was like, I tried to read Start with Why by Simon Sinek and I was really bored. I was like, this is way better than Simon Sinek’s Start with Why for the record. He was like, thank you. Because I know it’s a really [00:57:00] popular book that I’m like, I’m bored reading that but this book is incredible.

    The other thing that I always think about with culture, it’s funny because it feels like it should be an indirect effect rather than something, gosh, I think how we engage with each other is our core values, how we feel about the entity is the culture code; vulnerability, belongingness, purpose.

    How people feel internally about their role, I always draw on Cal Newport. I love Cal Newport too from So Good They Can’t Ignore You. He writes about competence, autonomy, and relatedness being three necessary components for people feeling like they have a calling.

    And so I want to know how do people feel about the work that they’re doing? How do they feel about the practice vibe, meaning like the vulnerability, belongingness, [00:58:00] purpose? And then how do they feel about the way we engage with each other?

    And like all of those, they feel, I think about a bigger balloon and larger paper mache, core values is one nested balloon, then the largest one is all three of those things getting out. What is the big experience being here in your role with these people?

    And so I seek to figure out as much as possible, I want all of that information from people. With reviews, I’m asking all of these things. When I’m talking with them, I want to talk about all of these things because they’re all important for different reasons.

    I think that can feel overwhelming. As I’m saying it out loud, it’s like, that might feel like a lot, but if you front-load the work and once it’s there, it’s not. It gets baked into everything that you’re already doing.

    [00:59:00] Dr. Sharp: Right. I hear you. I want to validate or maybe make it okay or something for it to be a lot. This is the work, it’s not always hard, but it’s deliberate at least, to make all this happen and run a business on purpose and shape things in a certain way. It is deliberate.

    Dr. Tara: Yeah, that’s fair. On purpose. I like that. Yes, it is on purpose and intentional. No move. I get wild hairs all the time, but I have to check myself and use leadership now. Decisions aren’t just made on a whim.

    Sometimes they are, but primarily it’s like, how does this fit with the rest of the things?

    And maybe it’s a [01:00:00] mental exercise. I think there is some component or something to be said for. I wouldn’t say it’s exhausting. I think it can be tiresome whenever you’re struggling with something and you’re trying to figure out what’s happening, what’s going wrong or what’s going on to keep your finger on the pulse of things.

    I think maybe that can be exhausting sometimes depending on the type of, it just depends. This is where temperament plays a part too. My history is emotional caretaking. So for me, it’s like I’m naturally inclined to worry and care for the people around. I want to know, how are you? How are you doing? How do you feel? What’s wrong? What’s going on?

    And so my work has been reining it back. There is discomfort letting it happen for people and relying more on okay, I need to keep this closer to me because the rest is going to be like, if I’m pulled too much by the people around me, it’s [01:01:00] depleting. I feel like it’s never enough.

    And so for somebody who’s tendency might be more avoidance, it might need to be like you need to lean into the people around you a little bit more versus someone like me, I needed to pull back a little, but always there does need to be attention paid to the people who are part of what you are trying to create and build.

    Dr. Sharp: Well said. That might be a good place to wrap up. I feel like we could talk about this stuff forever. This has been great. There’s so many threads that I did not pull on. I’m like, we could talk about that for an hour and this for an hour.

    This has been a lot of fun. I know you’ve got a lot going on. If people want to reach out, talk to you, do things with you, what does that look like?

    Dr. Tara: They can go to my website. It was a mess for a long time. It’s [01:02:00] finally a little bit cleaner and more in alignment with not necessarily how I show up but also what I’m seeking to do with consulting and in that area. So the website is taravossenkemper.com.

    There is a freebie resource called your last hiring process. So if you are on the website, there’s something called bonus and then free resources, and you can find that there. On the website, you also can book a discovery call with me. I stole that language from you. So thank you for letting me borrow and take it, Jeremy. I appreciate that.

    I’m just now telling you, so I hope you don’t care, but I did use that language. Discovery call is a 15-minute call to see if we wanted to work together ever, what it might look like, or who might be a better fit for you or if I could even help with whatever issue you might be having.

    I have a membership. [01:03:00] It’s focused on practice growth, but the emphasis is on the practice culture. So the membership is called the Practice Culture First Membership. I have a promo offer for your people listening who might be interested. There’s a 14-day free trial. I sent you a link. I don’t know if I could ask that be put in show notes or something.

    Dr. Sharp: Absolutely. We’ll put it all in the show notes.

    Dr. Tara: Sweet. So mostly my website, I think that would be the easiest place to seek me out, taravossenkemper.com.

    Dr. Sharp: Nice. That sounds good. All that stuff will be easy to access in the show notes for folks. I hope people reach out. It’s been fun.

    Dr. Tara: Yeah, I hope too.

    Dr. Sharp: Definitely. We have only interacted four or five times now.

    Dr. Tara: I think it’s two times. We click man. It’s only been three, I think. It’s our third time.

    Dr. Sharp: Yeah. [01:04:00] It’s pretty cool. You’re one of the most genuine, authentic people.

    Dr. Tara: It’s really nice.

    Dr. Sharp: I’ve interacted with, and that goes a long way. It’s instantly endearing.

    Dr. Tara: That’s so nice.

    Dr. Sharp: So thanks for sharing that with the audience and I think it came through here as well.

    Dr. Tara: And that is super validating because the practice values authentic and candid, boom, trying to live it out.

    Dr. Sharp: You’re doing it.

    Dr. Tara: Thank you. I appreciate that.

    Dr. Sharp: Thanks, Tara.

    Dr. Tara: Cool. Thanks.

    Dr. Sharp: All right, y’all. Thank you so much for tuning into this episode, always grateful to have you here. I hope that you take away some information that you can implement in your practice and in your life. Any resources that we mentioned during the episode will be listed in the show notes so make sure to check those out.

    If you like what you hear on the podcast, I would be so grateful if you left a review on iTunes or Spotify or wherever you listen to your [01:05:00] podcast.

    If you’re a practice owner or aspiring practice owner, I’d invite you to check out The Testing Psychologist mastermind groups. I have mastermind groups at every stage of practice development; beginner, intermediate and advanced. We have homework, we have accountability, we have support, we have resources. These groups are amazing. We do a lot of work and a lot of connecting.

    If that sounds interesting to you, you can check out the details at thetestingpsychologist.com/consulting. You can sign up for a pre-group phone call, we will chat and figure out if a group could be a good fit for you. Thanks so much.

    The information contained in this podcast [01:06:00] and on The Testing Psychologist website are intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric, or medical advice, diagnosis or treatment.

    Please note that no doctor-patient relationship is formed here and similarly, no supervisory or consultative relationship is formed between the host or guests of this podcast and listeners of this podcast. If you need the qualified advice of any mental health practitioner or medical provider, please seek one in your area. Similarly, if you need supervision on clinical matters, please find a supervisor with an expertise that fits your needs.

    Click here to listen instead!

  • 467. Beyond “Culture” w/ Dr. Tara Vossenkemper

    467. Beyond “Culture” w/ Dr. Tara Vossenkemper

    Would you rather read the transcript? Click here.

    “Culture” is such an important part of running a business, but the word itself is also getting a little overplayed and has almost become a cliche at this point. That’s why I’m so grateful to have Dr. Tara Vossenkemper here to dig deep into the idea of culture – what it is, how we define it in a mental health practice, how we create it, and how we nurture it. Whether you’re running a small practice or a larger one, there’s a ton of good info to take from this episode!

    Cool Things Mentioned

    Featured Resources

    I am honored to partner with two AMAZING companies to help improve your testing practice!

    PAR is a long time supporter of the Testing Psychologist podcast, and I will continue to bring you featured items from their catalog! Listen to each episode for specific product recommendations and links. Learn more at www.parinc.com.

    TherapyNotes is the leading EHR system for mental health practitioners. I’ve used TherapyNotes for over 10 years, and it just keeps getting better. Use this link and the promo code “testing” to get two free months and try it for yourself! www.therapynotes.com/testing

    The Testing Psychologist podcast is approved for CEU’s!

    I’ve partnered with At Health to offer CE credits for podcast episodes! Visit this link to access current and past episodes available for CE credit. You can use code “TTP10” for a discount on ALL the course credits you purchase from At Health!

    About Dr. Tara Vossenkemper

    Dr. Tara Vossenkemper is a consultant and practice owner who helps group practices thrive. She brings 10 years of experience and a refreshingly direct approach to tackling challenges like toxic hires and team burnout. Dr. Vossenkemper empowers leaders to build people-first businesses with strong cultures that prioritize both well-being and success.

    Get in Touch

    About Dr. Jeremy Sharp

    I’m a licensed psychologist and Clinical Director at the Colorado Center for Assessment & Counseling, a private practice that I founded in 2009 and have grown to over 20 clinicians. I earned my undergraduate degree in Experimental Psychology from the University of South Carolina before getting my Master’s and PhD in Counseling Psychology from Colorado State University. These days, I specialize in psychological and neuropsychological evaluation with kids and adolescents.

    As the host of the Testing Psychologist Podcast, I provide private practice consulting for psychologists and other mental health professionals who want to start or grow psychological testing services in their practices. I live in Fort Collins, Colorado with my wife (also a therapist) and two young kids.

    Ready to grow your testing services? Click below to schedule a complimentary 30-minute pre-consulting call!

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  • 466 transcript.

    [00:00:00] Dr. Sharp: Hello everyone and welcome to The Testing Psychologist podcast. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.

    Many of y’all know that I have been using TherapyNotes as our practice EHR for over 10 years now. I’ve looked at others and I keep coming back to TherapyNotes because they do it all. If you’re interested in an EHR for your practice, you can get two free months of TherapyNotes by going to thetestingpsychologist.com/therapynotes and enter the code “testing”.

    This podcast is brought to you in part by PAR.

    Hey, guess what y’all, the BRIEF-A has been updated. The BRIEF2A is the latest update to the BRIEF2 family. Use the gold standard in executive functioning assessment to assess adult clients. You can preorder it now, visit parinc.com/products/brief2a.

    Hello everyone and welcome back to The Testing [00:01:00] Psychologist. I am excited to be here with you to be talking about a topic that feels like we have needed to cover for a long time. Today, we’re talking about neurodivergent-affirming assessment with Dr. Matt Zakreski.

    Matt has a high-energy, creative clinical psychologist and professional speaker who utilizes an eclectic approach to meet the specific needs of the neurodivergent community. He is proud to serve the Gifted community as a consultant, a professor, an author, and a researcher. He has spoken hundreds of times all over the world about supporting neurodivergent kids.

    Dr. Zakreski is a member of Supporting the Emotional Needs of the Gifted, the National Association for Gifted Children, the New Jersey Association for Gifted Children, and Pennsylvania Association for Gifted Education. Matt graduated from Widener University’s Institute for Graduate Clinical Psychology in 2016. He is the co-founder of The Neurodiversity Collective.

    This is [00:02:00] a really cool interview. Matt, I think you will see pretty quickly, is a very humble, very kind individual, easy to chat with, and we get into a number of areas related to neurodiversity-affirming assessment.

    We start with some definitions around what is neurodivergent and what does it mean to be neurodivergent-affirming, we talk some statistics about neurodivergence in our country, and then we get into some specific tips around neurodivergent-affirming assessment practices. We talk about strategies for your website, for the scheduling process and paperwork, for financial communication, interviewing questions, the testing process and the report-writing process. So we cover a lot of bases here and I think there’s a lot to take away from this podcast.

    If you are a practice owner and you would like some support in running your practice, my mastermind groups are [00:03:00] full until January of 2025, but I have two spots open for individual consulting, either via strategy session, which is a one off hour or more ongoing one on one relationship. You can get more information and schedule a call to chat about it at thetestingpsychologist.com/consulting.

    Let’s get to my conversation with Dr. Matt Zakreski.

    Matt, hey, welcome to the podcast.

    Dr. Matt: Thanks so much for having me.

    Dr. Sharp: I am very glad to have you. I feel like I say this more and more often, which is an indicator of something. I don’t know what, but I can’t believe that we have gone this many episodes without talking explicitly about neurodiversity-affirming [00:04:00] assessment.

    It is such a hot topic that maybe will stay hot, maybe should not even be called hot because it’s part of the deal, we should be talking about it all the time, but it’s super important over the last few years and there’s a lot of energy behind this particular topic. So all that to say, thank you for being here. I’m really excited for our conversation.

    Dr. Matt: That makes two of us. It really is a fascinating thing for me because people are like, are you just jumping on the hot new trend? I sit there, I’m like, I don’t know, am I? To me, this is what I live, this is the way I see the world.

    To me, it’s like a restaurant, you want to be the hot new restaurant for a while but then you want to [00:05:00] be the restaurant people go to. You move to that, like it’s part of the fabric of the community. I want in a few years, 5 years, 10 years, that we consider the needs of neurodivergent kids like we would consider the needs of handicapped kids or kids with food allergies.

    We’re more or less the same age; do you remember growing up, the kids with the nut allergies were, you wrapped them in a bubble. They were like, from the bubble feeling, what if the kid’s going to die? Now there’s the gluten-free table, the veggie table, the nut-free table. It’s part of the zeitgeist now. Knock wood, that’s what I would love to see my kids be in a few years.

    Dr. Sharp: That’s fair. I think it’s getting more and more integrated into the fabric of school, work and media and so forth. I’m looking forward to diving into each of those areas and figuring out how we can do the best job as psychologists and [00:06:00] neuropsychologists as we can.

    I’ll start with the question that’s always the top of the podcast, which is, why is this important? Of all the things that you could spend your life, energy, emotions on, why this?

    Dr. Matt: The biggest thing for me is that I grew up as a gifted kid in New Jersey in the 90s. I’m from a small town with really good public schools. They had no idea what to do with me. I find it funny to no end that you get this thing where that’s why you moved to the town with a good public schools and I didn’t get a lot of those services.

    They cobbled something together and then fast forward a few years, it’s high school. I’m getting [00:07:00] up to my eyeballs in high school work. At that point, they’re like, you’re really struggling more than we thought. Let’s make sure we’re not missing anything. Let’s assess you for ADHD. I basically broke the scale. I was a twice-exceptional kid all along, but I was so smart and capable that no one ever looked for those things.

    Here I am now as an adult who specialize in working with kids like this, trying to make sure that I’m the adult for those kids that I needed growing up. I think like a lot of people in this field, this work is personal and professional.

    The more I get at playing these spaces, the more I get to remind myself, it’s like right, that there are really good reasons to do this. There are kids who really need me out there. It’s an honor to get to work with kids like that.

    Dr. Sharp: For sure. That’s [00:08:00] such a cool way to think of it. It’s funny, it sounds like we had somewhat parallel lives, different situate. I grew up as a gifted kid in a very small town in West Virginia. We did not have good public schools.

    What that meant back then, if you were gifted, is that you got bust to some other not-so-great school and you got to play Oregon Trail all day on the computer because there was only one computer in the district, and so of course, I loved it. But looking back, I’m thinking, maybe that was not the most enriching environment.

    Dr. Matt: How much did that actually help me?

    Dr. Sharp: Sure. We played Oregon Trail and did a bunch of those little logic puzzles with the matrix; if so and so has to get across the river in two step, that kind of thing, but their hat is yellow and they can’t be with somebody else with a red hat, anyway, that kind of thing. Lots of those games. Like many people, the personal motivates our work. It sounds like [00:09:00] you’re in that camp as well.

    Let’s jump into it. There’s a lot to talk about here. I’ll start with some background maybe just to set the stage. I know there’s a lot of varying definitions and operationalization of neurodivergent out there, but I’d love to start with your definition of neurodivergent. What is that? And then we can move to more of a definition of neurodivergent-affirming. How about that?

    Dr. Matt: Neurodivergent is a person who has a quantifiably different brain. So a person with a quantifiably different brain, as we can look at brain scans and we see that brain has functional and structural differences that make it different than a neurotypical brain; a brain that largely functions as we would expect a brain to function.

    Around 80% of people are neurotypical. That number is both lower and higher than you’d [00:10:00] expect, because it feels like everybody we see is somehow neurodivergent. They have a different brain because that’s why they’re ending up in our spaces, because we’re the translators. We get them from the neurodivergent world to how do you use that stuff to navigate the neurotypical world?

    When I say there’s not many people, it’s like, wait, so like one out of five kids is neurodivergent? I’m like, right. So in your classroom of 25 3rd graders, you’ve got probably four to six kids who are neurodivergent in some way. That’s not all gifted, which is certainly my subspecialty, but it is the idea of ADHD, dyslexia, autism, OCD when we combine those things, we’re looking at about 1:5 kids.

    I always start my definitions with the neuroscience because you still see people out there who are like ADHD, [00:11:00] isn’t that too much sugar? I hear autism and that’s just bad parenting. Dyslexia, those kids just aren’t trying hard enough, you hear those well-worn chestnuts.

    So I’m like, these are brain things. I could point to a brain scan and say, this is a dyslexia brain, this is a gifted brain because it gives us that counter narrative to the idea that this is the kid’s fault somehow, rather than this flows from a literal brain difference.

    Dr. Sharp: Yeah, that’s fair. I want to dig into that just a little bit because you mentioned OCD. That was interesting. That grabbed my attention. I feel like there’s some discussion around whether or not emotional concerns, we’ll just say emotional concerns, get lumped into neurodivergence.

    I’m not sure if you split OCD [00:12:00] off from anxiety and depression or even PTSD. I’ve seen that lumped in. How broad does the umbrella get as far as your concern and in terms of a quantifiably different brain?

    Dr. Matt: I put OCD in there because the recent studies out of, Penn State did a study on this, I believe it was Vanderbilt. They found the basal ganglia, which is a reward circuit in the middle of our brain is quantifiably different in OCD kids, so it really is a brain difference.

