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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.

    PAR offers the RIAS-2 and RIST-2 remote, to remotely assess or screen clients for intelligence and in-person e-stimulus books for these two tests for in-person administration. Learn more at parinc.com.

    Welcome back, everyone. Hey, my guest today is Dr. Courtney Ray. You may have seen Courtney in a variety of other venues in the field. She’s pretty active in the neuropsychology world. But she’s here today talking with me all about the Society for Black Neuropsychology.

    We talk about the origin story of the SBN, and we talk about their outreach efforts to recruit and mentor more black [00:01:00] neuropsychology students reaching all the way to the undergrad level. We talk about future directions for the society for black neuropsychology. We dip into certainly some of the cultural factors that may have contributed to the need and growth of the SBN here over the last two years. So we cover a lot of ground.

    We also touch on Courtney’s faith. As you’ll see in her bio, she is also an ordained minister. And we talk about that a bit and the overlap of faith and practice. So a lot to take away from this conversation. And Courtney is a dynamic and energetic guest who clearly cares a lot about what she’s doing and the work that she and many others are doing to reach a vastly underrepresented group in neuropsychology is pretty amazing.

    Let me give you her bio and then we will get to the interview. [00:02:00] Courtney is a licensed clinical neuropsychologist, neuroscience researcher, writer, professor, and ordained minister like I mentioned. She is the founder of Array Psychological Assessments, a private practice that provides neuropsychology evaluations in Northern New Jersey and New York City. Dr. Ray is the current president of the Society for Black Neuropsychology, as well as a member of the American Psychological Association, the International Psychological Society, and the Society for Neuroscience.

    Pastor Ray earned her Ph.D. in Neuroscience and Neuropsychology from Loma Linda University and her master’s in Divinity from Andrews University. She is the author of the upcoming book, Just Pray More and other church myths about mental health.

    So, I hope you enjoy this one. And without any further delay, let’s get to my conversation with Dr. Courtney Ray.

    [00:03:13] Hey, Courtney, welcome to the podcast.

    Dr. Courtney: Hi, how are you? I’m glad to be here.

    Dr. Sharp: Yes, thank you. I am doing well. Thank you for asking. And I’m excited to have you here. We were chatting ahead of time about how this has been a long time coming. I feel like I’ve been stalking you online for a while and finally got in touch with you. And now it’s been a few months since we chatted and here we are. So, I’m glad to be here.

    Dr. Courtney: Thanks so much for inviting me. I do appreciate it.

    Dr. Sharp: Yeah, absolutely. I just feel like there’s so much that we can chat about today. Of course, I reached out to you [00:04:00] to make some connection around your involvement with the Society for Black Neuropsychology. I know you’re doing a lot of things in your life, but this is one of those things. And I’m just excited to learn more and hear what y’all are up to. And honestly, just try to spread the word as much as possible for something that is really important in our field.

    I usually start with this question of why is this important or why is this important to you? And in this case, I feel like that’s basically our entire conversation. So, I’ll still ask the question, but just knowing we’re going to really take that and run with it for the rest of the conversation. So yeah, I’m curious, however, you might want to take that, like the why now, or what’s driving you to [00:05:00] put your energy into something like this, what’s this about for you?

    Dr. Courtney: Oh, well, I guess for personal reasons as someone who is a black neuropsychologist, I know that as a trainee, I really felt that there was a vacuum of just people within the field who could really help reach out network with trainees as they send the pipeline and also just professionals as we continue to work in our communities.

    And that’s not to say that there aren’t wonderful, brilliant neuropsychologists who are black, who have gone before. I mean, we have 6 fantastic people who are veteran neuropsychologists who are on our advisory board and there are many others who [00:06:00] are phenomenal people, but as individuals just working on their own, you can only take so many lab students. You can only personally mentor so many people. And if you have a collective network of people, you can use those synergistic efforts to do a lot more than you can accomplish just on your own.

    So one of the things that I really wanted to do with SBN and the rest of the Founding members of SBN really had this vision for having a collaborative network of neuropsychologists to really work together, doing these things that can help improve the field and help our trainees move through the pipeline and also to reach out to the community. So, I really think that these are things that [00:07:00] other organizations I have had some emphasis on, but not the focused energy that I think that it deserves on its own.

    Dr. Sharp: Sure. I feel like there’s so much history maybe to trace there. I mean, what are some of the efforts that have been present over the years that like you said, maybe, move the needle a bit but still left some room for y’all to step in? What do the efforts look like over the years outside of the Society for Black Neuropsychology?

    Dr. Courtney: Well, before SBN came around, like I said, there were definitely several black neuropsychologists who have done excellent work in research in specifically the black community, and making sure to have representation [00:08:00] within samples and research and making sure that black people are represented in those samples.

    One of the big things that you’re probably really familiar with is the Heaton norms and they’re called the Heaton norms, but they’re demographically adjusted norms for a lot of the neuropsychological tests that we usually work with, just in recognition of the fact that a lot of these norms were normed on white populations, right? And when you take just this homogeneous population and you say, this is the standard for everyone, then what you find is that it’s not generalizable to all of these other populations.

    I think it was really a Seminorm project to make sure that black [00:09:00] people communities were looked at and just the demographic differences were taken into account. And so that recognition of making sure that black people are seen as a population for norming different tests was I think a huge step in having this attention brought to the diversification of the field.

    And even though I say the heat norms, that’s because the first author in this book or in this work is Robert Heaton who’s a great psychologist. He’s still in California working. Also, Samuel Miller was also a black neuropsychologist who worked right alongside Dr. Heaton and Dr. Miller was one of the individuals who helped to [00:10:00] organize the communities and organized the testing so that you could have a black sample of individuals because you can’t make something like this, derive these norms, unless you know how to outreach to the community. And unless you’re able to build that trust and build that foundation so that people will participate in the testing. And so it was very interesting.

    Now, I’m kind of veering off into something totally different, but this is the initiative that SBN did this past year and it’s called the Luminary series. One of the things that we wanted to do was to highlight black neuropsychologists who have done things in our field and whose stories should be told and whose work should be publicized. And so we have [00:11:00] that whole series on YouTube and we started out by looking at the 6 neuropsychologists who we have asked to be on our advisory board.

    And so one of the things that we did before each of the interviews, we asked them, who is somebody who has been influential to you? We’re interviewing you because you’re a trailblazer in this field, but who was the trailblazer for you? Who was the person who helped you to become the professional that you are?

    Many of them talked about Dr. Miller and talked about the fact that he really was a huge influential factor in their training and in their ability to become the people who they are. And I was like, “Wow, I’ve never heard of this guy.” And then finding out that he was like a part of the Heaton norms, and like I said, he called it the Heaton norms because think [00:12:00] about Robert Heaton, but he didn’t do this on his own, right?

    And just the fact that there is a black neuropsychologist who did this huge undertaking and who was pivotal and crucial in this work that we still today use and reference and are always going back to, I think the fact that his name is even in the one generation has been lost to history in a way before you were able to get these stories, these oral stories from these luminaries that we interviewed. I think that that in and of itself demonstrates how important it is to be intentional in sharing the contributions of black people, people of color altogether, but particularly SBN focuses on is black people.

    So [00:13:00] looking at how our black professionals have really contributed to the field and continuing to tell those stories so that they can inspire the next generation of neuropsychologists to say, hey, there are people who have been doing this and who’ve done just landmark work and whose footsteps you can follow as you grow in this field as well.

    That to me is one of the biggest things as we’re going forward and paving a way, looking back and making sure that we have the recognition of the things that people have done in the past that have built up neuropsychology to what it is even right now.

    Dr. Sharp: Sure. I think that’s so important. You used the phrase “lost to history” and I was just thinking to myself as you were sharing all of that, I certainly can not recall hearing that name [00:14:00] during my training or people. Maybe lost is the right word. It seems like it takes a concerted effort to bring those efforts to the forefront and make sure people are still aware of such a huge contribution.

