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Dr. Sharp:  Hello, everyone. Welcome to The Testing Psychologist podcast, the podcast where we talk all about the business and practice of psychological and neuropsychological assessment. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.

This episode is brought to you by PAR. PAR has recently released the Feifer Assessment of Childhood Trauma, or the FACT, the first and only comprehensive instrument measuring how stress and trauma can impact children in a school-based setting. You can learn more or purchase the FACT teacher form by visiting parinc.com\fact_teacher.

Hey, y’all. I am back with you today with another business episode. Today we are talking all about financial literacy and knowing your numbers. Today’s episode, like a lot of episodes, was inspired by some of the discussions in one of my recent mastermind groups.

During one of the hot seat sessions in this particular group, we got to talking about this whole topic, about financial literacy. So, understanding money, moving money around within your practice, profit, revenue, all sorts of things. We also got into talking about specific benchmarks for budgeting and targets that you should be shooting for within your practice to make sure that your practice is financially healthy.

I thought that I would share some of the key points on the podcast and expand a little bit on that discussion in the hopes that it would be helpful for the rest of you.

Now, at this point in time, I think there’s still a spot or two left in both the intermediate mastermind group and the beginner mastermind group. So if you’re in that beginning phase of launching your practice, and you would like some support with that and some guidance, we have a group for you. Likewise, if you are a solo practitioner who has mastered the beginning phase, but you’re feeling overwhelmed and you need better systems and maybe want to hire an admin person or train an admin a little bit better, the intermediate group could be a great fit for you.

So these are group coaching experiences. There’s lots of accountability. There’s homework. There is guidance. There is support. And they are pretty awesome. If that sounds interesting to you, you can go to thetestingpsychologist.com/consulting and book a pre-group call to see if it’s a good fit.

All right, let’s jump to this discussion about finances.

Okay, y’all. This will be a pretty short and sweet episode. If you’ve been listening to the podcast for any amount of time, you know that I’ve had a number of financial folks on the podcast. I’ve had accountants. I’ve had financial planners. I’ve had Tiffany McClain talking all about the money mindset.

So we’ve talked about money before, but just recently, I started working with a new accountant over the last six months or so, and they have shared some really helpful information that has never really been articulated at least to me in the context of accounting for my practice.

My new accountant is Green Oak accounting. Shout out to Green Oak. There’s a link to them in the show notes. I don’t have any sort of affiliate relationship with them or anything like that, but Green Oak has done a great job at helping me get an understanding of the benchmarks that I should be shooting for within the practice. So, I’ll get to that here in just a little bit.

First, I want to do a little bit of an introduction just around what this all means, what I mean by financial literacy, some terms, and some ideas that I’ve run into in my own practice that I wonder if they might resonate with you as well.

The main idea is that for many of us money is either scary or at best unfamiliar to most of us. We do not learn much about money management in grad school unless you had the foresight to take a business class at some point. And so, most of us get thrown into the situation of being a great clinician and starting a practice because we want to be in private practice, but then not having a great idea of different aspects of running the business and money or finances or budgeting or accounting is a big part of running a business.

A little statistic that I found is that 40% of small business owners said that they are financially illiterate. So almost half of the small business owners would say they’re financially illiterate, yet 80% are doing their own books and finances. That’s not good.

If you are in that camp, don’t despair. That’s okay. That’s what this episode is about. And there are plenty of resources out there to help you. I know that I personally was in that boat for at least the first 5 or 6 years of our practice. I was doing the books “not well.” I was doing all the accounting. I was doing my own taxes. I was doing all the budgeting. And when I say doing, I mean scraping by and messing up and not actually doing a great job.

I think that’s super tempting when you just start out because you don’t want to pay for it. And it seems easy. That’s understandable, but if that’s happening for you, just know that you’re not alone. There are a bunch of small business owners out there who are again, financially illiterate.

So here’s what we do. I mean, what do we do as psychologists when something is uncomfortable or scary? Well, we confront that fear because we know avoiding makes it stronger and we’ve got to cut through that avoidance. We got to get comfortable with money.

If you get to the point in your practice eventually where you don’t have to look at your numbers and you just read the reports that come back from your accountant or your bookkeeper, that’s fantastic. Likewise, if you are totally financially literate and you’re super comfortable with money and you have no work or no avoidance around that, then this is not a big deal. You can totally avoid it. You can just let it ride and not make the soup overly complicated.

However, if you are one of the folks like myself who has or had a lot of avoidance around money and it’s scary and you’re not sure what to do with it, it’s great when you have it, it’s the worst thing in the world when you don’t, if any of those things resonate, then you got to approach it. That’s what I’ve found in my experience has been super helpful. So, forcing myself to learn more about the numbers. Talk with my accountant, look at the books even when I feel scared. You got to go and face it.

So, that’s dipping my toe into a small amount of therapy for some of you, but on totally my own experience. But let’s talk about some terms. I’ll just talk about two terms and then give a few benchmarks and then we’ll wrap up. So terms.

Gross Revenue. This is top line. You might hear the term top line revenue. This is just everything you bring in before expenses. For most of us that is client payments. So it’s just everything. It’s all the money that you bring in before your expenses. That’s the top line.

Your net income which is typically equivalent to profit is what’s left after you take away the expenses. So, gross revenue minus expenses, that is your profit. Sometimes people call this the bottom line.

A bookkeeper is an individual who makes your finances make sense. So a bookkeeper goes into your accounts. They reconcile all of the accounts. If you use financial software like QuickBooks or some kind of accounting software, the bookkeeper will go in and make sure that everything makes sense. All the math adds up. So they do the numbers. They look through and make sure all the numbers make sense. Your expenses match your credit card statement, and your profit matches revenue minus expenses. They just make all the numbers make sense. They live in QuickBooks or your accounting software and balancing the books if you’ve heard that, or kind of like balancing your checkbook way back when we had checkbooks.

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All right, let’s get back to the podcast.

An accountant is an individual who takes the information from the bookkeeper and then typically files your taxes. That’s primarily what an accountant does. Some accountants, like my own, like Green Oak, offer more services that dip into the realm of financial planning, or even like external CFO services where they’re really looking at the numbers, they’re diving deep, they’re helping you plan for expenditures. They’re budgeting for your practice. They can do a lot, but at the core, an accountant is going to file your taxes, which is important as you might’ve known.

Lastly, financial planner. I had Ariel Ward on the podcast a few months ago. She’s a financial planner. So financial planners really help you figure out where to put your money in terms of retirement savings, investments, things like that.

Okay, so let’s talk about some benchmarks. And again, this comes straight from the folks at Green Oak. I imagine that these numbers may vary a little bit depending on who you talk to, but I’m going to give you a little bit of a range. So when you think about where the money in your practice should go, these are some things to shoot for:

Payroll, which includes your own salary or your own compensation but also includes any clinical staff you might have. It does not include any admin staff. So we’ll hold that for a second. But your payroll is by far the largest expenditure within your budget. And that’s going to account for anywhere from say 53% to 60% of your budget goes to payroll and paying your folks, including yourself.

Your admin staff should eat up about 5% to 7% of your budget. So let me go back. Admin staff, that includes: receptionist, billing staff, anyone, any non-clinical staff. Rent, I talked about briefly in a podcast a little bit ago, I think in finding office space a couple of months ago. I ballparked that a little bit high and said, if you’re around 10%, you’re good. My accounting folks say 6 to 7% is more of a target to shoot for. So if you make, let’s say $100,000 a year, about $7000 of that should go to rent, or if you want to make it easy, $6000 goes to rent. That’s about $500 a month.

Let’s see. Other overhead. For us, this would include things like testing expenses, furniture, computers, iPads, and so on and so forth. Other overheads should comprise about 10 to 12% of your revenue.

And then lastly, the profit in your practice should fall, especially if you’re smaller, should fall around 15% to 20%. So profit is what is left over after all expenses, everything’s said and done, including payroll. This is just the profit from the business. This is the free and clear money that you can do whatever you would want with. So, that’s where we’re at. And then that’s where you pay taxes from. So you pay taxes on your net profit.

Okay. So what if you are listening to these benchmarks and you’re not there? Well, that is totally okay. Full disclosure. Our practice is not right there in those ideal ranges for each of those categories. That’s something to work toward. It fluctuates month to month a little bit. So that’s totally okay. There have been a few times, I can think of two times right off the top of my head here in the practice when I was extremely concerned about money. Every time it was because I just wasn’t paying attention and had avoided the financial reality within the practice.

And then as soon as I got it together and faced that fear, things always got a lot better. I’ve said on the podcast many times that a lot of anxiety can be solved with math and that has always been true in my case. So if you are someone who tends to avoid finances in your practice, doesn’t like to talk about it, doesn’t like to look at them, this is a call for accountability to turn that around and get some folks on your team who can help you with the financial part and just generally, stop avoiding it.

There are all sorts of reasons we might do that and that’s outside the scope of this podcast, but I know that money is powerful and there are so many emotions tied up in money, but this is, like I said, a quick and easy, kind of scratching the surface discussion around money, some benchmarks for your practice. Some things to think about.

There are folks out there who can definitely help. There are the financial folks, but then there are also financial therapists. There are people that do work on a money mindset. So there are lots of resources out there if you would like to get some support. So, don’t hesitate to do it.

If you want to take things into your own hands, you can always take a class on small business finance. That’s easy. You could take an accounting class just to get more comfortable, more familiar, do a little exposure around finances. There are tons of podcasts out there. I’ll give another shout-out to my friend, Tiffany McClain, who has a podcast called the money sessions, where she talks to therapists all about money mindset and rates and fees and wrapping your head around the money. So, lots of resources out there. Don’t despair. If you are struggling with money, it happens, but it’s totally doable to jump in there and turn things around.

So I hope this was helpful for some of you. Even talking about this for me is a little bit therapeutic, because like I said, I’m an avoider when it comes to money. So, it’s just all part of the process of facing that fear.

Like I said at the beginning, if you would like some support in the beginning stages of your practice or in that sort of messy middle stage of your practice after you’ve gotten past the beginning, The Beginner Practice and Intermediate Practice Mastermind Groups are open at the moment. They both start in mid-November. I think there’s a spot left in each. So you can schedule a pre-group call at thetestingpsychologist.com/consulting and we’ll see if it’s a good fit.

Otherwise, I hope everyone is doing well. And I will catch you next time.

The information contained in this podcast and on The Testing Psychologist website is 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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Dr. Sharp: [00:00:00] Hello, everyone. Welcome to The Testing Psychologist podcast, the podcast where we talk all about the business and practice of psychological and neuropsychological assessment. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.

This episode is brought to you by PAR. PAR has recently released the Feifer Assessment of Childhood Trauma or the FACT, the first and only comprehensive instrument measuring how stress and trauma can impact children in a school-based setting. You can learn more or purchase the FACT teacher form by visiting parinc.com\fact_teacher.

All right, y’all. Hey, welcome back to The Testing Psychologist podcast. I love today’s episode. This was action-packed, information-packed, and we had a little bit of laughter as well. I’m talking with Nicol Stolar-Peterson who is an expert witness. She is a licensed clinical social worker and the founder of therapistcourtprep.com where she helps therapists prepare for court and deflect it when possible.

Nicol and I got into all sorts of things about going to court: when you have to go to court, how to respond to a subpoena, how to negotiate fees, how to set your fees, what not to do in court, what to do in court, you get the idea. There’s a ton of information here. A lot of the topics we talk about directly address the questions that come up often in The Testing psychologist Community on Facebook. So I think there’s a lot to take away.

Before we get to the episode, I would like to invite the intermediate practice owners and beginner practice owners to perk up. I have two spots in each of those mastermind groups at least at the time of this recording. They will be starting in mid to late November.

The intermediate practice group is for those solo practice owners who have mastered the basics but are feeling overwhelmed and would love to dial in their systems, maybe hire an admin support person, and just generally do better while still staying in solo practice. The beginner practice group is for folks who are getting ready to launch or just launched their practices and would love some support and accountability with marketing, setting your schedule, figuring out which measures to buy, how to set your fee, establish a business entity, all sorts of stuff like that. So if either of those fit you, I’d love to talk with you. Like I said, two spots left in each group. You can book a pre-group call at thetestingpsychologist.com/consulting, and we’ll figure out if the group is a good fit for you.

All right. Let’s get to my conversation with Nicol Stolar-Peterson.

Hey Nicol, welcome to The Testing Psychologist.

Nicol: Thank you so much. I’m very happy to be here.

Dr. Sharp: Well, I’m happy to have you. I’ve heard of you through the Grapevine, through professional connections many, many times over the years. I think I’ve seen pictures of you on Facebook having fun with my friends and I’m like, “I need to reach out to Nicol and see what she’s all about. I’ve heard such good things.” So I’m super grateful to have you. I know you have a lot of knowledge to share with us. It’s going to be great. So, thanks.

Nicol: Thank you.

Dr. Sharp: The first question as usual is, why do this? Why make a specialty of this in addition to the work that you are already doing, but to create something, to be a resource for mental health folks going to court?

Nicol: I think because the work that mental health folks are doing is so important, what could be more important than learning and understanding how to protect your brand and your business by making smart choices when somebody asks at court or asks you to write a letter, or can you come and speak for me in court? Essentially asking a therapist to advocate, which we know in court, when therapists show up in court, 99.9% of the time it’s as a fact witness. They’re there to share information about what they’ve seen, what they’ve heard, what they’ve observed.

And so, I think what I’ve learned over time is that therapists really weren’t given the information that they needed about court and it comes up. And so we all went to grad school and they gave us certain things, but they really didn’t give us any information on how to run our business. And then, of course, the information we would need when people would ask us for these things, or they’re stuck in some type of a custody battle, and they’re trying to get something additional from the therapist.

And so without having that training and you’re just thrown into, sometimes these situations, I became very aware over time that a lot of my colleagues and friends needed help the day before court, or the week before, they were calling me and I was prepping them and helping them understand what the environment was going to be like.

I used to have an earpiece. I remember giving one of my kids a bath and trying to talk to somebody and thinking, this is nuts, and realizing there had to be a better way. And then I met Kelly and Miranda through Zynnyme, and went to their most awesome conference and had it kind of explained to me like, Hey Nicol, you have this thing that people need. And I was like, “What?” Like, yeah, you need to find a way to get it to more people without you because there are only so many hours in the day that you can do this thing. So, how do you help others in a smarter way?

And so then therapist court prep was birthed that weekend. And it was like, oh, people did meet this. This is something. Okay, I get this. And so I started developing therapist court prep. Here we are today. It’s been, I think, surprising to a lot of colleagues the help that is available and the fact that they really do have the skills that they’re going to need there. They just have to be teased out sometimes.

So, I’m just grateful that I have something that can help therapists because I really do believe in the work that we do as therapists and the importance of understanding the steps we have to take to protect it, which is sometimes things we don’t think about. We’re like, oh, we’ve gotten all practice. That’s good. Actually, there are some other things we have to do along the way, and this is one of them because it’s kind of a litigious time, people are involving therapists more and more often in court proceedings. So, I think it’s an important resource. So that’s why I do it.

Dr. Sharp: That’s fantastic. There’s so much in that that I want to dig into, but just a couple of things I’ll pull out right away that stuck with me is looking at it as a way to protect your brand and yourself and your practice. I think that’s a cool perspective that wouldn’t necessarily be the first thing to occur to me. I hope we can dig into that as we go along. `

Nicol: Yeah, it’s called CYA, Cover Your Assets. You need to protect your work. And it’s not enough to just understand the code of ethics just to pass the exam. It’s an ongoing living, breathing expectation. And so part of those expectations, one of the biggest ones is going to be staying in our scope. And when people pull on our heartstrings and ask us, can you do this for me? Or can you do that? And you’re like, oh, I want to help. And what can happen is then we can get led down a road that can be really dangerous for our business, because if we’re out of scope, then we have all sorts of issues that can come up, board complaints, the list goes on.

Our brand is really our name. It’s the service that we provide. It’s the same as knowing no, I know Dr. Sharp because he does this, this, and this. When we go in and we go out of scope, it can spread around. People are like, oh, wait a second. This therapist went and did this. Okay, hold on. And things can change pretty quickly.

So I always think of it as, it’s not a defensive thing. I’m not going to defend my brand but I’m going to stand for it. I stand for my work. I stand for the importance of the work that we do as therapists. And if I can convey that information in a clear way, in a concise way in a court, so that the bench officer has the information that they need, or if it’s a jury, they have the information they need to make a decision, that’s great, but my only job is, to tell the truth, and to talk about facts.

And so, it gets, I think, a little bit cloudy and murky for a lot of us therapists because, again, our heartstrings, and we’ve been with our clients for so long. And so things can change, but it’s our brand and our name is everything in the work that we do, obviously. So protecting it and recognizing what we can and can’t do, really knowing what our limits are and expectations, that’s great. And then, we can take care of ourselves and our businesses, these very important businesses.

Dr. Sharp: Right. Yeah, I think that speaking for myself, especially early in my career, and I think what I see with a lot of my therapists and psychologists here at the practice is that people freak out when the court gets involved. So like you get a subpoena or a client asks you to do something in the forensic setting. And that’s not our fault. I don’t know about you, we definitely did not have any courses in graduate school about… 

How do you respond to a subpoena was the most we ever got. It never went to here’s what you actually need to consider or here’s what you do once you get to court. That’s not something that we learned, but you must have had experiences to lead you in this direction, right? And then to somehow decide to make a career of it and get really good at it. I’m curious what that evolution looked like for you?

Nicol: It was rough. The very first trial that I had to sit on, I was terrible. I was a social worker for child protective services. My boss said, “Just read through your case, go in there and tell the truth, and Stolar it’s going to be fine.” I said, okay.

So I did that. I showed up with this big old case file and I’d read it. I got up on that stand and probably one of the best attorneys in the area, of course, was questioning me. I didn’t know what I was doing. I over-talked. I under-talked. I interrupted. I went too fast. I was so worried. I was trying to keep up. I was flipping through this huge folder trying to find things cause I was feeling so rushed. The whole thing was unsettling. I had no idea what to expect in that room. The environment. My nerves were through the roof. I’m sure my leg was shaking. My legs usually don’t shake. You name it. Everything under the sun.

What I realized that day because, of course, I hate feeling like I don’t know what I’m doing. I don’t mind being wrong. I don’t mind getting things wrong and learning something new, but I hate that feeling of just not knowing what I’m doing at all. And I had that day. It was terrifying because it was such an important case. The work is so important that to not be able to convey basic factual information, was really hard and it was embarrassing. I just have this dark cloud over my head. It was just terrible.

So I left and I was like, oh, that’s it. I’m going back to the waiting tables. This is not for me. This is terrible. I told my boss, hey, I saw, “Help wanted” sign down the street at the restaurant. I’m going to go get a job there. And he’s like, just take a breath, take a breath. I just felt terrible and he’s like, “Well, what would you have done differently?” I’m like, “Everything. I don’t even know what to do about that. I didn’t even have to explain what had happened because I think I had this trauma experience of being just completely unsettled and I didn’t know what had happened. I was trying to explain and I couldn’t.

So, I really had to sit with it that night. And then, I kept thinking about the importance of the work that I was doing. So, I went back the next day and I said, “Hey, that was terrible. I’d really like to go learn. I’d really like to understand it.” And so, I was able to go back to that same courtroom, same attorneys who were like, oh, there’s that one.

When I walked in and had to just swallow my pride and say, hey, I didn’t understand anything that happened. And I would like to learn. What really surprised me is they were like, “Okay.” And I said, I just needed explained. I need to understand. And so I sat there and they would explain to me some of the handshakes that happen, even before you walk into the room. They would explain how everybody at that table actually does get along. They’re going to have lunch after even though they seem like they hate each other during that time.

I had it explained the difference between listening for a question and if you don’t get to finish, maybe the other side will pick it up and you can circle back. And just, it was the strangest day of just watching it play by play and recognizing that it’s such a different environment. And recognizing how they look when the social workers walk in with these huge case files.

And that was one of the things that I definitely obviously teach very differently now how to prepare for court. It’s very different from coming in with 5,000 pages and trying to flip it and find something magically. Instead, it’s like, okay, what can we do ahead of time? How can we prepare? What do we need to expect? What’s it going to feel like? What’s it going to be like?

I think being willing to swallow my pride was probably the best thing I could do at that moment in time. And to this day, I’m still willing to be wrong. I’m still willing to get stuff wrong because I think we can always learn. And people who think they know everything, they scare me. They scare me a lot because I feel like they’re dangerous because they’re not capable of learning more. And I always think there’s more. There’s always more to know and there are always new experiences.

And so, with my clients for therapist court prep, first, we do some grounding work and then we talk about what to expect. And a lot of things in life are preparation. It’s just like what we do with our clients is we sometimes are preparing them for situations that are uncomfortable, right? And oftentimes that’s why they’re with us is because there’s discomfort and we’re helping them through that. And so that’s the same thing that I’m doing.

I don’t hold myself out to be an attorney. It is not the same. I am literally a therapist who happens to also be an expert witness. And what I bring to the table is coming from a therapist’s perspective. I’m talking about the facts and understanding what our role is and what our scope is.

And all of those pieces together came out of this horrible day in court. But what’s great about that horrible day is that I was able to then go back years later on a very big case, same attorney. And I was like, “Okay.” I had a notebook I prepared that was a 3-ring binder. I had a timeline prepared. I had tabs. I had everything available to me. I learned how to pace myself. He would ask his questions and I was able to do what I needed to do in that space. And the outcome was extremely positive and the results were amazing. It was so worth it.

I always think back to, and the irony of it being that same attorney, same courtroom, I was like, Ooh, we’re coming back to it.

Dr. Sharp: I love it. It’s like a corrective, emotional experience.

Nicol: Absolutely. And I left just standing tall and you feel like you’ve literally climbed Mount Everest. You just feel amazing because you were able to stand in it. You are proud of the work you’ve done. Be honest and everything works out. But again, it was just getting used to that environment and the expectations of the environment, being prepared ahead of time, and getting organized.

Those are the pieces that I think we just don’t get taught and maybe wouldn’t think of, and our fear sometimes takes over. A lot of the therapists I work with fear really has driven them to a point where they’re like, I called my malpractice and there is an attorney, but he’s not really going to prep me. And he’s just said, oh, everything will be fine. And I’ll sit with you in the depo. And I’m like, yeah, I know us. Our people, for the most part, we like to be prepared. We like information. We like to practice.