    Obviously, OCD shows up in all sorts of different ways. I think OCD has not been as readily looped into the neurodivergent spaces, especially with kids in school, because OCD doesn’t necessarily impact learning in the same way that ADHD, autism, dyslexia, giftedness [00:13:00] do.

    I see that kids who have that perfectionistic morality driven, you see a lot of that co-occurring with autism and giftedness. I list it because it becomes to me more of a social emotional neurodivergence in addition to its impacts on how we navigate the world.

    When I would say depression, anxiety disorders, panic attacks, to me, that’s mental illness. It’s a different category and those things can be related to neurodivergences. In fact, they usually flow from that neurodivergence. I’m depressed because I have ADHD and I can’t figure out how to survive in this world.

    What we’re really looking at here is functional brain differences that flow [00:14:00] downhill into behavioral and emotional changes, something like PTSD to your point. That’s what we would call an acquired neurodivergence. So a lot of this stuff is neurodevelopmental; the brain changes based on its developmental trajectories, but concussions, TBI, long COVID, these things are all acquired neurodivergences.

    I’ve had four concussions, and neurologist who yells at me all the time for stuff like that. She’s like yo, you specialize with people with different brains. She’s like, your brain’s been different quite a bit. I’m like, yes, it has but thankfully all of those concussions have healed and my brain has returned to its typical neurodivergence.

    Dr. Sharp: Sure. Baseline neurodivergence.

    Dr. Matt: Just the normal ways that I’m weird, right?

    Dr. Sharp: Fair enough. Let me throw one more thing in there just to get your thoughts at [00:15:00] the risk of stirring up a whole bunch of trouble, but asking these questions is important. I’ve also seen gender identity, gender diversity, that kind of thing lumped in with neurodivergence. I’m curious how you approach that as well.

    Dr. Matt: I love that you asked that question because we have to be willing and able to have these conversations. What we know is that there is a significant overlap within the LGBTQ community and the neurodivergent community. The number that gets cited all the time is somewhere between 38 and 70%. That’s a lot of people. That is somewhere around, if we split the difference, we call it half.

    When I think about my clients, I see primarily neurodivergent people, I have a highly LGBTQ group that I see. It’s not always the [00:16:00] presenting concern. It’s not always the thing, but it’s part of that conceptualization. What does that mean? Gosh, I wish I could tell you.

    Our awareness of these brain differences is in many ways in its infancy, we are just learning how to do this stuff. I’ve heard a lot of different theories thrown around the campfire, I think they’re interesting. They’re worth further study. I don’t have access to a research lab, so I can’t do that work anymore.

    What I would say is, it definitely has something to do with neurodivergence, but we don’t have enough information to draw any meaningful conclusions on it yet. I would say that it’s a correlation, not a causation at this point.

    Dr. Sharp: Yeah, that’s reasonable. I look forward to digging in [00:17:00] and getting some of the research. I know it’s out there. I know people are doing it. I just want to see more of it. Let’s talk about neurodivergent-affirming, how would you define that?

    Dr. Matt: Let’s use a metaphor here. Let’s say that everybody in your life is about 6 feet tall. They’re about average height for an American male. Jeremy, how tall are you?

    Dr. Sharp: I’m 6 feet tall.

    Dr. Matt: I am also 6 feet tall, so we are typical in this particular iteration of things. If you’ve got a person in your life who’s 6 foot 10, that is a person who is quantifiably different. They are in some sort of higher percentile of human height.

    That height isn’t better or worse [00:18:00] than anything else, they’re just taller. They might be better at basketball, they might be able to get that thing off the top shelf in the garage and we’re very excited about that, but it’s not meaningfully superior. I think it’s important to push back against that narrative.

    So if I was going to build a home for that person, I wouldn’t assume that the person I’m building this home for is about six-foot-tall, so I’d make my door frames about 7 feet tall; because that’s your standard American doorframe height.

    If I ask the question of my client, hey, how tall are you as I build your house? And they say I’m 6 feet 10 inches, I’m going to build those doors bigger because I want to affirm that person’s way of seeing the world, and that’s really challenging to do because you have to do a lot of things differently than how the world is set up.

    The world is set [00:19:00] up to teach and serve the middle of people where most people are. My favorite exercise to do on this is, if you’re having a dinner party, Jeremy, what would you cook for your dinner party?

    Dr. Sharp: Ooh, I personally, I don’t eat a lot of meat, if any. I am always saying 90% vegan and so I’d lean in that direction and probably do more of a plant-based meal.

    Dr. Matt: Love it. We’re going to invert this because I usually do it the other way, but it’s your home, you’re cooking a plant-based meal for us. Let’s say I’m coming and I’m like, Jeremy, man, I would love to get down with those impossible burgers. I just can’t brother. It gives me the heebie-jeebies. Do you think you can build a piece of chicken on the grill for me or an egg or some other thing?

    We find a way, and you’re going to build the thing [00:20:00] you’re doing around what you are most comfortable with, what serves the most people. School, work and society is built on that same idea as it should be. We cannot hyperspecify for every single person who walks through our door, but we also have to be willing to specify when those people walk through our door.

    So if I’m throwing a dinner party as a proud mediator, I’m going to probably grill up a bunch of chicken, but if I know you’re coming, I’m going to make sure you have an impossible burger, gluten-free bun, whatever the heck you need. I’ll even let you sit at our table and eat.

    Dr. Sharp: Oh, my gosh. You are so gracious.

    Dr. Matt: It is inefficient to plan a million different individual plans, so we’re allowed to plan for the middle as long as we’ve built in the flexibility to adapt when a unique case walks through our door. And so that, to [00:21:00] me, is what neurodivergent-affirming is all about.

    Dr. Sharp: That’s fair. I think both of those examples, my veganism notwithstanding, it gets at this idea that I’ve heard it described as just the idea that we’re acknowledging that the vast majority of circumstances, places, environments, processes in our U.S. culture are geared toward the middle and neurodivergent folks is not that there is anything “wrong” or anything like that by any means, it’s just a mismatch between how their brains work and the environment that exists in the majority of our culture and the majority of spaces, much like the 610 individual, they’re going to have a hard time in most cars.

    Dr. Matt: And there’s this idea here [00:22:00] that is a fundamental tenant of the neurodiversity movement is that differences aren’t deficits.

    Dr. Sharp: Yes.

    Dr. Matt: We tend to see people through the lens of this idea that, why are you different? Why is this harder? I don’t know a single person on this planet who would choose to have ADHD. It has some real strengths, but it makes a lot of things a lot harder. All the parents out there who are trying to push their kids into the gifted program; giftedness as a neurodivergence comes with a lot of downsides in addition to its incredible strengths.

    I do a whole talk about pushing back on the myths of being gifted and my favorite one to say is oh, you’re so lucky you have a gifted kid, and every parent in that room bursts out laughing, and they’re like, oh my God, if only they knew. I’m like, exactly, if only they knew. It isn’t some [00:23:00] greased skid path straight to Harvard, it’s a psychoeducational emotional struggle.

    Dr. Sharp: It’s interesting that you say that. I want to go back to the thing you said about nobody would choose to have ADHD and yet, I think there’s a lot of discussion and experience in my community, which is neuropsychologists and psychologists doing testing, it seems like a lot of folks, kids, adolescents and adults want to be identified as neurodivergent in some way. Can you speak to that at all? Does that match what you’re seeing, if not, how do we navigate that?

    Dr. Matt: The culture shift is real around this. The conversations we’re having about this are, it’s out in the open now. It’s not this secret thing like, [00:24:00] hi, don’t tell anybody, right now, kids are on TikTok, this is my favorite ADHD content creator. As a member of that community, I’m like, yes, oh, it’s so cool that this thing is out there now. That makes me very happy.

    I tend to be of the mindset that, if I’m going to miss, I want to miss by overincluding people, not overexcluding people. So if there are a few kids out there who think they have ADHD who don’t, they’re still going to benefit from the structures and systems we would use to support ADHD learners like emailing homework home. That’s just a good idea. Sending reminders to that kid, that’s just a good idea.

    The structures that we can put into support neurodivergent kids [00:25:00] remind us that the best practices in special education are just the best practices, full stop. Everyone benefits; so what do we have to lose? The only thing I would be worried about would be having a kid who’s on medication, who doesn’t need to be, that’s why we’re having a medical professional look at that to make sure we’re not missing that side of things.

    Dr. Sharp: Of course. I do worry about the overpathologizing but that assumes that you’re giving diagnoses that don’t necessarily fit and you’re right, that a lot of interventions that we talk about are just helpful for people independent of diagnosis, right?

    Dr. Matt: Yeah.

    Dr. Sharp: And that’s fair. That’s a great point. [00:26:00] Before we leave that topic, I would love to hear how you approach the most of situations. I’m guessing you’ve run into situations where folks come in, kids or adolescents, and they are maybe overidentified with some diagnosis or neurodivergence, and you maybe have to have a conversation around, I don’t think this is really what’s happening for you, but maybe it’s something different. How do you approach those conversations when they come up?

    Dr. Matt: I think it’s helpful to ground these conversations in what I like to call the big three: frequency, intensity and duration. Everybody has moments where they’re down in the dumps; how often is that happening? How intense are those feelings and how long do they last? Because there’s difference between I’m in a funk for a few days and I’m clinically depressed.

    Everybody, especially kids who are growing up and their brains are [00:27:00] rapidly changing, have moments of executive dysfunction. It’s not uncommon to forget what your mom asked you to buy you at the store or to forget to clean your room or to lose your car keys. Basically, all humans do that, but how often does that happen? How intense is the forgetting and how long do those things last?

    To me, the biggest marker of true ADHD is the emotional stuff that, I didn’t feel like they told me about that growing up, ADHD is very much as this executive functioning, you can’t find the things, you’re spacing out, you can’t keep your focus, it was very performance-based.

    Russell Barkley’s team at University of South Carolina to Lawrence Fung and his team at Stanford, where these researchers show one of the biggest [00:28:00] symptomologies of ADHD is the emotional side; the rejection, sensitivity, dysphoria, the impulse of anger.

    That’s the stuff that when I probe these questions with these kids, I’m like, sometimes you forget things and sometimes you lose things, that’s okay. We’re moving along the diagnostic trail. Tell me, do you ever have this emotional symptom?

    And that’s so local, oh, gosh, no, that doesn’t happen to me. That doesn’t mean they do or don’t have ADHD, but it means that we are approaching these questions from a place of diagnostic nuance that, and no insult to TikTok here, that TikTok just can’t handle. We’re always going to have a job, but it’s cool that these kids are driving these questions now.

    Dr. Sharp: I agree. Ultimately, a lot of folks demonize TikTok. I don’t love it by any means. I think the research is [00:29:00] showing, as far as we can tell, fully 50% of mental health information on TikTok is incorrect is what I’m saying.

    It’s not great, but I do like that it’s increased the awareness of mental health and maybe decreased the stigma and ultimately leading more people to our offices, hopefully, so that we can work with them on affirming accurate way.

    Dr. Matt: I like to call that phenomenon fence posting. Instead of having to start my client from scratch, I can take the information as a fence post and lead that fence in a different direction.

    I had a kid say to me the other day, it’s like, I’m pretty sure I’m autistic because both of my parents are in IT. Okay, so there’s a common perception out there that a lot of IT professionals are autistic. This kid who was very neurodivergent was like, am I autistic because of [00:30:00] this?

    I’m like dude, it may not be that simple. Your parents both have neurotypes and that genetic thing made you, let’s explore those questions, but once again, correlation not causation. I’ve got autistic adults in the restaurant industry, in law enforcement, in architecture, in child care, in education and in mental health so it’s not a directionality thing, it’s a, are these things co-occurring.

    But now I don’t have to start that conversation at zero, I can take what my client knows and gently direct them to a more factual place, which is perhaps […] psychology thing I’ve ever said, oh, that was a very […].

    Dr. Sharp: That was really good. I like the term fence posting too. I’m going to take that and work it into many conversations. Let’s talk about [00:31:00] the actual concrete tip strategies. People love that stuff. You specialize in this; neurodiversity-affirming practice.

    There are several aspects of the client experience that we could touch on that we may not be thinking about. So maybe we start with a website. You brought that up as a place that we could be more affirming. So let’s start there.

    Dr. Matt: So one of the things that we unwittingly do is we all end up doing things that are more ableist than we mean them to. There’s a difference between intention and impact here. We may not intend to be ableist but the impact of our actions, if it’s ableist, is that we’re still excluding people. So both of those things [00:32:00] can be true.

    The reason I started the conversation there is, is your website designed for people of different ability levels and neurotypes to navigate? I have a call, she and I were just talking about this. Her website is gorgeous. It’s like a Pinterest board come to life. It’s amazing but all the links are hidden in the flowers and stuff that are on this beautiful website.

    I was like, hey, as a person who loves beauty and design; top-notch, as a neurodivergent-affirming person; you’re missing the mark here because if I’m ADHDer, I’m looking at your website and I don’t see that link, here’s how to book, I’m going to navigate to the next page. I’m confused and lost.

    [00:33:00] What I’m seeing a lot of people do now is having a plain text version of their website that you can click to, that strips out all the pretty stuff that makes us stand out from the other therapists to like, book me, my rates, here’s my Calendly, go. It’s like there you go.

    That’s helpful to people who are overwhelmed by visual stimuli or people perhaps who have some visual impairments who just need to stripped out all the noise and just the facts, mam. Those are little ways we can be neurodivergent-affirming.

    We also want to allow our clients to give us their backstories in multiple different ways; maybe it’s an intake Google form you just fill out; a lot of people can do that. My colleague, Gordon Smith, he’s an amazing therapist for the neurodivergent [00:34:00] community. He allows people to just do a voice memo, just click record and just vomit the information to him.

    Then he sends that through an Otter, the Otter does voice to text, he gets the same content but it’s a little bit easier for people to do that. I don’t know about you; I hate filling out forms online. I find it very great.

    Dr. Sharp: It sucks.

    Dr. Matt: I’m seeing people use more click down menus like this or this; you’re lowering the barrier to entry by having multiple ways in. I think that helps everybody do better.

    Dr. Sharp: Yeah. I really like that, to think about that voice memo idea. And to your point from earlier, you’ve said the special education recommendations are good for everybody; I think that’s true for website design too. Your website should be [00:35:00] simple, easy to navigate, big buttons, clear calls to action and that kind of thing. That’s going to benefit everyone not just neurodivergent folks.

    Dr. Matt: That idea, that the best practices in neurodivergent people are just the best practices. Have you ever seen that cartoon, it floats around the internet where you’ve got, it’s like a wintry day and all the kids are waiting to climb into the school, the janitor is shuffling the stairs and the kid in the wheelchair is saying, hey, can you shovel my ramp? The guy’s like, as soon as I’m finished with the stairs, son. Well, if you shovel the ramp, everybody can get in. Is it that’s simple, because maybe it’s just that simple.

    Dr. Sharp: I’m mind blown, what? It’s so true, we get wrapped up in all these [00:36:00] nuances and “unique” accommodations, but it really, most of the time just works for everyone and it’s just fine.

    So started with website, you dipped into the scheduling process and onboarding process. Are there other ideas there to be more affirming?

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    Let’s get back to the podcast.

    Dr. Matt: This is the thing that I struggle with a lot, I would ask you here if you feel comfortable sharing, what’s your cancellation no-show policy?

    Dr. Sharp: Pretty standard, for testing, it’s 48 hours. We ask people to cancel 48 hours before the appointment or we charge the fee.

    Dr. Matt: That’s very similar to mine. I sometimes go back and forth on this because I do think structure and accountability are good tools for the neurodivergent community, we need to give them those things. Also, there’s something that just feels fundamentally icky about taking people who have trouble with [00:39:00] scheduling and time management, and punishing them financially for not attending a thing.

    It’s like, who is this balance. It’s different because I do more therapy so it’s the hourly block that’s easier to risk. This cracks me up, I’ll tell my kids, I’m like, if you missed the appointment, if you can reschedule with me this week, I will charge you.

    Dr. Sharp: That’s cool. We do the same thing; if you can reschedule within the same week, we’re happy to do that.

    Dr. Matt: It’s become a much more affirming practice for me. Yes, our time has value and I don’t love charging people when I’m not seeing them, also, I do need to keep my lights on; it is a business.

    [00:40:00] We use TherapyNotes for our EMR and there is every reminder short of skywriting. It’s been like email, text alert, go on your Google Calendar and I still have people forget, but at least I know I have covered my bases.

    I found booking this website with you very neurodivergent-affirming, you send me a lot of reminders. So I’m up, there’s the thing, and it’s on my calendar, and I got a reminder yesterday, I got a reminder today, so I’m not going to miss this session. Sometimes you book a podcast and they’re like, cool, I’ll see you in November, and it’s just crickets. Are you still alive?

    Dr. Sharp: That’s a good point. I go back and forth on the reminders. Honestly, I’m like, is this too much? Is this overkill? I’ve never been annoyed myself by too many [00:41:00] reminders.

    It’s always good because it goes the other direction too, you were alluding to with the podcast. It also makes sure that whoever you’re scheduling with has it on their calendar; you didn’t misunderstand or mishear, write it down wrong. So it goes both directions. I think it keeps both people accountable.

    Dr. Matt: Absolutely.

    Dr. Sharp: What do you think about self-scheduling? I know this might be a little bit different for therapy versus testing, but there are a lot of testing folks out there that will experiment with self-scheduling. How does that fall on the spectrum of affirming?

    Dr. Matt: When I worked in a group practice, when I was getting my hours for licensure, we had self-scheduling through that website. Largely, it was a good thing. I pushed for [00:42:00] a way to schedule the clients for them because I found that sometimes you do a session and you’re like, great, I’ll see you next week. And like cool, and then they leave, the thought immediately goes out of their head.