    Dr. Courtney: Absolutely. And now we’ve actually named our luminary series after Dr. Miller because we think that his name really needs to be one that people know and people will remember and to be able to recognize all the contributions that he’s made. I mean, when I dug into his biography and just learned about so many things that he’s been pivotal in, I was like, wow, why have I not heard about that name in my textbooks and in classes and things like that. And I’m sure that there are many other people out there whose stories also need to be told.

    Dr. Sharp: Right. Well, I was just thinking, I mean, this is just the same [00:15:00] story that’s happened in so many areas of our culture or society, it’s the same story hiding the stories of those that… yeah, maybe more obscure. It’s not cool.

    Dr. Courtney: Definitely not.

    Dr. Sharp: We’ll definitely link to that Luminaries series in the show notes. I’m super curious about that. I think there are so many directions that we can go. I would love to just hear the origin story though if you’re willing to share it for the Society for Black Neuropsychology? And before we go any further, I feel like I’m going to use that phrase Society for Black Neuropsychology about a thousand times during our interview. Is that okay?

    Dr. Courtney: SBN is fine[00:16:00] Yeah SBN is absolutely fine.

    Dr. Sharp: Sounds good. Thank you. So where did this come about? How did this start?

    Dr. Courtney: Well, I think I alluded to it just a little bit. When I was a trainee, I had gone to my first I&S and I remember just looking around and seeing like, huh, are there any other people who look like me? And they were but few and far between. I mean, there were definitely some people whose names that I knew, and there were definitely some people who I had personal attachments with.

    My externship supervisor at the City of Hope in California was Dr. Natalie Kelly and she is a black [00:17:00] neuropsychologist. So she was the first black neuropsychologist that I ever knew. I had heard of. Dr. Anthony stringer is amazing and phenomenal in his own light. And he’s also one of the people that we interviewed for the Luminaries series. He’s on our advisory board. He’s at Emory and I’ve read different papers that he had written at I&S. There was Dr. Jennifer Manly. She’s done a lot of research here in New York. She’s at Columbia and she’s also phenomenal.

    All three of them are on our advisory panel now. And at that time, those were the names of the black people who I knew had already been established veteran neuropsychologists. I didn’t really know of any other ones. And [00:18:00] just being in the mix, in the middle of all these brilliant minds, I’m like, okay, well, I’m sure they’re not the only three I’m sure that there are others out there. Where are they?

    I remember just looking in the crowd, trying to find out if there were any other black people, and just striking up a conversation with two other people who are trainees as well and just asking them like, “Hey, do you know of any other black neuropsychologists?” And just having that conversation. And we had seen H&S was doing… I think they do at I&S have an H&S conference that they do afterward. But I’m not sure if that was… I don’t remember which number that was that they were doing that, but I remember they were doing it [00:19:00] at that particular I&S.

    I also recognized that I had heard that there were rumblings about people starting an Asian Neuropsychological Association as well. And I remember like, oh, that’s really interesting. I wonder if there’s anything for black neuropsychologists. And so I was asking and nobody knew of anything. They haven’t heard of anything. And I’m like, well, if there’s not anything new, well, maybe there should be. And so, like I said, there were 3 of us who were trainees who had been there at that I&S who just met together to talk together and we’re like, Hey, why don’t we start something? Why, why?

    And I remember going to… like I said, I had heard rumblings about ANS starting. And so I went to [00:20:00] their meeting because they were like, everybody can come. And I was like, Hey, I’ll come and see what they’re talking about. And I remember Dr. Darryl Fujii was there and he was facilitating, just talking to the other people there about his vision for ANS. And so I remember I met back up with the other two trainees that I was talking to and it was like, Hey, they’re starting up too. We could do the same thing. We just need to get people.

    And I literally walked around I&S just try to find other black people. I was just wandering. Anytime I saw somebody who had a little bit of melanin, I’m sure there were people that I missed because they might not have looked apparently black and there might’ve been people that I might mistake. I don’t know, but I just started going up to people like, Hey, we’re trying to start this society for black neuropsychology, would you want to…

    [00:21:00] and actually, I don’t even think we had a name at that point. I’m pretty sure we didn’t have a name. We were just like, oh, we want to start a group for black neuropsychologists. Do you want to be a part of it? And just asking people, Hey, can I get your contact information? And we were first a GroupMe. I don’t know if you even know that app. I don’t use the app anymore. And it was just a GroupMe of people whose names and numbers I had gotten. We all just compiled all these names and numbers of people.

    And so for the first, maybe year and a half, SBN lived on GroupMe. And all it was, was a GroupMe group. We would pass messages back and forth if there was something very interesting or if there was like a post or something that we thought was, or maybe an opportunity, a job posting [00:22:00] or a conference or a call for papers or something like that. We put it on the GroupMe app but it wasn’t necessarily like super solidified. So that is the original kernel SBN being was before it became more organized into what we have right now.

    Dr. Sharp: Yeah. I love that story though. I feel like that’s how so many of these things start out as just some message thread between friends or people with a shared interest and it just grows from there.  How did you take the leap then? I’m just curious. I’m always curious about how things come to be and how things are created especially like this. How did you make that leap from, okay, we’ve got this app and we’re [00:23:00] sharing stuff back and forth to, okay, we’re doing a website and now there is a society and we’re going to partner with these other neuropsychology entities. Was that a conscious choice or did it happen organically? Like how was that?

    Dr. Courtney: I will say that initially, we were just going to be like, what do you call this, a special interest group underneath I&S. That was originally what we were going to do. The other two neuropsychologists that I was working with were Arthur Grayson and Will McBride. So Arthur was going to really take the lead on this. And so we’re like, Hey, you could be the president and Will was to add the flavor, something like that. Because you had to have like an established when you do the submission process for the special [00:24:00] interest group, you have to like say the names of the people who are going to be in charge or whatever. So it’s going to be the three of us, so Arthur, Will and myself.

    And then Arthur actually wound up leaving the fields for different personal reasons. So then it was just Will and me. And there were two other people who Arthur had talked to a little bit, but Will and I had not met them personally, but we knew about them. We knew that Arthur had talked to them and stuff like that. And so then when he left, I was like, well, we can’t just let it die. This is bigger than us and than one person.

    And so I reached back out to Will and he’s like, I have the contact information for the other two people that Arthur was talking to. And [00:25:00] so I talked to Kendra Anderson and also to Valencia Montgomery. And so then it became the four of us who were like, Hey, let’s make this into something that can be a little bit bigger. And as we were talking together, we said, well again, with the acknowledgment that we aren’t the people who are the first black neuropsychologist, we need to get people who have been where we want to go and who are veterans in this field and have like a knowledge base that we can draw from. And so we solicited the advice of the three people who had mentioned before, Dr. Natalie Kelly, and then Dr. Jim Manley, and Dr. Anthony Stringer. And then also in addition to that, we also reached out to Dr. Mark Morman and Dr. Monaco Rivera-MinDt, and Dr. Desiree Byrd. [00:26:00] And they became our advisory board formally.

    And one of the things that we were talking about was that this should be more formalized than just being a SIG. This is something that we should probably make into a nonprofit and make into something a little bit larger than just being underneath the umbrella of a SIG in I&S.

    I reached out to some people who I knew who were in H&S and asked them, how is it that you guys got to be where you are because I knew that they were more than just a SIG as well? And so we had some conversations with them.

    We had decided we want to expand to be something larger than just the subsidiary of I&S. And it was very simultaneous in a way [00:27:00] because I genuinely cannot tell you which came first, because as we were talking to different people about it, there were some people I will say, even some people who are now on our advisory board, that when we first reached out weren’t very interested, to be honest. They were just like, ah, whatever.