So that’s what we do, but yes, it definitely came out of a very traumatic experience. So I’ve been there. I’m the weird courtship because I like court stuff, but I totally get it when somebody says they’re scared. I’m like, “Oh yeah, I remember that. And I remember falling on my face and it sucked. It was woo pride swallowing.” Oh my God.

Dr. Sharp: Right. That’s the part of the story. That’s the thing that sticks out to me though. You had that experience and then you made the choice to go back and figure out a way to do it better. I think a lot of folks get turned off. It becomes an avoidance thing and this huge source of anxiety.

Nicol: We got to go back to practice what we preach a little bit because we’re in the field of helping others move through discomfort. And for some reason, our particular community, I’m not speaking for everybody, of course, but I would say there’s a lot who will just bury their heads in the sand. I’ve heard therapists say, if I get a subpoena, I just don’t respond. I’m like, holy catfish, you have to respond. Are you trying to get pulled over? And you’re trying to find out that there’s a bench warrant out for you. You have to respond. That’s crazy-making, but I’ve heard everything. This is my favorite. I just charge $10,000 for court and then nobody’s going to make me go. But yet they’re cash pay.

I think hourly is like $100 an hour. Like how could you possibly explain that to a judge because it’s not going to go well? And by not responding, that’s when you do get ordered by a judge to show up in court. And that’s the whole thing that nobody needs. Nobody needs that.

Dr. Sharp: Of course, not. I think I’ve heard most of the funny myths that are out there. Well, they are not myths because we’re actually doing them. I’ll take that back.

Dr. Sharp: Yeah, the crazy realities that are. Well, I think those are good. Let’s start with some of that stuff then since it’s coming up because I think people, people have these questions, right.

So right off the bat, let’s do the subpoena thing. And then let’s talk about the fees because both of those are hot topics. We’ll just cover some basics and give people some info that they probably don’t have, or may have forgotten. So you get a subpoena. Let’s start there. You get a subpoena. What do you do?

Nicol: First thing is to make sure it’s for you. I always make a photocopy of one. That way I can highlight and underline on it because I am a very visual person. And I think a lot of us feel traumatized just by getting it. And when we see it, sometimes what I have found is therapists don’t always read them thoroughly. And you want to understand if it’s asking you for records, if it’s asking you for appearance, or both. You’re wanting to understand, is it for a deposition, is it going to be for going to court?

And there seems to be this idea that I hear this all the time. Well, if it’s not from a judge, then it doesn’t mean anything. I’m like, actually it does. You still need to respond to it. You don’t want something from a judge because you’re going to be ordered and that’s a whole different bucket. This is the nicer version.

And then once you have it, you need to determine, okay, is this client yours? And then, always reach out to your client because here’s the thing about subpoenas, they did not magically pick your name out of a hat. It’s not like, oh, I’m going to pick out of this Ms. Stolar-Peterson. I’m going to pick Dr. Sharp. That’s who I’m going to pick. No, somebody gave us up. Let’s see. Who could it be? 90% of the time, it’s going to be our client. They gave us up.

This is when we get to the importance of our informed consent. Back at the point of informed consent, we have to have a court policy in place that clearly states what’s expected and what we will and won’t do in regards to court. However, if they do subpoenas, they’re responsible for the fees. If they do provide us as a witness, they’re responsible for the fees. And then we clarify that. 

But if we don’t have that and the subpoena shows up, it’s like, ah! And it makes it very difficult to get paid for something when you don’t have a contract. And when that informed consent with the court policy is not there that says that one thing about the court that clearly states it, that’s where a lot of therapists are not going to get paid for going to court because they might try to bill for it later. But if there’s nothing signed, maybe their client’s just like, actually I didn’t agree to that. I thought you did that for free. So I don’t really have to pay you.

And I’m going to say good luck to that therapist because you should have had that available to your client at the very beginning, right? It should be known from that first session.

Dr. Sharp: Right. Could I ask then, what would you say are the core components of an informed consent policy around court that we should be thinking about?

Nicol: So I will tell everybody, have your informed consent and then have the court policy separate, but do it at the same time. That way, if something comes up and somebody asks you to go to court, you can just email them a copy. PS, don’t forget you filled this out and signed this. These are the fees. These are the limitations and expectations. That way, oftentimes it’s just a deterrent. They’re like, oh wait, I forgot you charge $1000 for court. Ooh, maybe I don’t want to do this. I was thinking in my head like just a code-pay or just a one-hour session. No, actually these are my fees because I set aside my time, blah, blah, blah.

So having it be at the beginning, one clarifies if you do or don’t do court, right? Some people like it. Some people are like, “I’m happy to.” So you can say, this office does not provide court letters, dah, dah, dah, because court letters, that’s something additional, right? If somebody prefers to write them and they can say, we do write court letters, we charge this much per hour. This cannot be charged to your insurance or whatever.

And then the next section is going to be something to the effect of, if you provide me as a witness, however, this is going to be my fee for the day. This is how many days ahead of time I need to be paid. This is how I need to be paid. You also understand that you’re releasing your information because that’s the thing that I think a lot of clients don’t understand is once they say yes, they don’t get to pick and choose which parts of their file become known. It’s everything. It’s Pandora’s box. So I always like to do a session actually around it with my clients, like, Hey, don’t forget we did this, but let’s talk about what this really could mean to let everybody have access to me and to your records.

And so just taking steps through that, like what the fees are. But I think one of the biggest sections that I always focus on is limitations and expectations. I will not be making any child custody recommendations. That’s probably the biggest issue across the board. I have therapists who think, oh, why aren’t we talking about visits?

No, visitation is directly tied to custody and time timeshare. So we’re not doing that unless you have been appointed by the court as the child custody evaluator, and you’ve done it, then obviously you’re not going to be in a position anyway, right? So therapists, stay in our lane, we’re staying in our scope, but we have to clearly state that because some clients will be shopping for a therapist because their attorney told them, go find this. And then they get in there. And the therapist gets asked maybe a month, three, or four, hey, can you write me a letter? And the therapist is like, well, I don’t do that. Well, that’s not really fair to either party.

Wait, let’s talk about that at the very beginning, make a court policy, put it in there. I have one I sell online that’s a copy and paste. If you can take the yay or nay court, but anybody can write their own. You just have to make sure that it happens at the very beginning because you don’t want to end up six months in and not being able to charge for court or not being able to charge.

And I’m not saying you want to go to court, but however, should they subpoena you, here are the fees. So you just want it clearly stated. And then tends to be a deterrent because they forget, they ask you to go to court and you’re like, oh, hold on, let me just send you this one part of the informed consent, because if we send them 20 pages, they’re not going to read it. All of us kind of get traumatized. We’re like, oh, so much paper. Just send them the one piece that they need to look at it and be like, oh.

The other thing is they’re still going to have to sign consent for the release of information. That has to be done before we can release anything. Now, let’s say it’s an older client, we haven’t seen him in a few years and we get the subpoena, we still have to try to reach out and make a good faith effort to try to reach out. We can’t get a hold of them. Okay. And we don’t have consent. I like to respond to attorneys in writing. I like to do it by email. A lot of therapists don’t. I really do. I love paper trails. I’m a huge fan. I’m a huge fan because that shows that I made communication with you, you can’t go into court now and say, oh, she never called or we couldn’t locate her. I’ve got this email.

I would send an email at this time, I’m unable to confirm or deny that this person was ever a client. I don’t have any releases of information on file at this time to be able to release any information to you. That’s it. Then they’re going to call their client, and then they’re going to be like, oh, you need to call so-and-so, and then we’ll have a conversation. And then if they decide to release, okay. But I almost always encourage therapists to have a session around what that release is really going to look like. And then we release.

I prefer always releasing directly to a client if I can, but if there’s a subpoena, it is what it is. I’m going to have to release to counsel. But I love having paper trails. I’m a huge, huge fan. I’ve known, maybe hypothetically, a few attorneys who’ve gone into court and have said, we weren’t able to locate Ms. So-and-so and blah, blah, blah, blah. And I’m like, here’s my email. Actually, we did have a conversation.

So, it’s a lot of CYA. You’re taking steps to protect the communications that we’re having. The fact that we are looking out for confidentiality, whether or not we’re a HIPAA entity, but we’re still making sure that we’re looking out for our clients.

The other issue I think that comes up with this particular area is clients often, they’ll want their file, they’ll want their records and therapists are like, I don’t want to give it to them. Will they be in danger if they see it? Well, no. Okay. Well their stuff, right? It’s their record. They have a right to it unless, of course, we’re concerned about danger. So that comes up quite a bit too which I think has been interesting. And then that’s what I dig in a little bit deeper.

Therapists might say, well, actually my notes aren’t that great. And I’m worried that they’re going to think this, or they thought this during the session, but this is how it looks on paper. And I’m like, well, those are conversations you need to probably have with your clients. So you have a session around it.

Dr. Sharp:  Yeah. I have a few questions around all that. So one thing that happens, at least for us, is we will get subpoenas, but then the client, for whatever reason, I don’t think it’s malicious necessarily with any ill intent, but they won’t sign a release of information. Like we can’t get ahold of them or they just don’t send it back. What are you doing in that situation?

Nicol: I haven’t necessarily had to deal with that, but if that does happen, then you have no choice, but to invoke the privilege. So, there are two different ways. You can say, I have, at this time again, there is currently no informed consent that has been signed. There’s no release of information. There’s not anything that I have to give you. I’m so sorry.

And if they still have you come to court because they think they’re going to have a judge compel you, you can say, your honor, I have to invoke privilege because, at this point in time, I don’t have a release of information. This could really hurt my ability to practice as a therapist without having that to release. Now, if the judge compels you and says, no, I want to know what’s in that record, which I’ve never had happen, I’ve only had it invoked a few times, but let’s say that did happen well, you’re kind of weighing your odds.

Okay. So is it a judge being unhappy with you or the board and the judge has the ability to put you in a little cell. So I’m going to go with the judge. That’s who I’m going to answer to at that point. You do have to decide. I can’t say either one’s better than the other, but when I think about the judge holding me in contempt or having to deal with the board, and I imagine the argument from the board is I have a judge compelling me, ordering me in a court of law to do this thing that I know is unethical but at the same time, I’m being told I have to do it by a judge who can put me in jail? So hello.

As long as you get on the record, I think what I’m invoking privilege and here’s why, blah, blah, blah, then I think more likely than not a typical judge is going to be like, okay, well, like, hold on. Let’s maybe step back for a second and see what else we can do.

The other thing with that is I think a lot of therapists will invoke privilege on behalf of minors because oftentimes one parent or the other is trying to tug and pull and trying to get the information. And what I, at least my experience with some amazing judges has been a recognition of the importance of the relationship that therapist has with the minor. And they don’t want it damaged. And they’ll say, okay, you know what? We’re not going to compel because this kid needs somebody to feel safe with. This information is just to get better. It’s not going to be used as some tactic in court to win points. So, I think as long as we’re ethical, that’s everything. And we’ve voiced that. But sometimes we just have to clearly voice it to the bench officer so they understand.

Dr. Sharp: Sure.Thank you. Let’s go back to the fee thing. That’s come up a couple of times and then we will circle back to how you actually respond to a subpoena. So you brought up the fees. Let’s talk about it. How do you set your fees for forensic work?

Nicol: Okay. What is reasonable? It’s good to have an idea of what others are charging, like what makes sense for you, but again, there’s always going to be a therapist who charges $100 an hour and a therapist who charges $500 an hour. So you just have to figure out where you fit as far as that and whatever your hourly cash rate is.

The way that I figure out a court rate is if you are going to have worked, let’s say eight hours in your office. And we’ll just go low. We’ll say everybody’s making $100 dollars an hour, so $800, right? Okay. So then that person will probably maybe consider charging $1000 for a day because we’ve got drive time and lunch. And they’re not able to be at their office. They’re not able to conduct work.

The other thing I don’t usually agree to is being on call. I don’t like being on call. I think it really messes with your practice. So really getting a set date and time is important. Some therapists will agree to charge for a half-day or a full day. You just don’t know how long, but the problem is maybe you’re only up there for an hour, but you couldn’t book three more clients because you thought you were going to be at court. So it’s still lost fees. So that typically is considered reasonable. So, if a judge asks you, how did you come up with your fees? You can say, well, I charged you this much. And then this is what I would have lost. So basically this.

Now, maybe you want to charge more for court because you’re going to include maybe prep time. That’s okay. Maybe you’re going to charge $200 an hour, right? Okay. So maybe that day is actually going to be $2000, but in that fee, you’re going to include prep. You’re going to include time away from your business. You just have to be able to reasonably state how you came up with them.

To say $10,000 because I don’t want to go to court, it’s only going to piss off a judge. Right? That’s like, are you kidding? They’re looking to us as fact witnesses. You’re here to bring information so I can make a decision and understand what’s going on. And to say to me, basically, nope, I didn’t want to come here and I shouldn’t have to, I charged this just so I don’t have to, you’re taking advantage. It’s not reasonable. So I would imagine that the judge would be like, actually, you can take $1000 for today or maybe you can go for free. So be careful. 

When I hear the crazy fees, I’m like, how is that reasonable? And how is it ethical? I get that. You don’t want to go, but is it really feasible? Is it ethical? Does it feel good to you? And I think that’s where people forget, it’s your client that’s getting stuck with that bill. It’s not the attorney. It’s the client. So, let’s step back. I’m not saying do it for free. Absolutely not because I know the stress that therapists go through before court, but be reasonable. And so some people will charge maybe a prep fee and then their daily fee, or they’ll just put it into that fee. It’s really what you’re comfortable with, but again, is it reasonable?

Dr. Sharp: Yeah. So let me see. Let me run a couple of situations by you. I’ve heard and seen folks take your hourly rate for whatever you do in your private practice, testing or therapy and double it. And that’s your court fee? I’ve heard that as a rule of thumb.

Nicol: If that includes prep, but otherwise, what is it that’s so special about what you’re doing at court, and how are you going to show that that makes sense for drive time or lunch time? Again, when you break it down, if you’re sitting, imagine explaining it to a judge. That’s what I say by any fees.

Imagine just explaining it to a judge. And if you sound ridonculous then probably not the best way to go, but if it makes sense and you’re like, oh, okay, I get that. I’m charging double because it takes more preparation on my part. I’m doing this. I’m doing that. I’m away from my office, blah, blah, blah. Okay, I can buy that. But again, what’s your argument for it, right?

Dr. Sharp:  That’s fair. Okay, so the next question is, do attorney fees figure into this at all? Because at least in our area, I think in a lot of other areas, the typical fee for an hour for an attorney is much higher than an hour of a mental health professional’s time. That’s also something that I’ve thought about is can we make our fees commensurate with the other advanced educated individuals in the courtroom?

Nicol: I think that’s fair if you’re testifying as an expert. I think if you are going into that room as an expert, I think because if we’re talking about fact witnesses, I don’t think that’s fair because you’re not bringing this additional information. You’re not bringing this additional teaching opportunity of specialized training and experience. Okay, that’s something.

I think if we’re talking to folks who are in the area of testing, and you’re just doing the testing and you’re just doing evaluations, then I think it’s fair to consider because you’re essentially testifying as an expert versus a treating therapist. So they’re very different things in my world. So treating therapists, fact witnesses, right? There’s a very tiny group of folks who are treating and are also experts. I don’t go into that world. I keep my two worlds separate because it can get really, really dicey.

But if you’re just going in as let’s say, you’re just doing the psych testing and then you’re going to testify about it, that is an area of expertise. You are going to be most likely vetted as an expert. There’s going to be a […]. And then if you’re testifying as an expert, why not get paid like one? And there are actually lists of fees that are available online for free of what different experts in different areas. So you can look and see Ph.D. versus an MD, like what are they charging to get an idea of what is reasonable. Is mine so far out there? Oh, it’s not. Okay. That might be something to consider. 

Dr. Sharp: Sure, so this is where I tell my humiliating story. So the first time that I got called to testify, yeah, I’ll join you here, the humiliating part was around fees.

So I went through this whole process. I went to court, did the testifying. This was a case through a local DHS department. It was on me. We didn’t agree to any kind of fee ahead of time. That was just sort of compelled to be there. And then, I sent them… Well, let me back up. I did so much research on what my fees should be. I looked online. I probably found some of these lists you’re talking about. I thought I was being very deliberate and conscientious and I sent them…

Nicol: You gave them the contract for those amazing fees that you were looking at?

Dr. Sharp: No contract.

Nicol: Okay.

Dr. Sharp: Of course not. No, that would be too diligent.

Nicol: Okay, research.

Dr. Sharp:  Yeah. So I sent them this invoice and God bless this attorney who came back to me and was like, Dr. Sharp. I don’t really know how to say this, but these fees are higher than anything we’ve ever seen on any invoice. And I was like, oh my gosh, I am so embarrassed. And I tried to explain. I was like, oh, I’m so sorry. I did this research. I thought it was. And he was like, that’s okay. We’re going to need a new invoice though. And I backed it down.

Nicol: Let’s talk about the government if we can.

Dr. Sharp: Yes.

Nicol: Okay, because there’s a difference. Definitely, that’s a great opportunity for that.

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

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All right, let’s get back to the podcast.

Nicol: If you are subpoenaed by the district attorney or the public defender, you are going to get whatever set government rate. Now, if you are agreeing to be their expert, you need to agree upon, ahead of time what they pay their experts because they will have certain fees they’re allowed to and certain ones they’re not. And then definitely the same is true if you’re dealing with dependency court or family law, depending on which state you’re in and you’re talking about foster care issues, they’re going to have set rates as well for their experts. And so, anything with the government, again, you have to clearly understand ahead of time because otherwise, you’re going to get whatever they pay. 

Dr. Sharp: Yes. So, that situation came up probably a year ago with two of my psychologists where we got into and the government rate, at least here is, let’s say a third of our regular forensic rate. And so I had a lot of questions about that with the attorneys and the folks involved just to try to figure out, do we have to do this? This is so much lower than…

Nicol: You don’t have to take the clients. And that’s the thing. You have to decide who you want to be in business with. And some people really like working with the government because they know they’re definitely going to get paid. They know it will take forever, right? Typical red tape, but it’s a lower rate, but it’s consistent work. Whereas others might prefer to charge a higher rate and not work with the government, but then at the same time, there are some risks of clients paying, not paying that sort of thing.

And then I think also what we see, there’s a trend with therapists and with experts who are doing testing and that sort of thing where you will have, like the newer therapists or the interns, who are taking on the government cases because they’re getting paid a lower rate. And so we see this across the board.

And so, some agencies will decide, okay, everybody’s going to donate. We call it donate. Let’s say, you’re used to making $200 an hour, and this is going to pay you $50. They’ll say, okay, we donate. We’re each going to take two of these a month and then we’re going to tell the government, we have a cap of 10. We only can take 10 from you because we feel like it’s important work. We still want to do it, but we can’t keep our business open if we do it this way.

So you just have to, from a business perspective, can you afford to do it and then, decide to, because I think it is a great opportunity to do the work that’s so important, especially with kids that need it the most. Decide how many like how you would decide how many sliding scales you would offer, that sort of thing. It’s the same concept. Okay. Well, we can only take 10 a month or we’re going to use these. These will be our teaching cases, and this is where we’ll teach our interns and we’ll take them through step by step to try to figure it out. But again, they are almost always going to be at a lower rate.

Dr. Sharp: So in this situation, and I think I’ve heard through my network and Facebook group, this happens fairly frequently. This was a situation where we did the evals with these kids. I don’t even know, let’s say six months before the court situation came up.

So we did the evals not knowing that it was going to go to court and then lo and behold, six months later, they asked two of my psychologists to come and testify as to the results of the evaluation. And that’s where we kind of, we didn’t get into it. It wasn’t contentious at all, but there was a lot of back and forth around like, so this is the rate that you pay, but we didn’t know, we didn’t really consent to do this. Are we compelled to be there? 

Nicol: So let’s clarify from the very beginning whether or not you’re taking them. And then what the fee is. But at the same time that court policy, look, here’s the deal, especially if it’s going to be directly with the county or with the state, this would be the fee if you want any of us to be able to come. But a subpoena is a subpoena. You got to go. And if it means you’re not getting paid, it does suck, but they’re also going to know, here’s the deal, if we screw over this one agency, they’re not going to want to work with us. And we need them.

We need these evaluations, but here’s what I’m going to say for any psychological testing. If any of you are doing, sometimes we call them 730s and it kind of depends on what state you’re in, but if you’re doing some type of an evaluation, whatever it is, I want you to 99.9999% of the time assume it’s going to court to save yourself the grief because somebody somewhere wants a forensic assessment of something.

And the purpose of that 99.99999% of the time is in a court of law. They’re going to want to know how that shows up? How does that influence this? How does that do that? And yes, in the DSM PS on page 25 where it says, hey, these diagnoses are not hammer to the nail, but their guidance.

And it even says the court should like with caution, right? But here’s the thing is when we do an evaluation and let’s say you’re doing something like an MMPI or you’re doing a PSI or whatever it is, and the court wants to know more about it because of the testing, hopefully, the writing is clear enough that they can understand it. But oftentimes, they’re going to question how come you didn’t do this test? How come you chose this one? Explain to me this. Because if that testing is not perceived as supportive of one of the parties, that party has a right to question the person who performed that testing, who decided on that testing to say, this is why we would use this instead of something else.

And knowing that ahead of time, any time you perform a test or an evaluation, something to that effect, you can expect that somebody is going to have questions and that they have a right to ask you why you chose this, or why you chose that, and that sort of thing. So, I would just say to know that ahead of time and at the very beginning, especially figure out who your contact person is. 

If you’re dealing with a government entity, say, show me what the let’s say, PR sounds terrible, Fellas would be, what the expectations are. Let’s sit down and have a conversation about what we can, and can’t do, what it’s going to look like and what you would need from us specifically so that we’re not racing to court, losing clients, and this, because we like this, or we want to keep helping, but we’re still running a business and government with all the love in the world I say this, they forget that because they don’t run like a regular business.