    But hey, listen, I’ll just put that on the schedule for you right now, click, click, boom, which is what I can do in TherapyNotes; that’s easy.

    Dr. Sharp: Yes.

    Dr. Matt: I only had one guy ever misuse it. He booked himself seven times in a week for me. A very hypomanic guy with a history of compulsive therapy use and hoarding behavior. It was the kind of case you want to talk about in graduate school, like oh, this fascinating case, but in terms of like, that’s a lot of that.

    So I called him, I’m like, listen, I can’t see you 7 times. He said, but you had availability. I did, that’s true. [00:43:00] I have many other clients who haven’t scheduled yet. He’s like, it’s not my problem. So that balance is…

    I would love nothing more than to send all of my clients to a secure website and say, hey, definitely want to see you next week, here’s my availability, fill it in; because then that puts the client in the driver’s seat and has you and I do more of the clinical work using our actual skill rather than spending a lot of time confirming and reconfirming appointments with families, which is just a lot of drudgery. I’ve not found a solution I like yet, but I would be absolutely to one should it present itself.

    Dr. Sharp: That’s fair. I think I’m in the same boat. What about paperwork? Anything that we need to consider with our paperwork? Your face says yes. I can’t wait.

    Dr. Matt: I sat on a panel [00:44:00] last year at a conference where we had the conversation about is not taking insurance neurodivergent-affirming.

    Dr. Sharp: Oh, wow. Okay.

    Dr. Matt: Fascinating panel. People got very passionate about it. Like a true mental health professional, I talked out of both sides of my mouth. I’m like, here’s the good stuff, but here’s also the bad stuff. A lot less paperwork, a lot less oversight, a lot less stuff you got to do.

    We create super bills, I send them to your insurance company, it’s easy for me to sign up as a non-network provider. So they know I exist. I think I’m not networking like Aetna, Blue Cross, two other ones; that’s sure. I’ll do that for my clients.

    It also pushes us in a way that therapy and testing should not be for the 1%. If I’m asking someone to pay out-of-pocket to either full stop or to hopefully getting reimbursed at some [00:45:00] point, I am cutting the number of people I can serve in half.

    I think that paperwork thing is, I’m trying to get the most important information up front and use my EMR to fill in information as I go. That’s a cool feature in TherapyNotes where I can add in, oh, I just learned about their religion, or I just learned about their family history, or I didn’t know that they were arrested when they were 19 for drunk driving.

    I’m going to add that into the file now vs you’ve got to fill out this four-page packet of information in my waiting room, which you may not want to do. You may not feel comfortable doing. If you’re dysgraphic or dyslexic, you may not even be able to do so. I think that nimbleness, that flexibility is always going to be the name of the game there.

    Dr. Sharp: That’s reasonable. Let’s move to the [00:46:00] clinical process a little bit more. This is where it gets really interesting. I’d love to talk about strategies for client interaction, let’s say, interviewing or intake, how can we be more affirming in those practices?

    Dr. Matt: I think the biggest thing I have found, and it’s a thing I ended up having to say to parents a lot is you have to understand that this therapy isn’t always going to look like therapy. I cannot tell you how many sessions I’ve done with clients over the years like my nerdy neurodivergent kids where our therapy session per se is them talking about the Star Trek fan fiction they wrote, they’re showing me the link [00:47:00] on the website, and it’s absolutely a thing.

    So the parents were like, you didn’t get anything done today. You didn’t work on their ADHD today. It’s like, you’re not wrong, however, let me gently say that this kid trusts me more today. This is a kid who showed me their world and I opened that door and went with them.

    I went to Mordo with them. I didn’t just say, excuse me, we’re supposed to be on the path to Elden Wood. Sometimes, you’ve got to do things that are very atypical to get these kids to open up to you.

    A lot of times with neurodivergent people, you can’t walk through the front door. In an ideal therapy session, it’s like listen, we need to talk about your childhood. [00:48:00] Okay, but a lot of neurodivergent people have built a lot of walls and boundaries, so sometimes you got be willing to go through the side door, or you’ve got to be willing to address things in a more roundabout way, and trust yourself as a clinician to guide the train there, but also trust your client that when they’re comfortable, they will go there with you.

    Every so often when I see a neurotypical client, I’m reminded that therapy is never easy, but it can be much easier. With some people, it’s like, oh, you’re just here to talk about. Oh, great. By all means, tell me about your husband. I’m here for it. I put my hands behind my head and I kick my feet back and relax.

    You’ve got to be willing to get on the wavelength of the people you’re seeing, and that [00:49:00] means moving away a little bit from the therapist as God model and see the therapist a collaborator model. That’s hard for a lot of our colleagues. We got these fancy doctorates for a reason. We want to be the boss.

    Dr. Sharp: Right or be helpful. I think that’s where I personally get wrapped up. Back when I was doing more therapy is, if we got off the plan, so to speak, I would have these concerns about not being helpful. I’m like we’re not doing anything; we’re not being productive.

    Over time, I’ve let go of that as much as I can, but it just speaks to that point. It’s okay to do some joining and chatting about things that may not immediately be productive.

    Dr. Matt: And isn’t it fascinating to think about what does [00:50:00] productive mean for our clients? One of the many reasons I don’t take insurance is that I got really tired of an insurance company saying to me, you got 12 sessions to fix this kid’s OCD. So I have to get a lot done. I have to move quickly.

    This work, it’s an art and a science. Sometimes you got to do a session about the drama in middle school so your kid knows they’ll listen to you, or you talk about the Star Wars Build that they’re doing in their LEGO set in their basement. Those things are not by the manual; the classic CBT approach to OCD, but there has to be room for us to do stuff like that with our clients or we risk losing them and they fall out of therapy.

    One of my kids that I see, [00:51:00] she has an auditory processing disorder, she finds the telehealth with the video very overwhelming. So we talk on the phone more often than not, and when she’s having a bad sensory day, we text, we do our sessions via text. It’s a little inelegant, but it gets the job done. It’s meeting my client where she is and then doing what I can from that place.

    Dr. Sharp: That seems to be the theme here is flexibility, adaptability and being willing to go off script a little bit and do what the client needs. It seems like a no-brainer, but it’s harder to put into practice.

    Dr. Matt: Really should be a no-brainer.

    Dr. Sharp: Sure. Let’s talk about the testing process. I know you do primarily therapy, but also have a lot of experience with testing. Maybe I would lump the environment into [00:52:00] that area as well. Maybe we tackle that at this point.

    Dr. Matt: My mentor, Dr. Michael Cassano, he was the guy who taught me how to test kids. We didn’t use that language at the time, but very neurodivergent-affirming. He’s like, I used to work at a therapeutic school for kids in Maine, and a lot of times kids would be so full of energy, they couldn’t sit in my testing room, and we would just walk the track.

    He’s like, so I had every question for vocabulary and every question for similarities memorized because I could just recite those questions. He’s like, I knew enough that it was a 2.1 or 2.0 answer. You can’t do everything like that, of course, you need to get to see matrix reasoning to do matrix reasoning, but there’s a lot of them you can do playing to that kid’s [00:53:00] physical, emotional, sensory needs.

    If you read my reports, it’s like we conducted visual puzzles with the client under the table because the client said they were overwhelmed. So I was like, here’s the thing, tell me the answer, I’ll write it down and then flip the page.

    Is it what the manual says we should do? No, it isn’t, but the manual is built to serve typical kids and these are not typical kids. I’m not going to let the kids look at the answers, I’m not going to give a kid with auditory processing disorder more hints, you only need to choose between two answers, not five. That’s inappropriate but the structure of how we approach the testing process and to your point, the physical space, I think we have a lot of adaptability in that, and that’s really cool.

    [00:54:00] Dr. Sharp: Definitely. I’ve heard some really cool stuff, just internet, Facebook groups and that sort of thing about even like lighting in the waiting area, lighting in the testing area, not getting away from fluorescence, trying to do as much.

    Dr. Matt: That won’t work, I’m telling you it’s forever.

    Dr. Sharp: Yeah, little things like that; the magazines in the waiting space, the type of furniture that you’re looking at, even the color palette, that kind of thing. Having a testing room that is safe enough where kids can move around and furniture that will accommodate hanging upside down or feet up on the couch or whatever it may be, little things like that that make a big difference. I wonder if that matches your experience as well or if you have other thoughts.

    Dr. Matt: It absolutely does. [00:55:00] I’m thinking about a testing case I did once with a very anxious kid on the autism spectrum. He was really into law enforcement. He’s having a lot of trouble providing verbal answers to me, so I said, what do police officers do when they need to talk to each other? They talk on a walkie-talkie.

    I was like, I don’t have a walkie-talkie with me, but what if you give me all your answers; come back breaker. Come on this is a hot cop. He locked into that. So he gave me all of his answers via this invisible walkie-talkie.

    And then around halfway of the session, he was like, can I bring out my stuffy? So now he’s got the stuffy, sometimes the stuffy is giving me the answers and sometimes he’s talking on the microphone.

    If you’re going to work with an autistic person, I’m going to get the best version of that person through the things they need to do to survive [00:56:00] rather than saying, excuse me, in the testing process, you sit still in the chair, you can have no toys or fidgets or water, you’re going to sit there and you’re going to answer the freaking questions. There aren’t that many people who can do that.

    I’m sitting here doing this podcast with you, I’m having sips of my coffee because my day started very early this morning. If you were like, excuse me, we don’t have beverages during our podcast, then I would be less effective as your podcast guest.

    I think as long as it doesn’t detract from what we’re here to do, which is answering the questions and figuring out how this kid’s brain works, then I give my clients a wide swathe of what they’re able to do in those spaces, including just pacing around the room as long as they’re not looking at the answers over my shoulder.

    I have had a few kids try to do that. It’s like, oh, I’m just… Like when you were in middle school and you got up to [00:57:00] sharpen your pencil and you’re like, what have you got for number seven, -3, interesting. Not that I ever did that, of course.

    Dr. Sharp: Never, me neither. For sure. I love that idea. I feel like we do a lot of testing with kids and sometimes adults not sitting where they’re “supposed to sit”. There’s a lot of on the floor, moving around, walking, standing, jumping, all those things. That’s great.

    Let’s talk about the report. Are there neurodiversity-affirming writing styles or even text layouts or considerations with the report that we could keep in mind?

    Dr. Matt: What I usually do is do a feedback session with my client and give them a one pager with bullet points [00:58:00] that says, here are the things you need to know based on this report because there’s a lot of jargon, there’s a lot of unnecessary stuff that we … If I’m doing Doc to Doc, I know you need to know that these pieces of information.

    I’m basically saying here are the most important recommendations. Here’s the diagnosis. Here’s how I got there. Here are the strengths and weaknesses. Here’s how you talk about this to your HR representative, to your school principal, to your school psychologist.

    When I do the report itself, I usually make two versions. One, I’ll do my standard Times New Roman size 12 font, but there are special fonts that you can download as a macro for word that are more readable for the dyslexic community; start bold and [00:59:00] fade. What that does is it re-engages the optic cortex every time a word starts.

    Dyslexic people have found that it’s significantly easier for them to read. I might make the font size bigger and have one and a half spaces. So now there’s a little bit more visual space because what do I care if I’m just emailing a PDF copy, I’m not killing any trees this way. So I’m sending my client a copy that’s more readable to them.

    I think even asking that question to your clients; are you somebody who listens to podcasts at 1.5x speed? On your Kindle, what sizes are the words? Asking those questions tell our clients we care about who they are and what their neurodivergent experience is for them.

    [01:00:00] Asking those questions align us with what they might need. When we know what they might need, we’re more able to give it to them.

    Dr. Sharp: I love that. Where in this whole process are you asking those questions? Is it happening along the way? Is it at feedback?

    Dr. Matt: I try to remember to ask it in the onboarding process. When I finish the testing process and I do my feedback session, when I’ve created the port of there, is there anything I can do to make this report more accessible for you?

    I had a client tell me this because an open-ended question for somebody who doesn’t know what they need to know is potentially problematic because she’s like, give me a few more options. What is it? How can I make this more for you? I don’t know.

    Can you [01:01:00] come over to my house and do it in interpretive dance? Can you make it a graphic novel? You have Morgan Freeman narrate it? I don’t know. So I started talking about like fonting, spacing and stuff like that; making it more concrete.

    Dr. Sharp: That’s fair. I’m thinking about this right now, so I don’t have the answer, but are there different file formats that are easier to go text to speech? Is it Word better for that or a PDF or some other format I’m not thinking of, just little things like that?

    Dr. Matt: And I don’t know the answer to that, but that’s a thing we could absolutely figure out. And that’s the beauty of all this, because we get to learn and grow along with our clients. Like Maya Angelou always said, do as well as you can until you know better and then do better.

    Dr. Sharp: It’s a great way to put it. [01:02:00] I appreciate you saying that. Just to zoom back out a little bit, talking about this stuff can be pretty fraught for clinicians. It’s one of those areas where a lot of us are afraid of doing the wrong thing or making a misstep or saying something offensive or not doing something correctly.

    It’s a good reminder that having a perpetual learning mindset or growth mindset is really valuable and it’s okay to keep learning along the way. You don’t have to have it all figured out from the very beginning.

    Dr. Matt: I think that kind of intellectual humility plays very well with this population. My clients constantly ask me questions that constantly challenge me on stuff. Sometimes it’s like no, I do this for a reason, and here’s why; I can show my work and [01:03:00] justify my choices.

    Sometimes I hang up the call and go, damn, do I need to do this better? I can’t always fix those problems, but I can absolutely hear them out and think about where do I go from here?

    Dr. Sharp: I think that’s the best that we can do; that’s the best we can ask for. At least consider it, see what could be different and do our best.

    Dr. Matt: Absolutely.

    Dr. Sharp: We’ve talked about a lot of different things. As usual, there’s much more that we could talk about, but I appreciate this. It’s a broad perspective. We touched on a lot of different areas and topics that will be helpful for folks. If they do want to either reach out or learn more or get more information from you, what’s the best way to do that?

    Dr. Matt: I have two primary online presences. The first is our therapy practice, which is, [01:04:00] The Neurodiversity Collective. That’s myself and my colleagues. We see people from all over the country. You can’t really do testing virtually, but we can do therapy virtually. So as I say to people, if you think I can help you, you contact the Neurodiversity Collective.

    If you think I can help your organization, whether that’s a school or a college or a business or your community organization, then you contact drmattzakreski.com. That’s where I do my speaking, my consulting, my training. I try and keep those two businesses separate because it’s two different parts of what I do.

    Dr. Sharp: That makes sense. I do the same thing. I really appreciate it. Thanks for coming on. I know you do a lot of this stuff and I’m appreciative for your time and willingness to dive into a pretty important topic. Thanks for being here.

    Dr. Matt: You created the space. It’s so cool to be able to [01:05:00] talk doctor to doctor in this way and talk to another mental health professional who really understands this stuff. I feel like a lot of times, I’m talking to educators and parents, which is so important, but it’s really cool to get very high level and stay very high level. I think we both got to learn something from each other and I’m sure the audience will learn a lot from us too.

    Dr. Sharp: I totally agree and certainly hope so. Hope that maybe we’ll talk again soon.

    Dr. Matt: I would love that.

    Dr. Sharp: All right, y’all. Thank you so much for tuning into this episode. Always grateful to have you here. I hope that you take away some information that you can implement in your practice and in your life. Any resources that we mentioned during the episode will be listed in the show notes, so make sure to check those out.

    If you like what you hear on the podcast, I would be so grateful if you left a review on iTunes or Spotify or wherever you listen to your podcasts.

    If you’re a practice [01:06:00] owner or aspiring practice owner, I’d invite you to check out The Testing Psychologist mastermind groups. I have mastermind groups at every stage of practice development; beginner, intermediate and advanced. We have homework, we have accountability, we have support, we have resources. These groups are amazing. We do a lot of work and a lot of connecting. If that sounds interesting to you, you can check out the details at thetestingpsychologist.com/consulting. You can sign up for a pre-group phone call and we will chat and figure out if a group could be a good fit for you. Thanks so much.

    The information contained in this podcast and on The Testing Psychologist website are [01:07:00] intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric or medical advice, diagnosis, or treatment.

    Please note that no doctor-patient relationship is formed here, and similarly, no supervisory or consultative relationship is formed between the host or guests of this podcast and listeners of this podcast. If you need the qualified advice of any mental health practitioner or medical provider, please seek one in your area. Similarly, if you need supervision on clinical matters, please find a supervisor with expertise that fits your needs.

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  • 466. Neurodiversity-Affirming Assessment w/ Dr. Matt Zakreski

    466. Neurodiversity-Affirming Assessment w/ Dr. Matt Zakreski

    Would you rather read the transcript? Click here.

    In yet another installment of “Why haven’t we talked about this on the podcast yet??”, I have Dr. Matt Zakreski here to dive into neurodiversity-affirming assessment practices. Matt draws from years of experience and hundreds of speaking engagements on this topic during this conversation. Perhaps most importantly, he makes it okay to not have all the answers and to keep getting better in this area of practice. These are a few other topics that we tackle:

    • Definitions of neurodiversity and neurodiversity-affirming
    • Statistics on neurodiversity in our country right now
    • Testing-specific practices to be more affirming, all the way from website design to report-writing

    Cool Things Mentioned

    Featured Resource

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    PAR is a long-time supporter of the Testing Psychologist podcast, and I will continue to bring you featured items from their catalog! Listen to each episode for specific product recommendations and links. Learn more at www.parinc.com.