    I’ve mentioned going around and talking to people like to get them on GroupMe. Even at that point, there were some people who were just like, I don’t want to be. I don’t know what this is. I don’t want to be a part of it. They didn’t really seem like they caught the vision or they saw what we were doing as a priority.

    And so as things unfolded last year with the pandemic and then with all of the protests around George Floyd’s murder and so many other racial and [00:28:00] social justice issues, the fact that SBN was on the cusp of becoming what we were, it was the zeitgeist for that moment. And so I’m not exactly, like I said, I can not tell you which came first, but I know that all of a sudden it was an eruption of people being interested now in, oh my goodness. How do we make sure that we are looking at and considering those things that are important for the black community? That was across so many other fields, like a lot of different fields, including psychology and specifically neuropsychology.

    And so now people were like, oh, there’s this thing. There’s this organization that is… people started hearing about us. And we did a talk, the four of us, Kendra and Valencia and Will and myself, [00:29:00] we did a talk about, the first thing was the COVID-19 response and how black communities really needed to be prioritized because at the very beginning, black communities were not being as hard impacted as some of the white communities.

    And there were even some myths about, oh yeah, black people can’t get Covid because we weren’t really being affected as much. But just knowing how these things unfold and recognizing from history, how our communities are often impacted, it might be a delayed impact, but we would get impacted. We would get impacted harder. Like that has been the trend of every single epidemiological outbreak in the United States history. And there was no reason to believe that this was going to be any different.

    So [00:30:00] we knew that, okay, we need to be speaking out and saying, hey, people need to be considering what’s going on in the black community. People need to be paying attention to what could potentially happen to us, not just on a social level, but on a health level and on a mental health level, because we also knew that there was a lot of precedent for how a lot of respiratory distress can impact brain function. And so we put together this webinar on that.

    And then after we did that, people who saw it reached out to us and said, hey, can you come and do this? Can you be a part of that? And then there were some people like, hey, how do we become a part of what you guys are doing? And so it just snowballed from there. And then with, like I said, the murder of George Floyd and with the protest and with just this [00:31:00] heightened awareness of social justice.

    And then there were also people who are in academia who were saying, hey, I don’t know where to turn to as a black trainee. I’m being overwhelmed by what’s happening outside, but I don’t know anyone who can empathize with what’s going on, who can help me to get through this? Because I think that the vicarious trauma of just the repercussions of the social issues that play black people, people don’t understand how much of an impact that has on people who might not be directly related to it.

    I mean, I don’t have to be George Floyd’s cousin to be impacted. Just by virtue of being a black woman in the United States, I’m impacted. And it has an [00:32:00] emotional impact on me. It has a psychological effect on me and it has real cognitive impacts on people and their ability to function. And I think that we discount that in many ways for all communities, but then specifically when we’re talking about in academia, there is this pressure to perform, pressure to just go and do whatever it is that you’re supposed to be doing. You have your dissertation to do, do it. You have your research to do, do it. And there’s not that time taken thinking.

    I mean, even though we talk about self-care and our whole entire profession is about helping people in their own mental health, we’re not very good at prioritizing mental health for our professionals and instilling the importance of our trainees developing good skills in mental health. And so they still have this pressure to perform and still dealing with those things and not [00:33:00] having those things be considered on how it’s going to really impact them had been taking a toll. And I think SBN was able to fill this gap or fill this void at that time that really needed people to really recognize.

    And so we had listening sessions that we did. We had two healing circles that we facilitated for trainees and other people who worked in academia and post-docs and interns. And we wanted to make sure that they felt like they were being heard, that they knew that there were people who did empathize with what they were going through and that it was okay to feel how they were feeling, even in the midst of what was going on.

    And a lot of them felt like, this was the first time that they had a platform where someone was listening to what was going on and really [00:34:00] feel what they were feeling because a lot of them didn’t have black PIs or black dissertation chairs or black DCTs. So there were people who might not have appreciated just how hard all of these things were because everybody was dealing with COVID sure, but that on top of the stresses of what was going on just socially was something that doubly impacted black people in a way that some other communities really didn’t understand and really didn’t extend that help for those trainees.

    And so, we were able to be there for that. We were also able to help educate some of those administrators and some of those supervisors and organizations and institutions and helping them to see like, this is important for you to recognize. And we didn’t want to hesitate in [00:35:00] building what we needed to build up to get up to speed, because like I said, H&S has had a bit like decades to be who they are and to develop their infrastructure and everything like that. And so we knew that there was not an expectation that we could be what they were, already at the level that they were at like 30 years, I think they’ve been around. But we wanted to do as much as we could to ramp up as much as we could because the truth is that you got to strike while the iron is hot because people are fickle.

    And while people were at were focused on, oh, we need to pay attention to what black people need. We’re like, you know what? Let’s make sure that we take advantage of this while people still care because next year, next month, we don’t know if people will even care about what we’re talking about because this is the hip thing in thing. There were all [00:36:00] these corporations like black lives matter and all this other kind of stuff, but sooner or later it’s going to go back to the status quo business as usual. And so we want to make sure that we do everything that we can now to get as far ahead in the game as we can towards building this organization to what we aspire to be with as much help from people as they’re willing to give at this moment because that goodwill can wither out very quickly once there’s another focus or people are shifted with something else that that gets their attention.

    Dr. Sharp: Oh, of course. It sounds like it was exactly what people needed at exactly the right time. You were there, right?

    Dr. Courtney: Yeah.

    Dr. Sharp: I just think about how isolating that would be as a black neuropsychology graduate student and not having, like you said, like any black faculty or staff members and having to, like grad [00:37:00] school was our life at that time. That is everything for you when you’re in grad school. You’re living with your cohort and just eating and sleeping and breathing grad school and to not have anyone that looks like you, that’s heartbreaking to think how isolating that might be. So to know that y’all stepped right at that time was pretty amazing.

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    Dr. Courtney: Yeah. And I’m glad that we were poised in that position that we were able to do that.

    Dr. Sharp: Right. What’s that phrase? I’m going to butcher this. It’s something like luck is when preparation meets opportunity or something like that. It’s like you had been laying the groundwork and then like environmental factors came in and you’re like right there and it could be what people need.

    So, what are y’all about now? We’re a [00:39:00] year down the road, year and a half, maybe two years as you’ve gotten this ramped up. I don’t know if this is what you call your mission or your focus, whatever you might call it. What are y’all really trying to do now that you have a little bit of time and some more membership under your belt?

    Dr. Courtney: Well the objectives that we have are twofold. So there is the building up of the fields and diversification of the field. So making sure that there is a pipeline of black professionals in neuropsychology. So we do a lot of outreach and mentorship. Outreach even down to the undergraduate level, because that’s where it starts. There’s a lot of people who wind up stumbling into neuropsychology.

    It’s funny because I asked different people, how did you [00:40:00] even get into this? And there are few people who are like, I wanted to do this from my undergraduate. A lot of people just stumble into it. I know when I was in grad school, that was when I found out what a neuropsychologist is about. I had never even heard of a neuropsychologist until I was in a psychology program. So just that idea that you can’t be what you can’t see. You have to know that something exists for you to want to pursue it as a field. So being able to get that education and outreach out there.

    A big part of what we do right now is mentorship. So the vast majority of our membership, it’s either 60/40, or maybe even it might even be 70/30 of our membership proportion is [00:41:00] trainees at some level all the way up to post-doc versus professionals in the field. So we are definitely heavily training focus right now in terms of helping them in their development, helping them get connected with mentors. Our mentorship program is one of the things that I’m most proud of. It is like the heartbeat right now of what SBN is. And I hope that it will continue to do that.

    But as obvious as our membership portions change, some of the dynamics of what we’ll be super focused on will change as well as they graduate and become professionals themselves. But right now, most of our energies are towards mentoring and helping those trainees to become competent professionals.