And we’re trying to keep the lights on. We’re trying to pay for our staff. And when you’re a government employee and you’re not in that administrative role of figuring out who’s going to get paid what, you’re just there to make sure things get done, they don’t get the kind of stressors I think sometimes that go on for somebody who’s not a two-week paycheck kind of person, which we’re not. Private practice is a very different beast and the stressors that come with that.

So I think maybe if you can sit at the table with that person and understand and have a conversation, it could really change how you guys work together, and maybe you can agree to a higher rate. Maybe they’ve only ever paid $250 an hour because that’s what this other therapist was billing. Okay, well, our therapists bill at $300, or maybe you really bill at $400 and you’re like, well, we’ll do it for $300 because this is for children who are in foster care, like whatever, but I would just sit with them maybe and have a deeper conversation as to like how to get kind of in that place of agreement, whatever that agreement looks like.

Dr. Sharp: Yeah, I like that. Just as maybe a procedural piece too, something that we learned in that process was, it’s important who signs the informed consent. So, in that particular case, we had the foster parents sign the informed consent, but it came to light that, well, you should actually have somebody from the government entity sign the informed consent because they’re going to be paying for it if you go to court.

Nicol: And they’re truly the ones that have custody of the kids. The foster parents are providing care. They’re fostering. They do not have custody. Think of it like that. They live there. It feels like custody, but legal custody is with the agency. And so having them sign off and in agreement to what is, or isn’t going to be used, that’s extremely important for a lot of different legality issues, but we can.

Dr. Sharp: Another can of worms.

Nicol: A whole can of worms.

Dr. Sharp: Yes. Let me ask another question around these. I’m really hammering on this, but these are the things that get tripped up. So, super naive question, but who pays for these fees? Is it the client? Is it the attorney? Who do we send the bill to? Who should we expect to be paying us in these situations? Not government-oriented. Let’s say these are private clients.

And the reason I think it gets mixed up is because often we are contacted by attorneys or by the court, and then yeah, it comes up. It’s like, well, who do we send this bill to?

Nicol: 90% of the time that bill is going to go, typically it’s going to go to your client. You’re going to invoice them. And oftentimes if they’re wanting you to show up at court or depo, you’re going to agree that you’re going to get paid maybe seven days ahead of time. So that way you have that in place.

I’ve had as a fact witness once where the law firm actually cut me a check, I think because they had whatever kind of a setup with the client where they had a certain amount that they were going to be spending on experts. I wasn’t coming in as an expert. I was just a fact witness, but they, for whatever reason, determined that they were going to cut me the check that day.  And I was like, okay, but the majority of the time it’s going to be from the client.

Now, the question is who’s the client, right? That’s always the question. Who is the client? And that’s probably one of the bigger issues is determining who’s the client. When it’s the government, we’re talking about a PD or we’re talking about a DA, then they’re going to be cutting a check. So it’ll come strictly from the county. And usually you need to have, I always say, keep a W9 with you, just to make life easier because they’re probably going to ask you for it. Keep an invoice. That way you can just hand it off. But I like emailing again, paper trail. It’s always nice. So I email a lot of that, but most of the time it’s going to be the client.

If it’s a public defender, if it’s a DA, it’s going to be typically going to come from the government and you have to deal with them and fill out whatever paperwork in order to get paid from them. If you are going in as an expert. So let’s say you’re doing the testing and you’re doing the psych evals, again, you had a client who said, I’m going to do this. Now, if that client talks with whatever law firm and the law firm says, okay, well, we’ll pay for the person who did your testing and they want to cut you a check, that’s fine.

It’s not like you’re bought and paid for by the person who writes the check. It has nothing to do with it. The person writing the check is paying for your time, not for your opinion. They’re paying for your time. And so, your statements, your statement of facts if you’re coming in as a fact witness, or if you’re coming in as an expert, your opinions, they’re never paid for, it’s your time.

So, that was probably one of the best things I got from it. I went to an expert witness training by Seak and one of my trainers, his name’s Jimmy, who appreciated this, but he talked to, he was like, you guys it’s your time. And it really is because the truth is the truth. And it’s just a matter of like the rest of us. We all show up at work and we get paid a certain rate for doing our work. And that’s it. It’s doing our work. It’s not paying for somebody to say yes or no. It’s just paying for your time. And then it’s up to you to show up as the ethical person that you are, and to tell the truth and to provide that information so the court can make whatever decisions they need to.

Dr. Sharp: I like that. That’s an easy rule of thumb.

Nicol: Yeah.

Dr. Sharp: Yeah. That’s nice. Let’s talk about facts versus experts. I hear a lot of confusion around this as well. And you’ve mentioned this a few times, so let’s break that down.

Nicol: Sure, let’s make it really easy. A fact witness is going to be your typical therapist who has a relationship with their client. They’re aligned with them. They’re working with them. Maybe they’ve worked with them for six sessions, maybe it’s been six years. I don’t know, but as therapists, it’s okay to be biased because it helps us do our job. It helps us to be on the side of alignment with our clients. That’s okay. Bias always sounds terrible. It’s always used in a horrible way, but in our world, it’s expected. So we are biased when we are the treating therapist. We are working with them.

Okay. Now, facts only. So if you are the treating therapist, again, I say 99% of the time, you are going to be the fact witness. You’re talking about what you’ve observed, what you’ve seen, tasted, smelled, it’s the basic senses, right? It’s facts. What you saw, maybe you saw a fight in the parking lot. Maybe you saw a black guy. Maybe you saw a kid go in the fetal position when dad was brought up, who knows? 

You’re talking about the facts. We’re not doing the whole forecasting. Well, do you think in the next two years that this person could be violent and blah, blah, blah, blah? Come on, please. I can tell you based on my experience, my observations, this is what we have today. That’s it. Okay.

So then we move over. Let’s say we’re moving over the world of expert witness. Expert, witness, very different. They do not have a preexisting relationship with the client. They’re coming in to do a test or coming in to do an evaluation. They’re coming in to do an assessment of a case maybe, but their whole job is to show up and to provide information to the court in different ways.

A lot of times we’re teaching about something very specific that we happen to know about. My area of expertise happens to be child welfare. So I’m going to talk a lot about the standards, what’s expected. I’ve never met any of the people on the case. I don’t talk to the social workers. I don’t talk to the clients. I just get it all, sometimes it’s 30,000 pages and I’m going to go in and I’m going to review, but I’ve never met these people. I don’t have that relationship. Maybe I’ve seen them, a picture of them somewhere, but I don’t know. I don’t have that with them.

So I don’t have bias. I’m going to do an objective review. I’m going to provide that to the court. But again, I don’t have that preexisting relationship. And so that allows me then to come in and just be really objective and say, this is what I see. This is my opinion about this. This is my opinion about that based upon my training, my experience, and my education.

But again, that’s very different from what we just talked about as being a fact witness. Being an expert is a strange spot to be in because you’re going to get vetted. You’re going to get […] Someone’s going to decide whether or not they find you truly to be an expert, whether or not they agree with everything on your CV. Is it really reflective of what you’re talking about? That sort of thing. Do you have the training, the education, and experience to be an expert in what you’re talking about, to say, I think this?

It is very different from a fact witness because all they have to do is tell the truth about the facts. They’re not opining. That’s a big difference. One is just providing facts. The expert witness can opine. We can have opinions about things because of these, this, this, this, this, and this. So they’re very separate. They’re intended to be separate.

A good example of this would be a forensic interviewer for children. There are CPS workers or DCFS, whatever you want to call them, who are going to go out in the field and do an investigation. And let’s say a child discloses sexual abuse, they’re going to let them finish whatever they’re saying. And then they’re going to try to get them over typically to some type of forensic interview. It might happen that day. It might happen in a month, depending on the forensic interviewing calendar and all the things.

So the whole purpose of that interview or not being that social worker is they don’t remove kids. Their only job is to talk to kids all day long in that room and to talk to them using typically like the 10 step interview, which is a very specific style of interviewing. Then when they go to court, they can talk about that style of interviewing and why it’s important. What the testing shows. Why that is the best style of interviewing for children? Then they’re going to also talk about the fact that they never met that kid before. They didn’t know that kid. They just did that interview. Maybe they had to do two interviews, but that’s it.

Their whole job is very forensic, right? It’s just this one thing versus having the social worker do it when there’s an assumption that, like they could take me away. So I’m going to tell them whatever I think I’m supposed to. That’s very different from going into forensic space and then having it recorded and having law enforcement on the other side of the mirror and all those pieces.

So again, it’s like, what’s the purpose of what the work is that we’re doing? Therapists again, 99.9% of the time, they’re going to come in as a fact witness. If you’re coming in as an expert, you’ve been hired to do an evaluation, an assessment, or review, you’ve been asked to give an opinion because you have a very specific area of expertise, whatever that might be. They just stay separate. And that person is providing opinions. The expert is providing opinions based on their training, education, and experience.

Dr. Sharp: What about those situations where we do an evaluation with an individual or a kid, and it was not for the purpose. We weren’t originally retained for the purpose of doing an evaluation for the court, but then we ended up again, like six months down the road where the families are now going to court and they pull in the evaluation results and pull us along with it. Where does that fall?

Nicol: Are you saying you’ve also been treating that kiddo, and then you also need to decide to do an evaluation to try to… Is the purpose of the evaluation to help treat, or to assess? What’s the purpose?

Dr. Sharp: Yeah. Let’s see. I’ll give you a great representative case. So typically when we do evaluations, we’re not doing any treatment at all. So, families, let’s say parents will contact us and say, Hey, my kid’s been struggling in school and he’s having meltdowns at home. We’d like to do an evaluation to figure out what’s going on.

So we do the assessment. Maybe we diagnose the kid with a learning disorder and some depression or a behavioral disorder. We don’t do any treatment. We do the evaluation. We give them the results. They go on their way. Six months down the road, they’re in court because parents are getting divorced, and lo and behold, there was something going on that was influencing the kid’s life, or they think that. So that’s kind of a representative situation that we might run into.

Nicol: Again, think of it from a teaching perspective. A lot of times when we see clients, we’re getting a snapshot. We don’t get the whole film. We get a snapshot and the snapshot in time. And I think when I was writing the evaluations, at the end, I would always put something like, if there’s additional information or something that you know, blah, blah, blah, that could potentially change the outcome of this.

I always put in a blurb about that because it’s true. There’s always more. We’re never going to get it all. We’re never going to get it all, not in the testing, there’s just no way. We’re getting snapshots and it’s like putting it together and trying to make sense out of the puzzle and yet some of the pieces are not there and you’re like, okay, what does the picture look like? Okay, well, I’m missing an eyeball. I’m missing afoot but okay, I can see the picture.

And oftentimes I think that’s what we have to convey is like, this is, again, it’s a snapshot. It’s not going to be the whole. So these are the impressions. And again, we’re not going to be forecasting, because I think forecasting can be dangerous. I think there’s I’m sure some folks out there who are capable of it, but if you’re just coming in for a quick evaluation, forecasting is not something I would probably get on board with because, if something does happen, you’re in a tough spot, right? And I don’t know that any of us have that magic crystal ball. That’d be great if we did. But I would just say for those particular situations, I would just recognize that, again, something additional information if they asked you.

I’ll give you an example. Dr. Sharp, when you agree that you weren’t privy to this information about mom and dad and their life, like yes, that’s true. We weren’t provided with that. Okay. Well, isn’t it true that that could have possibly influenced the outcomes of this particular test if you would have that information? Yes, that’s true.

That’s all you do. You just answer truthfully and honestly. And again, we can only do what we have in front of us. We just can’t do it any other way. So you just told the truth. That’s it.  

Dr. Sharp: That’s it. That’s easy.

Nicol: It’s so easy.

Dr. Sharp: I think that’s a great springboard to talking about mistakes that we might make or maybe tips for once we’re in the courtroom, but I am going to close the loop on how to respond to a subpoena. So is there ever a time when you can ignore a subpoena? And if not, okay, thank you.

Nicol: I see you want a new set of bracelets.

Dr. Sharp: Okay. I don’t need any bracelets. Okay, anything else to say about how to respond that we haven’t already covered?

Nicol: I think we’re pretty good. Emails are great. Talk to your clients. Make sure you’ve got consent. If not, if you’ve got an invoke privilege, sometimes you do have to show up to a deposition knowing you’re not going to be able to say anything. Somebody needs to show up to court. But knowing that too, because somebody didn’t sign, I always bring one to court in case they didn’t just in case, but I want to go off to the side and not do it in front. I don’t want them to feel like they’re under duress. I want to have a conversation and make sure they understand what they’re signing. They might’ve just not gotten a hold of me or something like that. But for the most part, I think we’ve covered it. Yeah.

Dr. Sharp: Great. All right. So I know we could do a whole series of episodes on how to behave in the courtroom. So I’ll put that caveat right at the front, but do you have any sort of big picture recommendations for once we get there and people are asking us questions, things that we might trip over things to keep in mind?

Nicol: Sure. I always start with the basics, like just as a therapist, ground your feet, make sure your feet are planted on the ground. For females, sometimes you don’t know if it’s going to be an open well or not, which means that, I always wear dress slacks because you’re typically going to sit in an elevated position. So you’re already crossing your legs, like a whole thing, right?. You’ve just nothing you need to worry about. So be comfortable. I always wear pants that have elastic because I breathe really big. I don’t need to be constricted and pass out. Wear something comfortable but professional. Almost always, I’ll be in a suit for court because I want to look the same as the attorneys in the hallway and not to look like a warm inviting therapist, which we usually do.

Dr. Sharp: Can I jump in and ask a question about that?

Nicol: Yeah.

Dr. Sharp: In two situations, I have had the opposite experience. And I wonder if it makes a difference. Two of the times that I’ve gone to court have been in rural areas. I don’t know if that is a factor or not, but I was the best-dressed person in the room.

Nicol: If you’re concerned about that ask, I’ve had been to a few courtrooms that I was surprised because I saw arms, I saw a woman wearing a dress that had no sleeves and I thought, oh my gosh, that would never fly in these other courthouses, but it was more rural. So again, if their attorneys, I mean, they would just ask, what is the dress? I want to make sure of that. And just they’ll say, oh, well I usually wear a polo shirt then you know you’re probably in a polo shirt.

But I recently had a colleague who went to court thinking it would be rural and showed up in jeans and a tie and a button-down shirt and was reprimanded for not showing up in dress slacks. So ask ahead. It just doesn’t hurt. Ask ahead. No, I totally hear you on that. And I do think about that too when I’m going to go and I’m going to testify is, where I will be kind of fitting into what everyone else, but usually if you’ve met the attorney, you see how they dress, but depositions, they tend to be more lax, is again, ask.

And if everybody else is in a t-shirt at the deposition, but you’re the one being videotaped. You’re the one that’s dressed up. So you have to know ahead. I always take my suit jacket out of the plastic. I pop it on and then it goes right back in the plastic when I go back to the car because I hate wearing suits. The same thing with flip-flops, all the way till I get there, and then I put on my heels. So dress comfortably.

I tend to wear an old watch. I don’t wear my apple watch to court because I feel like it’s going to be the one day that it’s going to beep and I don’t know how to turn it off. And I like having a dial because I actually will look at it and I will count four seconds if anybody’s familiar, four-square breathing. I do the four seconds of breathing in, breathing out. I hold. And that helps me slow down because core, as you can tell, I talk fast. 

So I work really hard. So if I’m in a courtroom, I want to make sure that I’m being clear, concise, and explaining so that the person who is writing down every word that I say it’s clear to them, and there are no mistakes, but if I’m talking like this, the way I’m talking with you or what a mess. I’ve been told I can talk at 200 words per minute.

Still sorry. Sorry to that court reporter. My bad. I’m getting better, but pacing [01:03:00] myself is listening for the question, right? Always listen for the question because here’s the thing. They’re going to ask a question and guess what happens after that?. Somebody may have an objection. We have to wait for it. We have to give them a chance to object. And then we have to wait for the judge to decide what’s going to happen. So, I learned this at a different training which I loved because I love taking little tidbits that are helpful. This is from attorney Bronstein. Hilarious guy. He said, here’s the deal. When they sustain the objection, sustain has an S that means shut your mouth. Sustain- shut your mouth. Overruled- open your mouth.

And if you’re still like, Hey, wait, what was that thing I heard about on the podcast? Oh, crap. I got in court. Look at the judge and the judge will say, you can go ahead and answer, or you’re not answering that. They appreciate it when you look to them because that’s their house. Look to them, show them respect. There are some times where I’m like, I’m listening to the question, somebody sustained or I don’t know what happened. And I’m thinking, oh crap, because I’m already thinking of my answer. I will look at the judge and wait. And the Judge will say, so you can go ahead and answer. And that gives me sometimes two extra seconds of like, okay, I can get my thoughts straight because still, my adrenaline’s going when I’m in there. I want to do a good job. I want to make sure that I’m being clear.

And if I make a mistake, we make mistakes in court, you can say, I’m sorry, your honor. Earlier I said something I wanted to clarify. Oh, okay. Go ahead and clarify because they want it correct on the record. So you can say, I said 10, it was really 6, I apologize. I was thinking about it. It’s six. Okay. Thank you so much. And then that might open up somebody. Oh, I have a question about that. Okay, we’ll answer it.

But the biggest mistake, there’s probably two, that call that colleagues have made in a courtroom is, getting defensive. That’s probably the biggest, because man, we’ve got some ego stuff going on. As therapists, we feel all the things and it feels like it’s an attack on our work, on our abilities, on what we know, what we don’t know. I think we’re just one group of people that overthink and second-guess ourselves, I would say more than most.

There’s good and bad in that, right. But in this space, here’s the deal. It’s not about you. You are there to tell the truth. It’s just so simple. You’re just there to tell the truth. And if it starts to feel defensive, look at your watch, do some four-square breathing and just take a second, take a sip of water, just slow things down. Do not feel like you have to go at some speed. It doesn’t matter. If somebody is talking like this, but Mr. So-and-so, isn’t it true that dah, dah, dah, dah? I’m sorry. Could you repeat that or slow that down for a second. I wanted to hear it. They’ll repeat it for you or they’ll have it read back to you. And that gives you more time to just take a breath.

Listen to what you’re being asked. It’s better to say, I don’t know if you don’t know the answer than to come up with something because you’re perjuring yourself. And we get nervous as adults. I should know that. I should know that. Sometimes you just don’t know. And you’d have to tell the court. I don’t know, or I don’t understand the question.

I work with kids when they have to testify in court. They’ve been a victim or witness of a crime and we have a nonprofit. And one of the things that we do is we prepare them and we talk about not understanding a question and saying, it’s okay to say, I don’t get it. Can you say that differently? And they have to reword it for you. That’s fine.

The other can be, if you get asked a forced option question, right? So a yes or no, for us, a lot of the time because of the way our work is, and like what we talked about earlier, snapshot, It’s not always a yes or no. It can be sometimes. It can be a maybe. It can be, at times. It can be, often. It could be so many things, right? I’ve had attorneys get frustrated, but Ms. Stolar-Pearson, you could have answered that with a yes or no. I say I can’t answer that with yes, no because that would be incorrect. And I’ve been asked to tell the truth and the truth is this.

Sometimes that is how it looks right. Sometimes this. So again, be comfortable with not knowing. Be comfortable with saying I made a mistake. Just tell the truth and it all tends to work itself out. But I would say the other big issue that I think comes up is, therapists will not come prepared. I would say go through your case.

I create myself like a three-ring binder so that I have everything I need. I create a timeline for every single case I do. I want the beginning, the middle and edit those hotspots. Maybe there was a day that a client showed up with a black eye and maybe there was a day where there was no show. Maybe the data canceled because they’re moving because there was domestic violence stuff, whatever it is.

But by having that timeline available to me, it keeps me calm and it keeps me from flipping through a million pieces of paper. And if I make a timeline, I’m going to bring copies. I’ll bring like four copies because the judge is going to want a copy, the attorney is, because whatever I show up with everybody gets to see. And I want to make sure that I don’t get dinged for that.

But at the same time, what it tells the attorneys is I’m ready. I know my case, and you’re not going to waste my time or try to get me nervous by saying, well, what date was that? And what date was that? And then you’re like, oh my gosh, where is it? No, no, no, no, no. Everybody will wait for you. And judges like to keep their calendars. And so when they see an attorney doing this, it’s like, okay, do we really need that date? Or what’s going on? And it’s a tactic and that’s fine, but why not have that appreciation of being prepared, and have that timeline ahead of time.

It takes that tactic away. And now you’re feeling more comfortable because you can see your whole case in front of you just, and it helps jog your memory. It helps you remember stuff. So you’re not constantly asking to look at your notes. And any time we look at our notes, I always say, your honor, may I look at my notes? Yes, you may look at your notes to refresh your memory. And you know, I’ll look at them and say, okay.

Those are the big things in the courtroom. A courtroom is a place where I tell therapists, if you get a chance, go ahead of time and sit in court. So you can typically sit in family law court, not dependency for confidentiality reasons. You can sit in a court where they just do restraint in orders. You can sit in criminal court unless they’ve sealed the courtroom. That’s a great opportunity to, first of all, get comfortable with where you’re going to park. Where’s the courthouse? What do the rooms look like? Where are you going to be walking to sitting, standing?

When you go in, if the deputy or the bailiff asks you,do you have a case? No, actually, I’m a therapist. I’m going to be testifying here in another week. I just wanted to get a feel for it. Oh, okay. Go ahead and have a seat. We’ll tell you where you’re supposed to sit. Don’t wear headphones. Don’t wear sunglasses on your head. And you just sit there and you get used to that environment and it makes it so much easier when you come back because it’s not so scary. You’re not like, where am I going? Or what’s it going to feel like? You already know those things. And you’re like, oh, that’s what the judge looks like.

Dr. Sharp: I like that. Yeah, make it more familiar, less scary.

Nicol: Yes. All those things.

Dr. Sharp: Awesome. Oh my gosh. This has been so good. I know there’s so much more that we could talk about. but I will close with a question. If there are folks out there who are thinking to themselves, for some reason, I would like to do more of this. I would like to get into this world. Are there resources? I know you obviously have an amazing resource. Are there other resources that folks could look into, training, entities that can help with that?