    TherapyNotes is the leading EHR system for mental health practitioners. I’ve used TherapyNotes for over 10 years, and it just keeps getting better. Use this link and the promo code “testing” to get two free months and try it for yourself! www.therapynotes.com/testing

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    About Dr. Matt Zakreski

    Matthew “Dr. Matt” Zakreski, PsyD is a high energy, creative clinical psychologist and professional speaker who utilizes an eclectic approach to meet the specific needs of his neurodivergent clients. He is proud to serve the Gifted community as a consultant, a professor, an author, and a researcher. He has spoken hundreds of times all over the world about supporting neurodivergent kids. Dr. Zakreski is a member of Supporting the Emotional Needs of the Gifted (SENG), the National Association for Gifted Children (NAGC), the New Jersey Association for Gifted Children (NJAGC), and Pennsylvania Association for Gifted Education (PAGE). Dr. Zakreski graduated from Widener University’s Institute for Graduate Clinical Psychology (IGCP) in 2016. He is the co-founder of The Neurodiversity Collective:

    Get in Touch

    About Dr. Jeremy Sharp

    I’m a licensed psychologist and Clinical Director at the Colorado Center for Assessment & Counseling, a private practice that I founded in 2009 and have grown to over 20 clinicians. I earned my undergraduate degree in Experimental Psychology from the University of South Carolina before getting my Master’s and PhD in Counseling Psychology from Colorado State University. These days, I specialize in psychological and neuropsychological evaluation with kids and adolescents.

    As the host of the Testing Psychologist Podcast, I provide private practice consulting for psychologists and other mental health professionals who want to start or grow psychological testing services in their practices. I live in Fort Collins, Colorado with my wife (also a therapist) and two young kids.

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  • 465 Transcript

    [00:00:00] Hello, everyone. Welcome to The Testing Psychologist podcast. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.

    Many of y’all know that I have been using TherapyNotes as our practice EHR for over 10 years now. I’ve looked at others and I just keep coming back to TherapyNotes because they do it all. If you’re interested in an EHR for your practice, you can get 2 free months of TherapyNotes by going to thetestingpsychologist.com/therapynotes and enter the code “testing”.

    This podcast is brought to you in part by PAR.

    Hey, guess what y’all, the BRIEFA has been updated. The BRIEF2A is the latest update to the BRIEF2 family. Use the gold standard in executive functioning assessment to assess adult clients. You can pre-order it now. Visit parinc.com/products/brief2a.

    Hey folks, welcome back to The [00:01:00] Testing Psychologist podcast. I’m excited to be here with you. Today is another somewhat unique episode because it is accompanied by a YouTube video. Today, I am doing an unboxing of the WAIS-5.

    As you know, the WAIS-5 has recently begun to ship and people are getting excited about it. So I would definitely encourage that you go check out the YouTube video for the full experience, but you can have the audio-only experience here if you would prefer that route.

    So listen in, I go over the basics of the WAIS-5, what’s new, what’s updated, and my first impressions as I look through all the materials and take everything out of the box, and actually think about using the test on a day-to-day basis.

    If you’re interested in the WAIS-5, you can go to the Pearson website and order the test. Q-Interactive will be out soon. In the meantime, enjoy this [00:02:00] unboxing podcast/YouTube video.

    Hello everyone. Welcome to a special episode of sorts of The Testing Psychologist. Today, as you can see, I am accompanied by this beautiful box that contains the WAIS-5. As we all know, anyone in the assessment world, this is a huge deal. The release of a brand new intelligence test, let alone a Wechsler Intelligence Test, is something that happens very infrequently.

    In our world, this is basically like the Super Bowl, a new Beyonce album, and Christmas all wrapped up into one event. So today I’m going to be doing an unboxing of the WAIS-5. [00:03:00] We’re going to check things out from an aesthetic perspective and a practical perspective. The hope is to give you a good idea of what to expect when your WAIS-5 kit arrives and what to do with it after that. Let’s get into it.

    Before I do, I want to make two quick notes. First note is that this is meant to be an unboxing video. I want to make sure and be clear that I have not administered the WAIS-5 to any actual clients yet, so this is purely a hands-on experience and a walkthrough of what’s in the kit and what you can expect as far as changes and updates to the WAIS-5.

    I’m sure there are plenty of reviews that are going to come out after folks have started to use it with clients and I look forward to those, but today is not the day for that particular style of review. Similarly, I am not going to get in the weeds on the psychometric properties [00:04:00] of the WAIS-5. I think there are plenty of folks out there who are much more qualified than I am to have that discussion. I will leave that to them.

    For our discussion today, I’m just going to go through what’s in the kit, some of the major updates, my experience so far just from walking through the materials and what I anticipate to be the pros and cons whenever we do start to administer with actual clients, but again, I’m not going to be getting super granular with the psychometrics and research and things like that.

    There’s plenty of information, both in the technical manual and again, from other folks who are way more involved with the project and skilled, frankly, at those kinds of discussions. All right, folks, let’s get to the actual unboxing here.

    As far as the literal box that the WAIS-5 comes in, you can see it’s pretty standard. It is a relatively sturdy box, or at least it seems to be. So if you are not planning to buy a [00:05:00] soft case or a hard sided case to keep the WAIS-5 in, you should probably be able to keep it on the shelf in this box for a fairly long period of time. I don’t think it’s going to be disintegrating after 2 months or anything like that but for long-term use, you’re definitely going to want to get a case for it.

    As far as the actual box and what comes in it, that’s the important part. As you could see when it was sitting upright, colors have changed just a little bit. Like I said, I’m paying attention to aesthetics, certainly. So a little bit of a darker blue, I’m a big fan of a dark navy blue. Glad to see this. They darken the color just a bit.

    The font is a little bit different on the script or the typeface for the WAIS-5 but beyond that, not a whole lot to speak of aesthetically, at least at this point, but let’s dig into it. [00:06:00] When you open your kit, my guess is it’s going to look very similar to this one. I repacked the kit exactly as it came to me so that we could have complete fidelity for this unboxing, plastic removal aside. So let’s get into this.

    Right off the bat, you’re going to notice a box that feels very familiar. The color of the box did change, or the color of the sticker on the box, and this caught my attention right away. I ran down the hall to one of my psychologists and said, don’t freak out but they changed the color of the sticker on the blocks box. So first thing that you notice there’s that dark navy looks good.

    Not going to open the box because test security just in case, but suffice it to say the blocks inside are the same color that we are all very used to. So set our blocks over there. We’ve got some more manipulatives coming in. We’ve got manipulatives [00:07:00] for the Spatial Addition subtest.

    I’ll talk about subtests in a bit, and the updates and changes to those subtests, but suffice it to say that we’ve got the manipulatives for Spatial Addition, this will sound familiar if you are familiar with the WMS but we’ve got the little circles; the discs, there are various colors in here.

    It seems like a relatively well-made plastic pouch. I’m sure like everything else, it will break in time, but you can see here, we’ve got our discs in their own individual bag and little pouch to snap shut. So that should keep these discs corralled, so they’re not going to be bouncing around or rolling away like some of the other materials you may have encountered.

    All right, let’s keep moving on. I’m going to jump over here to likely our best friend in this whole kit, the administration and scoring manual. I [00:08:00] have to say it was quite an experience to open a brand new admin and scoring manual and hear it creak as I opened it.

    The creak might be gone. That was maybe a first opening experience, but admin and scoring manual. It’s going to be very familiar to what we have encountered in the past with Wechsler tests. I’ll go into the subtests in a bit, but just want to say the manual itself, pretty standard, slight updates to the aesthetics and the design here, but nothing major.

    All right, we are going to keep moving. I’m going to grab this guy next, we got our technical interpretive manual. If y’all are like me, you maybe have not spent as much time with the technical and interpretive manuals as you should over the years, but I’ll tell you this, I did dive relatively deep into the technical and interpretive manual this time around just to familiarize myself with many of the items and [00:09:00] subtests and research and so forth.

    I would advise you to do the same. There’s a lot of good material in the technical manual as many of you know. If you are holding off or thought you might skip it, I would advise against that. Dive into the technical manual. It’s written pretty well. I think there’s maybe more of an effort to make it more readable and I don’t know if I go so far as to say enjoyable, but I did find it easier to read than some other technical manuals.

    All right, folks, what is next? Of course, we have our Stimulus books. My books are in reverse order so I will rearrange them a bit. We’ve got Stimulus Book 1; it’s got five of our subtests in there. They’re going to sound very familiar: Block Design, Matrix Reasoning, Vocabulary, Figure Weights, and Visual Puzzles.

    I’m not going to open these books, of course, test security, but I think we’ve all seen a Stimulus book. We know what these are for. Stimulus Book 2 is going to have [00:10:00] Arithmetic, Symbol Span, Naming Speed Quantity and Set Relations. We are moving on. We’ve got Stimulus Book 3, which has Spatial Addition, and that concludes our Stimulus books.

    What else do we have in here? Ah, yes, we can’t forget this. We all know we had an unsharpened pencil with no eraser is very important in the administration of many of these tests. Pearson was kind enough to send us an unsharpened pencil without an eraser. So make sure you have a pencil sharpener to turn that into a usable object.

    All right, let’s move on. We’ve got some record forms here. I’m going to talk about the record form in just a bit and some of the updates there, but for now, you can just take a gander at the record form. Again, I will say, this is not going to be a brand new material. For the most part, you are going to feel right at home [00:11:00] when you check out the record form for the WAIS-5.

    Same goes for the response booklets. We’ve got the response booklets. If anybody was concerned that your kit might not come with record forms or response booklets, don’t worry about that. You’re going to be in good shape. You could theoretically open this box and administer a WAIS-5 within 15 minutes or so, theoretically, I wouldn’t advise it as I will talk about in just a bit, but theoretically you could do that.

    And then last but not least, we have our scoring keys. So when you get your kit, if it is like mine, the scoring keys are actually separate. They are not all contained in this envelope, but I am not going to show them individually for test security sake but you can rest assured there are scoring keys for all the things that we might need; Coding, Symbol Search and Running Digits, which is a new subtest that we will talk about.

    [00:12:00] That’s it for the unboxing treatment of the WAIS-5. I hope you enjoyed this portion of the video. I’m going to clean this stuff up and we’ll be right back with you with more of a discussion about the updates and what to expect on a daily practical basis.

    Okay, everybody, we are back. We are cleaned up and ready to talk a little bit more about the updates and the changes that you’re going to see in theWAIS-5 but first, let’s talk about headlines; the big items that people are likely curious about.

    So release date, by the time you see this video, the WAIS-5 paper kits should be shipping. You can order them on Pearson’s website and they should ship out immediately and get there at whatever speed you choose with your shipping.

    Q-global scoring is also available. So you can manually score with the kit or you can use Q-global to enter the scores from the paper and pencil kit and get the digital report [00:13:00] through Q-global.

    I know people are very curious about Q-interactive, if you’re like us, we do a lot of Q-interactive administration here in our practice, and Q-interactive version of the WAIS-5 is going to be released on September 20th. That’s the plan right now. So by the time you see this video, we’re going to be very close to that date, if not already past that date.

    There’s your release date information. If you are anxious to get the paper kit, go for it. If you’re holding out for Q-interactive, it should not be too long.

    Let’s get to some of the clinical aspects of the WAIS-5. Lots of updates here. I’m sure you’ve heard of some of these updates just from watching webinars or reading some of the materials that Pearson has distributed over the last several months, but I’m going to run down some of the big picture highlights, and then we’ll get a little bit more granular with some of the updates and things that you can expect.

    First and maybe most [00:14:00] importantly, the norms are updated. So updated norms were collected over the last few years, primarily in 2023 and 2024. The age range is still the same. We’re looking at 16 years old and 0 months all the way up to 90 years old and 11 months.

    If you want to dive deep into the demographic information, I will say it’s available on page 45 of the technical manual. If you don’t, I can let you know that the normative sample was mirrored pretty closely to the U.S. census from 2022, I believe.

    The table in the technical manual breaks down all the norm groups and the percentages of each based on education, age, sex, racial and ethnic identity. I think those are the four factors that we’re looking at when we consider the norm group.

    So updated [00:15:00] norms, this is huge. I think this is one of the biggest concerns with any measure as it gets to be 10, 15 years old, or even more but we have updated norms. Great place to start.

    As for the test itself, there are a number of noteworthy changes. I will say right off the bat that if you are familiar with the WISC-V or the WMS, that many of these changes will feel pretty comfortable, but I’m going to go into them just to make sure what to expect here.

    Big picture, it’s going to be a shorter administration time. The manual says that you can get a Full Scale IQ, which is 7 of the primary subtests in about 45 minutes, and then if you administer all 10 of the primary subtests, you should be able to do that in about 60 minutes.

    I will note as well that there is a table in the administration manual that lists the average administration times per [00:16:00] subtest. It’s also stratified by age and suspected or anticipated IQ, I believe. So it varies slightly based on those factors, but you can check out that table if you’re really interested in learning what the average administration times per subtest might be.

    Another thing that you want to be aware of is there are going to be higher start points for suspected gifted individuals. This higher start point is going to be marked by a little box that says SIG in it within the record form. It’s the same as all the other start points that we are used to, but it’s just marked slightly differently. So look for that SIG, pretty easy to find. I believe that stands for suspected intellectually gifted.

    So we’re going to have higher start points. Hopefully, we don’t have to slog through some of those lower items for folks who we suspect to be gifted. So that will be good. That should [00:17:00] save us some time.

    Another touted benefit of the WAIS-5 is what they call simplified administration and scoring instructions. I will say, I don’t know that I found this to necessarily be obvious when I was looking through the administration and scoring manual, but your knowledge may vary and if you disagree with me, I would welcome those reports and let me know how you find these instructions to be simplified.

    I’m not saying they’re complex by any means, but I didn’t notice them to be overly simplified or noticeably more simple than what we’ve been used to in past versions of the test. There are many clinical updates. Like I hinted at earlier, I think a lot of these mirror what we’ve seen in the WISC-V so far, for those of us who are familiar with working with kids and doing the WISC-V.

    The biggest thing is probably that we now have a five index model to be working with [00:18:00] here in the WAIS-5. So the five index model was developed following research after the WISC-IV and the WAIS-IV were published. They found that there’s actually a five-factor model of the indexes that better captures the data.

    I’m not going to get into the weeds with whether this is necessarily the right structure for an intelligence test or the research behind that, I’m just simply reflecting that decision making process but I will say, it is very familiar for those of us who’ve used the WISC-V for years.

    The big difference is that the Perceptual Reasoning Index has been split into Fluid Reasoning and Visual Spatial Index. So make sure and check that out. It’s going to be pretty comfortable for anyone who’s done a lot of WISC-Vs but that’s a big factor here with the WAIS-5, is that we now have a five [00:19:00] index model, which I like.

    Within the indexes, Working Memory is richer, so to speak. There are now more aspects of Working Memory that are being measured. The primary Working Memory subtests are still going to be Auditory, but they got rid of Arithmetic as a primary Working Memory subtest, which makes sense. It was seemingly confounded pretty heavily by math ability.

    So now we’ve just got two Auditory Working Memory subtests as the primary index subtests, and then there are visual and spatial and capacity measures of Working Memory as well. So you will have a lot more choice in Working Memory subtests here in the WAIS-5.

    I will say though that this might be the most unfamiliar area for those of us who are moving to the WAIS-5

    within the Working Memory Index, simply because the two subtests there are both [00:20:00] newish. One of them, Digit Sequencing used to be a part of Digit Span, so it’s familiar. You’re going to know how to do it, but it’s now a standalone subtest. So just know that before you get into the WAIS-5 and try to administer it.

    The other subtest, Running Digits, is completely new subtest. I think it will feel relatively familiar just because it’s in that same vein as, it’s an Auditory Working Memory task that involves numbers, but the scoring is different and it’s measuring a slightly different construct.

    I think the main thing is, at least in my run through, there is manipulative that you’re going to be working with as you’re scoring the Running Digit subtest. It’s an overlay that it’s over the book and it’s more to manage during the administration, like something else that you’re going to be you balancing in your hands and negotiating on the desk.

    So just know that. [00:21:00] I think of all the indexes, like I said, Working Memory is probably going to be the one that requires the most practice as we move along.

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    Let’s get back to the podcast.

    There are [00:23:00] also expanded index scores. There’s a lot more information on discrepancies between index scores. You can dive a little deeper into those. There’s going to be more emphasis on ancillary indexes as well. So we’ve got a Nonverbal Index, Nonmotor Index, Motor Reduced Processing Speed.

    There are ancillary indexes for crystallized and fluid intelligence. So some of these are going to be carried over from the WAIS-IV, some of them are going to be new. The good news is that you’re going to be able to find all of them really easily on the record form, which I’ll talk about here in 2 minutes.

    In terms of subtest-specific information, let’s start with the ones that are going to be pretty familiar to you or well-known. I think the WAIS-5 carried over 13 subtests from the WAIS-IV that are going to be similar or nearly identical, but I’ll run through a few of them that are more well-known, some of the primary subtests, just to give you an idea of what to expect.

    [00:24:00] So with Similarities. Similarities is going to be very similar. They did change some items, of course. They updated many of the word pairs, but many of them are going to feel very familiar at the same time. So it’s not like you’re going to look at Similarities and not know where you’re at or how to score them.

    Many familiar items, some that are brand new.

    Vocabulary, kind of the same way. I would say, I didn’t do the math, but it struck me as maybe 40% new items, 60% familiar items. It seemed to me just in looking through Vocabulary, I’m sure others can verify this that more of the new items came into play toward the end of the subtest. So as we got toward the ceiling in Vocabulary, more of the words were new.

    Information, I was glad to see the questions updated in Information. I think there was a lot of attention paid here [00:25:00] to update the questions to make them appropriate. In my opinion, it seems like we have fewer science questions and many more factual or trivia-based questions that center more around maybe people, places, history, geography, and that kind of thing versus science-based questions.