    We also do CEs for our professionals now. We work together with [00:42:00] other organizations that make sure that they’re considering what they need to do to help make the environments that our professional colleagues work in is one that’s welcoming and taking into account what needs to be done so that they are being responsive when things like this happen because it doesn’t just affect trainees. It also affects our colleagues who are in professional settings as well.

    So we do training in that capacity. We have a lot of research things, that we have been collaborating with and making those connections with different professionals who are interested in the same things, who might need other people to collaborate with. We put out those different opportunities for people to be a part of those things.

    So that is the [00:43:00] internal stuff that we do with the professional pipeline because we want to make sure that we have a voice at every table. When there is a professional meeting, there’s a black representation that we have a voice at the table who will be talking about making sure that there is equity in the way that our professionals are treated.

    We want to foster the idea that we are not an afterthought. You need to definitely be intentional in the things that you do around making sure your black trainees and black colleagues are considered when different decisions are being made. So, as I said, we’ve done CEs just for professional development and all sorts of ways. So we do that.

    We’ve done a lot of webinars in terms of how to get into grad school and then how to [00:44:00] get an internship and then how to get a post-doc out. So we have a whole series like that still on our YouTube channel as well. And we’re also partnering with some of the editorial boards of different neuropsychology magazines to develop an editorial training program, because it’s not just about getting through but then now what do you do once you are in a position where you can be the gatekeeper of research and not just submitting your own research but being an editor on those publications that disseminate the knowledge to the rest of our field.

    So making sure that there are enough people who look like the composition of our constituency, who can say, okay, I’m on this editorial board as well. And I want to make sure that I’m representing the interests that may have been neglected in the past time. So [00:45:00] we’re working on developing that with these different editors. Actually, the first cohort of people who will be in that training program are going to be starting next month. So that’s really exciting as well. So that is the professional side.

    The second part that we do is be outreach part. The outreach part is making sure that we are advocating for black communities. Making sure that we are doing our part to keep black populations at the forefront of the minds of those people who are doing research in different ways. We know that unless you are intentional, if you’re just calling out a sample of people that come, you’re not necessarily going to get a diverse sample. You have to work with those communities. You have to build bonds with those communities. You have to make sure that you recruit in ways that those communities are receptive to.

    [00:46:00] So helping researchers understand how to make those connections and fostering trust within those communities as well and helping them to know like, this research is important and we want you to be a part of it. And also not just in research but education about neuropsychology in general. Because like I said, the average person doesn’t know what a neuropsychologist is or what they can do for them. And we want our communities to know that neuropsychology is a field that can help them. And that can be something that they utilize as a resource and that they can have access to. And so providing that access to various communities throughout the nation.

    And like I said when COVID hit, we did that webinar, but we also established some relationships within the congressional black caucus to make sure that we [00:47:00] are advocating for public policies that made sure to be intentional about helping black people to be considered when different changes and policies were being made that would affect their health.

    We also wrote to the task force that now, since this is a different administration, they’re not the same task force as it was last year, we were in communication with them by putting out there in the forefront like, COVID is something that’s going to impact mental health and cognition. We want to make sure that black people are recognized and that they’re able to get the help and the resources they need. And that means public policy needs to be focused on, making sure that those resources are allocated to reach out to those communities so they can get it.

    So doing a lot of that public work is another part of what we’ve done. We’ve partnered with [00:48:00] a few of the other agencies like the American Pediatric Association and the American Bar Association as well in talking about just things surrounding social justice and the death penalty, juvenile definitely. It’s still something that is done in some places. And just talking about brain development, human development, cognitive development, and the reasons why we need to make sure that we’re not penalizing people whose brains are not developed for adult decisions.

    Our penal system needs an overhaul in so many ways, but just making sure that we are doing what we can to lend our voices to causes that we know affect our community and have this intersection with black lives and with [00:49:00] cognitive and behavioral and neuropsychological health. So we’re doing all that. We have our hands on a lot of things, but like I said, we are trying to be focused on the things that we’re doing well and expanding out from there.

    Dr. Sharp: Yeah, that’s amazing. Just hearing all those ways that you are so active. I would love to focus on two. You said the mentorship is the heartbeat in a way of what you’re doing. Can you just give more detail about that mentorship program and what that looks like for folks?

    Dr. Courtney: Yeah. I’m very excited that when we put out the call for people to participate in the mentorship program, we had more professionals who wanted to mentor than we actually had mentees. So we actually had to turn away from mentors and say, we’ll get you in the next round of mentorship because there were so many people who were like, we want to give back [00:50:00] and we want to help trainees in a way that we would’ve liked to have been helped. There was a lot of enthusiasm there.

    Basically, we pair up black trainees at various levels with people who are professionals in their field and have them meet together. They get to choose the format in which they meet and they have the opportunity to formulate the way that they want those meetings to be held and the frequency, and things like that. But then we also have specific mentorship meetings where everybody comes and is invited to be a part of that are happening at regular intervals as well, because we want there to be some structure around it. We want to make sure that they’re checking in and being accountable to each other as they develop these mentorship relationships.

    So that is [00:51:00] being run by our mentorship and education committee. Dr. Willie McBride is overall in charge of that as well as Anny Reyes. She is now an intern at Emory, and I’m excited about that. And she’s just a phenomenal young woman as well. And we want to make sure that we have people who are really passionate about this themselves who are leading it because they bring that passion to making sure that this is a quality program for our trainees.

    So you have to be a member of SBN to be a part of the mentorship program. So if you are a member, then you can sign up. It’s that simple. It’s no charge for you to be a part of it once you are a member and you get a chance to pick the brain of some [00:52:00] really impressive people who are professionals in our field. The mentorship program, the first cycle I believe will be ending next spring. So actually, I say that as if it’s a long way away, but we’re more than halfway through. I can’t believe it. So in a few months, the first cycle will be ending, and then people can re-up if they want to just stay with their same mentor or they can choose to cycle to somebody else.

    And we wanted to keep it not an open-ended mentorship because sometimes when things are open-ended, people are hesitant to be a part of it, but we wanted people to know there’s a definitive ending part. And if you want to continue on later, you can. We’re only asking you for this commitment for this part, and then after [00:53:00] that, you can choose what you want to do. And that way, at least they say, I’ve committed for this much. And I can make sure that I’m doing what I can to help this mentee while we’re in this committed time-space. 

    Dr. Sharp: Interesting. I’m so curious because, to me, I think a lot about how we get into this field, and like you said, I think we sound like we had a similar experience. I always joke around it. I didn’t actually know what I wanted to do or even really what a psychologist did until probably 3 or 4 years into grad school. So I’m really curious about what y’all might be doing to spread the word, even to undergrads and others to build that pipeline, like you said. What does that even look like? I wouldn’t even know how to tackle something like that. Would you be willing to share anything about your strategies there?

    Dr. Courtney: [00:54:00] Sure. So actually, when I was in grad school, there’s this thing called the Brain Bee which is a national competition that is like a spelling bee in a way. They target high school students and trying to help them know about brain health and stuff like that. And you can be a person who facilitates a local Brain Bee in your area. And so I had signed up to do that and brought that to San Bernardino, which is the county that my grad school was in. I went to Loma Linda University and so we did a Brain Bee in San Bernardino county there for two years, my last two years of grad school.

    And so that was initially, one of the ways in which I wanted to bring that to SBN. This is when there was no [00:55:00] SBN formally. And this is when we were just talking about and stuff.  So when we formalized, that had been the plan for outreach initially, but then of course COVID happened, right? So the Brain Bee, the big thing about it is that you get young people in person and there are workshops and things like that in the morning and then the competition in the afternoon. And without that in-person piece, it was like, okay, what are we going to do now in order to really reach out?