Nicol: Yeah, if they’re interested in getting into expert witness, I really like Seak, which is spelled S-E-A-K. They seem to offer, I think probably the best that I found for experts on, testifying, on kind of organizing your business and marketing and writing reports and all of those amazing things. So that’s been great. For fact witnesses, I don’t know of any other resources other than therapists cour prep, because I looked and really didn’t find anything. And so I always tell them, utilize your malpractice insurance because you’re almost always going to get an attorney that’s included. It’s paid for by your malpractice. Why wouldn’t you?

But at the same time, there are some clients who will feel like I need more. I need to do some one-on-one with you to feel like it. I need to talk to another therapist who’s been in this situation. So it just depends. But I really haven’t found a lot of facts. And then I’ve been looking for years for expert, but Seak is the one that I really enjoy. And, I actually signed up for another three training, I think with them because they’re that good.

Dr. Sharp: That’s great. Well, all those resources will be in the show notes. We’ll definitely link to therapist court prep. I just appreciate your time. This has been great. And I hope one day we get to hang out together and actually have a good time face to face.

Nicol: One of these crazy conferences, I’ll see you. But thank you for highlighting this. I just think it’s really important for therapists to know that they have some help. What I’ve heard from therapists is they listened to one of my podcasts and they’re like, it was so helpful. I’m like, “Yeah, listen to them more. They’re free. Go for it.” That much information. You may not have to buy anything. You could just keep listening to podcasts.

And I love the work that you’re doing. So thank you for highlighting that. And I think it’s really, really helpful and you probably don’t realize it right now, but you’re probably saving somebody’s practice.

Dr. Sharp: One can hope. If one person’s practice is saved,

Nicol: It’s worth it, right?

Dr. Sharp: It’s worth it. Awesome. Take care, Nicol. Thanks so much.

Nicol: Thank you.

Dr. Sharp: Thank you so much for tuning in as always. I really appreciate it. It has been awesome to see the growth with the podcast over the last few months. I sort of lost track, to be honest. And we passed half a million downloads a few weeks ago, which is truly incredible. Thank you to everyone for listening and spreading the word and growing the audience.

Like I said, at the beginning, if you’re an intermediate practice owner or a beginner practice owner, I’d love to chat with you about jumping into a mastermind group and getting some accountability and coaching. You can get more info at thetestingpsychologist.com/consulting. All right, stay tuned. I’ve got some great episodes coming up. Take care in the meantime. Bye, all.

The information contained in this podcast and on The Testing Psychologist website is 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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Dr. Sharp: [00:00:00] Hello, everyone. Welcome to The Testing Psychologist podcast, the podcast where we talk all about the business and practice of psychological and neuropsychological assessment. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.

The BRIEF-2 ADHD form uses BRIEF-2 scores to predict the likelihood of ADHD. It is available on PARiConnect- PAR’s online assessment platform. Learn more at parinc.com.

Welcome to the podcast, everyone. We are here again with a clinical episode. This time, my guest is a true legend in our field.

For more than 50 years, Dr. Michael (Mike) Posner has studied how mental operations, particularly those related to attention, are carried out by neural networks. He has used cognitive, imaging, and genetic methods in his studies. In 1998, he was founding director of the Sackler Institute at Weill Medical College. He continues his research as Prof. Emeritus of Psychology at the University of Oregon and Adjunct Prof. at Weill Medical College. He has received many honors including being elected to NAS 1981, 2009 the medal of science presented by President Obama, maybe you’ve heard of him, and in 2017 he was awarded the Franklin Medal in Computer and Cognitive Science.

Mike has been in the field for over 50 years. He is a prolific researcher. He has been cited nearly 170,000 times on Google Scholar. His work spans decades, quite simply.

So this is a really engaging and intriguing conversation for me. I started out and approached this interview thinking we may just talk about attention, his theory of attention, and newer research with attention and memory, but our conversation delved into many aspects of Mike’s career and what it’s like to have been in the field for so long to see so many changes in the field, the evolution of the field. It was just a delightful conversation all around.

Without further ado, I will give you my conversation with Dr. Mike Posner.

Hey, Mike, welcome to the podcast.

Dr. Posner: Well, thank you very much for having me.

Dr. Sharp: Absolutely. I am honored to have you here. You have been doing this work for a long time. I think a lot of people know your name. So I just appreciate that you’re willing to take the time to chat with me here for a little bit.

I was looking on preparing for our interview and typically I’ll go through and try to read some of them folks’ work and get a handle on their research and so forth, but I quickly figured out that that would be a very, very challenging thing to do for you because you’ve been cited in Google Scholar more than anyone I’ve ever seen. You’ve been quite a prolific researcher over the years. That’s impressive.

So, I wanted to start maybe with a question related to that. You’ve dedicated a lot of time and energy to researching attention. So, why this? I mean, out of everything in psychology, why spend your time on attention?

Dr. Posner: I really wanted to know how the brain works. It seemed to me that being aware of things around you, visual things in the case of scanning the world or auditory things, indeed the idea is inside. And the interface between our awareness of the world around us seemed to be the study of attention. I thought this might be an entry. Actually, my wife told me that when I was courting her, she asked me what I planned to do with my life, I said, “I’m hoping to figure out how the brain works.” It was successful. She married me anyway. So I followed out on it.

Dr. Sharp: In spite of that, she married you. That’s great.

My understanding anyway is that our field’s understanding of attention has really evolved over the years. And even some of your research has evolved. I wonder if you might be willing to walk us through just a brief history of attention. I know that might be tough but I wonder if we might take a stab at that?

Dr. Posner: I won’t walk you through the 4 volumes that I wrote on the history of attention. Actually, I didn’t write but edited. It goes back 2500 years ago. People wondered how they could control their minds and has a long tradition in philosophy and so on. Its scientific tradition is shorter, but certainly, it goes back to the late 1800s. And even during the time when psychology was mainly about behavior with the theory of behaviorism, some of the main methods for studying attention were being developed.

Most people start the history at the end of World War II where particularly in order to try to understand how people could stay awake over long periods of time and pay attention to tasks, particularly in England but also in the United States, people began to study attention as an empirical discipline to try to understand how they could influence it.

And of course, in the late 1900s, with the development of brain imaging, it became possible to ask what are the mechanisms in the brain allow us to pay attention. And that really, I think, transformed the field from one largely based on experimental psychology to one based partly on imaging and partly on animal models and theories of artificial intelligence and so on that came through many disciplines.

Dr. Sharp: Right. I know you’ve done a lot of work with brain imaging. I want to certainly dive into that as we go along. And forgive me for not knowing this, but when you started researching attention, was brain imaging anywhere on the radar, or did that come along later in your career?

Dr. Posner: Well, hemodynamic brain imaging, what most people call brain imaging, really didn’t begin until the 1970s when the Scandinavians, Ingvar, and others, began to use inhaled Xenon to image activity in the brain.

My involvement with it began in the mid-1980s when I traveled from Oregon, which was my home base, to St. Louis to work with Marcus Raichle and the people at Washington University (WashU) medical school doing positron emission tomography. Raichle had developed a short-lived isotope of oxygen, O-15, and was able to really look at cognitive tasks in a way which the Scandinavians hadn’t yet been successful at. They had looked at like paying attention to a musical piece and, or reading aloud and showed much of the brain and different parts of the brain, but much of the brain we’re active in all these tasks, but they hadn’t really taken a cognitive approach to measure mental operations, which has been the heart of cognitive psychology.

Marcus Raichle and I took the ideas about mental operations and designed tasks that would allow us to isolate, not just say the brain is active in many places when you read, but isolate the phonological, visual, and semantic codes involved in the reading task.

That really transformed the field in ways that I couldn’t have imagined at the time because we had the idea that these tasks weren’t in one place in the brain, but even it’s very simple, psychological tasks involve a set of small isolated areas that had to be brought together orchestrated in a way which allowed you to carry out the task. And that is the underlying idea with brain networks, which right at this moment of time is probably the dominant idea in the field.

Dr. Sharp: Right. It’s so fascinating to me. Can you think back to that time, and do you remember the energy or the emotion around this kind of research? Did you know back then, or were you aware, like we’re doing something really cool?

Dr. Posner: I was perfectly aware of the highly emotional atmosphere in which we did this. For one thing, almost all my contemporary psychologists thought it was a fool’s errand. It may sound strange, but the reason being, in cognitive psychology, the mantra was it’s all about software. It really doesn’t matter the hardware that you use to run that software. Part of it came from computer simulation because, of course, you use various, I used IBMs, you use Macs, you might’ve used different computers, but people just didn’t think that understanding the underlying physiology really made any difference for cognitive psychology.

I did and shared that view. Of course, I didn’t know that this would take over the field in such a dramatic way. I just thought maybe we could make a connection and I could test a theory that I had about brain networks that came out of my work with patients with specific lesions in the brain. I was able to test the theory. I thought it was correct. It’s, of course, been changed a lot by many subsequent events. I think I did have ideas that were a strong contributor to what we’ve eventually found out.

Dr. Sharp: Absolutely. That might be a nice way to provide a little bit of a framework for our conversation. Would you be able to outline just your work over the years and how your research has evolved or changed in the different areas or types of work you have done over the past few decades?

Dr. Posner: Well, that may be a tease for something I wanted to tell you. I’ve just written a memoir of my over 60 years in psychology. I have a complete electronic form, but it will be printed. I’m self-publishing it. I knew my daughters-in-law were both interested in it, but I didn’t think probably many other people would be, but I suppose by the 1st of the year, it will be available from many different publishing sources. It’s called Overskirts Press. It’s as I said, a self-published volume, but I did have some meritorious work. I think I’m mostly going to have the final proofing to do.

Having written that, of course, I haven’t answered your question, it’s a little long to go into. I can say that there have been dramatic changes in the field. I’ve been called by many names during the time that I’ve worked in psychology. When I began, people who took the approach that I took, that is careful measurements of mental operations during tasks like matching two letters to say whether they had the same name or not, that kind of approach was called experimental psychology, but experimental psychology also includes a lot of animal work from rats and so on.

And when Neisser, in 1968 wrote the book, Cognitive Psychology textbook, then the name became cognitive psychology. I used that name as, of course, many others. And then when imaging came along, it got to be a part of not only psychology but neuroscience and we were called cognitive neuroscientists or sometimes systems neuroscientists, mostly for me, a cognitive neuroscientist. So, it was yet another name.

So, those presage methodological differences take place because new methods become available. I did use a method of imaging the brain prior to hemodynamic imaging. Prior to the 80s, many people used electrical recordings from the scalp so-called EEG recordings. And we averaged over many trials to produce a picture of the Timelock brain activity that would go on overtime.

There were a lot of suspicions about electrical recording from as far away as the scalp. It was a long way from the neurons which were actually producing the signal, but in retrospect, once hemodynamic imaging told you that there were particular areas of the brain that were generating it, then you could use electrical imaging in a more convincing way, because it’s difficult from a distribution of scalp electrical activity, in fact, impossible, to localize the generator, but if you start off with the generator, you can predict the scalp electrical activity.

And so in the current scene, electrical recording has quite a bit of legitimacy, both electrical and magnetic recording from on the skull or outside of the skull. And when I started doing it and many others, although we were convinced we were learning things about the brain, a lot of people doubted it.

Dr. Sharp: I can imagine. I’m just curious, we will get into attention and the specific work that you’ve done, but I am just curious about this experience of advancing theories or ideas that others did not agree with because I think we all wrestle with this in some form or fashion. How do you stand up in the face of disagreement and know that you’re doing the right thing? Was there some doubt? How did you work through that?

Dr. Posner: Well, there was always doubt. Even in retrospect, there’s doubt whether you’ve done the right thing. I never participated much in disputations about it. I just thought I would proceed as best I could with my limited abilities. I do the best I can and hopefully, I would learn something that would satisfy me and maybe others would feel that it was useful too. You never know.

When I got into imaging, most of my contemporaries in psychology thought it was just a ridiculous thing to do, but other fields were very interested in it. For example, the very famous physicists of Baylor OALA also wanted to measure brain activity using positron emission tomography. He and I both wanted to get on the machine. And there was a lot of contra competition among people in different fields. In psychology, there wasn’t much competition because as I said, people didn’t think it would work. And I had obviously considerable doubts whether it would work or not but I felt that devoting a few years to trying would be worthwhile.

Dr. Sharp: That’s a good way to put it. We talk about imposter syndrome a lot in our field and with our work. Well, does that ever go away? Do you ever lose that sense of imposter syndrome at some point?

Dr. Posner: You always feel you’re inadequate to the questions you’re asking. Of course, I didn’t think I was telling my wife quite the truth when I said I wanted to figure out how the brain works. It was a desire. I didn’t expect to actually do it, but it did help keep my motivation up. And she joined me in being very enthusiastic about it.

Dr. Sharp: Certainly worked out as far as I can tell. It seems like you had a pretty big contribution to our field. I would love to dig into some of that and talk about the nuances of attention. This has been your area for a long time. I hate to trouble you with a basic question, but I know folks are out there who could benefit from hearing a good working definition of attention. I wonder if we could just start there. What are we talking about when you say attention? What are we even looking at?

Dr. Posner: I’m really talking about nowadays three brain networks, which were partly defined even before there was imaging. One of them is getting and maintaining the alert state.

Everyone knows what it is to be alert and everyone knows what it is to fail to be alert. You can say, well, how do you go from a state where you’re resting to one where you’re alert and involved as I am in your question? That’s called the alerting network. We know a lot about it. It primarily uses the brain’s neuromodulator norepinephrine rising in the brain stem, in the locus coeruleus, and interacting with much of the dorsal cortex. It can change you from a resting state to a state of highly engagement, getting ready for the task. And then when the task occurs, responding. And so alerting is one aspect of it.

Another one is what I call orienting. You and I can see each other. I know your listeners can only hear, so they’re oriented to the auditory modality. They’re listening to my words or your words. Sometimes, we switched to a visual. If a person comes in the door that you weren’t expecting, you orient, turn to him or draw attention to him.

So orienting is surprisingly common. There’s a common orienting system, even though it might be to different modalities like vision or audition or smell or whatever, and allows you to give priority to the sensory information that’s coming in on the modality or set of modalities that you’ve chosen to orient or have been forced by some out external event.

And then there’s what I call the executive network. It’s called, in imaging, the cingulo-opercular network. They normally, in imaging, call things by their anatomy, but I usually use its function. And this controls what you might call your evolutionary behavior, including what we would call focal attention.

So if I am really engaged in looking at you and attending to you carefully, things can happen in the periphery. And if they don’t have any motion or luminance changed, I might not even notice them. Even if some crazy thing happened, like a horse’s head occurred somehow outside, I would maybe not notice it.

And there have been experiments that show when you suppress the particular cues for orienting, which are heavily motion and ruminations chain, then something can occur as even that’s very compelling such as a new figure or, as I said, a horse’s head, you don’t notice it. It doesn’t come to attention.

So that kind of attention is what I call executive attention. I believe, and this is not shared by everyone, I believe it’s the key to understanding what we’re conscious of. And that’s obviously an important question by itself, but that’s what the executive. Certainly, it’s involved in all kinds of evolutionary movements and choices, including the control of what you’re going to bring to consciousness.

Dr. Sharp: Yeah. It makes me think of that video that went around, I don’t even know how many years ago, but it’s the video of the basketball players on the court and the intro says, count the number of passes that these basketball players make. And then you’re busy counting the passes. And then after the video, they reveal that a guy in a gorilla suit walked across the court, and did you see it? Whatever percentage of people say, well, no, I didn’t. I think we’re in the same ballpark, right?

Dr. Posner: That’s the work of Rensink and others. And it’s called attentional blindness that you’re kind of blind to things outside the focal attention. It’s not always true though, because if you’re not focally engaged, then your attention can be drawn to almost anything without much problem.

I mean, there’s not much cause of having to orient to something if you’re not already very seriously engaged in what you’re attending to in the executive sense, but each of these senses of attention has its own brain network. And to me, that’s come to be a strong definition. It may not include all the important aspects of attention. There may be other networks that I’m not aware of or less aware of than these three, but it gives us an idea of the scope of the field.

Most laypeople don’t really understand that we actually do know the brain mechanisms of a lot of aspects of attention.  Maybe not fully, maybe not for all time, there may be new findings or will be new findings and new methods for exploring it, just like optical telescopes are not replaced by radio telescopes, but radio telehealth opened up a whole new window and hopefully, we’ll have whole new windows in the future.

Dr. Sharp: Right. I have so many questions about that. The quote that I wrote down, you said that the executive network is the key to understanding what we’re conscious of. Is that how you phrased it?

Dr. Posner: That’s how I should phrase it. Yes.

Dr. Sharp: Can you say more about that? What do you mean by that?

Dr. Posner: Well, it’s been shown that when you’re conscious of something, there’s a whole aspect, a very large part of the brain becomes synchronized with that object. And it’s often called an attentional workspace from the work of Berenstain Bears and Stan Dohan. And I agree with that. That happens, but I think it has to have a starting point. And the starting point, I think, I’ve never really been able to prove to everyone’s satisfaction, maybe not even on my own, but I think it is this executive network that it starts it. It has a particular type of cell which has very long axonal connections to other parts of the brain. It brings in other parts of the brain and forms a strong, almost full brain, not quite the whole brain, but almost full brain synchrony around the attentional object if you continue attending to it for a long time.

Dr. Sharp: Yes. Describing these networks, there has to be some interplay between them. Am I right there?

Dr. Posner: They’re definitely not if they’re in separate brains. They’re all in the same brain. They communicate. Just like almost every scientific problem, in the real world, it’s a whole network. You can talk about all the different activities. And, of course, the scientist’s goal is to break it down into the critical components so that they can really investigate them and understand them. That’s what we’ve done in trying to look at attention. There’s controversy about all the networks, but I think it’s progress to have these brain networks as a kind of a basic idea of what a scientific aspect of attention would be.

Dr. Sharp: Yes. I’m going to ask a question that may fall outside the scope of your knowledge. If that is true, that’s totally okay, but I want to take a stab at it. Can you talk about the relationship of these networks and attention to maybe like the neuro-psychological construct of executive functioning and even like a diagnosis of ADHD? Have you looked at that kind of thing much at all?

Dr. Posner: In conjunction with my friend, Jim Swanson, who’s probably the world’s expert on Attention Deficit Disorder, I have looked at aspects of it. I’m not sure we’ve solved all the questions of `attention deficit disorder. Jim has provided strong diagnostic tools for it.

He developed a school at one time. While he was involved with it, it was really the very best place to treat people who had this disorder. He even developed a new treatment based upon the finding that methylphenidate as a drug improves people’s ability to maintain focused attention and so on. For children who were diagnosed with attention deficit disorder, he developed a once-a-day pill. Because the methylphenidate quickly adapted, you’d have to take it every few hours, very bad for children to have to leave school and take medication. That was not good. So he developed a once-a-day pill, Concerta, which took over the drug market for this.

But also to his credit, he also found flaws with this treatment. For one thing, he believes that if you take it for a very long period of time, it might limit the height at which children grow. And so that makes a trade-off. It does have good effects on their focusing and their success in school and so on, but there are also some side effects that maybe wouldn’t be very desirable.

Dr. Sharp: Right. Now, my understanding with our conceptualization of attention is that over the years, it seems like the work has moved more in the direction of the integration of say genes and environment and culture and parenting and so forth. I’m curious to get your thoughts on that if we might dig into that a little bit.

Dr. Posner: Well, I believe that attention deficit or a very common aspect of mentee mental disorders. That doesn’t mean that attention solves all mental disorders. It doesn’t. But it does give you a clue.

I have written papers in which I try to divide different definitions or psychopathologies or whatever you want to call these disorders, and try to divide them based on what attention network is most affected in that disorder. And my idea isn’t that that would necessarily solve the problem of how to treat the disorder, but it would give someone who’s a scholar of that disorder, a start in seeing how that might aluminate a particular treatment.

Depression has been one that’s been very frequently called attention disorder. A strong concentration on negative effects and an inability to break off from negative effects. Some of the treatments for depression, the psychological treatments for depression build on this.

Interestingly enough, it’s been shown that the psychological treatment called cognitive behavioral therapy, which is very common to be used here, and the drug treatments affect completely different aspects of the disorder. You can see this in imaging and that has been studied a lot. It’s kind of a better paradigm case for how much you can learn about different treatments by looking at the images of that treatment. What parts of the brain are affected by that treatment?

Helen Mayberg has published a lot on this and illuminated depression, its drug treatment, and cognitive-behavioral treatment which both are effective to some extent, but not completely effective. And she’s illuminated that whole topic

Dr. Sharp: And just for listeners, all the resources and people that we mentioned will be in the show notes as usual. You’re giving me some homework to do.

Dr. Posner: Oh, sorry. I’ve spent most of my life as a teacher.

Dr. Sharp: Oh, that’s great. I’ll take it.

Dr. Posner: I am usually not limited to the work that I’ve done, but to the work that’s going on in the field. At one time, I used to be very good at this but these days, since I haven’t really taught psychology for over 20 years, I’m not quite as sharp as I used to be.

Dr. Sharp: Well, you’re still giving me plenty to look at, so it doesn’t seem like you’ve lost it quite yet. I wanted to go back and ask about a couple of things that you said. One, just to clarify, did you say, and I may have gotten this wrong, that the brain networks that are lighting up on imaging are different for CBT versus a pharmacological treatment?

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Dr. Posner: For cognitive-behavioral therapy, yes, I did say that. Actually, Helen Mayberg said it and I was quoting from her work. She’s a psychiatrist. She has done treatment in this area. She’s now at Emory University in Georgia, I believe, at least last I heard.

Dr. Sharp: Got you. Yeah, that in itself is interesting to me. This point that you bring up of attention playing a pretty major role in these different disorders. We’ve done a lot of talks here on the podcast about dimensional models of diagnosis versus categorical. It just makes me think about that and how attention is a common factor across the board for a lot of diagnoses that we have, but not included in the diagnostic criteria, of course, for depression necessarily.

So, I wanted to ask about other instances of attention. As far as you have written about or thought about, where else do you see attention playing a major role in mental health that may not be obvious? ADHD is obvious, but depression…

Dr. Posner: Autism is one place where it’s been reported. Usually, people think of it as a social disorder and a failure to orient to social events, but early on before it usually is diagnosed, there’s a general orienting deficit in autism.

Several people have written about it. Jean Townsend is one of the people who’ve written the most about this. And that could be or may be not a clue to how one might intervene at an earlier time even before the social disorder has become apparent, which isn’t usually until two years of life.