    Again, others could verify this, but that’s just my layperson’s opinion here as I look through the WAIS-5 items. So Information has been updated pretty significantly.

    Arithmetic is no longer a primary subtest, like I mentioned, but you’ll be happy to know there are some new questions, there are some new numbers, there are some new names. The question structure and the concepts that are being measured are still pretty similar, but again, updated numbers, updated names.

    Last but not least in the familiar subtests, Comprehension not primary subtest but a lot of us will be grateful to know that the [00:26:00] Comprehension items have been updated, and to me, they feel less antiquated. There is still one question that I think people are going to take issue with and say, is that something that people are super familiar with nowadays, but many of those questions were updated and I think they did a good job with those updates.

    Those are the well-known subtests that I think you’ll be able to ease into pretty easily. What about the new subtests? I will say right off the bat, there’s only one new subtest that is a primary subtest, and that is Running Digits.

    I mentioned this earlier, this is part of the Working Memory Index, and it measures auditory working memory and requires flexibility in information processing and a progressive shift of attention, is what the materials say. I think you’ll find it relatively easy to administer, but again, there’s a manipulative component on the scoring side [00:27:00] that you’ll have to be aware of.

    Set Relations is a new Fluid Reasoning subtest that gets into deductive reasoning and logical thinking. In my perspective, it starts out like Matrix Reasoning then moves into more of a verbal format instead of the visual format that I think we’re used to with Matrix Reasoning. Not a tough transition and administration looks to be pretty straightforward.

    Naming Speed Quantity, I was excited to see Naming Speed Quantity. This is a new processing speed subtest that measures numerical processing fluency and the ability to recognize and label quantities efficiently. I wouldn’t get thrown off by the numerical component. It’s very simple and straightforward.

    This is a good rapid naming test. It’s very similar to other rapid naming tests that you have seen on other measures. It’s slightly different with that numerical component versus say, [00:28:00] a color or simple word but pretty equivalent in terms of the simplicity and straightforwardness of that numerical naming.

    I was excited to see Naming Speed Quantity. I think it’s great to have another processing speed subtest that does not have any motor components whatsoever.

    Another two subtests that we’ll talk about, if you are familiar with the WMS, these are also going to be very familiar to you. So Spatial Addition, this is a visual working memory subtest that looks at spatial working memory and storage, and you have to manipulate some of the information and ignore competing stimuli.

    So to me, Spatial Addition is like Zoo Locations from the WPPSI, but just on steroids and a lot more complicated from an administration standpoint and a client standpoint, but it will be relatively straightforward, especially if you’ve done it on the WMS. If not, I would absolutely practice this one before [00:29:00] you jump into the WAIS-5. It’s not a primary subtest, so you may not need to do that.

    Symbol Span is the last new subtest that I want to talk about. Symbol Span is another visual working memory subtest. It is very similar to Picture Span on WISC-V if you’re familiar with that, but it uses symbols instead of pictures.

    Alright, let’s transition to more of the granular stuff and observations from looking through the manual and the record forms. Let’s dive into the manual and the record forms.

    You might be thinking, Jeremy, why are we talking about the manual and the record forms? These are boring. Everybody knows what’s going on here but I will say, just having the opportunity to walk through a brand new test with fresh eyes, it is nice to appreciate some of the updates to both of these things.

    There are a few important aspects [00:30:00] of both the manual and the record form that are worth talking about. First of all, in the admin manual, on page 2, there are a list of abbreviations of the subtests and the indexes. Indexes are easy, subtests, not so much.

    There are many two-letter abbreviations for the subtests. They’re going to be used throughout the WAIS-5 materials and so you’ll want to get familiar with those abbreviations because you’re going to see them over and over.

    Even going through the materials a little bit that I have so far, I will say there was frequent checking back, what’s the abbreviation? What’s that mean? And so getting familiar with those is going to be important and just helpful.

    On pages 25 and 26 of admin manual, it will tell you the average time to administer the subtests, like I mentioned. I think this is helpful [00:31:00] information. You can refer back to it, especially in the beginning before you get your feet underneath you with the WAIS-5.

    If you’re using Q-interactive, of course, you will get that information built into the software and the app, but if you’re doing paper and pencil, it can be nice just to know how much time to expect. And for those of us that bill insurance, there are always questions about how much time should I be taking to administer the subtest or this full test. So you can get that information here and get a good ballpark for at least what Pearson anticipates as far as administration time for all these subtests.

    Page 29, there’s an important note that was tucked away that I would think might need to be highlighted. It said, and I hope I’m interpreting this right, but it said, to always administer Digits Forward before you administer Digit Sequencing, even though Digits [00:32:00] Forward is not part of the Full Scale IQ primary subtest list.

    So some of you might skip over it because it’s not part of that primary subtest list but the admin manual did specify that we need to always administer Digits Forward before Digit Sequencing. There’s something about this that just feels odd, so if there’s anyone out there who has better information or if I’ve read that wrong, please let me know.

    All right, let’s jump over to the record form. So record form, as you can see, pretty familiar but there are two changes. The biggest one is that right here on the front, instead of that scoring rubric that we’re used to, that’s now in the back and here on the front, we have a summary the composite structure and primary indexes, ancillary indexes, and all the subtests that flow into each of those [00:33:00] indexes and the composite structure.

    So you can check that out. It’s right here on the front. I think that’s helpful. It’s really nice. It’s got the new subtests. It’s got the five indexes and so forth.

    If we flip to the back, you can see all of the manual scoring rubric information is back here in the back. The primary analysis page is going to have a lot more information on here. Specifically, and this came straight from Pearson just as comparison to the mean index score and mean scaled scores before pairwise comparison to reduce Type I error in discrepancy comparisons.

    So definitely check that out. And then on the ancillary summary page, it has the index scores, including all the expanded index scores that I mentioned earlier for each of the five factors in case you have big discrepancies between two subtests [00:34:00] on a primary index score.

    As far as the record form itself and just some observations that I had, I’m not going to open the record form, test security very important here but I noticed that it does give the reading rate of items which is helpful. This is a slight update from our small update from the WAIS-IV. So it tells you at what pace you should be reading the test items. I think that’s helpful just to have it there. You’re going to learn it very quickly within the first probably three to five administrations, but it’s nice to have it there in case you need it.

    What else? The only thing that I noticed is, this could be complete imagination on my part, but it seems like the paper is a little bit more flexible and it feels a little nicer in my hand. I could be totally making that up though.

    In summary, what are we looking at here? My initial thoughts are that this is a positive update. [00:35:00] There is a lot of familiarity here, especially if you are used to the WISC-V and the WMS-IV or WMS-V. I think you’re going to find a lot of comfort in these new subtests and it’s not going to be a huge learning curve for you. If you have used some of these other measures, I think you’re going to be right at home.

    That said, I told my practice this morning, that this is definitely a test that you are going to want to practice before you administer it the first time, if for nothing else than the Working Memory subtests and just making sure that you have a handle on how to administer and score those new Working Memory subtests.

    The others, I think you could probably wing it. I hate to say that. I know that’s not the right thing to say but if you had to, you could probably wing the other ones. I know that you’d be scoring after the fact and it would be clunky and slow. Of course, you should [00:36:00] be totally familiar with all the new items, particularly in Similarities and Vocabulary and so forth.

    I wouldn’t advise just leaping into it. You probably could, don’t do that. You should practice. I told my team, let’s practice at least five good times with especially those Working Memory subtests, and make sure that we’ve got a handle on that. So don’t just try to wing it one morning when you’re feeling crazy and super motivated to get into this new WAIS-5.

    I mentioned the Running Digits subtest. I think it will take a little getting used to, nothing too wild, but definitely put some time into that and make sure you’re familiar with it.

    One other note, if you are doing supplementary subtests and you aren’t familiar with the WMS, especially Spatial Addition, I think that’s going to require a lot of practice as well, just to make sure that you’re doing things as you should. [00:37:00] I would compare it maybe to D-KEFS Tower.

    There are other subtests that are similar too, but just know it’s something where you’re going to have to be dealing with a fair number of manipulatives and know exactly where to place things and when to place them. So make sure you practice that if you’re going to be doing some of those supplementary subtests.

    Overall, I think first impressions of the WAIS-5 are positive. There are enough updates to subtest items that I think it feels more modern. I don’t want to know that I go so far as to say that it feels completely updated and modern, but I don’t know that that’s actually possible with the pattern and progress of test development.

    These tests are in development 5, sometimes 10 years, sometimes more, and it’s really hard to anticipate what’s going to be happening culturally, societally, and what’s going to be considered “modern” or updated by the time everything is finished. [00:38:00] So a lot of kudos to the team.

    I think it’s a more modern update, and we’ll be able to notice that. It definitely does not feel as antiquated as the WAIS-IV did, which is appropriate. We’ve crossed a major threshold in our society with technology, smartphones, internet of everything, all of those things, and there were no glaring outliers in the questions that I thought, oh my gosh, this is completely irrelevant. And so a modern enough update.

    I also didn’t see any subtests right off the bat that are going to be a huge pain in the ass to administer their goodness. I know there are many of those subtests out there. We’ve all had that experience with different subtests.

    I didn’t see any, at least, in my cursory look through materials without having done it on an actual client, I didn’t see anything that right off the bat told me, okay, I’m going to hate this after 7 times or 27 times or 97. [00:39:00] Actually, maybe we probably hate everything after 97 times, but you get what I’m saying. Nothing right off the bat that seems like a total pain.

    Just to recap, folks, WAIS-5 is going to be available by the time you see this video. You can order the paper and pencil kit. If you don’t want to score manually, you can score on Q-global and print out single score reports. If you want to hold out for Q-interactive, that’s going to be released on September 20th. All of this is happening on the Pearson website. You can go and order from there.

    I would love to hear your experience as always. If you have comments or thoughts, if you want to fact-check me on any of the things that I presented here in the video, feel free to do so and send me your experiences. I think there’s going to be a lot of discussion around the WAIS-5 and my hope is that it’s a generally positive update for those of us here in the testing world. So thanks for tuning into this unboxing [00:40:00] and happy testing.

    All right, y’all. Thank you so much for tuning into this episode, always grateful to have you here. I hope that you take away some information that you can implement in your practice and in your life. Any resources that we mentioned during the episode will be listed in the show notes so make sure to check those out.

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    If that sounds interesting to you, you can check out the details at thetestingpsychologist.com/consulting. You can sign [00:41:00] up for a pre-group phone call, we will chat and figure out if a group could be a good fit for you. Thanks so much.

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  • 465. WAIS-5 Unboxing

    465. WAIS-5 Unboxing

    Would you rather read the transcript? Click here.

    Hello all! I’m here today with likely the most anticipated event of the year in the assessment world: the arrival and unboxing of the WAIS-5! Pearson was kind enough to send me a kit a little early so I could check it out and share some thoughts with all of you. Just a possibly obvious note: today’s “episode” is best consumed in video format, so head on over to the Testing Psychologist YouTube channel to see the full unboxing video!

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    About Dr. Jeremy Sharp

    I’m a licensed psychologist and Clinical Director at the Colorado Center for Assessment & Counseling, a private practice that I founded in 2009 and have grown to over 20 clinicians. I earned my undergraduate degree in Experimental Psychology from the University of South Carolina before getting my Master’s and PhD in Counseling Psychology from Colorado State University. These days, I specialize in psychological and neuropsychological evaluation with kids and adolescents.

    As the host of the Testing Psychologist Podcast, I provide private practice consulting for psychologists and other mental health professionals who want to start or grow psychological testing services in their practices. I live in Fort Collins, Colorado with my wife (also a therapist) and two young kids.

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  • 464 Transcript

    [00:00:00] Hello everyone. Welcome to The Testing Psychologist podcast. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.

    Many of y’all know that I have been using TherapyNotes as our practice EHR for over 10 years now. I’ve looked at others and I keep coming back to TherapyNotes because they do it all. If you’re interested in an EHR for your practice, you can get two free months of TherapyNotes by going to thetestingpsychologist.com/therapynotes and enter the code “testing.”

    This podcast is brought to you by PAR.

    The Neuropsychological Assessment Battery (NAB) offers the combined strengths of a flexible and fixed Neuropsychological Battery. And now you can score any of the NAB’s six modules on PARiConnect, PAR’s online assessment platform. Visit parinc.com\nab.

    Hey folks, welcome back to the podcast.

    [00:01:00] Today, I am talking about one of the most rewarding professional experiences I have undertaken, and that is hosting the annual Crafted Practice retreat.

    Many of you know, I think in the summer of 2023, I hosted the first annual Crafted Practice retreat. This was meant to be an anti-conference for testing psychologists. It was an incredible experience for me as the host and by all indications for the attendees as well. Today, I’m reflecting on the 2nd annual event that occurred here in the summer of 2024. I learned a lot between the first and second events and learned even more this time around that will help in planning the third annual crafted practice event in the summer of 2025.

    Speaking of the summer of 2025, if you’re interested in signing up for the event, you can check out the show notes and click the link to get on the Crafted Practice interest list. Being on the interest list means that you will get the first [00:02:00] round of email announcements to sign up for Crafted Practice, and you’ll be the first to hear about the event and get first dibs on the spots. So check that out if you want to join us in Colorado in the summer of 2025.

    If that is not an appropriate fit for you right now, if you just can’t make it for whatever reason, I’m also launching new cohorts of mastermind groups in January of 2025. There’s a beginner, an intermediate, and an advanced group, depending on where you’re at in your practice stage. Check that out at thetestingpsychologist.com/consulting, and see if it could be a good fit for you.

    All right, let’s jump to this conversation about my experience leading Crafted Practice in 2024.

    [00:03:00] All right, everyone, like I said, I’m going to do a little bit of reflection about the experience of hosting the Crafted Practice event this year. Now, this is a little bit of a, I would say self-indulgent episode, but I have learned over the years that processing and sharing some of the stuff on the podcast can certainly be cathartic and helpful for me and sometimes even helpful for others.

    Hosting this retreat was an incredibly meaningful moment last year. I’d had the idea to host retreats for years and could not take the leap because I was worried about it working and people signing up. Would it make any money? Would it be interesting? Would it be engaging? All those things. It felt like a big mountain to climb. But after going to conferences that were, honestly, overwhelming and [00:04:00] jam-packed with sessions, not helpful for those of us in private practice, there were just no business sessions, and honestly, just too theoretical to be applied, I wanted something different. I decided to go down that route and see what could happen.

    Thankfully, I had the support and encouragement of a lot of important folks in my life, of course, including my wife, my small group of psychologists, and our Slack chat. I’m glad that they pushed me to do that. It turned out to be incredibly fulfilling.

    After having a successful first go around, I committed to doing the event every year, which is how I do it. It takes me a long time to warm up to something, but once it happens and I get some affirmation that it was a good idea, it’s all in. A little bit of an all-or-nothing person.

    That brings us to the second annual Crafted Practice event which took place here in Fort Collins, Colorado in [00:05:00] late summer, 2024. Now, I made a few changes this year that improved the experience based on feedback from participants. But before I talk all about that, I’ll give just a little bit of an overview of this event.

    I called it the anti-conference. What I mean by that is this was meant to be an event that had plenty of space and spaciousness for individuals to connect with one another, and to apply the knowledge that they were gaining. So we had plenty of time. I called it co-working time or open work time where you could collaborate with others, put some of the ideas into practice, and do things at the event versus learning a lot of theoretical knowledge and then taking it home and forgetting about it. That’s typically what happened to me. So there’s a lot of spaciousness. There’s a lot of applied knowledge and lots of connections. We had a lot of small group experiences, small group coaching that is, and [00:06:00] then informal small group experiences.

    It was a relatively small intimate event. It’s only 20 people and that proved to be a pretty good number for folks to connect. It’s enough to create small groups, but also not so big that everyone felt like they were lost in the crowd. That’s what I was hoping to create.

    There was also plenty of time for recreation. We did happy hours at the end of every day. We didn’t start until 9 a.m. So you had time in the morning to get outside or just have a leisurely breakfast or whatever it might be. The food was mostly all catered. So breakfast and lunch were catered at the hotel. It was just meant to be an all-inclusive, accessible, convenient experience where folks were able to connect with one another, do some learning, and implement some [00:07:00] ideas in their businesses. So that was the framework.

    The first year, like I said, it went relatively well. This year, I got some feedback from folks and made some changes, like I said. We had fewer didactic sessions this year. The first year we started with six, it was six hour and a half sessions. This year, I dialed it back to four and what that allowed was more time for small-group mastermind experiences. So almost to a person. Everyone said that they loved connecting in these small groups. So I created more time to do that this year.

    We also had a little more structure this year. Last year, we had lots of open time to work and relax and so forth. This year I think we had just as much open time, but I employed a lot more guidance around how to use the time. And I think it went over a lot better. [00:08:00] I recognize now, of course, that I think folks wanted a little bit more structure and we’re a little lost as to what to do with the open time because most of us struggle with that. I just provided a little more structure on how to use the time. We had some themes for co-working. We broke into small groups during the open time based on whether folks wanted to work on finances, billing, scheduling, revising the report templates, marketing, or whatever it may be. I think that went over pretty well.

    Let’s take a break to hear from a featured partner.

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    The Neuropsychological Assessment Battery or NAB, is a comprehensive instrument offering [00:10:00] the combined strengths of a flexible and fixed neuropsychological battery. It lets you administer the full battery, any of its six modules, or individual tests. And now, the NAB modules are available for scoring on PARiConnect, PAR’s online assessment platform. Learn more at parinc.com\nab.

    Let’s get back to the podcast.