    And so what we have done is it’s just not elegant. It’s just like a blunt force instrument. I’m just looking up, looking at different undergrad programs, and emailing them. [00:56:00] Hey, this is SBN. This is what we’re doing. And whenever we had a webinar or a program that we did on YouTube or something that we’re a zoom webinar or something like that, we would just do these cold email blasts or cold calls to all of these different institutions, and like, this is what we’re doing. We want you to be a part of this, tell your students, and some departments.

    I will say this, I don’t know who your listening audience all comprises, but if there are any people who are department folks listening out there and you’re administrators, please make your contact information readily accessible on your website because sometimes it’s buried so deep in there. I would be like, okay, well, how do I get a contact with this department? And it will be a task but really [00:57:00] just going down, now we have a directory, a list of contact information for different undergrad departments.

    High school is a whole different beast. We haven’t been able to do that in COVID like we would love to, but in terms of undergrad psychology programs and in the country, we have a substantial database. We haven’t gotten to all of them. I’m sure there are some other colleges that we don’t know about. We tried to hit some of the major ones like the State school systems, the HBCUs because one of the things we want to do is diversification with the pipeline, right? So we wanted to make sure that HBCUs were on our mailing lists and things like that.

    So just sending those out and saying, want people to be apart. And it was receptive. There were a lot of people who sent that to their students. I’m sure there are some who [00:58:00] just toss your stuff in the spam folder and just forgot it. But we have gotten a lot of people who would listen and who eventually did join. And they said, my department sent me this flyer or my department told me that this is something that you guys were doing. This webinar or whatever and that’s how they got involved in SBN. So that’s been like I said, it’s not elegant. I’m sure that there are lots of more refined ways to do it, but it gets the job done.

    Dr. Sharp: Exactly. I mean, when you don’t have any other means, that’s what you do. You just send that and see where it lands. Well, it seems to be working. I know y’all are gathering a lot of steam, and like you said, that it’s a snowball effect that keeps growing.

    I’m curious just looking forward, are [00:59:00] there any objectives, any goals that you haven’t already spoken about, and if not, that’s totally okay. I want to make sure to make it clear how people can get involved and contact you and join if they would like to do that.

    Dr. Courtney: Oh yeah, absolutely. So right now we are in the midst of rebuilding our website. So the old website is under construction. We have a new website. The domain is www.soblackneuro.org and that is our website. Like I said, it is under construction now. So if you are listening to this, shortly after our interview, it might still be under construction, but check back soon.

    In the meantime, [01:00:00] if you want information on the organization, you can get in touch with us by email, which we are very responsive to. And that’s soblackneuro@gmail.com and shoot us an email and say, how can I be a part of this?

    Membership is something that we actually did a lot of back and forth in this because we want people to know that this is a valuable organization to belong to. And so we do have membership dues, but if the amount is so encumbering that they cannot expend that money to be a part of it, we will still allow them to be a part of it. They just need to explain. I can’t do the suggested [01:01:00] membership price. And we’re going to let you be a part of it because that’s one of the things that we don’t want finances to be a hindrance or barrier to anyone to be able to be a part of this organization because our whole goal is to be more inclusive and to help diversify the pipeline and to make sure that as many people who are interested in being a part of SBN are able to do so.

    So that’s something that we’re really committed to doing. But it’s not a lot. The fees aren’t a lot anyway. We’re not trying to break the bank on anybody. And this is basically our upkeep in different things like that, to do some of these initiatives that we’re doing.

    One of the things you asked in the future, what are things that we really want to do more of, [01:02:00] I think that making more inroads into various communities is really important. And now we’re at another place of another zeitgeist moment where a lot of people are directing their attention towards mental health, right? So many people in the community are seeing the value of making sure that your mental health is taken care of just as much as your physical health is taken care of.

    And for a long time, especially in the black community, there has been a stigma about mental health, and for good reason. There’s a lot of reasons why black communities are distrustful of the medical community in general, because of things that have institutionally been propagated against black populations in the United States. And just the history of gynecology, the Tuskegee [01:03:00] experiments, so many other things that are a little bit obscure to many of your listeners, but have made a big impact in the black community in terms of fostering this mistrust.

    So you have people who are not necessarily willing to do this. Would you say, oh, do you want to be a part of a research program? That doesn’t necessarily render a good feeling. So you got to say, okay, how can we make sure that people understand that they’re not going to be part of something that’s going to be detrimental to them and really fostering those relationships within communities and institutions that other people trust that we can collaborate with to make sure that we are letting black people in the country know that this is something that we should be a part of.

    Also, one of the things I have not mentioned as well [01:04:00] is some of the things that we want to do outside of the country. So we are in the very nascent stages of trying to foster some relationships in some countries in Africa, in helping to build up their neuropsychological professional communities as well. Like I said, it’s still pretty new. We have some people who have already worked in different areas. So like Dr. Charles Conger. He works in the Congo. He is exceptionally brilliant and has made a lot of connections, both here in the US and in Congo to try to establish that community there. And we want to help him to facilitate that.

    Also, we have some people who have connections in Ghana, some people who were actually in Sierra Leone who [01:05:00] reached out to us to see if we could help them. They’re building up the neuroscience community there. So we’re trying to expand beyond the borders of the United States. It’s slow going right now. I shouldn’t say slow going because it’s only been a year, right? But it takes time.

    Dr. Sharp: Of course. Yeah, It always feels slow. And then you look back, hopefully, reflect on all the amazing things that happened over that period of time. Yeah.

    If anything is striking me about this conversation is just how many places you are extending the reach and trying to make connections and do this important work. There are so many avenues that y’all are exploring. It’s really amazing.

    Dr. Courtney: Well, thanks. I feel like I’m talking a lot, but it’s something that I am very passionate about, obviously.

    Dr. Sharp: Well, yeah, [01:06:00] this is all important stuff. I know that our time is starting to run a little short, but I feel like I’d be remiss to not touch on this whole idea of faith and practice. I mean, this is big for you. I could have introduced you as a pastor Courtney Ray in addition to Dr. Courtney Ray. So we didn’t really jump into that in the context of the SBN but I would love to hear a little bit about that from you, how faith comes into your life and overlaps with psychology and the work that you do.

    Dr. Sharp: So just as you said, not really knowing which specific field of psychology you want to go into, and I mentioned not knowing what a neuro-psychologist was. Initially, when I went into psychology, it was for the purpose [01:07:00] of specifically reaching my faith community.

    So I am an ordained minister in my denomination. I spent 17 years as a pastor at different churches. I’m a Seventh-day Adventist. And so we have what are called conferences and you work for the conference and then they can move you to different churches. I don’t know if you’re familiar with Catholicism, but they have different parishes similar things.

    Anyway, so I had worked in different congregations and most of the congregations that I worked with were primarily black. And one of the things that people would often come to me to talk about where there are different issues, and it wasn’t just spiritual issues but just regular issues they felt they needed counseling for, [01:08:00] and they will be very open to talking to me about those things. I had taken specifically taken pastoral counseling classes because I knew that this was a really important part of ministry.

    But then there were people who would come to talk about things that were what I felt outside the borders of pastoral ministry, and I felt really needed to be dealt with somebody who was more well-versed in mental health specifically. And I would refer people. I would refer people in my congregation to a psychologist or a social worker or other psychotherapists. And they say, yeah, yeah, I’ll go. And then they wouldn’t.

    And I felt like, well, you guys got to go. Like I talked about the stigma and some of the hesitancy around some of these mental health issues, I would find that there would be this [01:09:00] just the stalemate. And so what I decided was, well, if you’re not going to go, I guess you will come to me but you won’t go to anybody else. So then I guess I need to be that somebody else, right? I need to be the expert and be that person for you.