Dr. Sharp: That’s a great example. I didn’t want to cut you off. Were there other examples that you wanted to mention? If not, that’s okay.

Dr. Posner: Well, neurologic, the way I got into this way of thinking about it before imaging was because people began to look at the parietal lobes as an area where there were cells and neurons that were related to attention.

Vernon Mountcastle, a very well-known neurophysiologist, wrote a paper in the late 70s on this. And I got very interested in this because I thought it might be possible to relate the psychological phenomena that we were studying and orienting to these cells that Mountcastle was studying in the parietal lobe. And the key to it would be patients who had lesions of the parietal lobe. And so, with the help of a very well-known neurologist at the time, Oscar Morin, I set up a laboratory in Portland and we tested patients with lesions of the parietal lobe, who will be said by neurologists to have neglected of the side of space opposite the lesion as if that information didn’t get in.

And we found rather surprisingly that lesions of the parietal lobe were the only thing that produced a temporary and neglect. They produced the most profound neglect, but frontal lesions and lesions of the superior colliculus also produced a kind of neglect. And in fact, we had thought we had discovered a network of brain areas that produced a profound inability to orient attention in the opposite direction of the lesion, away from the area of current focus. And so we ran tests on patients with lesions in various places. And although all of these patients had a sort of neglect, the underlying mental operations that were involved seem to depend on the particular area of the brain which was activated, which we were studying, where had the lesions.

And that was the origin of my interest in network theory. But psychologists generally, although they pay some attention to the lesion patients and particularly those psychologists who are providing clinical services, of course, psychology is about a quarter of normal brain activity. And so many people would say, well, if they have a lesion of the brain, it’s going to be entirely different. You’re not going to get any insight into the normal person.

So I was looking for a method that might give us that insight. This was 1984 or so, and there was an advertisement from Washington University in St. Louis for psychologists who might work in conjunction with pet scanning. I had already read the Scandinavian papers. So I knew it was possible to look at the areas of the brain. And that’s how I went from the work on neuro-psychology patients to see if I could test my theory with mammals. That’s how I happened to go to St. Louis or as people said the wrong way on the Oregon Trail.

Dr. Sharp: I guess that’s true. Your work has evolved over the years, right? And I want to make sure and talk about some of the current work that you’re doing around attention and memory. Is that right?

Dr. Posner: That’s correct. It arose in a very strange way. I’ll tell you the story and then you can see why it happened to be this late in life working with mice having never done animal work before my graduate school days.

I worked with a man by the name of Yi-Yuan who had developed a method of meditation, which he called Integrative body-mind training. The unique part of his story was that he felt that within five days he could get profound effects in people. Only five days of training. Well, most of the work on meditation was comparing Buddhist monks who spent thousands and thousands of hours in meditation with a control group. How you get a control group for a Buddhist monk is very, very difficult to imagine.

And so it was very easy to set aside this research, but for five days, you could select a group of undergraduates and randomly assign them to either this meditation technique or we use relaxation training because it’s also a part of cognitive-behavioral therapy, very popular. And we found within five days, we were able to objectively measure changes in the executive network as measured by attention tasks and also changes in cortisol- the ability to the stress hormone and so on. So we had some pretty good effects after five days of training.

After 2 to 4 weeks of training, a really curious then was by using a so-called diffusion tensor imaging, which is a kind of magnetic resonance imaging that looks at white matter, we looked at a statistic called fractional anisotropy which is thought to be related to the efficiency of conducting over that white matter. And it improved after two weeks to a month of meditation training. We published two papers on this and there was very great skepticism.

For me, the big motivator was even my brother who’s helped my career all his life, who’s a very well-known neurologist, much better than I am. Now, maybe you’re wrong on this. And that was a strong motivator. And the key was to try to find what the effective ingredient of meditation is. That’s could be a lifetime job, but I went read the literature and I got the idea that the white matter change might be related to the strong frontal theta rhythm that is set up when you train to do meditation, even your resting state, even when you’re resting, following the meditation training, you get this strong frontal theta, 6-Hz rhythm in the electrical activity.

So I gave a talk on this and a young man came up to me afterward, an assistant professor at Oregon, now a very close friend of mine, Chris Neil. And he said, you know, we could test your theory in mice. His specialty was optogenetics and it was possible for him to get mice where you could impose by laser light in implanted lasers, not from the scalp, but implanted. You could impose a theta rhythm and ask yourself, did the white matter change?

His wife was able to do electron microscopy and show I think completely convincingly, at least to me, that we were able to get changes. The behavior of the mouse didn’t seem to change while we were stimulating him with theta rhythm, but afterward, we showed that after the white matter changed, they also showed reduced fear in fearful situations. There were behavioral changes as well. You also get reports from patients or from normal people who undergo meditation training that have reduced anxiety and fear.

So that was all very encouraging and got us into mice work. I’ve been following up with various studies in mice since that time. And one of the things that we’ve done is try to study the integration between attention networks, particularly the anterior single and this executive network, and learning a new skill. Now, mice are kind of hard to learn, but we have a mouse whisper in our group who’s very good with mice.

We’ve learned a lot about these two networks, one of them involving the ACC and, of course, other brain structures as well, and the other one, the memory network involving the hippocampus. And there are two dominant pathways between the two and we’re working on the whole question of what are their functions in normal learning. And we have considerable evidence from humans that they don’t differ that much from the mice in a lot of their learning at this level of learning basic associations. So, yeah, I’m working with mice trying to understand learning as an integration of two major brain networks that have been studied a great deal.

Dr. Sharp: Now, I’m guessing that people out there might be thinking, sure, it seems like attention and memory would be related. That seems to make sense. I wonder, and this is just not being as familiar with the literature, I just wonder how we’ve kind of gone this long without more of a clear understanding of this.

Dr. Posner: That’s not so surprising. Many people have written about how attention is related to memory. At the psychological level, that would be very common and unsurprising to people. Nonetheless, when Michael Merzenich showed that by attending to a task involving, this is a monkey, so the finger is called a digit, if you gave him a task on a particular digit and they attended closely to it, you would change the representation of that digit and the primary somatosensory cortex. And that was very surprising to neuroscientists when Michael Merzenich showed this.

So yes, on one level you can say, oh yeah, sure, obvious attention is related to memory. I agree with that. But the results that Michael Merzenich showed that really transformed a lot of the beliefs of neuroscientists about whether the nervous system could change with experience, which of course it can, but neuroscientists were a little doubtful until Merzenich was able to show it right at the primary somatosensory area. Then they generally had to accept this kind of plasticity.

So, once you have a question that you think is fundamental and there is learning that may be unconscious and not involve attention as much, but most of our learning, we all know involves careful attention. If I remember your name it is because I attended to it. I said, oh, I should call him Jeremy. But being able to look at the networks, the pathways and the direction of information flow, and so on all of which we’re doing right now, well, I hope what we’re doing right now is worth doing, I think.

Dr. Sharp: Absolutely. Sorry, I did not mean to imply it’s not worth doing by any means.

Dr. Posner: Yeah, I wasn’t saying that that was what you were saying, but you were asking me about, well, how come the people didn’t write about this over the years? Well, they did. There was a lot of writing about it and yet a discovery like Merzenich’s can really transform the field quite a bit.

Dr. Sharp: Yeah. And what about your findings thus far? Is there anything you can speak to even in terms of preliminary outcomes or in anything that you’re finding that is worth sharing?

Dr. Posner: The biggest surprise for me, I thought this would all be the executive network. The executive network was working with the hippocampus to store and retrieve information, but actually, the orienting network also works with the hippocampus.

A friend of mine, Michael Anderson developed a task in which people were asked what they learned. They learned a bunch of associations that could be words or pictures or picture-word or anything like that. And on some trials, they’d get a green light and they were supposed to think about that association. So you’d present them with a stimulus, whether a picture or word, and they were supposed to think about the response, what they had learned, but if it got a red light, they were supposed to avoid thinking about it.

Now, it’s true that the anterior cingulate and surrounding areas damp down the activity in the hippocampus when you’re at the red light. So that’s a relation between the executive network and hippocampus and memory. But if the person reports to you that he didn’t want to think about it, but he yet actually think about it all at that trial, it gives an honest report of failure to keep it out of mind. Then you see this other network which goes up to the parietal lobe, overlaps the orienting network pretty strongly active in imaging. So, we learned that there were actually two networks that were very important in aspects of learning new associations or at least aspects of it.

The interesting part about us, once you know that, then it helps explain in rats and other rodents, the dominant role of the hippocampus is not really memory it’s navigation. And it looks like the link between navigation in the rodent is that that involves an orienting network and that remains present, but the rodents mostly navigate, but humans, they spend time navigating, but they do a lot of other things.

And in the Anderson work that I described, it doesn’t matter what the content is. It doesn’t have to be spatial content. The spatial network is involved mainly because probably it had an old evolutionary development. And I thought it was interesting that this occurred and we found out something that was really wouldn’t have thought about, at least I wouldn’t have thought about before, and that may help us understand the whole evolutionary process by which this network evolves. That would be a good outcome, I think.

Dr. Sharp: Absolutely. Yes. Hearing you talk about it, I’m actually surprised as a completely naive individual in this whole equation that the alerting network is not more involved in this whole process. It seems like that would be a bedrock.

Dr. Posner: In the real world, that clearly has to be. We haven’t got a model task that shows that, but we probably could develop one. In the real world, of course, the full aspect of that executive performance depends big on the alert state. So getting into the alert state activates the anterior cingulate, for example. Before that, when you’re in what Mark Rico calls the default mode, you’re kind of relaxed and maybe ruminating about something like, how is this interview going, something like that and then you come out of it to pay attention to a question and everything, then you get into a state where the cingulate is very active and also the rest of the executive network.

Dr. Sharp: Got you. Well, I wonder where you see things headed from here. I know this research on memory is exciting, but I’m curious both for yourself and for the field in general, what’s coming? What’s exciting for the future?

Dr. Posner: I think probably a lot of people are interested in this idea of mind-reading, whether you can use imaging to figure out what the person is thinking. Actually, it’s not an interest of mine, but it is I think something that appeals to both scientists, very good ones, and to the laypeople. And there, you rely on statistics a lot because you’re trying to say, can I use the whole brain activity to predict something about what’s the dominant conscious mode?

And that I think is going to attract a lot of interest. There are already several papers about it from people at Carnegie Mellon. It’s not a direction I would want to go in. I don’t know exactly why. And of course, the field is going in many directions at the same time.

One of the main aspects of imaging work that has been drawing the interest of a lot of people who wouldn’t normally be involved in the field of psychology, don’t even think of themselves as being anything like psychologists, but they’re maybe people who are interested in apparatus and methods and so on. And of course, it pets itself. MRI are very important methods for looking at the brain, but probably in someone’s garage, there’s a young person, man or woman who’s looking at new methods that would open up new issues that we can’t even imagine. And that’s a very important aspect of the field right now that it could be new techniques statistical or other for looking at brain imaging, but also new methods of brain imaging that might provide a window on and open up a brand new question. So some things we can imagine and some things we can’t really imagine though, probably all likely to happen if the species is alive long enough for them to happen.

Dr. Sharp: Right. We always have to keep that in mind. It makes me think about all this, you know, we’re talking about attention and how much focus there has been on say things like social media and the attention economy and things like that, how all those technologies are just competing for our attention. I’m sure there’s research being done out there on looking at imaging and smartphones and…

Dr. Posner: Oh yeah, there’s a lot. It’s a very large field of research people doing it. I don’t think things are as dire as most people seem to think about this.

The best studies have compared people who use multiple devices with those who generally don’t use multiple devices. The original study of this sort was done at Stanford University, and it showed that actually, people who use multiple devices were much worse in attention tally, somewhat worse, I wouldn’t say much worse, but somewhat worse than those who didn’t. And it led people to think that the devices were causing a deficit. I don’t think that’s probably justified. It’s probably more likely that people who are attracted to multiple devices, having multiple devices all at the same time. This was not a randomized study because, of course, you really can’t do it. So it does compare people who use mobile devices with those who don’t and they looked like they were different even before the study ever began, and maybe before there were multiple devices.

And so I am not as skeptical about it. The human is very susceptible to environmental influences. And of course, as long as there are multiple devices that are an attractive thing, some major number of people will be using them. And there are some advantages and disadvantages, but I don’t know that they’ll be hindered for their lifetime provided they are getting a lot of good information because you’re getting mostly misinformation and then it could be bad.

Dr. Sharp: That’s another story. Yeah.

Dr. Posner: Yeah, that’s another story. Definitely outside of my field.

Dr. Sharp: Sure. Well, maybe that’s a hopeful note. Our devices aren’t completely hijacking and ruining our brains. Just as we close, I would love to circle back. And you mentioned this memoir that you’ve written and you said that it would be available more widely around the 1st of the year. Is that right?

Dr. Posner: That’s what I think. I haven’t done the proofs yet, and I haven’t gotten word from the publisher about when it will be available. They told me that it would be available on Amazon and other publishers that might do it. And the price, I don’t know whether it will be better, it’ll be low because I’ve already paid upfront for a lot of the costs. And so, hopefully, it will be very low and people in this country will be able to afford it also because so many other countries in which psychology is a popular topic now. So hopefully people, even if they’re not in a wealthy country, would be able to afford it.

Dr. Sharp: Of course. Well, I’m just speaking for myself, but hopefully for others as well that the ability to tap into your experiences and hear everything that you have done over the years is just endlessly fascinating. So I would imagine there will be an audience for this book simply because you’ve seen so much over the years and done so much good work in our field. I really appreciate that.

Dr. Posner: Well, thank you. That’s very nice of you to say.

Dr. Sharp: Sure. Well, I know that we’ve only really scratched the surface here today. There’s so much more that we could have gone into, but I really appreciate your time and willingness to talk through attention, the history there, and some of the new frontiers in attention. I hope people find this valuable. So one more time, just thanks, Mike. I really appreciate it.

Dr. Posner: Thank you very much.

Dr. Sharp: All right, y’all, thanks as always for listening. I really hope that you enjoyed listening to that interview as much as I enjoyed conducting and participating in it. Mike is a great guy, easy to talk to, so much to say, and so much knowledge. I am fully aware that we were just scratching the surface of his experience and conceptualization with attention and memory and so many other things. So I hope that you enjoyed this.

If you are a practice owner or soon-to-be practice owner, and you’d like some support and accountability and some group coaching to help you along your way and really build your practice, you can check out The Testing Psychologist mastermind groups at thetestingpsychologist.com/consulting. You can schedule a pre-group call and we’ll chat, it’s complimentary, just to talk about whether the group could be a good fit for you. I would love to have you. Seeing these groups be pretty incredible and seeing the members really carry one another along and reach pretty amazing levels of success in their practice, just from being connected with others and feeling accountable to others, and staying on the path. If that sounds interesting, again, thetestingpsychologist.com/consulting. I would love to talk with you.

All right. Stay tuned for more business and clinical episodes in the coming weeks. Thanks, y’all.

The information contained in this podcast and on The Testing Psychologist website is 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.

Click here to listen instead!

[00:00:00] Dr. Sharp: Hello, everyone. Welcome to The Testing Psychologist podcast, the podcast where we talk all about the business and practice of psychological and neuropsychological assessment. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.

This episode is brought to you by PAR. PAR has recently released the Feifer Assessment of Childhood Trauma or the FACT, the first and only comprehensive instrument measuring how stress and trauma can impact children in a school-based setting. You can learn more or purchase the FACT teacher form by visiting parinc.com\fact_teacher.

All right, y’all, welcome back to the podcast. Glad to be here. Very glad to be talking about technology today. I love technology. I’ve talked a lot about technology throughout the history of the podcast, but I realized that I’ve never done an episode where I did a rundown of all the technology that I’m currently using.

We’ve talked about different pieces here and there, but today is a big episode all about everything that goes into running the practice. So, I’ll be talking about all sorts of different pieces of software, how they all fit together, and which ones I truly couldn’t live without.

If you are, let’s see, which masterminds are open? Y’all, I’m forgetting my own call to action here. I think at this point in time, I may have one spot in the Beginner Practice Mastermind and one spot in the Intermediate Practice Mastermind. If either of those fit for you, you can get more information and schedule a pre-group call at thetestingpsychologist.com/consulting.

So these mastermind groups are groups of 6 psychologists and myself as a facilitator. We talk about any number of things relevant to your stage of practice, whether a beginner or more in that middle phase where you’re trying to dial things in and just be less overwhelmed. And there’s a big accountability component. There is a lot of support. There’s a lot of coaching. And it’s been super cool over the years to see these mastermind cohorts grow together over the five or six months that we meet.

So again, if that’s interesting, thetestingpsychologist.com/consulting and see if the group is a good fit. Both are starting in mid-November. So don’t wait too long.

All right. Let’s jump to this episode on technology.

Okay, everybody. Hey, let’s talk about some technology. I am excited about this one. This is really interesting to list out all of the pieces of technology that I use. It’s a long list, but I’m going to go through the list and try to articulate how everything fits together. So, let’s get to it.

First of all, let me talk about the EHR system that we use. EHR- Electronic Health Record. This is how you keep track of notes, appointments, billing, insurance claims, patient accounting, all sorts of other things, calendar, all that stuff.

We have a little bit of a complex system, but it works. So at the core is our main EHR which is TherapyNotes. I’ve talked about TherapyNotes a lot. I’ve done an EHR review series on my YouTube channel. There are lots of considerations for an EHR, but I have been with TherapyNotes for probably 10 or 12 years now. I really like them. I think that they are working steadily to add new features that are helpful for us as testing folks, but it was the easiest to use right out of the box for me. So our main EHR is TherapyNotes. TherapyNotes takes care of appointments, insurance claims, billing, accounting, notes, all that stuff.

Layered on top of TherapyNotes are a few things. We definitely utilize IntakeQ pretty heavily to send our intake forms. IntakeQ is a system that started out as software to send forms, to get HIPAA compliant signatures on forms. They have since expanded into a full-blown EHR. I also reviewed IntakeQ as a stand-alone EHR in the review series which I’ll link in the show notes. But for our part, we use IntakeQ layered on top of TherapyNotes simply because one of the areas that TherapyNotes does not do so well is with forms. So we use the IntakeQ to supplement and make the forms part of the practice super easy.

So when clients schedule a new appointment, they get an email from IntakeQ with a link to all of our intake paperwork, releases of information, and so forth, and that IntakeQ paperwork automatically gets fed into Google Drive, which I will talk about in just a moment. So, when the client fills out their IntakeQ paperwork, it is integrated with Google Workspace and it automatically creates a folder with the client’s name and puts that intake paperwork into the folder, which is great.

Also layered on top of TherapyNotes, TherapyNotes has its own calendar, but some of us also use our Google Calendar or Google Workspace Calendar to supplement TherapyNotes particularly if we are scheduling telehealth appointments. Now, TherapyNotes does have a telehealth feature, but for the most part, we have not migrated over to using that simply because we did not start using it at the beginning of the pandemic and we got into our routines and continue to use other software that I’ll talk about in a second.

So some of us use Google Calendar layered on top of TherapyNotes. TherapyNotes does connect to your Google calendar. It will export your appointments on the Google calendar so that you can see them. You cannot alter them from Google calendar and have them actually changed in TherapyNotes, but it’s helpful to see your appointments at least in Google calendar.

I also use Google calendar because that is where our family calendar resides. And I like to have all of those calendars in one place. So I export my TherapyNotes calendar to my Google Calendar which also has my kids’ school calendar, our family calendar, the soccer schedule, all that stuff.

All right. The last piece of calendaring/EHR software that we use is Acuity. I have not talked a lot about Acuity on the podcast as far as I can remember, but we use Acuity within the practice to schedule intake phone calls.

We have moved from a model where we’re trying to answer every phone call live to a model where we direct all incoming clients to book an intake phone call. To do that, we use Acuity. We have a booking link on our website. The client goes in, or the potential client goes in, books a call on Acuity, and our admin team conducts that phone call at the appropriate time. Once we have the client information, they are screened, we determine if they’re an appropriate client. Then we move all that data over to TherapyNotes and actually input them into our system.

I also use Acuity for my consulting appointments. Acuity also connects or integrates with Google Calendar. So I feed everything into Google calendar. That’s where my schedule lives these days.

Okay. So that’s it for EHR, calendaring, and client and appointment management.

As far as file management, like I mentioned a bit ago, we are heavily invested in Google Workspace. Google workspace includes everything in the Google universe except it is HIPAA compliant. So it is a great option for healthcare. This includes Gmail, Google Calendar, Chat, Google Voice, Text, Google Drive which is a cloud-based storage system for all your electronic files.  We use all of those tools pretty heavily.

For file management, we keep everything in Google Drive. We do not upload or transfer files over to TherapyNotes. We keep everything in Google Drive. As far as other file management, I still write all of my reports in Word for the time being. I would love to use Google Docs, but I don’t like the formatting. I just find that word is easier to work in for. It’s a little bit inefficient. I would love to find a way to use Google docs, but like I said, I just can’t get the formatting to work the way that I wanted partly because I built a lot of our templates in Word initially, and a lot of our recommendations banks. Our recommendation sets are built in Word, and it’s really hard to transfer them over. The formatting does not transition very well. And so, they look weird in Google docs. So I just continue to do everything in word. I am working on a way to change that though.

Now, as far as communication, there are a few tools that we use there as well. It’s primarily in the Google universe. We use Google Voice as our phone system. It allows for a phone tree which is great. It lets the calls roll over from one admin staff to the next if someone doesn’t answer. And the thing I love about Google Voice is that it transcribes voicemails and sends you an email with the voicemail transcription.

So we use Google Voice for our phone system. We also use Google Text, I guess, it’s what it’s called. It’s within Google Voice, but you can text as well. That is also HIPAA compliant. We really appreciate that. Like I said, I use Gmail for email. We use Google Chat as our intra office communication platform. So this is how we talk with each other within the practice. And again, it’s all HIPAA compliant. We can share confidential information. We have various channels or groups or threads that we talk under. So we have all of our communication basically in the Google universe.

The only thing that falls outside of that is my consulting and other communication. So I use Slack to talk with and hang out with some other psychologists friends. And I use Facebook messenger here and there simply because I’m on Facebook so much managing the Facebook group for The Testing Psychologist Community. I don’t prefer messenger. I honestly do not like messenger as a communication platform, but it is a part of the deal being on Facebook so much.