    Another small change that made a big difference was bringing lunch on-site. The first year, I set it up where folks could go out in the downtown and get their lunch. The intent, of course, was to be as flexible as possible and allow folks to eat whatever they wanted. But this year I had lunch catered every day and the feedback was pretty positive. It just meant that people were able to stay on-site and didn’t have to make one more decision. I think it just cut back on the hassle and made things a lot easier, which is super cool.

    [00:11:00] Now, thoughts for next year. I’ve already gotten some great feedback from participants and look forward to making some changes for next year. So if you are thinking about signing up and coming to hang with us in Colorado in 2025, this is what you might look forward to.

    I’ll probably put in even more structure, which sounds wild, but I think it could be helpful. People asked for more structured themes or tracks in the event; small groups or workshops that are based around specific topics like finances or marketing or report writing, that kind of thing. So creating a little bit more structure around that.

    I don’t think I’m going to do any clinical content next year, which seems also crazy. In the past two years, we’ve had half of the CES available were clinical, and half of the sessions were business-oriented. But [00:12:00] I know, even though it’s tough to find clinical CES for testing, most folks noted that they’re just there for the business development and there’s no need to mix in clinical content. So I think we’re just going to go all in on business development next year.

    We’re also going to do more hands-on content. People love the applied sections and the ability to put those things in place while bouncing ideas off of other clinicians. So I’m going to lean into that and go give more time for people to do that. I think one of the benefits is that there is time to implement these ideas. So we’re going to try to do more of that.

    Probably, I’m going to do a little more structured time for our sponsors to share their expertise. We had some awesome sponsors this year, and I’ll spotlight their services if possible. I think that’s helpful.

    We’re going to be keeping the happy hours next year. Just to be clear, this is not about drinking at all. We had several [00:13:00] non-drinkers this year or alcohol drinkers anyway. So it’s not really about that. There’s just something about the ritual of marking the end of the day and getting together in a less formal atmosphere. I think folks look forward to that and it was a nice bonding experience for a lot of people over the course of the week. So definitely going to keep that.

    What else. I’m thinking about adding in some chair massages or a spa gift card, so if people want to sneak off and head to the spa they can do that and take the relaxation to another level.

    What else? Let’s see. This is funny. In 2024, 3 individuals got tattoos at the event. And so, we joke around and say next year the goal is five. We’re going to try to keep integrating [00:14:00] tattoos as part of this event. That’s just how we roll with Crafted Practice. So if that’s appealing to you, sign up and come get a tattoo here in Colorado while we work on your business.

    I will stop there and close with a little bit of gratitude to the sponsors. Productive Therapist was back, the VA company that came back this year. RevKey is also a returning sponsor. RevKey does Google ads for psychologists and has a stellar reputation in our community. My software company, Reverb, an AI-powered software to help with report writing was a sponsor, and TextExpander was a sponsor as well. I think you all know TextExpander if you’ve listened to the podcast for a while. Huge thanks to all of them. The event couldn’t have taken place without them.

    Also, of course, very grateful for all of our fabulous speakers. A lot of gratitude to my wife and [00:15:00] my small group for the ongoing support, my accountability group, and all the folks who keep encouraging this whole process. Of course, a ton of gratitude for all of the attendees. We had someone return from Australia this year again. That was amazing. And then, of course, folks coming from all across the country. It was such a cool event. Amazing people doing good work and connecting with one another.

    Like I said, if you’re hearing all of this and you think, Hey, I might want to be a part of the next event, you can check out the link in the show notes, get on the interest list, and you’ll be the first one to know when registration opens up for 2025.

    Thanks for listening as always. Happy testing.

    All right, y’all. Thank you so much for tuning into this episode. Always grateful to have you here. I hope that you take away some information that you can implement in your practice and your life. [00:16:00] Any resources that we mentioned during the episode will be listed in the show notes. So make sure to check those out.

    If you like what you hear on the podcast, I would be so grateful if you left a review on iTunes, Spotify, or wherever you listen to your podcast.

    If you’re a practice owner or aspiring practice owner, I’d invite you to check out The Testing Psychologist mastermind groups. I have mastermind groups at every stage of practice development, beginner, intermediate, and advanced. We have homework, we have accountability, we have support, we have resources. These groups are amazing. We do a lot of work and a lot of connecting. If that sounds interesting to you, you can check out the details at thetestingpsychologist.com/consulting. You can sign up for a pre-group phone call and we will chat and figure out if a group could be a good fit for you.

    Thanks so much.

    [00:17:00] The information contained in this podcast and on The Testing Psychologist website are intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional psychological, psychiatric, or medical advice, diagnosis, or treatment.

    Please note that no doctor-patient relationship is formed here, and similarly, no supervisory or consultative relationship is formed between the host or guests of this podcast and the listeners of this podcast. If you need the qualified advice of any mental health practitioner or medical provider, please seek one in your area. Similarly, if you need [00:18:00] supervision on clinical matters, please find a supervisor with expertise that fits your needs.

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  • 464. Reflections on the Crafted Practice Retreat (2024)

    464. Reflections on the Crafted Practice Retreat (2024)

    Would you rather read the transcript? Click here.

    In the summer of 2023, I hosted the first annual Crafted Practice retreat – an “anti-conference” for testing psychologists. It was an incredible experience for me as the host, and by all indications, for the attendees as well. Today, I’m reflecting on the second annual event. I learned a lot between the first and second events, and learned even more this time around that will help in planning the third annual Crafted Practice event in summer 2025!

    Cool Things Mentioned

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    I’ve partnered with At Health to offer CE credits for podcast episodes! Visit this link to access current and past episodes available for CE credit. You can use code “TTP10” for a discount on ALL the course credits you purchase from At Health!d for CEU’s!I’ve partnered with At Health to offer CE credits for podcast episodes! Visit this link to access current and past episodes available for CE credit. You can use code “TTP10” for a discount on ALL the course credits you purchase from At Health!

    About Dr. Jeremy Sharp

    I’m a licensed psychologist and Clinical Director at the Colorado Center for Assessment & Counseling, a private practice that I founded in 2009 and have grown to over 20 clinicians. I earned my undergraduate degree in Experimental Psychology from the University of South Carolina before getting my Master’s and PhD in Counseling Psychology from Colorado State University. These days, I specialize in psychological and neuropsychological evaluation with kids and adolescents.

    As the host of the Testing Psychologist Podcast, I provide private practice consulting for psychologists and other mental health professionals who want to start or grow psychological testing services in their practices. I live in Fort Collins, Colorado with my wife (also a therapist) and two young kids.

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  • 463 Transcript 

    [00:00:00] Dr. Sharp: Hello everyone and welcome to The Testing Psychologist podcast. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.

    Many of y’all know that I have been using TherapyNotes as our practice EHR for over 10 years now. I’ve looked at others and I keep coming back to TherapyNotes because they do it all. If you’re interested in an EHR for your practice, you can get two free months of TherapyNotes by going to thetestingpsychologist.com/therapynotes and enter the code “testing”.

    This podcast is brought to you in part by PAR.

    Hey, guess what y’all, the BRIEF-A has been updated. The BRIEF2A is the latest update to the BRIEF2 family. Use the gold standard in executive functioning assessment to assess adult clients. You can preorder it now, visit parinc.com/products/brief2a.

    Hey everybody, welcome back to a clinical [00:01:00] episode of the podcast. I’m excited to be talking with you today about pediatric bipolar. I cannot believe that we have not talked about pediatric bipolar in nearly 500 episodes of this podcast.

    My guest today is Elizabeth Errico. Elizabeth founded the Children’s Mental Health Resource Center after more than 20 years as a mental health professional. Throughout those years, she saw countless families struggle to find answers and support from a complex mental healthcare system that often ignores or minimizes their concerns. CMHRC grew out of the awareness that these families and their providers deserve better access to information, resources, and expert guidance as they seek accurate diagnosis and effective treatment.

    We talk today about many aspects of pediatric bipolar; we talk about the history of the diagnosis and why it’s so misunderstood, we talk about differentiating pediatric bipolar from ADHD, DMDD, ODD, and other alphabet soup diagnoses, we talk about [00:02:00] communicating with families about a pediatric bipolar diagnosis, we talk about treatment options for pediatric bipolar and many other things. Elizabeth has a ton of experience in this area and I am very grateful to have her.

    Before we get to the episode, if you are a practice owner and you’re looking for a little bit of support, groups are full for now, they will reopen in January, but individual consulting is available either in one-off strategy sessions or ongoing consulting. You can get more information and set up a call at thetestingpsychologist.com/consulting.

    All right, let’s get to my conversation with Elizabeth Errico about pediatric bipolar.

    Elizabeth, hey, welcome to the podcast.

    Elizabeth: Thank you so [00:03:00] much for having me.

    Dr. Sharp: I’m glad to have you. We’re talking about pediatric bipolar, which is a topic that we have not talked a lot about, somehow in almost 500 episodes of this podcast, we have not talked extensively about pediatric bipolar. So I’m so grateful that you are here and willing to chat with us about this topic.

    Elizabeth: Thank you, I’m grateful to be here because as you just outlined, this isn’t a topic that gets talked about very much. It’s important for providers to know what they’re looking for when a pediatric bipolar is a concern because not enough people get trained in it.

    Dr. Sharp: Absolutely. There’s a lot of confusion and maybe misinformation out there as well. I look forward to clearing some of these things up and hopefully, folks will walk away with a good understanding of pediatric bipolar.

    I’ll start with the question I always start with, which is, why this? Of all the things you [00:04:00] could spend your life, energy, and time on, why pediatric bipolar stuff?

    Elizabeth: Bipolar disorder is to some degree one of the least well-funded, least well-examined mental health conditions out there that has changed in the last two years with a huge influx of research dollars that have been put towards bipolar.

    When you consider how difficult it is to diagnose and treat bipolar in adults, and then you add that to the pediatric population, families are stuck in a circumstance where they are not getting accurate diagnoses, they’re not getting effective treatment plans put in place, they are losing their childhood to [00:05:00] misdiagnosis and the wrong medications.

    When I was working at the Juvenile Bipolar Research Foundation, as the executive director, I was seeing family after family who were coming to us, desperate for help. They were falling through the cracks of the mental health care and physical health care systems in the country because providers were not being able to identify what was going on with them.

    Their parents were being told that it was their parenting that was the problem, kids were being told that they were bad kids and being disciplined at school and having all of these character or logical assessments being made of them that were inaccurate.

    The pain that I saw these families in was awful. And so my colleagues and I decided to form a new [00:06:00] organization where our whole purpose is to educate providers and to shepherd families through the process of finding the right diagnosis and effective treatment for the disorder. And so it’s become a mission for all of us that we not let families go through the years and years of struggle.

    The statistics on treatment onset delay are horrifying. It’s an average of 10 years from the time a parent finds out or discovers that there’s something going on with their kid that needs addressing, to the point where they have an accurate diagnosis and an effective treatment plan. And that’s a childhood loss. And so we feel as though no family should have to go through that.

    Dr. Sharp: Oh yeah, that is an entire childhood, the kid is not a kid anymore after 10 years. That’s terrible. [00:07:00] Tell us about your organization; that’s maybe a good place to start and what y’all do, what you’re about, and then we’ll get into more bipolar-specific clinical information, but I’d love to hear about your organization.

    Elizabeth: We were founded to, as I said, be a resource for families and for providers in the area of juvenile-onset bipolar but we realized that most folks who have juvenile-onset bipolar don’t know that’s what it is. And so if we were to present ourselves exclusively of being about bipolar disorder, folks wouldn’t know that we had the services they needed. And so we branched out and we now address any and all mood disorders that exist in children, because it’s very hard for folks to differentiate among them.

    [00:08:00] We still keep as a core part of what we do, education around bipolar and support around bipolar, because it’s so difficult to identify for many people, but we work with families who have any mood disorders. We coach them on how to talk to their providers, how to know which providers they need to be trying to find, and how to identify what providers they’re going to be comfortable working with.

    We educate them on symptom presentation, on updated research, what’s happening right now. We work with their providers so that they understand what effective treatment modalities are for bipolar, which oftentimes aren’t what most providers default to in their practice. We try to make sure that everybody has the education and support to positively [00:09:00] impact the kids who are living with the disorders.

    Dr. Sharp: It’s super important; all the things that you mentioned, I feel like are areas that are really tough for parents, especially if they are potentially in the throes of a kid struggling or having a mental health crisis.

    Let’s talk about some details around pediatric bipolar, I would love to start with the history. For context, I came into the scene, so to speak, in graduate school. I started in 2003. At that time, pediatric bipolar was pretty hot, so to speak. It was very popular. Any kid with any kind of explosive, tantrums or disruptive behavior was getting diagnosed with pediatric bipolar.

    My advisor was a big proponent of pediatric bipolar. It has shifted over the years, [00:10:00] but that’s why I’ll stop my story there and defer to you. I’d love to hear the history of this diagnosis.

    Elizabeth: Your history is a snapshot of that period of time where you’re right, it had become in vogue to diagnose kids with pediatric bipolar. And that was in part a pendulum swing in the opposite direction from the years and years in which it was believed that kids can’t have serious mental illnesses. And so bipolar wasn’t considered and that’s reflected in the way the DSM criteria is written because it’s all written with adult symptomology in mind.

    In the late 90s, a few prominent psychiatrists wrote some books. One is The Bipolar Child by Demitri Papolos, there’s a book by Rosalie Greenberg on bipolar in [00:11:00] childhood. It became something that everybody started learning about. And so it started getting diagnosed much more frequently.

    The pendulum, of course, as it does, swung back in the other direction. In the mid-2000s to late 2000s, we saw backlash against that. In fact, the DSM committee introduced a brand new disorder that had not been identified through research. It had been created essentially through consensus around the idea that there needed to be an alternative to bipolar disorder in the DSM. And so they created the diagnosis of disruptive mood dysregulation disorder.

    They did know that they wanted to differentiate it from bipolar as they saw them to be [00:12:00] very rare cases of bipolar presenting kids. And so they included the criteria in the DSM that if a child has had a manic episode, then the diagnosis of DMDD doesn’t apply.

    Unfortunately, what has happened is that it’s difficult for providers to identify manic episodes in children when they don’t know what to look for:

    a) Because the symptomology is so different from adult presentation.

    b) Because it’s not in the DSM in the juvenile presentation.

    And also because manic episodes cycle very quickly in children, typically, so even though that’s in there, folks swung in the other direction, were diagnosing DMDD instead, and we then discovered that there was a whole generation of kids who may have qualified for the bipolar [00:13:00] diagnosis, but weren’t given it.

    And so even today, the statistics that come out of the National Institutes for Mental Health are showing that fully one-third of all of the kids and teens who are diagnosed with major depression likely have bipolar, it’s just that their manic episodes have not been identified correctly.

    There’s a huge uphill battle and reframing for people that there’s a middle ground between these pendulum swings of kids can’t have bipolar or every child with a behavioral issue has bipolar. There’s room in between, and we pushed the idea that accurate diagnosis is what matters, not what the diagnosis is.

    Dr. Sharp: I look forward to getting into the diagnostic pieces. I think those are really interesting to my audience, specifically. I would love to go back and clarify something. This [00:14:00] is super interesting. I was always under the impression that DMDD emerged from research showing that kids, gosh, how would I phrase it? I don’t know. My words are escaping me now.

    I had a really great question though, but it was something around the research, it emerged from this research showing that kids went down this trajectory of kids that were historically diagnosed with bipolar, when they follow them, they were more likely to end up either anxious or depressed versus permanently bipolar, so to speak.

    And we figured there’s something else that must be going on, that’s more of a milder mood disorder, but it sounds like that was maybe not the case. What am I getting wrong here?

    Elizabeth: None of the diagnoses in the [00:15:00] DSM were initially introduced as a result of research that all of the diagnoses and the criteria are consensus-based. Committees come and they develop what are the criteria that are going to be listed.

    And so whenever we look at the DSM, it’s one of the things that puts an over-reliance on the DSM is that providers assume that everything that is in there has a list of research that supports it but the truth is that it’s all consensus-based.

    We have drifted more towards research as we’ve evolved as a field but initially, when DSM-3 was coming out, it was really about taking a clinical observation and organizing it. And [00:16:00] so when we’re basing our understanding of diagnoses on clinical observation, we are, by default, leaving out anything that we are disinclined to observe.

    And so that is part of what gets into that tricky area around mania with kids because if you don’t know what mania looks like and you’re only going based on your clinical observation, you’re not going to be able to identify whether or not DMDD is the correct or incorrect diagnosis because you’re missing these enormous exclusionary criteria. So it’s tricky and a lot of providers are actually surprised to hear that a manic episode is exclusionary for DMDD.

    Dr. Sharp: I think it’d be really worthwhile to dig into the [00:17:00] manic side of things in particular, as far as what this looks like. Let me zoom out maybe just for a second though, and first say, you hinted at how pediatric bipolar and adult bipolar can present differently. I would love to talk big picture about those differences because that’s another, I don’t know if misconception is the right term, but at least in this latest iteration of the DSM, it is presented as largely similar and there’s not separate criteria for pediatric bipolar. What do you see as the differences there?

    Elizabeth: We’ll start with the cycling. That’s a huge difference in that in the criteria for adults, we’re looking at days, weeks, months [00:18:00] of a depressive episode or manic episode, in kids, it doesn’t present that way. Kids, rapid cycle. And so they are going to be demonstrating sometimes manic episodes and depressive episodes within the same day. That is not something that anybody is taught to look for.

    So when they’re seeing these wild mood swings throughout the day, they’re not thinking bipolar because they’re not, in their minds, lasting long enough to qualify for the bipolar diagnosis, but what the kids are experiencing in those abrupt mood fluctuations are condensed depressive and manic episodes.

    And because for kids, depressive symptoms and [00:19:00] manic symptoms can both present as irritability, it’s perceived as oppositional or defiant behavior rather than irritability as a result of either mania or depression. And so kids who are chronically irritable experience rigidity, refusals to try new things, refusals to do things that they would have enjoyed.