    And so, I went to Loma Linda. I decided to do political psychology. And while I was there is like what I said, I was introduced to neuropsychology and just found so many of the ways in which it goes beyond just counseling. And I was like, I feel like this is also a very specific need within my community as well, not just the black community but in the faith community. And I think just the animosity that the faith community sometimes will have with psychology, and it’s [01:10:00] definitely a two-way street. I feel like that does not foster good relationships and a good desire for people to want to participate.

    And so, some different issues that are really neuro-psychological in nature or organically based or something that is cognitive disturbance will sometimes be poo-pooed away. Or maybe people will say you can just pray it away. If you only had one faith, this would evaporate. Interestingly enough, in my particular denomination, there’s a very strong emphasis on what we call the health message. So, making sure that your body is very strong and making sure that you’re healthy, but that has not traditionally extended to mental health for some reason.

    And I really [01:11:00] want it to be able to help people recognize that your mental health is just as important as your physical health and that just like we help people become doctors and physical therapists and who treat the physical body, we also have doctors who treat your mental health as well. And that they are people that you can also be trusted with your mental health as well. I think that there’s this antagonistic relationship because people feel like it’s a betrayal of faith to see someone for their mental health and it’s not.

    The same types of professional development that physicians go through and the rigor and care that they are trained to provide to their patients without judgment, psychologists also are trained in the same way when it comes to mental health. And I don’t want [01:12:00] people to fear the fact that psychologists, I’ve heard so many things like, oh, psychologists who could try to talk you out of your faith and tell you that do not believe in God.

    There are lots of different things that people believe that psychology will do if you go to someone who is a mental health professional, and I want it to help dispel those myths and help people to really recognize that they can be devoted followers of faith and followers of God and trusting God, and also utilize the resources that we have in terms of professional help.

    I even wrote a book about it. It’s coming out soon. Not as soon as I’d like because I’m doing 50 million other things, but I’m almost there. It’s one of those things where it’s like, I just want to just change this one more thing. And I just got to say, I got to stop and just do it and just put it out there. And it’s about [01:13:00] people of faith and helping them to recognize that you can’t just say, oh, I’m just going to pray about it because faith is not just believing, but it’s also doing and stepping out on faith and that there’s no reason to feel like you can’t also take action to help improve your mental health as you are being a person of faith. So that is that’s the nutshell version of my desire to bridge those two worlds.

    Dr. Sharp: Well said, there’s so much. I am just so impressed. I feel like any moment now you’re going to reveal that you’re also like a concert violinist or know Japanese or something. My gosh.

    Dr. Courtney: I only played it shallow, not very well.

    Dr. Sharp: Okay. Fair enough. So you are mortal. That’s good to know.

    [01:14:00] This has been great. I really enjoyed spending most of our time on the SBN but being able to end on a little more of the personal note and that intersection of faith and practice was great.

    I’m just thankful for your time. I’ll make sure that we have all the resources you mentioned, all the folks you mentioned, and certainly, contact info in the show notes. I’m guessing that, or I’m hoping that this will reach some individuals who may not have heard of the SBN or might just need a little motivation to reach out and help keep the ball rolling. It’s so important in our field. So thanks for your time. This is awesome, Courtney.

    Dr. Courtney: Thank you for having me. I ran my mouth.

    Dr. Sharp: Hey, that’s what this is about. You did not run your mouth. You took advantage of the platform and shared tons of valuable information with us.

    Dr. Courtney: Thank you for [01:15:00] having me. I appreciate that opportunity.

    Dr. Sharp: Thanks for listening y’all hope you enjoyed that one. And like Courtney said, if there are any training directors, program directors, department chairs out there listening who would like to get in touch, make your information more available so that the SBN can reach out and reach more black students. That would be incredible. Courtney’s contact info is in the show notes. Don’t hesitate to reach out.

    All right. That is it for today.

    As I mentioned before, I am opening up a number of mastermind groups. So if you’ve been wanting to hold yourself accountable and connect with other practice owners around either launching or growing or maximizing your testing practice, now might be the time. So check out more [01:16:00] information at thetestingpsychologist.com/beginner or advanced or intermediate, and you can get the info that’s appropriate for you, or you can check them all out and see which one feels like the best fit. And you can schedule a pre-group call and talk to me for a little bit, and we’ll make sure that it’s the right choice for you.

    All right. Y’all take care. I will be back with you on Thursday with a business episode. Until then.

    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, [01:17:00] 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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  • 231. How and Who to Start Hiring

    231. How and Who to Start Hiring

    Would you rather read the transcript? Click here.

    In my mastermind groups and individual consulting sessions, I get a lot of questions about hiring. Many folks are interested in expanding but are unsure of how to do it, which makes sense because it can definitely be an overwhelming process. This episode discusses some of the foundations for bringing other clinicians into your practice. These are a few topics that I discuss:

    • Why would you hire other clinicians?
    • When should you start hiring?
    • What are the steps to actually put out a job ad?

    Cool Things Mentioned

    Featured Resource

    I am honored to partner with PAR for 2021 to bring you featured items from their catalog! Listen to each episode for specific product recommendations and links. Learn more at www.parinc.com.

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

    About Dr. Jeremy Sharp

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

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

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  • 231 Transcript

    [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.

    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.

    Hey, welcome back y’all to another business episode of The Testing Psychologist. Hope you’re doing well as always.

    Today’s topic is hiring. I’ve been getting a lot of questions lately in my mastermind groups and individual consulting sessions about hiring. I’ve been talking to a lot of folks about writing job ads- which I just talked about in a prior episode a few weeks ago. I’ve been talking [00:01:00] about how to hire, interview questions, who to look for, when to hire, all sorts of things. Lots of questions about hiring. So I thought I’ll do an episode on hiring to revisit some of these principles and hopefully give you a good idea of what to look for, when you might want to hire, why you would want to hire, and what steps to actually go through to put out a job.

    Before we get to the full conversation, if you are launching a practice or trying to grow your practice, I would invite you to check out the mastermind groups that are available. Each mastermind group is a cohort of 6 psychologists. We meet for about five months together. The idea is that you have some accountability and folks to help you reach your goals in your practice, whether you’re a beginner or more advanced or just in that intermediate phase where you’re [00:02:00] trying to hone your systems and just run a better practice without expanding necessary. You can get more information at thetestingpsychologist.com/beginner, thetestingpsychologist.com/intermediate, or thetestingpsychologist.com/advanced, depending on which one you’re interested in, and you can schedule a pre-group call there, which is free. We’ll just talk for 20 minutes or so and figure out if the group is a good fit for you.

    I would love to have you. These groups have been amazing over the last gosh, four years now I think, maybe longer. It’s really cool to see folks go through these groups and make the gains that they do. So if that’s interesting to you, check it out, schedule a pre-group call and let’s see if it’s a good fit.

    All right, let’s talk about hiring.

    [00:03:00] Okay, here we are talking about hiring. This is going to be pretty straightforward.  I’m not going to get into the weeds too much with hiring. There’s so much we could talk about here. I will do a separate episode on interviewing. I’ve gotten a lot of questions about interviewing as well and the actual hiring process, but today I’m going to focus more on the basics and the ins and outs of hiring.

    Let’s start with why you would want to hire.

    Why would you want to hire someone? Why would you want to complicate your life in that way? I am joking of course, but I’m also not joking. It is complicated. Hiring folks is going to complicate your life a little bit. So let’s talk about why you might want to do that.

    One reason is that you want to reduce your own workload. I hear this a lot. I think this is a primary motivation for [00:04:00] folks is that they want to stop trading time for money. So the idea is that any time an associate or an employee or contractor is working in your practice, that brings in income that you yourself do not have to bring in. So you get to reduce your workload.