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

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All right, let’s get back to the podcast.

As far as telehealth, we use Google Meet within the practice. I think all of our therapists use Google Meet. I prefer Zoom because I’m only doing evaluations and Zoom has the capability to do two things:

1) you can have multiple windows open for the same call. If you’re screen sharing and so forth, it works really well for 2 monitors.

2) You can minimize zoom and it will create a tiny window that you can move around the screen, which I love because then that allows me to have the Zoom window up and be participating in the call, but I can also have other applications open. For example, taking notes during intakes or feedback and whatnot which I really appreciate being able to multitask in that way.

That’s one thing that I did not mention a little bit ago with Google Drive, taking notes. So I take notes in a Google Doc for every evaluation that I do. So when I jump on the intake call, I create a Google Doc within the client’s folder which was already created by IntakeQ when they filled out their paperwork. So, I create a document in that folder. It’s an intake note template. I take notes via that document when I’m on the Zoom call.

Now, I did that before we moved to telehealth as well. So when people were here in the office, I would just take notes on my computer while we were chatting. I think I mentioned before that I am a pretty good touch typer. So I can maintain eye contact and carry on a conversation pretty well while taking notes. I don’t think it’s too disruptive to the rapport with the client. So that’s helpful.

Let’s see, moving on, task management. We are in the middle of a transition with task management. We’ve used Asana for a long time, but as you know, I have recently within the last six months moved over and really gotten on board with Doc Health.

Doc Health has a task management system specifically for healthcare professionals. It’s HIPAA compliant. It’s got all kinds of cool features. I did a whole episode with the founder of Doc Health a few months ago. I’ll list that in the show notes. You can definitely check that out, but the short story is that Doc Health allows you to create workflows specific to your practice.

For example, there is a testing workflow that keeps track of all the tasks that go into the testing process from intake to testing to feedback. I think there are maybe like 20 separate tasks to carry out throughout that process like sending a behavior checklist and scoring your tests, and writing the report. So there are tons of tasks like we know in the testing process and Doc Health allows you to create workflows with all those tasks and assign that workflow to each client as they come in and you can check off those tasks as you complete them.

So it’s a great way to keep track of your evaluations and where you’re at in that process and make sure that nothing slips through the cracks. So yes, we are starting to convert fully over to Doc Health. That is one lesson that I’ve learned is that once you get invested in a software ecosystem, it is challenging to convert over both from a training standpoint and just the logistical standpoint, but we’re doing that.

As far as what I would call random productivity, there are a few apps that I use. TextExpander is one of them. I’ve talked about TextExpander a lot on the podcast. If you have not heard of it somehow, the quick story is that TextExpander is a piece of software that allows you to compress longer pieces of information into a very short Phrase sort of like a shortcut or a what… sorry, my mind just totally went blank, …an abbreviation, something like that.

For example, I have one particular paragraph that I often put in reports that explains what ADHD is. So I created a shortcut called ADHD explanation. And all I have to do is type that phrase that expands into this much longer paragraph. So you create shortcuts that then expand into longer strings or paragraphs or even entire report templates. So TextExpander is great. That saves me a lot of time each day.

I also use something called the Magnet App. So if you have dual monitors, the Magnet App is super helpful. It’s actually helpful if you just have one monitor or one screen. The Magnet App is an app that lets you drag windows around your screen and place them in particular positions within the screen. And it does it automatically just based on where you drag the window. It’s hard to describe verbally, but if you look it up, I think you will get an understanding for why this is helpful.

So if you have say a screen open with your word document and a window open with some scoring software and you’re trying to convert scores over to a word document, you can drag the windows into specific positions, and they kind of snap into place in the shape and size that you want them to be without you having to manually position them or manually change the size of the window. So you could set it up where, or you could drag a window where it just takes up a quarter of your screen or a half of your screen. It could be the top half, the bottom half, the left half, the right half, so on and so forth. So it’s really nice for arranging multiple windows.

Also random productivity. I use Zapier for a number of things within our practice. So Zapier is a piece of software that allows other software to talk to each other. For example, I have it set up where if we get a referral faxed in, I have it set up where it automatically goes into our Google drive, and then it automatically sends an email to my admin team to let them know that a new fax has come in.

Zapier has integrations with probably thousands of software programs and there are a million ways that you could use it. So, if you ever find yourself thinking, oh, I wish that would happen automatically, Zapier is a great option to look into because you can often connect two pieces of seemingly disconnected software with Zapier and create some really cool automations.

Let’s see. I think that’s it. Actually, that’s not it. Sorry. There are two other things. I use Canva for graphic design- creating flyers, email templates, graphics, anything like that. And then I use QuickBooks for accounting.

So, that’s a big list of a bunch of random software, but hopefully, you get some idea of how they work together and integrate with one another. I, of course, would love to find a way to compress the EHR software. I think that’d be great. I would love to find a way to integrate task management with the EHR. I know that Doc Health is working on integrations. I think with IntakeQ and maybe some others. So there’s a lot of room to get more streamlined, but these are all the pieces of software that come up within my practice.

Now, as far as the ones that I don’t think I could live without, certainly Google Workspace. I feel like that’s cheating because Google workspace encompasses so many aspects of our practice and there are so many facets to Google workspace. I mean, it’s email, it’s chat, it’s telehealth, it’s the phone system. It counts for a lot. So, I definitely couldn’t live without that.

The other is our EHR. I have no idea what we would be doing if we were trying to keep all these records on paper somehow. That seems absolutely crazy. I know that there are folks out there. I know that there are some of you who are doing it. I don’t know how you do it, especially if you are taking insurance. So the EHR is a crucial part of our practice.

And then the last one was a tough call, but I went with TextExpander simply because I use TextExpander so much at this point. I’ve created so many snippets or dot phrases, if you’re familiar with epic or just shortcuts is what I’m referring to. I have so many snippets that expand into so many different things. It’s unconscious at this point that as far as using them within my day-to-day workflow. And so, if I had to go back, like if TextExpander is getting updated or something, I have to actually use or type out those phrases as they literally are. It’s very challenging to train my brain in that different way.

So those are my top three that I can’t live without. I’m always on the lookout for new technology and things that will improve efficiency within the practice. So, I would love to hear from you if there are any other things that you are using that you just can’t live with. You can look out for the Tech Tools thread in The Testing Psychologist Community on Facebook, or you can shoot me a message and maybe I will feature your preferred technology in a future episode.

So thank you as always for tuning in. I love talking about technology and hope that this has been helpful for some of you.

If you are looking for group coaching and accountability experience, I would invite you to check out The Testing Psychologist mastermind groups that are starting up soonish. Very soon. I think we have a spot or two left in the intermediate group and the beginner group like I said in the beginning. So you can schedule a pre-group call at thetestingpsychologist.com/consulting and we’ll figure out if it’s a good fit for you.

Okay, y’all, take care and stay tuned for more clinical and business episodes.

The information contained in this podcast and on The Testing Psychologist website is 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!

Dr. Sharp: [00:00:00] Hello, everyone. Welcome to The Testing Psychologist podcast, the podcast where we talk all about the business and practice of psychological and neuropsychological assessment. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.

The BRIEF-2 ADHD form uses BRIEF-2 scores to predict the likelihood of ADHD. It is available on PARiConnect- PAR’s online assessment platform. Learn more at parinc.com

Okay, y’all. Hey, welcome back. Today, I’ve got part two of parent perspectives on the assessment process with Dr. Caroline Buzanko. Caroline was here last week for part one. If you didn’t listen to that episode, I highly encourage you to go check that out before you listen to this one. I do think that they can stand independently, but listening to the first episode last week will give you [00:01:00] a lot more context and I think will be a nice setup for the conversation that we have today.

You’ll notice, we jumped right into it from the get-go. Like I mentioned last week, with these multi-part episodes, it’s sometimes tough to separate the audio because we’re just on a roll, but we did our best and I think it turned out okay, but just be ready for that. Right after the music, we’re going to jump right into it, talking about ways to empower parents and adapt our assessment process to really cater to them.

If you are a testing practice owner or hope to be a testing practice owner, I have three mastermind groups that might be a good fit for you. There’s a beginner, an intermediate, and an advanced. Each of those cohorts is on a rolling admission until we reach our cap on members, which is 6 per [00:02:00] group. And then we just get started. I think at this point I have 1 or 2 spots left in both the intermediate and beginner cohorts.

So, if you are just launching your practice or wanting to launch your practice, or you’re a solo practitioner who doesn’t really have any plans to expand but you would like to dial in your systems, be more efficient and feel less overwhelmed, these could be a good fit for you. You can go to thetestingpsychologist.com/consulting, and set up a pre-group call to figure out if it’s a good fit. I would love to have you in one of those groups. They’ve been pretty transformative for other members in the past.

All right. Without further ado, I would like to jump to part two of my conversation with Dr. Caroline Buzanko.

Dr. Caroline: There are a lot of things that parents complain about. They’ve given us a lot of insight into how to make things better for them as well. So right from the beginning, before you even get started, parents must understand that assessment process. That’s going to help reduce their anxiety. They’re still going to feel anxious. They’re going to still feel stressed, but we can reduce some of that.

So, what is it that they are going to expect? Having that conversation from the beginning, what they expect, and then educating them if there are things that, oh, actually, we don’t do that, and actually this is how long it’s going to take or whatever else it is. This is what’s being measured. This is what your kiddo is going to be doing. This is how that task is going to directly inform any decisions that are made.

So pulling all of that together so that they’re feeling… And it still might not totally make sense to them the [00:04:00] way it does for us, but at least they’re feeling like, wow, I’m a part of this process. And you’re obviously knowledgeable and you’re bringing me along with this. That alone can really help set up some positive experiences for parents. That’s what we definitely want to be focusing on.

They also want to know how to best set up their kid. So bringing snacks, doing a morning session, if you’ve got younger kiddo with attention difficulties, for example, breaking it into more than one session. How will your child function at their best? That’s what we want. We want to be able to see them at their best.

Having those conversations with parents right from the start can be really helpful. I always have a handout for an overview of what to expect from the assessment, even just things around parking. This is where you can go. You got to register your car. Even little things like that because they’re already stressed. Got to find your office. And now I can’t find parking. And now I’ve got to register. All of those little things, what can we do to just smooth the process a [00:05:00] little bit? So I do have a little handout just explaining, this is how you can explain the process to your kiddo. These are the kinds of things that help you do anything like that.

Helping them prepare for the intake meeting, that’s really important. So I do tell them, hey, I’m going to go right back to your pregnancy and delivery. So they’ll think of those stories. That way, when we’re preparing them about what we’re going to be asking, they can give us so much more information, way more details. And that’s going to be important if we’re looking at a proper diagnosis.

And depending on the type of assessment we’re doing, I often for sure, autism, I’m always getting them to find pictures of their kiddo in those preschool ages and watch videos of your kiddo. That’s going to help you jog your memory. Look through the report cards. I will want to see report cards anyway but look through those report cards. I want you to start thinking about when you were first concerned about your kiddo’s learning or whatever it is. So, I’m getting them to think about those.

I also have them collect data for me [00:06:00] right from the beginning. So I give them a datasheet, especially if there’s anxiety or behavioral disorders that we’re looking at. I want them to start taking concrete data even just to maybe see sort of sheets so that they can come in and be like, okay, this is what happened. This is how I responded. This is what I think the function of the behavior is or whatever else it is because that’s going to give us, even if it’s just doing reading, okay, we sat down, we’re going to read the assigned ebook or whatever it was, and this is what he said, or he started getting a stomach ache and this was the time of day and all the circumstances. That’s going to give us a lot of information and parents won’t be scrambling for different ideas. So that can be really helpful as well.

Getting them to bring a list of questions. I know we always say, do you have any questions on the spot? They’ll never think of it, but as soon as they leave our office, they’re going to be like, oh my gosh, I’ve got 50 million questions. So getting them to start thinking of some of those questions from the start is really good.

One thing I know we all [00:07:00] already do is get them to figure out their goals for the assessment, what they want to learn. So, they’re helping us formulate those assessment questions, but I go beyond just asking what questions they want answered to also know how will you know that this assessment process or this assessment was helpful for you? What will be different when this assessment is done in your life? Because then we’re going beyond just the referral question and we can start outlining some of the recommendations that are going to be helpful.

I’ll know that this was helpful because we can get out the door happy together in the morning. I’ll know that this is helpful that I can read for 20 minutes with my kiddo at night without a fight. So I really get at some of those kinds of things. It’s their dream, right? What will be different for them at the end of the process?

Dr. Sharp: I like that question. Can I ask a really practical question?

Dr. Caroline: Sure.

Dr. Sharp: How are you preparing them with this [00:08:00] information? Are you sending an email before their intake? Are you talking to them on the phone while you’re scheduling them? How does this happen?

Dr. Caroline: Most of the time, I try to do a call. It is just a 10-minute call to orient them just to help. Okay, we’ve got this upcoming assessment. Oftentimes, if they call in and they just want that consultation, but I do try.

And I will admit, it doesn’t always happen. There are times where I show up and I’m like, oh man, somebody just at the last minute got scheduled today. And it’s just a panic scramble for everybody. But then, I’ll take them in at the beginning and I’ll sit them down. I don’t just take the kiddo into the room. I’ll sit down with parents and say, okay, kiddo, what do you know about this process? What did mom and dad tell you? They almost always say, I don’t know. Nothing. I thought I was going to a doctor. You’re not going to give needles, right? They really have no idea.

So then I talk with the parents right at the beginning there if [00:09:00] I don’t have that chance to have that clarity call before they come into the assessment. But we do have an intake package that goes through and outlines everything. So we do have that by email, but then just that additional call before the assessment can really help them.

Dr. Sharp: Sure, that’s a great idea. I’m thinking from a business perspective, is that a video that you could record and attach to an email somehow so that you’re not doing the same talk over and over and over.

Dr. Caroline: Good idea.

Dr. Sharp: I digress, but thank you for answering that.

Dr. Caroline: I think that’s a great idea. I wonder if we could edit it, but still personalize it, but that’s a good one. I’m going to think about that myself.

Dr. Sharp: Sure.

Dr. Caroline: We’ve already talked about asking parents for their thoughts on the assessment process too, right? What do you already know about the process? What are your [00:10:00] expectations? How do you think this is all going to play out? That’s really important. And then, of course, what is it that you’re wondering about? That’s their hypothesis. So if they’re like, why can’t Johnny follow instructions? Is it because he’s defined? What’s going on?

I always get their hypotheses right from the beginning because then I can see what they’re thinking. Oh, I think he’s lazy. Oh, I think he’s got ODD. Oh, I think he’s got whatever. So we’re already thinking about how parents are perceiving their kiddo’s difficulties. And not only we’re getting information from that perspective because that’s going to be really helpful for us when we get to the feedback section to where they’re at.

So if it’s congruent with what they’re talking about, it’s going to be a way easier feedback than if it’s something completely different. If they’re just sure that their kid’s defined or lazy, and we’re trying to say no, no, no. There really is going to have to be a big parenting shift here. That’s going to be helpful for how we frame our [00:11:00] feedback meeting. Or if parents are really stressed. I don’t want to hear ADHD. It’s not ADHD. Please stop telling me it’s ADHD. And then we’re like, oh my gosh, it’s ADHD. That’s going to give us a lot of information on how we’re going to frame that feedback meeting.

But we’re collaborating too, right? When we’re saying, well, what do you think? You’re the expert here. You’ve known Johnny for 10 years. What are your thoughts if you had to say what was going on? So then we’re individualizing this process and we’re really empowering parents because up until now, they might not feel empowered. Everybody else is telling them what’s going on. What’s wrong? And maybe they’ve seen it as well, but just no idea what to do, but we’re starting to make that shift. No, you really do know your kiddo here and we want to use your expertise. So, that’s going to be really important.

Also looking at the entire family. I do look at the parent’s well-being. I look at their skill set. I look at their confidence in their skills, what resources they have, how they’ve managed, especially [00:12:00] if there are behavioral difficulties, for example, how have you managed, what strategies have you used that’s applicable even for reading or writing difficulties? All of that’s really important to consider when we make our recommendations.

So if I have a parent who’s really struggling, I’m sure you’ve had the parents who’ve got every medical condition under the sun and they’re just not coping well. They’ve been on stress leave for the past 18 months. I’m not going to give them as many recommendations. I am only going to give them 1 or 2.

So, getting that understanding of what’s going on in the family context can help us frame those recommendations in the end. What’s going to be more valuable. And maybe it’s, these are now recommendations. These are in when you’re ready, when things settle down. When your health is back to normal, then maybe we can look at that. Because if we’re giving them things that they can’t even follow through on, or they’re not confident in doing, [00:13:00] that’s going to be really different. And maybe, this is going to be important. But instead of saying, you have to do this, maybe it’s educating them first. So our recommendations shift a little bit, or maybe I’m searching out more YouTube videos or some sort of resource to supplement what it is that they can do.

Dr. Sharp: Now, are you formally assessing parental stress level or confidence or personality, or are these more qualitative questions you might be asking or talking about in the intake?

Dr. Caroline: It really is more qualitative. I’m not formally assessing them. Oftentimes, they’re like, wow, I think I’ve got difficulties too. Let’s do an assessment, right? So that’s a whole different story, but it really is qualitative. 

So yeah, I am looking at the best as we can within a semi-structured interview or unstructured interview, even when it comes to all these kinds of things, but we are [00:14:00] showing parents we care. We are showing parents we are looking at the big context because remember, one of their complaints is, you don’t understand my kid. You don’t understand my family and the context of this child. And so, it’s broadening that snapshot. I think that that’s really important. So, it’s more about bringing them along and them feeling empowered, heard, understood and supported at the end of the day.

Dr. Sharp: I like that.

Dr. Caroline: Yeah. I look at the siblings as well. That’s a huge piece of the puzzle as well because they’ve got their own needs and there are a huge dynamic within the family. So I also ask about how they’re doing. That gives us a lot to you. Oh my gosh, I’ve got two other kids with severe ADHD or whatever else. So that’s going to give us a lot of information on what can this family actually do when it comes to some of our recommendations.

So [00:15:00] that’s the intake piece where we’re really laying that groundwork. We’re really being supportive. We’re really giving parents that opportunity to tell their story because oftentimes they don’t. And it’s that genuine connection, which is important just from the beginning.

Once we get into the actual testing sessions, I do have a quick meeting before the assessment. So we’re going to prepare the kiddos. Even if I already had that consultation call with parents, getting kids prepared, they’re often really anxious as well, addressing any parent questions that have come up, and of course, asking how they slept. Did they eat breakfast? How eager were they coming? How did you feel about coming?

I always lighten the air. Almost every kid is just looking so apprehensive and I’m like, yeah, you’re so excited to see me this morning right away there. And even my teenagers who’ve got their baseball cap down over their eyes and their arms crossed across their chest [00:16:00] and slept down in their chair. I’m like, oh, wow, you’re so excited. It just lightens the air a little bit. But really checking in. I also ask, what are you missing that’s important today?

Dr. Sharp: Great question.

Dr. Caroline: Yeah, most of the time they say nothing, but right before the end of the school year, last year,  I had a little girl, she was bawling. It was her first day of testing. I could tell she was bawling. She calmed down. And then I asked her that question. She started bawling again, and I’m like, “What’s going on?” And her mom’s like, “We didn’t realize they’re having their last day of school party.” And I’m like, “You are leaving right now. You’re going back to school.” And the little girl was like, “What?” And the mom was like, “What? I’ve waited months to see you.” I’m like, “I don’t care because if she is missing her last day, and with everything going on, with COVID, they’d already missed so much [00:17:00] school anyway, and you’re not going to see your friends, these are not going to be valid results. So you’re going to go back to school. You’re going to have your party and we’ll figure it out.” And again, this is maybe my bleeding heart that I did open up a weekend that we could get it done, but for me, I knew that the results just wouldn’t be valid

Dr. Sharp: For sure. Applause for the flexibility and being willing to meet the family where they’re at, talk about personal service. That’s pretty amazing.

Dr. Caroline: Yeah, well, they were also moving. And so we really only had one week to get it all done. I don’t always necessarily do that, but we got to watch out for our own selves as well. So I always ask, what are you missing? And it’s like, oh, I’m missing the gym or whatever it is. I think that that’s important for us to know. 

On the second day of testing, I always do at least two days, [00:18:00] I will ask what were they like after the first day. Were they exhausted? Were they frustrated? Were they really apprehensive to come back? I think that that’s important information.

So, that’s kind of the debrief at the beginning, or not a debrief, but we’re taking them in just kind of chatting with how things are. But then afterwards, I save time at the end of the session to debrief with the kids and the parents. And I actually tell them what happened in the assessment.

So the feedback meeting for me is never a shock because I’m starting to think like, I am seeing some of the attention difficulties. If kids are there, I say it in friendly ways. Like, hey, remember when we were laughing because they’re like, what did you say? Totally looking around the room and had no idea what I was talking about. So, I’ll bring kids into that kind of conversation, but to also let parents know I am looking at attention.

I was talking to a kiddo the other day who really can’t read at all. And I’m like, oh man, you know [00:19:00] your sounds and you can map your letter sounds to the letters. No problem. But your memory, it’s like when you’re holding too much laundry, and your socks and your underwear falling, that’s kind of what’s happening. You know those letters and you know those sounds, dude, you’ve got a reading brain, but that memory can’t hold it all. And so that’s why when you try to sound out those words, you’ve got all the sounds. You just can’t remember the sounds to figure out what that word is.

So I’m already talking about what I’m seeing. And then I said, wow, you’ve got this amazing ability to figure out what that word was. Remember you were reading the dirt, blah, blah, blah. Oh, fly. No, it’s not dirt. It’s a bird. And I’m like, remember how you figured out those words? And then mom’s like, yeah, his tutor said he’s really good at using context to figure things out. So we’re already debriefing. And I’m already getting a little bit more information.

Mom never would have thought about saying, [00:20:00] oh, the tutor said he can use context to help them decode the words. But through this debrief, again, we’re being collaborative with parents. We’re getting more information that’s not only going to help our assessment, but it’s really helping them along that process as well. And so we’re already talking about, oh, that makes sense. That’s why I see this. For whatever reason, they can start putting puzzle pieces together about what they’re seeing in their kiddo’s situation and everyday life.