    The parents are usually the ones instigating those activities. So when a child refuses, it’s not perceived as a loss of interest in things that used to bring them joy, it’s perceived as a refusal to follow instructions. Mom comes and says, we’re going to the water park today, get your bathing suit on and the kid says, no.

    Mom doesn’t think, gee, [00:20:00] why doesn’t he want to do this thing that he used to love; mom thinks, why is he making us all late? We’re meeting people. We have to get going, put on your bathing suit.

    And so there’s this tendency to view a lot of the typical depressive characteristics and criteria through the lens of opposition, through the lens of defiance, through the fact that the child doesn’t have the autonomy to make his own decisions. So when someone else comes in and makes a decision for them that they can’t follow through on, the perception is, this kid is difficult.

    The same is experienced on the manic side when the child is unable to contain their energy, is unable to control the behaviors that are happening as a result of that symptom and they’re viewed as disruptive, they’re [00:21:00] viewed as disrespectful, they’re viewed as intentionally allowing themselves to get out of control and hyperactive instead of recognizing that the child is not able to control what’s happening to them in that moment. And so it’s a lot about the difference between signs versus symptoms.

    As a clinician, we look at symptoms as the experience that the patient is having while signs are the observations we have of those symptoms. And so while the symptoms that the child has experienced may be a loss of interest in things they used to enjoy, it may be that they are experiencing shifts in their sleeping patterns or eating patterns as a result of depression but the observation that we have of it is, my child isn’t following [00:22:00] instructions, my student isn’t doing what is being asked of him in the classroom and that filter through our observation distorts our ability to be able to identify active symptoms when they’re there.

    Dr. Sharp: That’s interesting to make that distinction between signs and symptoms. I like that. I would love to clarify a little bit, what you described as this rapid cycling manic and depressed episodes sometimes occurring in the same day or two days; how do you distinguish that from typical kid behavior?

    That sounds like both of my kids, on any given day, they can be at 7 or 8 or 9 or 2 whatever, I’m guessing a lot of people have the same question, when does it cross into pathological territory, so to speak?

    [00:23:00] Elizabeth: That’s a great question because oftentimes, those manic episodes are happening so quickly that they are misperceived as hyperactivity. And so one of the most commonly misdiagnoses that is given for a child who actually has bipolar is ADHD.

    In that case, once those stimulants are given, the proof is in the pudding, so to speak. A child who has bipolar who’s given stimulants, there are only two things that can happen afterwards, either it has no effect, and if that’s the case, then you’re lucky or it creates mania, and that can include aggression, hostility, violence.

    I know of many children who have been put on stimulants [00:24:00] thinking it was ADHD who then didn’t sleep for three days because they were triggered into a manic episode. So the medication response itself is a clue, but also on a more fundamental level, kids who have bipolar disorder are experiencing distress so we have to go back to the first two categories of things that we look for when we’re even determining whether or not any set of experiences is symptomatic or not, is it causing subjective distress and is it an obstacle to normal daily functioning?

    If we take a big picture look at the DSM, every behavior, every criteria in there, every symptom is a normal human behavior that has been taken to a degree where it is no longer [00:25:00] considered to be an expected part of daily life. And when it crosses that threshold of causing subjective distress and being an obstacle to normal daily functioning, then we know that we’re pushing into territory where there may be some kind of pathology there.

    Dr. Sharp: That makes sense. Gosh, it feels really tricky. And then there’s this question of, which we are getting into, how do you differentiate it from some of these other disorders? ADHD is a big one, DMDD is a big one, maybe even depression or defiant behavior. Can you talk about some of the major differential diagnoses with pediatric bipolar and what you see is getting misdiagnosed or not?

    Elizabeth: We call it the alphabet soup [00:26:00] because the diagnoses that they get are ADHD, ODD, DMDD, and GAD. That’s the attention deficit, mood dysregulation, it’s the generalized anxiety; it’s all of these things that are seen as existing in silos and having disparate causes when in fact they all wind up under the same umbrella.

    And so usually when we see a family, when they’ve come to us and they say, okay, our child has been diagnosed with DMDD, generalized anxiety and ADHD, we say, okay, slow down because that’s the red flag combination. Usually, the ADHD is capturing the mania and the manic episodes, the DMDD is capturing some of that irritability [00:27:00] that goes along with both depression and mania, and then the anxiety is representing a lot of the depressive episodes as they manifest in children.

    Also very common is ODD. As I said, opposition is how these symptoms are perceived by others. And so when we see that, we think, okay, let’s step back, this may all fall under one umbrella. To circle back to the question you had about differentiating it from adult symptomology, the other piece of it is that kids don’t have autonomy over their lives in the way that adults do, and so certain symptoms as they’re described in the DSM simply don’t apply to children.

    The examples that I always give in mania are [00:28:00] spending sprees. 7-year-olds don’t have credit cards. They can’t go on spending sprees unless they’ve got their parents credit card in their tablet and they’re playing a game, and they’re just racking up charge after charge, which we do see but they can’t go drive to the mall and spend $3,000 because they don’t have the means to do it.

    The other example is hypersexuality which in a prepubescent child may be difficult to identify as such, may be perceived as that they don’t have very good physical boundaries, that they may not respect other people’s personal space, that they may ask precocious questions but when we can look at it within the context of the other symptoms and how they present, we can then correctly identify that, oh, that’s [00:29:00] hypersexuality in a child, and do that in a way that is contextually appropriate.

    And so that speaks a little bit to the question of differentiation; no kids should be diagnosed with bipolar disorder without a very thorough differential diagnosis. But when you dig into those diagnoses, you see that symptoms present differently.

    Charles Popper, who’s adolescent psychiatrist, he is a lecturer at McLean Hospital, part of Harvard Medical School, he wrote a wonderful paper on differentiating ADHD from bipolar. Dr. Papolos’s and Dr. Steven Mattis, who’s a neuropsychologist, wrote a wonderful paper on the neurodevelopmental differences between bipolar and ADHD.

    They looked at [00:30:00] three subsets; they looked at kids with ADHD, they looked at kids with bipolar, and they looked at kids who had both, to identify these markers that can be seen in testing that differentiate which is which.

    The quick summary there is that kids who have ADHD experience, it’s the signs that are the same, it’s not the symptoms. For example, breaking things, parents often complain that their children break things. In ADHD, that breaking of thing is often accidental; it is through the course of moving too quickly, of not paying attention to their surroundings, of lack of ability to figure out where they are in [00:31:00] space.

    With a kid with bipolar disorder, when they break things, it’s intentional most of the time. It is an expression of anger, frustration, distress. So the fact that they’re breaking things isn’t sufficient to determine a diagnosis. Also with bipolar and ADHD, there are 15 different differential criteria that Dr. Popper offers in his paper.

    I had another one in mind to mention, it just blew right out of my head. I’ll come back to it when I remember but the bottom line is, Dr. Popper’s point ultimately was, you can’t diagnose ADHD until you’ve ruled out a mood disorder. That’s the order of operations in the diagnostic process, but that’s not what’s done [00:32:00] for the most part because clinicians are not given the luxury of the time necessary to do a complete differential diagnosis.

    So when we’re working with families, we’re looking at the criteria for bipolar, for ADHD, DMDD, ODD, PTSD, generalized anxiety, major depression, pervasive depressive disorder or persistent depressive disorder, as it’s called now, cyclothymia.

    We’re looking at all of these diagnoses because there’s so much symptom overlap and because there’s the filtering that goes through our observation of those symptoms that we have to look at detectives to go through and dig into the history and figure out how long has this been going on? What is the seeming origin of [00:33:00] these symptoms? And move away as much as we can from the idea that there’s any intentionality behind any of the behaviors.

    I’ve remembered, another example that Dr. Popper gives of differentiating ADHD from bipolar is attention. Kids with ADHD can lose the ability to attend to things that they enjoy, that they want to be attending to. With bipolar, motivation can overcome inattentiveness and motivation cannot as commonly overcome inattentiveness in ADHD. So there are these details that have to be examined through the differential diagnosis to be able to determine, yes, it’s the same symptom but which diagnosis is it actually a part of?

    Dr. Sharp: Sure. [00:34:00] I like that distinction as well; motivation can overcome inattention or not. Yes. Gosh, there’s so many questions. All of a sudden I’m wishing we had four hours instead of an hour and a half.

    Elizabeth: I can always come back.

    Dr. Sharp: My gosh, I’m going to give it a good shot, but there’s so much to look through here. I’m going to keep focusing on this differential diagnosis component, especially with DMDD. With irritability being a symptom or sign of both depression and manic episodes in kids, I am curious how you distinguish between DMDD and pediatric bipolar.

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    Let’s get back to the podcast.

    Elizabeth: With DMDD, part of the criteria is that the mood remains irritable in between mood episodes. That is not the case with bipolar. With bipolar disorder, for the most part, kids who have bipolar are kind, gentle, empathetic, and there is a marked [00:37:00] difference between how their affect and their behavior in between mood episodes, they are likely to experience tremendous regret and remorse after they have been verbally aggressive, or they have been irritable.

    They will express distress with their own behavior, they’ll apologize to their parents. They will be sometimes racked with guilt over what they did. In between you’re seeing that kindness, that gentleness, that empathy, and in some cases, an ability to over-empathize with others and absorb the pain and distress that other people are experiencing and be triggered by it.

    Whereas with DMDD, one of the characteristics listed is that the [00:38:00] irritable mood is chronic and pervasive in between mood episodes. And so that’s a huge indicator. As soon as we hear the parent talking about the child’s remorse, we start thinking, we’ve got to dig in here and figure out which one we’re seeing.

    Dr. Sharp: I got you. With all the overlap with all the diagnoses we mentioned; DMDD, GAD, ODD, ADHD, depression, all these things; do we have anything that you would call defining or pathognomic features of pediatric bipolar at this point? Anything where you could say, oh yeah, if this is present, it’s basically a guarantee we’ve got pediatric bipolar, or if these three things are present at the same time, basically it means pediatric bipolar.

    Elizabeth: That’s an interesting question. No, not [00:39:00] to my knowledge. I would say that there’s a phenotype of bipolar that was recently identified in the glacial movement of academia, it’s recent. It was 2005, 2006 that this new phenotype was identified. It does have a biomarker.

    Unlike the other diagnoses in the DSM, it requires every single criteria must be met in order for the diagnosis to be given. It’s not 5/8 or that sort of thing. Every single one. One of them is a biomarker of temperature dysregulation. And so when that is present amongst all the other symptoms, it is an identifier that [00:40:00] says we can rule out traditional bipolar. We can rule out the others because of this is present.

    The interesting thing about that diagnosis is that when the temperature dysregulation is treated; two or three of the other symptoms dissipate without direct treatment because they’re being triggered by the temperature dysregulation.

    Dr. Sharp: That’s fascinating. I assume that these kids are running hot or cold?

    Elizabeth: It can be either, although more commonly it’s hot and it’s not. The issue is that their body is not expelling normally generated heat, and so it’s holding onto it. And so there’s a differential between proximal and distal body temperature that’s outside of the range of expected.

    It’s very easy for parents to identify based on the [00:41:00] characteristics that go along with it. There’s a slightly more complicated way that it’s identified from a scientific and research standpoint, but we could spend hours on that as well.

    Currently, it’s being called thermoregulatory sleep dysregulation disorder. Years ago, it got the moniker fear of harm because that was one of its hallmark symptoms, which was exaggerated and extreme fear response, and a misfiring of the fight or flight response when it was not needed based on environmental stimuli. And so that moniker just stuck. And so folks call it FOH for short. We could spend hours and hours on that one.

    Dr. Sharp: I have to look into that more deeply. I have not heard of that before, so check it out. Let’s [00:42:00] transition to the evaluation process. I think people are anxious to hear about this. I’m curious from your perspective, what each stage of the evaluation process looks like.

    We can start at the interview and then talk about actual assessment tools and go from there. What are best practices here in the interview portion?

    Elizabeth: We are using a lot of assessments to look at. One of the things that we do is we always use the Child Bipolar Questionnaire and the Jeannie and Jeffrey Illustrated Interview for Children. Both of them were developed by Dr. Papolos and his team at the Juvenile Bipolar Research Foundation.

    Both of these are taken at home. The Child Bipolar Questionnaire is done by the parents and then the Jeannie and Jeffrey Illustrated Interview for Children [00:43:00] is, I don’t know if it’s still the only, but when it was developed, it was the only assessment that was designed for children to take without it being administered by a professional.

    And so it’s all done in cartoons. The answers are Likert scale. And so the child can see a representation of what that symptom might look like or feel like when they’re experiencing it, and then they’re able to rate it based on its level of severity, which gives the clinician who’s reviewing it insight into the degree to which it’s disruptive.

    We also always encourage people to use the Pittsburgh Sleep Questionnaire because that gives information on disrupted sleep patterns that are often missed in kids who have bipolar. Because parents will [00:44:00] think that their child just doesn’t want to go to bed when in reality they’re experiencing late day mania that’s disrupting their ability to fall asleep. So we do encourage the use of the Pittsburgh Sleep Questionnaire in addition to the Child Bipolar Questionnaire and the Jeannie and Jeffrey.

    In the clinical interview, we’re looking for clarification on a lot of the questions that have been answered, looking to dig deeper. A lot of times, with sleep, parents will say, oh, no, my child sleeps, they sleep fine. What they’re not realizing is that their child isn’t getting quality sleep; that mania can disrupt the sleep cycles.

    And so we’ll say, okay, why don’t you try tracking your sleep with a Fitbit or the Withings company has a great map that goes [00:45:00] between the box spring in the mattress that will record data on REM sleep and all the different sleep cycles, and then they look at that and they say, oh, my child isn’t getting any restorative sleep and so they’re realizing that that’s also a factor.

    And so we’re looking at what assumptions are the parents making about the behavior to strip that away. Parents will start talking to us and will say, he didn’t want to do such and such and so he responded this way. And we say, don’t tell us what you think was the motivation, don’t tell us what how you are interpreting what he did or said, just give us the facts.

    I always joke it’s like that old Dragnet tv show Just the facts, ma’am. We want to pull away all those levels of interpretation [00:46:00] as we’re gathering data just like detectives. We go back very far into the child’s history. We review pediatric records, sometimes going back to birth. We review emails that go back and forth between the school and the parents. We start noticing diurnal patterns in the mood fluctuations.

    And when we’re seeing that there’s every afternoon at 3.25, this kid is starting to become dysregulated, we’re looking at what are those diurnal patterns telling us about their mood cycling and so we’re able to identify when they’re rapid cycling by looking at those patterns.

    And so it’s a lot of digging in and being a detective, and then once we have the facts, then we say, okay, parents, talk to us about what [00:47:00] your gut is telling you about how your child is doing. Parents very often at that point will start talking about the emotions that they have when they’re witnessing their child.

    And if we think of parents as amateur clinicians, that’s their instinct telling them what their child is experiencing. And so then we’re able to start labeling the sadness, the frustration, the loss of interest and things that they loved, the hyperfixations, what we call mission mode. It starts to come out when we are then able to look at what are the parent’s instincts and what are the facts.

    Dr. Sharp: I like the distinction between parent’s instincts and the facts. It [00:48:00] reminds me of how complicated this whole process is because you’re filtering all this information most of the time through two layers of subjectivity; there’s the parent’s interpretation and perception of the kid’s behaviors and memory for that for that matter, and then that gets filtered through the clinician’s perceptions and assumptions and how they ask the questions and what information they’re eliciting and so forth. It’s a complicated process. I’m just acknowledging that.

    Elizabeth: It is. One of the things that we’ve been able to do that it’s actually quite helpful is, because we work with such a wide community of families, we’re able to collect what we like to call community sourced symptom descriptions. And so we have lists of what do these [00:49:00] symptoms look like when a kid is experiencing it and what is it?

    Because across the board, I always say the details are different, but the themes are exactly the same from one family to another, and once you start being able to identify those common themes, we have these lists that parents have helped us compile of what it actually looks like when their child is dysregulated with either a manic, depressive or mixed mood episode.

    Parents usually, after looking at that, say to us, it was at that moment that I thought, oh, this isn’t just my child; other people have seen this before. Because when they go in with their anecdotes, very often psychiatrists in particular will not connect those anecdotes to [00:50:00] these symptoms that are in the DSM that were written for adults, and so our community sourced criteria is that bridge.

    Dr. Sharp: Right. I know we’ve touched on two of those, but I would love to highlight any of those little anecdotes that you can think of, off the top of your head, things that we may miss or overlook, not be aware of, that y’all are seeing or hearing over and over.

    Elizabeth: One thing that happens a lot is when the parents are engaging in that clinical interview, and then the children are brought in, the children will frequently deny everything that the parents have said. When they filled out the Jeannie and Jeffrey, and they did it themselves and they gave their answers, they will deny that any of it occurs.

    There’s a real refusal to be able to [00:51:00] acknowledge that they’re experiencing the problems at all in the first place. We also find, just pulling something up here because we get a lot of reports from families and we document it all and keep track so I’m looking at some of it now to find a good one to share.

    Dr. Sharp: Of course. I think it’s these real-life examples that bring things to life and animate these symptoms or signs.

    Elizabeth: There was the experience that is somewhat common of a child being diagnosed with ADHD and then given a stimulant, and then they don’t sleep for days. One mother said to us, we followed the doctor’s instructions; we went to the doctor, we said, our child is [00:52:00] having trouble sitting still in class, is being disruptive at school, is having trouble following instructions at home. The pediatrician said, oh this is ADHD, gave a stimulant, and then the child did not sleep for three days and the mother was up the entire time and was saying a child with ADHD doesn’t respond this way to this medication.