    Another reason is that you want to simply make more money. So maybe you don’t want to reduce your own workload. Maybe you just want to bring in some extra money. That is totally fine. This, in some ways, is called passive income. I would argue it’s not that passive because you’re going to be doing some management of the person that you hire in some form or fashion. But it is money that comes in that you did not personally have to make. And if you are working the same amount that you did in solo practice, this will just be more money assuming that you have run the numbers and hired someone at a rate that will actually be profitable for your practice. We can talk in a bit about what that [00:05:00] might be.

    Another reason is that you want to serve the community. This was a big motivation for me when I started to expand our practice. I recognized that I was getting way too many calls, way more calls than I could handle. I also was referring people out at an exceptionally high rate. So, I figured that bringing people on would allow me to provide more services within our practice and better serve the community around us.

    Another reason is, yet another one that was pretty motivating for me,  and this was to build a team or to create a great work environment for the folks who work there. I always say my two main goals with our practice are to be the best place for clients and the best place for employees. So be the best place to work and provide the best [00:06:00] service. And this is related to this reason.

    So if you are fired up, if you get charged by the idea of building a team, bringing people together, helping them connect with one another, and creating a cohesive, enjoyable work environment, then that’s totally valid. I think that’s a big part of growing a practice especially once you get beyond that first employee or two. Although, I would argue that creating your team and your culture should be at the forefront of your mind right from the beginning. A lot of us get, I don’t want to say desperate, but kind of desperate to bring people on and we lose the cultural aspect and what we want our practices to look like and who we want to be in our practice. We just want warm bodies and that’s a recipe for disaster in my [00:07:00] book. So yeah, building a team, creating a great work environment, that’s another reason to start hiring.

    Another one, especially for us as testing folks, is that we have the capability to bring on psychometrists or grad students. And a big reason for you might be to just provide some supervision or training or to give back to the field in that way, in bringing technicians into your practice.

    So, there are a number of reasons why you might want to start hiring. And they’re all I think, equally valid. We’re not rank-ordering anyone’s desires here or values. So whatever resonates with you, run with it, and let’s figure out how to do it really well.

    Let’s talk about when to hire.

    The very first thing and this is something that I would not have said over the past few [00:08:00] years with coaching or consulting, but something that I’ve really come to appreciate and lean on us as a sort of a bedrock principle in hiring or really doing anything is the time to do it is when you have the time to actually dedicate to it. So bringing people on, training them, onboarding them, managing them, even if it’s a technician or psychometrist all the way up to… or admin staff or a licensed psychologist, whoever it is, it is going to take time to do and to do correctly. So if this is something that you’re trying to squeeze in around a full clinical schedule, my advice would be, just wait. Wait three months to where you can clear your calendar or six months or however, and make sure that you have the time to dedicate to it.

    There are a few things that have contributed to really poor employee experiences for me. [00:09:00] And one of those is not having the time to train the person adequately. So they onboard and it does not go well. They feel out of sorts. You get upset because they’re not doing a good job, but ultimately it was because you probably did not train them well enough. So first of all, make sure you have the time to dedicate to it. As you can see, this whole process is an investment of time from the very beginning to bringing someone on and training them. So make sure you have the time.

    Now, getting beyond the rain on the parade, don’t do this until you have time advice, let’s talk about when you could actually hire someone.

    I always say, when you have the referrals to support them. So if you’re in the testing world, I think if you’re consisting concern instantly booking out three months and your waitlist has continued to grow for at least the past six [00:10:00] months, then you’re probably in a good spot to hire another psychologist or a trainee or someone to take some of the business.

    The reason I picked three months is because this will basically give you one month’s worth of referrals to backfill a new person’s schedule when they start, and then, it’ll still leave you with a 2-months waitlist if you want to call it that or you’re booking out two months. The idea then is that your new employee has a little runway to work with and you’re not stressing about getting them cases. They should have about a month booked ahead of time before they even start. Three months is I think a nice number for that.

    The second part though is making sure that your waitlist has continued to grow for at least six months. This is a delicate balance, right? People are always scared that if they book out too far, people are going to just stop [00:11:00] booking, but thus far, we haven’t found that to be the case, and at this point, we are booking many months out and cannot add providers fast enough, but people still keep booking. So if you’re at three months, that’s a pretty short wait for testing based on everything I’ve heard and talked with folks about around the country. So don’t get too scared about that.

    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.

    But try to tune into whether your waitlist has been growing for the past six months. If you were at three months out maybe four months ago, but then it dipped to one month and then you’re back up to two months, and then it was down to two weeks, if you have that variability, I would probably hold off for a bit to make sure that you have more consistent referrals. Preferably, if you can track the last 8, 10, even 12 months to make sure that your waitlist has continued to grow steadily and your referrals are growing and your conversion rates are [00:13:00] growing, that’s going to give you a little bit more peace of mind.

    I always think about trying to anticipate your hiring needs about six months in advance. So if you can look ahead and guess who you might need on your staff in about six months, it’s nice to think for the future. This is an excellent activity to do in say a Think Week or a business retreat like I’ve talked about in previous episodes. I think that’s especially important if you take insurance because you’re going to have to take quite a bit of time. It’s going to take several months to credential anyone with insurance. So, try to look about six months in advance and anticipate when you want to hire.

    There’s a theme here. Being deliberate and not rushing things. When we rush, we get desperate. When we get desperate, we bring on folks that might not be a good fit. And then that [00:14:00] just can come back and bite you.

    So let’s think about who to hire. I get this question a lot. Should I hire a psychologist or should I hire a technician?

    Well, I always say start with whatever the low-hanging fruit is. By low-hanging fruit, I just mean, where do you have the most referrals? What’s easy? What will allow you to bring someone on without having to learn a new skillset or establish a new referral stream or any of that extra work? Just figure out where you’re already seeing the most clients, what referrals you tend to get the most, and what do you know the best if you have to supervise that person, make it easy on you.  Chances are that low-hanging fruit is going to be an area of expertise and it’s going to be something that you’re known for, anyway. That’s where I would [00:15:00] suggest starting.

    Start with the low-hanging fruit. So this might be someone who does what you do in your area of specialty for referrals. If you’re a pediatric, it would be a pediatric person. If you are getting a ton of autism referrals, it would be evaluations for autism.

    On the flip side, another aspect of low-hanging fruit or a different variation of low-hanging fruit might be to hire a therapist to see the referrals that you make after the evaluations. This was the route that I took. I actually hired 2 therapists before I brought on another psychologist to do testing because I was doing all these evaluations and then had nowhere to refer them. So, that was really beneficial for our practice because we could keep those referrals in-house.

    Ethically, I don’t love the idea of [00:16:00] doing an evaluation and then only referring someone to a service that you offer in your practice. My advice will be that you should always provide multiple referrals after evaluation, but what I ended up hearing year after year was that folks wanted to stay in-house. They were always asking, “Do you have someone who could see us here?” I think people like that consistency. And if you are able to hire a therapist or 2 to see your most frequent referrals, that could be a great option.

    Now, if you’re looking in the realm of a testing clinician though, often I would recommend looking for a psychometrist. Psychometrists are easy in the sense that you supervise them, of course, and you have to train them, but you also have the ability to really dictate everything that they do. So if you are one of those individuals who are hesitant to give up [00:17:00] control, and frankly, is there anyone out there who’s not hesitant to give up control in our practices? If you are one of those folks like myself, it can be an easy way to wade into hiring someone by bringing on a psychometrist and learning what it’s like to train them, learning how to manage someone, how to get feedback, how to make corrections on reports, how to develop your training materials. I think a psychometrist could be a good choice for a lot of folks. It will easily let you trade some of your time back and get your time back so that you can do other things. And again, just an easy entry to hiring.

    A postdoc or early-career psychologist can be nice as well. They require less supervision but are still malleable. So if you are interested in bringing someone [00:18:00] on and really kind of grooming them to be in your practice, an early career person could be great.