Dr. Sharp: Sure.

Dr. Caroline: Transparency. I already talked about that. Like, if I am thinking about autism, even though you’re bringing them in for anxiety, I’m going to start sharing that hypothesis. Have you ever thought about this? Have you ever noticed this? Maybe I might not use that word, but social difficulties and conversations. And I might start asking those questions. Sometimes they’ll say, yes, somebody said he’s autistic but I was like, whatever. [00:21:00] Just helping share those hypotheses can be really helpful right from the start.

Dr. Sharp: Right. So you’re doing that during the intake?

Dr. Caroline: This is during my assessment with the kiddos. When they’re coming back to pick up their kids, I usually leave 15 minutes where we can start debriefing things that I noticed right then and there. So then by the time we meet, parents already know what I’m going to say. This little debrief, they’re already starting to think, oh man, she did notice some of that awkwardness pieces or whatever else is going on. So they’re understanding that process. They already know what directions I’m going into. Now, they can start looking out for things too.

I’ll just say, pay attention. If Sally is trying to get your attention, just ignore her. Just not say anything and see what she does. See how she repairs that. I’ll start already giving them things to [00:22:00] start looking for.

Dr. Sharp: Okay. Nice.

Dr. Caroline: When we have parents do rating scales, giving them an opportunity to talk about it. I love the ease of the online ones where we can just email them the links, but I do like the paper ones so that they can write all over it. If I do see, oh, you said this kiddo likes to harm animals, I’m going to talk about that. And I keep bringing that up because that’s been one that has come up quite a bit in the research where parents will endorse those types of items, but then be like, well, no, no, no, it’s just because they love. It’s a cuteness aggressive disorder. They’re Lenny. They’re just hugging the cat too hard.

Dr. Sharp: That’s an aggressive disorder. That’s great.

Dr. Caroline: So it’s just that. They’re loving it too much. It’s not that they’re trying to torture it, right? In their parents’ heads, they’re thinking of something completely different. So they might endorse items. So I go through any of the [00:23:00] flakes, any of those critical items that I might be worried about and actually do a bit of a qualitative interview about that as well, because it’s not about the scores, it’s about the story about what’s going on for kiddos. So that’s really important as well.

Dr. Sharp: At what point are you doing this? I know I’m asking a lot of practical questions, but I think people probably have those questions too. Like, is this post-testing, pre feedback. And is it a phone call? Is it a separate meeting? How does this actually happen in real life?

Dr. Caroline: Most of the time, it’s another phone call or video session in between before I do the final feedback meeting. I actually do things a little bit differently. I actually see the kids first for the first testing session and then I do an intake meeting. And then I do another assessment.

Dr. Sharp: What’s the rationale there?

Dr. Caroline: It’s because I have way more questions once I know the kiddo. Always so many more [00:24:00] questions. I find that our biases can really start to set in when we already know what the referral question is. We’re going to be looking at this kiddo a little bit differently and I found it really valuable for me. It doesn’t always happen, but that’s how I generally like to set it up. We do informed consent, but I don’t do any of the intake things. Then I have way more questions. I’m not persuaded by anything that teachers have said or parents have said. I really don’t look at any of the paperwork or anything.

And then it’s in that intake interview where I will now go through some of those rating scales. Hey, you said that you saw these vocal tics, for example. Let’s talk about that a little bit more. So then I can really go through, obviously the background information and all of the story pieces, but then things that they’ve already endorsed on the rating scales.

If we run out of time, then it’s usually a follow-up or they didn’t [00:25:00] get the rating scales, then it’s usually, hey, just want to chat. I have a few more questions before our feedback meeting. That’s usually how I do that.

Dr. Sharp: Got you. Can I ask another, maybe dumb question as a follow-up?

Dr. Caroline: Sure. No dumb questions.

Dr. Sharp: How do you construct a test battery even just for a half a day before you have done an intake and presumably have information that might guide the choice of test battery?

Dr. Caroline: The first day, most of the time it’s some cognitive piece. I do cognitive tests. I can’t think of anything I wouldn’t do cognitive. Is there anything? I can’t think of anything that I wouldn’t do a cognitive for.

Sometimes I do have to, all of a sudden I realized, oh man, this kiddo doesn’t have any English. There are basic things that I do already because I already have conversations with [00:26:00] preparing parents. I do have a bit of a referral question for example, but sometimes I do change things on the fly once I start working with kiddos.

So I think that there is a lot of that flexibility that I have. I just have them right there on my shelf. I’m like, okay, we are discontinuing […] we’re pulling out the Ravens or whatever it is that’s going on, or we’re adding things. But as you’ll see, I do a lot of different types of testing when we get into more of the therapeutic type of things. I’ll talk a little bit about that, but generally, it’s the cognitive stuff.

Dr. Sharp: So, those more common measures that you would likely administer during any evaluation?

Dr. Caroline: Exactly. And a lot of the time they demand, depending on agencies and things like that, they just want to see a WISC for example, right? There are some places here that say we do not take a Stanford-Binet. We do not accept a WJ. We need an FSIQ score or whatever that is. So, it’s pretty standard here in terms of that. Everything else is [00:27:00] very different, but generally speaking, that’s…

Dr. Sharp: That’s great.

Dr. Caroline: Yeah, it makes it easy. And then I also look at the why behind different things. When we’re doing… Well, even just the gentleman that I was doing an autism assessment for, I actually had him do the rating scales right there with me. He is quite complex and he’s endorsing things. And I see this even to my teen girls who are gifted and ADHD and now they’re wondering about autism, for example, because there is so much overlap. I start to ask the why.

You’re rigid. Let’s look at why you might be rigid. Is it because you’re governed by rule-bound behavior or is it that you have to have your things in this exact order because you’re totally going to forget where you put them? So there might be a different function to the behavior.

I had one kiddo, and this really hit home when I was much younger early in my practice, where he [00:28:00] had trouble with visual modulation. I didn’t even know that that was a thing, and we didn’t know about it. So, we’re trying to bust up all these rigidities that this kiddo had. And one of his biggest rigidities was he had to have on his bookshelf, his books and games in the exact same order, every single time. And he’d freak out if one wasn’t in the right place.

So we’re busting things up, we’re mixing up a shelf and we’re practicing relaxation strategies, frustration tolerance, and all this stuff but we were causing him more distress. And we found out it wasn’t a rigidity problem at all. He literally could not tell one book from another. And so he just learned, if I want that game, it’s the 5th game because he couldn’t tell. He’s the only kid since then that I had these visual modulation difficulties, but just looking at the function of Y.

One of the things we ask parents is, if you walk into a room and say [00:29:00] the kiddo’s name, will he look up at you? Will he acknowledge you? Well, just because he doesn’t, it doesn’t mean it’s autism. If it’s a kid with ADHD playing video, well,any kid playing a video game really at the end of the day, but why is that? So it’s looking at the context. We can’t just take scores of rating scales at face value. So it’s just doing a little bit more digging in. And parents now know, oh, you didn’t just base it on a rating scale. You’re actually digging deeper. So we’re bringing parents along and they’re having more faith in the work that we’re doing.

And I think it depends too at what we’re looking at, but I do know that almost all my ADHD kids score high on the autism scales. And so, it might look the same, but the reasons might be really different. Yeah, it is time-consuming when we do this. And I know that that’s probably what a lot of people are thinking, just all these extra calls and these extra questions, but we get so much more information.

At the [00:30:00] end of the day, if we’ve got happy parents, from a business perspective, we’re going to get more referrals too. And so, we can look at it that way, but really it’s about, we do this work because we want to help the families. We are going to most help these kids that we work with or the individuals that we work with when the parents are feeling confident in the work that we did, and that we did a comprehensive job.

Oftentimes, right then and there, I will just do extended inquiries. So that’s why I like having them in the moment do rating scales with me just because right then and there, I can start asking them questions. I’ve already talked a little bit about that, but I think that that’s important that we’re doing this to get good information and parents are seeing that we’re being comprehensive. We’re not just focusing on test scores. We’re really trying to understand their child.

If there’s an opportunity for [00:31:00] parents to observe, that can be really helpful too. They can take this role of co-assessor where they’re providing observations. They can provide interpretations of what’s going on especially in some of the more social, emotional types of assessments. I just did an ADOS the other day, actually not my favorite.

Dr. Sharp: I know the conversation.

Dr. Caroline: I was just kidding. Yeah, I know the conversation. But I was doing an ADOS just because that’s what the pediatrician wanted me to do, but it was interesting. The dad at the end was like, “Wow, that was so incredible to see. I didn’t realize how deficited my kid was” because he has his older kiddo, an adolescent functioning fantastically, but we see how much we compensate for him.

I left things hanging. I left things so awkward. The dad was shifting in his seat. It was so awkward. And I had debriefed him at the beginning. Do not say anything. I’m going to look like I’m mean. I’m going to [00:32:00] ignore him. I’m going to be doing these things. But it was so awkward. And so, then it can be really helpful, but that opportunity for parents to see what’s going on can give us a lot of information and it helps them understand the child.

I used to have, when I did more early intervention stuff and did just assessments for funding for kiddos with autism, I’d have aides sit in the room, especially if there were huge behaviors or I didn’t really know the kid. And I always checked in with them afterward. So how do you think the kiddo did? They’re like, well, if you had phrased it this way, for example, they probably would have understood it. So just understanding. So it can give us more information that way.

I do a lot of that, anyway. That was in my early years where I just found it so valuable when you had people who knew these kids. Oh, they per separate on Thomas the train. And you mentioned Thomas and now that’s all they can think about. So [00:33:00] every question was something around Thomas the Train or whatever it is. It just gives us a lot of information.

So giving them that space to share their story, to share their experiences, making that time throughout the assessment can go such a long way. And it doesn’t have to, I know in our minds it’s like, oh my gosh, it’s such a long process. Just give them an extra five minutes. It doesn’t have to be a long time. They’re just feeling like they’re part of that.

So we’re just moving beyond that standard battery. We’re engaging the child. We’re or engaging the family so we can understand that child as best as we can in different contexts, maybe get a better understanding of them. There’s lots of different things that we could be doing.

So that brings me to dynamic testing. I do lots of things within the testing itself with kids. I’m always asking them what their experience was like especially if I [00:34:00] start to see them shifting or losing focus or getting frustrated, what was easy? What was hard? What didn’t you like about that? What didn’t you like? Having them really reflect on their responses.

Just the other day I was doing the CBLT and the kiddo who I was working with, the third trial of the verbal learning and they’re like, ah! And their hands go up and they’re just like, ah. I just continued on and then afterwards I’m like, okay, around the third trial, you went ah, what was that about? Because is it boring? Is it their brains getting tired? What is it? And they’re like, “Yeah, man, I’ve already heard it three times. Why do I have to hear it again?” That’s going to be really helpful.

And then there was a little bit of anger. So this is a kiddo. Now, I’m wondering, are there autism spectrum things going on because I hate it when people repeat themselves. There was also a little bit of anger there. So it’s really interesting. Whereas other kids you can see they’re just getting tired. They can’t hold all that information. So just getting their [00:35:00] experiences.

If there is a kid with ADHD, how has your attention on this? Or what kind of tasks was it easier to focus on? What was harder and how does that compare to in the classroom or at your hockey lesson or whatever it is. So I’m asking them what their experiences are like. So that can give us a lot of information too.

Of course, we all know about limit testing. I do a lot of dynamic testing and trying out different interventions, dynamic interviews. So when I’m working with kiddos, if writing’s really hard and they’re getting defeated, they’ll have a little bit of an interview. Who’s a good writer? Who do you know that’s a good writer in your class? What makes them a good writer? What is it that you think that they do and how do you know that they’re a good writer? So looking at all of those kinds of things can be really helpful.

And then just doing, if I’m looking at, I might redo a subtest and then I might [00:36:00] give some prompting. I might repeat instructions. I might rephrase instructions. Does that all help? Figure weights is a great example of one where I’ll go through standardized testing. That’s the score I’m going to report, but then I’ll go back and be like, hey, remember, and color and shape matters, dude. And especially when you’ve got kiddos, I keep going to ADHD, but maybe they can’t pay attention to too many details or they’re using the wrong information to solve problems.

We know that kids with ADHD lack frameworks. So what if we give them that framework? What if we help them figure out what’s the information I need to figure out to be able to problem solve effectively? And then we can say once we gave them this framework, or once we gave them that clarification or directed their attention to what it was they needed to pay attention to in the first place, because half the time that’s the problem, they had no problem. [00:37:00] And then maybe I will report that when we gave the framework, look at how much more of their score improved. So now that’s feeding into our interventions as well and our recommendations, right?

So we can start integrating these intervention breaks into the standardized tests that we’re doing so we can see what is actually helpful. Is it just a rephrase? Is that all it is that they need or is it helpful for them to remember? There are two things you need to look at here. Matrix reasoning is another one. It might just be color, but it might be color and direction, right? So there are two pieces of information you need to look at.

So looking at what supports or prompts or feedback or questions, all of those things, then we know for sure, that’s actually going to help this kiddo if they’re really nervous, right? They’re really nervous. You can tell. Block design. It’s one of the first things that we do. Their heads are trembling. Let’s do it. Let’s get our score. Now we’re going to go do [00:38:00] some shake off the stress, or we’re going to do some reframing or relaxation. And now we’re going to come back and test the limits and see what happens. So those are going to directly inform some of our recommendations.

Dr. Sharp: This is great.

Dr. Caroline: Yeah, hopefully. Just jump in. I know I talk a lot.

One thing too that I tell kids, I always say that we’re detectives. I know Loki is super big. Not all kids know Loki, but I often introduce Loki. I talk about how our Loki brain likes to cause problems and might like us to think things are too hard or it’s too boring or whatever.

So we’re going to play detectives and we’re going to figure out Loki and his henchmen. And then I’ll talk about different henchmen that get in the way of our learning. So there could be the attention robbers. There could be brain eaters. There could be the letter mixer, upper, or whatever name. You figure out what’s going on for the kiddo and you can kind of come up with all these [00:39:00] henchmen. So then in the testing, they can be like, oh my gosh, the brain eater just showed up.

And I do that with my teenagers too. They kind of get a kick out of it. And we’ll talk about time robbers when they’re studying. TikTok is a huge time robber for me, for example, or whatever. But then they can start sharing their experiences and not get frustrated. They’re not beating themselves up. They can start actually articulating. That was really hard. My brain started to shut off. And if they can’t come up with it in the moment, they can start looking for it, and this is why I like having it over more than one session too.

It’s okay. Through the next week, before I see you again, look for when those henchmen show up. And then they come back and report on it. They don’t always, but they can start reflecting on some of their experiences. And those are experiences we might not get to just based on our standardized scores. I think that that’s really important. So just looking at that.

I also will go back. Hey, [00:40:00] on this one, how come you answered that the way you did? How did you figure that one out? And I don’t tell them if they’re right or wrong. I just want to know how you figured it out. So it can be really… like on picture concepts, it might look like they’re really concrete in their thinking, but are they? And oftentimes you can go back.

My gifted kids, man, they’ll do terrible. They’ll have a scale score of 5, but then when you go back and get their reasoning, it’s like, wow, that was phenomenal. I wouldn’t have never thought of those relationships between those things. So it can be really interesting to go back or it really is because they were all yellow or whatever else.

Sometimes I’ll use tests and novel ways too. These are some of those intervention breaks. Therapeutic assessment can look really daunting when you look at the literature and they’re 3 to 6 months long. It’s not the same kind of testing that we do, but we can do little breaks and we can do things in [00:41:00] novel ways. So maybe it’s, now that you’ve done this task, I want you to explain it to me like you’re a teacher and I want you to talk through it to me. Or like I said, giving them those different frameworks.

If there are behavioral concerns, I’ll bring parents in, and maybe we’ll do some activities together. This is again, after all the standardized testing is done, but see how they interact. So are there things in my recommendations that I can give to parents? Hey, I noticed this.

Actually, I had one kiddo who has accidents still quite a bit during the day. He’s older. He’s 10. And it’s quite embarrassing, but some of the research talks about kiddos who lack this internal sense, their awareness of their body when they’re not feeling heard. And so there’s a correlation between that. And so I had parents come in because that was one of the pieces. They were [00:42:00] wondering about ADHD. They were wondering about learning disabilities, but that was a piece too. And so I had them come in and I had them look at a picture and they had to problem solve through this picture. What was going on and how they could… like what just happened right before, and then what happened as the picture was taken and what can they do to resolve the information?

And the kiddo started giving his story and the dad’s like, “Really? That’s what you think is happening here?” And the kid’s like, “Yeah.” And then the dad was great after that. He was like, okay, let’s see. What do you think? Oh yeah, that’s a great idea. And then he was super engaged with the kiddo, but that first really that’s what you think. And so then afterwards, I asked the kiddo, and I was praising dad for everything that he did right.

And then I say, just at the beginning there, I noticed you tried to correct him. He’s like, “What? I didn’t correct him.” I’m like, no, but you questioned his interpretation of the picture. So then I turned to the kiddo and I’m like, does [00:43:00] dad correct you a lot? And he’s like, “Yeah, all the time.” And the dad’s like what? And he is. And I joked with that a few times because he is mean-looking. He’s law enforcement and so he just comes across rough and gruff and he’s like, I had no idea.

And so just that awareness of, wow, I really had no idea. And I know it’s not therapy that we’re doing, but these little pieces can make all the difference in the world just by shifting their awareness. So, it’s just looking at how can we bring in the whole family here? What’s the bigger picture really at the end of the day? And then dad left feeling like, “Wow.” It’s just one little thing. It took three minutes from beginning to end. It didn’t take any extra time, but dad was feeling almost refreshed, rejuvenated. He had a lot of energy after that.

[00:44:00] Dr. Sharp: Let’s take a quick break to hear from our featured partner.

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All right, let’s get back to the podcast.

Dr. Caroline: Diagnosis. So before I talk about it, this is a [00:45:00] life-altering event for a lot of parents. Of course, there’s context and information that we need to think about. So there are considerations like having a face-to-face conversation, not doing it over the telephone, being in a private location because some of the stories were about in a hallway or in a classroom with just a divider and the sheep on the other side could hear. So just being aware of those little contextual pieces can be really helpful.

How we communicate the results though is really important. And there are a few key pieces here. So the first thing to consider is our way of being, and I talked a little bit about that. So our way of being a professional. Are we helping parents feel supported? Are they feeling respected and heard and informed, or are they still feeling confused or angry, or stressed out? So making sure we have that compassion, that sensitivity. Putting ourselves in their shoes, especially at this point in the assessment when they’re learning about their kiddos [00:46:00] difficulties. Even if they already are aware, it’s still hard to hear it in actuality.

So addressing any worries parents might have before jumping into the results, that can really help minimize. Like I said, I always say, what do you want to hear? What don’t you want to hear? What are you worried about hearing? All sorts of things. So right away, it already lightens the mood. They laugh at that, but it really is addressing that I get that this is really anxiety-provoking for you.

Dr. Sharp: You’re seeing them. You’re validating it without them having to ask for it.

Dr. Caroline: Yeah, exactly. Which is so important. And just by doing that, they’re going to be able to attend better. They’re going to be able to understand and accept the results better.

We still want to be hopeful. I know we talked about the strengths-based approach before and we don’t want to go overboard where it’s like, yeah, yeah. But okay, just give it to me. But we still want to maintain [00:47:00] that hopeful side of things.

I always say, congratulations when I’m talking about autism or ADHD, but even if I’m not saying, congratulations, your kid has got dyslexia. I’m still being hopeful because we do know lots of successful people, right? It’s not an end-all be-all. And I think most parents take these diagnoses as a death sentence. And so, just the language that we share with them is going to really affect how they perceive what’s going on for their kiddo.

I had to have one feedback via video while I was at my cabin. And usually, I make sure my kids are gone, but they happen to come in for a second right before I was giving the diagnosis to a family. And unfortunately, it’s just all open so they could hear. And afterward, they immediately left, but there was a moment they [00:48:00] heard the mom crying and they’re like, was that mom crying? I heard you say ADHD, and then the mom was crying. And they’re like, why. ADHD is awesome.

We have a family with ADHD. I always talk about how it’s awesome and they just couldn’t get their head wrapped around it. So, how we think of it greatly affects our kids. Obviously, I talk about ADHD being a superpower at my house. So my kids see it as that. They don’t see it as a disability.

And so, the words we use are really influential. Even just in the report, I would say, kiddo had tremendous difficulty with something. That tremendous is going to be really hard for parents. And it doesn’t matter how empathetic we are. So we got to look at the language that we’re using. But again, it’s that balance because we do need to be direct, especially when we’re talking about the areas of challenge and what the implications of all of that kind of stuff are. So, I think that [00:49:00] it’s finding that balance between.

Dr. Sharp: So in a case like that, would you just drop the tremendous and say something like, this task was really hard or so-and-so struggled?

Dr. Caroline: Yeah, I do. I’ve stopped using those big words anymore even though it might be true. I still use it though, because parents still laugh at this. With the Digit Span, for example, I’ll use his performance plummeted. Digit Span is a good example where I still might use a word like that.

So great when they take it in and simply have to repeat it back. They can do that. Johnny go do X, Y, Z. But as soon as they have to do anything with that information, they turn to go do X, Y, and Z, it’s gone. They can’t remember it. Then parents see that and they can see it in their everyday life. And then it’s just a moment of lightness. So I’ll say, it’s how I say the word plummeted, [00:50:00] and then we can have a little laugh at that. So it’s just understanding the family and things like that. But yeah, I just say that was hard.

Dr. Sharp: Sure.

Dr. Caroline: One of the things that I often do too, is I ask them about their worries, of course, but I get them to start answering their assessment questions themselves because then they’re getting out of their worrying brain in that anticipation of what I’m going to say, and we’re getting into their thinking brains. So now we’re going to get them engaged. So they can answer those questions or even if I’m going to look at something like reading, I’m giving the feedback on reading, I’ll tell them, say, Hey, I look to these three areas of reading and I’ll explain each three areas and then I’ll ask them, how do you think they did? What do you think out of those three areas was easier or harder for them? And then I can really gauge the conversation based on how they respond.