    I have one report from a gentleman who’s now an adult who describes when he was first given those stimulant medications as a child, he ran out into the street almost immediately. He lived in a city, he ran out to the street and his parents had to chase him for close to an hour before they were able to catch him because he was waving in and out of traffic, he came home and didn’t sleep for two [00:53:00] days.

    So those are big clues. Kids with bipolar are, as I said before, very empathetic most of the time, so they’re very overly sensitive. They can’t handle feeling excluded, feeling as though they don’t belong. They become extremely sensitive to anything that could be perceived as criticism.

    Even if it’s intended as constructive criticism, it’s a real blow to their sense of self, their sense of their self-efficacy, their sense of self-confidence and competence. They have tantrums and outbursts that last much longer than a typical childhood tantrum.

    A neurotypical child has a tantrum that lasts for 15, 20 minutes. They pull [00:54:00] themselves together. They move on with their day. A child with bipolar disorder can have tantrums that last 90 minutes, 120 minutes. I’ve heard cases where they’ve lasted for four hours.

    Commonly, it involves destructive behaviors either towards themselves, towards other people, towards property. Kids will go into their rooms, have tantrums, throw things, knock over bookshelves and be inconsolable.

    That’s one of the other pieces that when you have kids who are neurotypical or maybe have ADHD or unipolar depression, when they experience distress, for the most part, there’s always going to be exceptions, but they want to be comforted. They want that sense of security that comes from comfort from their parents.

    A child with bipolar disorder may fall [00:55:00] down and hurt themselves, and when a parent instinct is to comfort, that bipolar child is going to start screaming and yelling that it was the parents fault, that they were walking too fast, and that was why they fell down and they were walking too fast because the parent was walking too fast and they couldn’t keep up.

    And why weren’t you paying attention? And the parent is thinking, I was right here next to you the whole time. There’s an inability to take responsibility for or accept the fact that they just fell, they tripped, there was something. There’s a blame that happens, there’s an aggressiveness, there’s a rejection of comfort, and there’s an extended tantrum that is, to the parent, immediately recognizable as out of the ordinary.

    Whether they have other children or not, but most especially if they have other children, they’re able to say, this isn’t how my other children handle disappointment. This isn’t [00:56:00] how other kids handle stubbing their toe. This isn’t how other kids handle being told no. No is a huge trigger for kids with bipolar and parents may be baffled as to why their child is reacting in such an extreme manner to simply being told, no, we’re not going to have pizza for dinner.

    It has to do with some of those neurodevelopmental issues that kids with bipolar have where their executive functioning skills are not developed to the point where one would expect them to be, based on their age, and so their planning, their processing and their ability to adopt and change gears, and make a different plan in their head becomes disrupted. Traditionally, the response is one that is aggressive.

    Dr. Sharp: Sure. [00:57:00] So much information to take in here. This is great. Lots to think about. I would like to talk with you about the part of this process where you are talking with families about the diagnosis and maybe delivering that diagnosis for the first time, managing any emotions that might come up around that, how do you approach that process?

    Elizabeth: What we do in our diagnostic consultation process is we do this deep dive into the child’s history, the family’s history, family dynamics, school, everything usually takes a few months. On average, it takes two to four months to do a complete review and a whole series of clinical interviews with the parents, with the kid.

    [00:58:00] And then in the end, we say, look, this is the differential diagnosis and we go through; this is why we don’t think it’s this, this is why we think that this is going to be the most likely diagnosis. By the time we’ve gotten to that point, and we don’t look for bipolar, we look for the accurate diagnosis. Sometimes we’re saying to parents, it’s not bipolar it’s something else.

    But by the time we get there, parents have had the entire process of the assessment over the course of months to get used to the idea. So very often what we see is relief in families, that there’s finally an answer that makes sense.

    One parent that we worked with said that she kept taking her son to [00:59:00] doctors and psychologists and social workers who kept telling her it was, ODD or DMDD. She kept going back. Smart lady, with the criteria from the DSM printed out and saying, but he doesn’t have this and he doesn’t have this, how can it be this diagnosis if he doesn’t have these things?

    Finally, there was a psychologist who said, I think this may be bipolar. It was only then that the family said, oh, now it makes sense. And so that’s really the predominant experience that we have, which is families that say, thank goodness we have an answer that finally makes sense, where all of these different things now fit under one umbrella. It’s a relief for them.

    And then what we do is our relationship with [01:00:00] them doesn’t end just because that process has concluded. Those families become part of our support groups, those families become part of our community of networking with other parents.

    We have books that we got them on our website or on Amazon that actually go through the bipolar diagnosis for kids. It has checklists. Sometimes we have families who take them and they go through, they fill in all the notes sections, they check things off, and then they take those to their providers and they say, look at this, here’s all the criteria and here’s what my kid is manifesting at home.

    And so they’re then able to get that research batch treatment that we document in the book as well. There’s a [01:01:00] tremendous relief that maybe now we’ve found the thing that is going to help. We have this system that’s based on the idea that we’re going to try kids out on all these medications. The language that’s used is they have to fail on those medications before it can be upgraded to a bipolar diagnosis.

    Doctors in systems, they say, I can’t prescribe a mood stabilizer until we’ve already tried Prozac and Zoloft. We can’t prescribe Lithium or Lamotrigine or Oxcarbazepine until we’ve tried the stimulants and the SSRIs, all of which make bipolar disorder symptoms worse, not better.

    And so we go in there with research that shows that this is how symptoms present in kids, these are the [01:02:00] medications that are supposed to be used to treat these symptoms in bipolar disorder. Oftentimes, the proof is in the pudding; they get started on a mood stabilizer, and suddenly, they’re doing better.

    And that’s another one of Dr. Popper’s 15 criteria for differentiating ADHD and bipolar is Lithium doesn’t do anything for ADHD. It does a lot for bipolar. And so sometimes we have to try the cure to see if that’s the illness.

    Dr. Sharp: Sure. I think that’s a really nice segue into a full discussion of treatment options. You’ve mentioned a few, but let’s talk through what kind of recommendations you’re making for families.

    Elizabeth: We don’t make medication recommendations. First of all, we talk about treatment as a three-legged stool. There’s [01:03:00] medication, there’s psychotherapy, and there’s lifestyle interventions. Those three things are all interdependent.

    You can’t just take a medication and expect that’s going to solve everything, you can’t go to therapy and not practice any of those principles outside of the therapeutic setting and expect things to get better, and you can’t just change what time your kid goes to bed at night and think that’s going to solve a mental illness. So we talk about medication, therapy and lifestyle changes as being integrated with one another and essential to one another for success.

    We go so far as to share research backed data on what medications are most effective and to state the obvious, which is that antidepressants work for unipolar depression, mood [01:04:00] stabilizers work to stabilize mood in bipolar disorder. And so that’s what they’re used for in adults, that’s what they’re used for in kids.

    We do, in our book, have a list of the commonly used mood stabilizers and the degree to which psychiatrists who specialize in this have preferences. We focus on the psychotherapeutic aspects and the lifestyle interventions.

    From a psychotherapeutic standpoint, we discourage a lot of things that most counselors and teachers rely on as tools. We do not recommend the use of reward systems or token economies for kids who have mood disorders, most [01:05:00] especially bipolar because it creates.

    Dr. Rosalie Greenberg has a great section in her book on this, where she talks about the amount of anxiety that is provoked in a bipolar child when they are offered a reward for something that they have difficulty doing because just as motivation can be a way to overcome inattention, it works in the opposite direction.

    Lacking motivation, there’s no way to overcome that, there’s no way to conjure or tap dance your way around something that a kid with bipolar doesn’t want to do. They cannot mount the motivation to accomplish it. And so if you’re offering them a reward for doing something that they don’t think they can do, it creates a cycle of perceived [01:06:00] failure.

    And so most parents will come to us and say, I offered this great reward, why did they sabotage themselves? I wanted to give it to them and then I couldn’t. It’s because they couldn’t get there. And so failure up front is preferable to failure down the line once you’ve exhausted all of your energy on trying. So we discourage that. No reward chats, no token economies. None of that is for kids.

    We discourage the use of CBT until they’re stable and have been stable for a while. The reasoning behind that is that kids who have bipolar are often quite bright. In fact, that’s another one of Dr. Popper’s differentiation criteria that kids with bipolar are often gifted intellectually, and they were in some artistic [01:07:00] way.

    And so one of the things that happens with kids who have these disorders when they’re engaging in CBT is that they are able to understand the concepts that are being presented to them beautifully. They understand them quickly. They’re able to explain them back. They’re able to describe circumstances in which they can be used, but when they become dysregulated, their limbic system takes over and they cannot access any of that rational information and so they cannot implement any of those CBT strategies.

    It’s quite frustrating to look at IEPs and all these other things that say child will use these strategies when they become frustrated. No, their limbic system is taken over. They are a wild animal trapped in a cage. You’re never going to get them to be able to [01:08:00] use this breathing technique that you taught them when they were regulated, when they’re dysregulated.

    And so very often, over a period of time, as the child demonstrates their intellectual capacity to understand process and share back these strategies, but their inability to implement them when they’re needed, it’s perceived as resistance, as being an intentional choice and then they wind up going down that path of the parents being told they don’t want to get better.

    And so we encourage a focus on DBT strategies that are teaching them mindfulness or teaching them to identify what’s happening in their body; what are their triggers? If you identify when you are regulated, that being hungry or tired is a trigger for [01:09:00] a mood disruption, then you can teach how do I identify the fact that I am starting to get hungry so that you can intervene before the dysregulation occurs.

    We do encourage the use of DBT and mindfulness in terms of identifying how they’re feeling, cultivating and developing insight before you’re worrying about implementing skill development. And that’s pretty much across the board for kids with bipolar.

    Dr. Sharp: That makes sense. You talked about lifestyle changes or support, I would love to touch on that before we wrap up because it’s important and it’s something a little different than medication, which is, for better or for worse, pretty [01:10:00] well-known, I suppose. What about the lifestyle side?

    Elizabeth: The lifestyle side of it comes into recognizing that part of bipolar disorder is difficulty with sleep and so developing sleep hygiene. Sometimes, we have to do full circadian rhythm resets for kids because it’s not uncommon for them to develop night-day reversals.

    We have a book also called Managing Temperature and Sleep Disruptions. We go through that on, these are strategies that you can use to reset circadian rhythms so that you are able to go to sleep at night at the time that you’re supposed to so that you can stay asleep and have restful sleep so that you can wake up in the morning when it’s time to wake up and feel [01:11:00] refreshed and be ready to start the day.

    We do talk also about temperature regulation because of this particular phenotype of bipolar disorder. We do a lot around managing temperature disruptions and how to proactively avoid the temperature dysregulation that triggers some of these symptoms.

    We also are starting to talk about food and diet. There’s a lot of research happening right now in the world of adult bipolar that is reconceptualizing bipolar disorder, not as a mood disorder, but as an energy disorder, and looking at the disruptions that go along with bipolar disorder episodes as originating on a cellular level.

    There are a lot of studies looking at [01:12:00] the use of metabolic therapies to treat bipolar disorder. In fact, we are starting one shortly in conjunction with the Baszucki Group who’s funding. It’s a study looking at the use of the ketogenic diet in children to treat bipolar disorder.

    And so diet is also another part of it, whether you want to go full keto or not, moving your child away from a standard American diet with highly processed foods, lots of dyes and all sorts of things that our grandmothers wouldn’t have recognized on a label, that’s also important as well. Making sure that they’re controlling sugar, controlling other things in their diet that may be creating yet another obstacle that they don’t need to have to face on a day to day [01:13:00] basis in terms of regulating their mood.

    Dr. Sharp: Sure. These things are all important. I had a pretty wide ranging discussion about this and any number of these things we could go really deep on, but I just appreciate you being willing to shine a light on something that’s pretty fraught and misunderstood. There’s complex history in the mental health world. I think there’s so many things that folks can take away from this conversation and actually put into practice in their businesses.

    Elizabeth: I think one of the most important things that we emphasize over and over again is that because there are these pendulum swings for so long, there tend to be camps that get set up of no kids can’t have bipolar. Yes, kids have bipolar.

    We want to bring that pendulum back to the middle and say [01:14:00] whether or not they have bipolar is only relevant insofar as we want the right diagnosis. The only way that you can rule out bipolar is by being willing to consider it in your differential diagnosis.

    Dr. Sharp: It’s a great point. I think not many of us probably start from that place, it’s easy to rule it out. There’s so much good information here. If people want to learn more about the organization or get more resources, what’s the best way to do that?

    Elizabeth: They can find us at www.cmhrc.org, that stands for Children’s Mental Health Resource Center. They can also reach us by just emailing info@cmhrc.org. [01:15:00] We have a lot of services for providers, for families.

    We have professional discussion groups where we get interdisciplinary groups of providers together to discuss bipolar and its presentation in children. That’s a 6 session series that we do with providers. We have parenting classes where we teach parenting strategies that are effective when you’re dealing with kids who have mental illness. That’s a 9 session series that we do.

    We have school advocacy where we work with schools in order to make sure that children’s mental health needs are being met, not just in terms of generic mental health, but in terms of how to make accommodations for kids who have mental illnesses and need to be able to succeed in school. As I said, we work to better the entire system so that families and kids can get to a place of stability [01:16:00] sooner rather than later.

    Dr. Sharp: It sounds amazing. So many cool things that y’all are up to. We’ll definitely put all that in the show notes. Once again, thanks for being here, Elizabeth. This is a really cool conversation and maybe our paths will cross again here sometime soon.

    Elizabeth: I look forward to that. I’ll send you a webinar series that we did with Dr. Papolos on the phenotype of bipolar referred to as FOH. You can take a look at it. It goes through the history of the development of the diagnosis as well as the development of its treatments.

    Dr. Sharp: That’d be great. I really appreciate it. Thanks again for being here.

    Elizabeth: Thank you for having me.

    Dr. Sharp: All right, y’all. Thank you so much for tuning into this episode, always grateful to have you here. I hope that you take away some information that you can implement in your practice and in your life. Any resources that we mentioned during the [01:17:00] episode will be listed in the show notes so make sure to check those out.

    If you like what you hear on the podcast, I would be so grateful if you left a review on iTunes or Spotify or wherever you listen to your podcasts.

    If you’re a practice owner or aspiring practice owner, I’d invite you to check out The Testing Psychologist mastermind groups. I have mastermind groups at every stage of practice development; beginner, intermediate and advanced. We have homework, we have accountability, we have support, we have resources. These groups are amazing. We do a lot of work and a lot of connecting.

    If that sounds interesting to you, you can check out the details at thetestingpsychologist.com/consulting. You can sign up for a pre-group phone call, we will chat and figure out if a group could be a good fit for you.

    Thanks so much.

    [01:18:00] The information contained in this podcast and on The Testing Psychologist website are intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric, or medical advice, diagnosis, or treatment.

    Please note that no doctor-patient relationship is formed here and similarly no supervisory or consultative relationship is formed between the host or guests of this podcast and listeners of this podcast. If you need the qualified advice of any mental health practitioner or medical provider, please seek one in your area. Similarly, if you need supervision on clinical matters, please find a supervisor with expertise that fits your [01:19:00] needs.

    Click here to listen instead!

  • 463. Pediatric Bipolar w/ Elizabeth Errico

    463. Pediatric Bipolar w/ Elizabeth Errico

    Would you rather read the transcript? Click here.

    How could we have possibly recorded nearly 500 episodes of the podcast without talking about pediatric bipolar?? Unbelievable. That’s why I’m so grateful to have my guest today, Elizabeth Errico, to dive deep into one of the most controversial diagnoses in our field. Elizabeth and I talk about several aspects of pediatric bipolar, including:

    • The history of the diagnosis and why it’s so misunderstood
    • Differentiating pediatric bipolar from ADHD, DMDD, and ODD
    • Communicating with families about a pediatric bipolar diagnosis
    • Treatment options for pediatric bipolar

    Cool Things Mentioned

    Featured Resource

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    PAR is a long-time supporter of the Testing Psychologist podcast, and I will continue to bring you featured items from their catalog! Listen to each episode for specific product recommendations and links. Learn more at www.parinc.com.

    TherapyNotes is the leading EHR system for mental health practitioners. I’ve used TherapyNotes for over 10 years, and it just keeps getting better. Use this link and the promo code “testing” to get two free months and try it for yourself! www.therapynotes.com/testing

    The Testing Psychologist podcast is approved for CEU’s!

    I’ve partnered with At Health to offer CE credits for podcast episodes! Visit this link to access current and past episodes available for CE credit. You can use code “TTP10” for a discount on ALL the course credits you purchase from At Health!

    About Elizabeth Errico

    Elizabeth founded the Children’s Mental Health Resource Center after more than 20 years as a mental health professional. Throughout those years she saw countless families struggle to find answers and support from a complex mental healthcare system that often ignores or minimizes their concerns. CMHRC grew out of the awareness that these families and their providers deserve better access to information, resources, and expert guidance as they seek accurate diagnosis and effective treatment.

    Get in Touch

    About Dr. Jeremy Sharp

    I’m a licensed psychologist and Clinical Director at the Colorado Center for Assessment & Counseling, a private practice that I founded in 2009 and have grown to over 20 clinicians. I earned my undergraduate degree in Experimental Psychology from the University of South Carolina before getting my Master’s and PhD in Counseling Psychology from Colorado State University. These days, I specialize in psychological and neuropsychological evaluation with kids and adolescents.

    As the host of the Testing Psychologist Podcast, I provide private practice consulting for psychologists and other mental health professionals who want to start or grow psychological testing services in their practices. I live in Fort Collins, Colorado with my wife (also a therapist) and two young kids.

    Ready to grow your testing services? Click below to schedule a complimentary 30-minute pre-consulting call!

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