Predictions are [00:51:00] really important. And that’s why I do this. We know that making predictions, and this is entrenched in the research, keeps us engaged because we want to know if our prediction is right. Our brain is motivated when we’re right because then we’re like, yes, I got it. Nailed it. And then we can praise parents. Wow, you’ve got really good intuition. You really know your child. So now we’re empowering parents because yeah, you got it. You’re bang on.

But then if they’re wrong, we want to learn more about why we’re wrong. Oh, I totally thought it was decoding that was wrong. Now I want to hear more because if it’s not decoding, let me know. Now they’re engaged and they’re not worried about a label that we might give them. So that’s one way I kind of get around that. And especially when it’s an important topic like this, we’re just kind of engaging their brain.

So I think that that’s really important because, at the end of the day, the most important goal for our feedback meeting is to empower [00:52:00] parents. That’s what we want to do. That’s our goal. So yes, understanding their kids is important; knowing exactly what’s going on and everything else.

So to really empower parents, the information they receive, everything that we’ve talked about in all of our training and every professional training development, we always know that all the information has to be memorable, has to be understandable, and useful, of course. So we can arrange our sessions in response to parents’ questions. We’re getting them to answer those questions. Hopefully, they’re already involved throughout the process, so they can actually answer those questions pretty bang on because we’ve already talked about it.

Now we’re just digging deeper and now we can talk about it. Yeah, you are right. They really do have these reading difficulties. So let’s talk about the implications of that. So the feedback meeting isn’t really a feedback meeting so much as we’re going to dig deeper here and we’re going to talk about, we can spend more time on what we’re going to [00:53:00] do about it. So I think that that can be really helpful.

The results section when we’re doing the feedback meeting should really just be about how we initiate this dialogue about how the scores actually contribute to their everyday situations. So now, we’re doing this in-depth co-investigation of what’s happening.

It’s not me saying he was 50 percentile on this, and he was 25th percentile on this, but only 5th percentile on this, and therefore, he’s got dyslexia. It’s not about that. It’s together. We’re looking at, this is what I noticed was hard. What do you notice at home? How does that fit with what you know? Does that fit with your hypothesis? So then they can start reflecting on what we have to say. Does that fit with what’s going on for their child? Because that’s going to be really important.

Now, I know you asked before about the whole [00:54:00] average, do parents really want to know that or not? We can educate parents about what normal expectations are for our kiddo’s development and where their kiddo fits, but they really don’t care about that normative data at the end of the day. And it’s not just anecdotal. We do see that in the research. They want to see how it connects with everyday life. That’s what they want to see.

Dr. Sharp: Right. Like, how do these numbers explain what I’m seeing with my kid?

Dr. Caroline: Yeah. So how does it fit their child? We also want to respect their expertise too. That’s why we’re reflecting on the results and how they can connect it to real-life examples, because then that’s giving us, oh, you’re really struggling here. I’m going to make sure my recommendations talk around that area that you’re struggling with. So that’s helpful.

I had a little girl. Oh, it was so heartbreaking. She’s just beautiful; [00:55:00] blonde hair, blue eyes. Her FSIQ was in the 50s and her parents don’t see that. I had to talk about compared to other kids her age where that fits into, but what was most helpful was talking about the future and the vulnerability.

One of the examples that I often give parents is, I had worked with a teenager, talking to him I would have had no idea had I not done the cognitive testing. I really wouldn’t have had any idea how low he was cognitively because he seemed like a normal teenager. But his decisions, he had gone to a party the weekend before I saw him and he got picked up for DUI and he’s like, “Caroline, I don’t get it because, after every beer, I drank a glass of water.” So he thought he was neutralizing the alcohol with every glass of water.

And so I shared that example and they’re like, oh my gosh, Caroline, our little [00:56:00] girl, she knows she’s not supposed to go past the yellow house. But one day dad went for a walk with the dog and was like six blocks away and saw her riding her bike with a little boy who’s like, just follow me. It’s a vulnerability piece. And that’s where the pieces all came together because even teachers were questioning, no, no, it can’t be a cognitive disability. She’s so sweet. And that’s the problem. She’s so sweet. And she’s so beautiful. And she’s so funny and so engaging, but you’ve got a kiddo who’s 9 or 10 years old who will come and sit in your lap without having ever met you before and give you hugs and say she loves you.

I think that vulnerability piece for them connects to a real-life example of, oh my gosh. They didn’t think of it as a big deal, but they started to realize the implications going into the future. So that’s [00:57:00] really what we need to do is how it applies to their kiddo, their family situation, their everyday routines, and then we can look at those recommendations.

So a huge recommendation for me really was about your circle of intimacy. We’re going to focus on that circle of intimacy. That’s our focus. I don’t care about reading. I know you do, but then parents really in the bigger picture, they didn’t care so much about, she’s still reading not even kindergarten level books, it’s man, what are the bigger implications?

So we’re giving them very specific information about what’s going on positively as well, right? How is your kiddo thriving? Where do they do their best? And then going into some of those difficulties and can we use some of their interests and strengths in these other areas? That’s going to be important. Really clear, relevant information about those difficulties. And that was just a great example of how they understood the diagnosis of the cognitive disability, the day-to-day functioning, and what the future could look like for them. [00:58:00] That’s a huge piece for parents.

Are they going to outgrow it? Will they always need medications? Will they be able to go to college? We don’t always know what that’s going to look like. For this little girl, well, I had another teenage girl similar profile, and she’s going to college near us. It was like a wilderness adventure kind of thing. So no, she’s not going to med school. So I give examples. We really don’t know.

When I did early intervention with kiddos with autism, you really don’t know what they’re going to look like as adults. We do know we need to start working on daily life skills a lot earlier for them. They’re going to be doing things at a much younger age because they need that repetition or whatever, but that’s a big stressor for parents too. They just want to know about the future.

Dr. Sharp: I know. Those are the hardest questions to answer sometimes. It’s hard to disappoint parents or at least leave them hanging in my experience.

[00:59:00] I interviewed Karen Postal a long time ago around her Feedback that Sticks book. And I think she was the one that said she’ll do a best-case and a worst-case scenario. And then say, it’s probably going to end up somewhere in the middle, but it’ll at least give you the extreme so you can start to wrap your mind around this.

Dr. Caroline: Right. And I hate to be the Debbie Downer Because we actually have…

I know a woman who was the chair of her department with a Ph.D. who was identified back then it was mental retardation and she was in special Ed classes, pretty much all of elementary. And she was reassessed in middle school and they were like, no, actually she’s quite bright. It’s so scary. And so there are those stories too where it’s just like, what happened? I actually see that all the time where you’ve got a kid with severe ADHD and ESL and [01:00:00] they’re misdiagnosed. But I didn’t tell those stories about this little girl because it really was a different kind of story, but there’s always those comparisons. It’s scary.

So always thinking, what am I telling them about their kiddo? What is their kiddo going through? What are their kiddo’s experiences? What are your experiences as a parent? Why might your child be behaving this way? They aren’t brats. They aren’t lazy. What’s going on for them?

I do a few exercises and I like to show this picture. I don’t know. Do you want me to show it to you and I can send you the link or should I just talk about it?

Dr. Sharp: Yeah, let’s see. I’d love to see it. Let’s do that.

Dr. Caroline: Okay, I’ll see if I can share my screen.

Dr. Sharp: Got it.

Dr. Caroline: So what’s in this [01:01:00] picture? Have you seen this picture before?

Dr. Sharp: No.

Dr. Caroline: Okay. Oh, I guess I can. Okay, you can now see. What’s in this picture?

Dr. Sharp: Okay. This is interesting. I’m just going to describe it for the listeners. It’s a black and white picture with what looks like ink or sand on it strewn around it. I don’t see anything discernible here. Maybe it’s a map. I don’t know. It looks like a map of parts of Europe or something.

Dr. Caroline: Come on, Jeremy, you’re not trying hard enough. Come on.

Dr. Sharp: I don’t like being put on the spot. Yeah, I really don’t know this. That’s the best I can do. Maybe it’s a microscopic view of something.

Dr. Caroline: So maybe you’re not lazy. Maybe you’re not motivated enough. I’ll give you $100. Tell me what’s in this picture.

Dr. Sharp: Let’s see. It’s a rabbit leaping over a dandelion.

Dr. Caroline: Okay. Now, you’re just being a class clown. Go to the [01:02:00] principal’s office. I’ll show you. Where’s my draw? Okay. I can’t go on my drawer, but it’s a, it’s a cow. And I can send this so that people can actually see what it is. Here’s the top of its head. Here’s one ear. Here’s its face. There’s a size. And then the body is out over here. Normally, I would draw it out for you.

Dr. Sharp: Sure.

Dr. Caroline: So I will often give that to parents, and do that. And I’ll actually be really neat. Like, come on, come on. You’re not like, come on, look at it. You’re not trying. Why are you being so defiant? But the problem is with that, they can’t perceive it. The kiddos can’t perceive it. They can see it and we can motivate them, but they can’t bring meaning to it just like you couldn’t bring meaning to it. Kids need a teacher. We need to give them [01:03:00] direct instruction. We can’t just leave them on their own to themselves to figure it out, and then they’re going to feel defeated. Why can’t I do this? I’m the only one who can’t get it.

So, in the feedback meetings, depending on what’s going on for kiddos, I’ll give them different exercises or I’ll give them pictures like that. I have another one where from a distance, it looks like a skull and I’ll have parents to give me a title of this story. And there’s something about a skull and then I’ll yell at them. How dare you talk about a skull. I’m trying to show you this beautiful Victorian picture. And then you see it up close and it’s a woman in a mirror putting on her makeup.

And so it’s just helping parents understand what’s going on for their kiddo and what their kid is experiencing. So if there is pushback every time they’re doing writing or there’s this defiance or anything, how can I as a parent respond in helpful ways? How can I create the right environment?

And so I do experiential things like that with them right in the feedback [01:04:00] session as it pertains to their kiddos. I’ll give them a mirror and I’ll have them. So all they can see, they have to use their non-dominant hand looking at the mirror, trying to write their name or something like that. Look at how effortful that was for you. Now you’ve got a kiddo with severe fine motor difficulties who has to actually think about just how to form their letter, forget about spelling, forget about everything else.

So it’s just that aha, where parents are like, wow, I didn’t even realize. I just always thought the fight, the fight, the fight, whenever we were doing this. So doing those experiential things can be really valuable for parents and checking in. And sometimes I won’t even explain it. I’ll be like, why do you think I showed you that picture? Sometimes they’ll think about it. I mean, some things are very obvious and then they can start reflecting back right on what that means for their own kiddo.

So it’s really going beyond just [01:05:00] sharing the results. It’s sharing it in a way that makes sense that they’re getting to hear it. They’re going to take it in and take it to heart. And we’re really inviting them to be co-meaning makers of this information and what that means for them and for their kiddo too.

So it’s looking at now, they understand their child’s needs and how much of a struggle it is. They’re going to feel empowered and that’s our goal, to make sure that they’re feeling empowered. So what it is they can do to just respond differently. That can be really helpful. Advocating for parents, that’s another big one where they’re feeling at the end. I don’t know what to do. How can we advocate for them? How can we connect them to appropriate resources? Ultimately we want to coach them on how to be good advocates themselves, right? How you can go advocate to the school and with the teacher, with these learning supports or whatever it is.

So looking at, what do we need to do to help parents be successful? And if we did that little [01:06:00] bit of qualitative information gathering at the beginning, we now have a bit of an understanding of what their dashboard for success looks like. Maybe they do need a little bit more holding and we will help them through that process. Or it says, here you go. Here’s the checklist. And off you go, right. Or what could be getting in the way of their success? That’s what we need to do.

A few more things. Are you still good to hear a little bit more?

Dr. Sharp: Yeah, I think we’re good. I’m particularly curious about this process after the feedback session and how we support parents and not just leave them hanging. You mentioned that a while back. I wonder if we could chat about that if that fits in your…

Dr. Caroline: For sure. So again, they’re not coming for labels. That’s a good segue. I like to think of the assessment as a comma. It’s not a period, right? It’s the beginning of a new journey for them.

The reason they came was for a [01:07:00] roadmap. So we are creating that game plan and the next step. So a huge piece of it really is in that feedback meeting. Well, ideally you want a second feedback meeting. And that’s where we’re going to deep dive. And together, we’re going to go through some of those recommendations.

Is this feasible? We are checking in with them. And so helping them along the way. And where do I come in? And do you want me to talk to the school and give that feedback or the IPP? So we are doing that together. I think that that’s really important in terms of how do we translate this into something that’s going to be helpful for you and just going through what’s not important necessarily, or what do you need to learn? Ideally, I would love for you to be doing this, but what is it that you need to do to learn or to support this?

So it’s a second feedback meeting where we can really go into making sure that those interventions and the next steps make sense and that they’re doable, and the parents are actually feeling motivated and confident that they could do it because there is some grief here and we don’t want [01:08:00] them to feel stuck in that grief and then feeling that they’re abandoned because that’s not going to be helpful.

So having that follow-up feedback session is really helpful. That’s where we dig deep into the recommendations and maybe clarify any questions they had because now they’ve had a chance to read the report. I also ask, what did you learn from this assessment about your kiddo? So looking at all of those things can be really important.

But then after that, every family is going to be a little bit different. Not to say that we have to have 50 million different pathways for every family, but you’re creating a library of resources. So you got a diagnosis of Mixed Dyslexia. Here’s a packet. Start here. It talks about what  Mixed Dyslexia is. It talks about some of the things that you could be doing. These are some local resources, national resources, or whatever it is that you could start looking at.

So we curate a lot of those. [01:09:00] So just a little resource package. Maybe there are other people. This is the kind of intervention program that’s going to be really helpful for your kiddo. Here are people in the city who do that kind of intervention, for example. So if we can give them really easy, next steps, that’s so valuable.

Maybe you have a clinician in your office who could then take on some of that. Maybe there’s anxiety and you’ve got someone who does counseling around anxiety. Maybe you have an executive functioning coach that kiddo can develop some strategies around that. So maybe there are things in-house that you can do, but if not, where things that they can do or go to and what resources they can have afterward, that’s huge.

At the end of the day, that’s about what we can do. We do need to be careful about dual roles. Being assessor and then interventionist and all of those [01:10:00] kinds of things, but it’s really laying out those next steps. And I often tell parents too, I think even just the reassurance of knowing, in a few weeks, once you’ve had it, let me know if you’ve got questions. But you know what, you can let me know next year when you’re creating the IPP or next year when your kid has got an exam, you’re like, ah, Caroline, we didn’t even think about this, but we have no study strategies, help. You can call me and let me know because these recommendations are based on this assessment right now. But next year or in two years, well, they might be needing a reassessment anyway, you can call me back and we can look at those strategies.

And I think that alone can make all the difference in the world for parents because they’re not feeling like they’re abandoned. They can’t call you back.

Dr. Sharp: Yes. That’s so crucial. I always try to impress that upon parents. I am available anytime. It could be six years from now. It could be six months from now. It could be six days from now.

Dr. Caroline: Exactly. [01:11:00] Our relationship is one of the strongest variables to their experiences with the assessment process. And it’s directly correlated with their involvement with their kiddo’s intervention in the future. So whether they take up treatment or intervention or tutoring or whatever else, our relationship directly affects that. So when we have a strong relationship, that’s really…

Everything that I’ve talked about is about building that relationship. Yes, it’s about getting more detailed information, which is also helpful and all of those kinds of things, but we’re promoting that relationship. And parents will say, and this is in the research, they’ll say, just talk to me like a person. Talk to me like a friend who’s genuinely interested. You really want to know about me. You really want to know about my kiddo. You’re not just some stuffy clinician.

And so that approachability, that openness, easygoing-ness, that’s all really important. And even little things like eye contact. Are you stuck on your clipboard madly taking notes or are you actually looking and engaging with families because [01:12:00] that is a piece? They pick up on that.

Dr. Sharp: Sure. That’s huge.

Dr. Caroline: Yeah, so just looking at those little things like what can we do to enhance their experiences and really validate where they’re going with everything. And of course, looking at their expertise because that’s going to help with the empowerment piece. That’s going to help build the relationships.

So if we can engage in collaborative problem solving just like we would do with a kiddo if we’ve got behavioral problems or whatever, let’s come up with as many ideas for difficulties. So what are some of the things that you’re really struggling with? And so those were some of those questions at the beginning that I asked, remember.

How will you know this assessment was helpful? Oh, well, I will know because of these situations. Okay, let’s go back to those situations. What are the things you’ve tried, haven’t tried, let’s look at all of our ideas. Let’s do some problem, solving here. Let’s make a plan and then go put it into practice, evaluate it, come back and let’s [01:13:00] let me know how it goes. And then we can update from there. So now we’re teaching them skills that we want them to do anyway. So it’s just looking at that piece.

Right from the start, there’s that collaboration. And from all of the research that I had done, I did develop this parent input form. It’s tricky because it’s another form. It’s one more thing for us to do, but just helps gather some of that information that we know is most important to parents. And I’ve got a link for that for you if people want to look at it, then you can modify it however you think, but those are the most important pieces that are identified in the research that are important for parents. It’s just looking at all of these little pieces.

The only other thing, I know we talk about the reports a lot. We don’t necessarily need to go too much into this, but the recommendations for the report, it’s still important to bring up again because I think us hearing the same messages over and over is really [01:14:00] helpful. So, of course, readability is important. Short sentences, no jargon, simplifying vocabulary, only short paragraphs, plain language, all of those things can be really important.

I break it down into concrete examples of everyday functioning. I don’t say visual, spatial processing, blah, blah. I’m like, this skill is going to be important for your kid to pack a suitcase or to read a map. That’s how I break it down in the report. That’s how I talk about it.

I really don’t like bullets. I do see reports with bullets, but if you do have parents who maybe their language or their literacy skills are limited, then a simplified bulleted summary can be helpful. I do pictorials, especially if I think parents might be low cognitive. I actually use pictures and talk about things in that way.

Definitely, next steps, we already talked about that and specific behavior [01:15:00] management strategies. Where do you need follow-up support, what kind of support, funding. Here in Canada, we’ve got disability tax credits, I don’t know what you guys have, but do we think that they can qualify? You know what, we can do those forms for you? This is what that looks like. So we’re really giving those next steps.

The only last thing I really wanted to talk about was thinking about our values and our purpose. And I know that that’s a big piece in the counseling psychology world. We’re always thinking about our values, but it really applies here too, even in our report writing. My value and mission in the work that I do is to inspire and empower families. And really at the end of the day, it’s to promote the resilience and growth of kiddos. That’s also therefore the purpose of my reports.

And so if I always remember, that’s my mission in all of the work even my reports, how do I empower family? So it has to make sense. It has to help them understand [01:16:00] their kiddo. They have to know exactly what they need to do next. They need to be hopeful and inspired.

It’s one thing to know what’s going on for my kiddo and what I need to do next, but if there’s no hope for the future, that’s going to be pretty defeating for them as well. So when we look at the report, how do you do whatever is important for you and how you want to be most helpful is going to be really important because this really should be a manual for their kiddo.

We get a manual for everything in life. And the most complex things in our life are our kids, and we have nothing. Even dogs, I’ve got 2 dogs. You’ve probably heard them shift here, but they […] too, right? Like it’s really easy for, it’s not quite the same, but there are trainers and there are black and white steps. This is what you need to do if you’ve got this problem. Kids are a whole other game. So this is the beginning manual. And we don’t want it to go in the garbage or the shredder.

Dr. Sharp: [01:17:00] Yes, such a good point. I like what you just said about living the values of your practice through the report and the other parts of the assessment process. I talk about values a lot in the context of business and employees and things like that, but it is equally applicable on the clinical side. You’ve got to bring those values to life in the work that you do as well.

Dr. Caroline: Yeah, exactly. And it’s just bringing it down. I often talk about myself as this big blonde baboon, because I was just on a panel with a bunch of other professionals for experts around COVID the other day. And I was the one who was like, oh, blah, blah, blah. I use layman language. I don’t talk about orthographic processing and all of these different things that nobody can make sense of. I break it down for people to make sense of it, and that for me is what’s really important.

But man, that was a lot of information. Like I said, I think it’s just focusing on [01:18:00] one thing. What’s one thing that stands out for you that you could start doing in your practice and then you can build from there once that’s entrenched, but starting small and just building from there.

Dr. Sharp: Yeah. I love that. You shared so much information with us and so many actionable ideas which I love. I think we all want to take that sort of information away from a podcast like this, but there is a lot. I think ending on this note of, hey, this is a lot of info and just pick one thing that you can work on this week or this month and the rest of the list will be there. You don’t have to do everything but think about one thing that you could do to change things for the better.

Dr. Caroline: And I shared with you a link to just basic parent recommendations too, just so people who are like, [01:19:00] what was that all again? I can’t remember it at all. There are a few recommendations there that they can get started with.

Dr. Sharp: That’s fantastic. Thank you so much. All the resources will be put in the show notes, everything we mentioned, everything that you sent me. Gosh, I took so many notes during this episode and got the wheels turning about ways that we can do things differently here. So personally and professionally, I’m so grateful for the time that you’ve spent with me here. 

Dr. Caroline: Good, I’m glad it was helpful. Thank you.

Dr. Sharp: Absolutely. Well, I hope our paths cross again sometime soon. In the meantime, take care and do good work.

Dr. Caroline:  Thanks. You too. Take care.

Dr. Sharp:  Thank you as always for listening. I really appreciate it. I hope that you were taking notes. I know I was. I had to review those here as I was putting the podcast together so that I can implement some of those things in our own practice. Just so many good [01:20:00] pieces of information.

Like I said at the beginning, if you are attracted to the idea of an accountability group where you can work with other psychologists to grow your testing practice, I would love to chat with you and see if it would be a good fit. I’ve got space in the intermediate group and the beginner group. You can get more information and schedule a pre-group call at thetestingpsychologist.com/consulting.

Okay, y’all, that is it for today. I will be back on Thursday with a business episode and the following Monday with a clinical episode. I believe I’ve got Dr. Michael (Mike) Posner coming on to talk about attention and his research in that area and just his perspectives from being in the field for so long. He was one of the most prolific researchers in our field. It’s a good conversation. So stay tuned and don’t miss it.

All right. Y’all take care.

The information contained in this podcast and on The Testing Psychologists website is 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.

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