    Now, totally on the opposite side of the spectrum, if you have experience as a manager already and you feel comfortable bringing on another licensed psychologist, that individual will certainly require less time in supervision and training. I think there are more variables to consider as far as fit with your practice, what that person might bring, do they do the kind of work that you need in the practice?  Do they have the same standards that you have? So there was a lot more work I found in giving feedback and managing another licensed professional compared to managing a psychometrist who’s there to learn. They’re asking you for feedback and that’s part of the job, but it can be tougher to give feedback to a licensed clinician.

    [00:19:00] So those are some options. I would say, really think about starting with a psychometrist or think about a therapist who can see the referrals that you tend to make after your evaluations.

    Okay. So let’s think about how to actually hire.

    It’s funny. This is a process that is so ubiquitous in our society, but the steps to do so are interestingly opaque. Here’s the way that I have come to do it, and you can take this or leave it. The first place that I start is in defining your values. I talked about this in my episode about writing a job ad. I think the first step in hiring is to define the values of your practice because values are going to drive the person that you’re looking for and the person that you ultimately bring [00:20:00] on.

    And if you don’t have your values defined, then for me, it’s just like, what is this about then? What is this culture going to look like? And if that’s not important in your practice, that’s totally fine. But I haven’t run into many practices that are successful without some kind of cohesion around practice values and culture and the vibe that they’re trying to put out. I’d be really curious if anyone is out there running a practice without well-defined values and practice culture. Give me a shout. I’d love to chat with you and see how that’s working.

    So, my first step is to define your values. There’s such a range of options for how to define values. I’m not going to go into all those here, but suffice it to say that I think this is an important [00:21:00] exercise to go through.

    Once you have defined your values, then you’ve got to run your numbers, okay? So first, you’re defining values and figuring out who you’re looking for, basically, but then you’ve got to run the numbers and figure out what you can afford. People come at this in so many different ways, but honestly, I think it just comes down to the numbers. What can you afford to pay someone?

    This is going to vary depending on the practice, but ballpark, not written in stone, but ballpark, W2, employees should be around 55% of your gross revenue, give or take. 1099s or contractors should be around 60 to 62% give or take. There’s a lot of variation. So like I said, do your homework, work with your accountant and really figure out what you can afford based on your other expenses and [00:22:00] overhead. That’s going to drive the salary. People are going to want to know their salary and what they can expect to make.

    The next piece is figuring out actually who and or what you’re looking for. So you want to have a really well-defined position and clearly outlined expectations on both sides. Individuals during an interview are going to want to know what you’re providing or not providing, and that could be benefits, compensation, testing, materials, office, space, marketing, any number of things. So just work hard to define both sides. You want to know what you’re looking for?

    The reason I say to do this ahead of time is because it’s easy to get into interviews and like people. There’s a lot of research around how interviews are not a great way to hire because [00:23:00] we fall in love with people. We like them. We connect with them and we can get swayed if they are not exactly what we’re looking for. So make sure to take some time to define who you’re looking for, what that role will be, and try to stick to that.

    Now, the last step in this whole process for me is actually writing the ad. And like I said, I did the episode a few weeks ago on writing a stellar job ad.

    So definitely go back and check that out. I’m not going to jump back into those details, but the last step for me is writing the ad and actually publishing it on the various platforms and venues for hiring.

    So, a lot of front-end work here. Defining values is important, running numbers is important, and trying to set expectations is very important.

    In this whole process, I would anticipate [00:24:00] at least a month from start to finish probably, more like two months when all is said and done by the time you really… and when I say start to finish, I mean, from the time you release your job ad to the time that you actually have someone starting because you’re are going to have to, one, you have to wait at least2-3 weeks, maybe 4 weeks for applications to roll in, then you have to interview, then you have to do a second interview, and then that person might have to quit their previous job or make arrangements to move or whatever it might be. So you’re easily looking at about say 6 to 8 weeks. So, it takes time.

    And if you are trying to bring on practicum students or psychometricians who are grad students, we do that six months ahead of time just based on the academic calendar. So, we’re taking applications in January, February for positions that start in [00:25:00] July for the following calendar year.

    All right. So there is some hopefully helpful information about hiring: when to think about it, what to do, how to approach it. I would love to hear from anyone if there are other processes or other questions around hiring. Like I said, I do plan to do an episode all about interviewing here in the coming weeks. So be on the lookout for that.

    And related to that, if you have not subscribed to the podcast or followed the podcast, now is a good time to do that so that you don’t miss any future episodes.

    Like I said at the beginning, if you would like some group accountability and group coaching to take your practice to the next level, you can check out the upcoming mastermind groups. We are always enrolling for different cohorts. So just check-in, schedule a pre-group call, [00:26:00] and figure out if one of these groups could be a good fit for you.

    All right. I will be back with you on Monday with a clinical episode. I hope you have a great weekend.

    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. 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 [00:27:00] 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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  • 230. Identifying Adult Autism w/ Dr. Theresa Regan

    230. Identifying Adult Autism w/ Dr. Theresa Regan

    Would you rather read the transcript? Click here

    “When you advocate for your kid, you want to advocate for everyone else.”

    Dr. Theresa Regan translated her personal experience with an autistic child into a passion for helping autistic adults in her neuropsych practice. She’s here today to talk with me about her approach to identifying and assessing adult autism. We cover a lot of theoretical and practical ground in this conversation! Here are a few things that we dive into:

    • Reasons that all clinicians should consider autism as a differential diagnosis
    • Ways to screen for autism in our interviews with adults
    • Theresa’s preferred testing battery for adult autism
    • The pros and cons of self-identification as an autistic adult

    Cool Things Mentioned

    Use the Promo code testingpsychologist to receive 20% off Dr. Regan’s courses for autism diagnosis in adults 

    Featured Resource

    I am honored to partner with PAR for 2021 to bring you featured items from their catalog! Listen to each episode for specific product recommendations and links. Learn more at www.parinc.com.

    The Testing Psychologist podcast is approved for CEU’s!

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

    About Dr. Theresa Regan

    Dr. Regan has been practicing as an adult neuropsychologist for over 20 years in a large medical center in Illinois. She is the mother of a teen on the autism spectrum, certified autism specialist through the IBCCES, and founder/director of an autism diagnostic clinic for adolescents, adults, and geriatrics. She has published two books on autism in the adult, hosts a podcast, and offers training materials and consultation services through her website.

    Website: adultandgeriatricautism.com
    Podcast: Autism in the Adult
    Facebook page: Autism in the Adult
    Twitter: @regan_autism
    Instagram: @regan_autism
    Email: adultandgeriatricautism@gmail.com

    About Dr. Jeremy Sharp

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

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

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

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  • 230 Transcript

    [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.

    The TSCC and TSCYC screening forms allow you to quickly screen children for symptoms of trauma. Both forms are now available through PARiConnect-PAR’s online assessment platform. Learn more at parinc.com.

    Hey, y’all. Welcome back to another episode of the podcast. Hey, we’re talking today about the identification and assessment of adult autism. This is a topic that has come up certainly in other episodes, but we’ve never really done a deep dive into adult autism. So I feel really lucky to have my guests today. Dr. Theresa Regan.

    Let me tell you a little bit about her. She’s been practicing as an adult neuropsychologist for over 20 years in a large medical center in Illinois. She is the mother of a teen on the autism spectrum, certified autism specialist through the IBCCES, and founder/director of an autism diagnostic clinic for adolescents, adults, and geriatrics. She has published two books on autism in adults, hosts a podcast, and offers training materials and consultation services through her website.

    She has a number of resources on her website. Theresa was kind enough to put together a little promo that I want to make sure and mention here.

    If you use the promo code testing psychologist, all lowercase, you’ll get 20% off any of her courses for diagnosing autism in adults on her website. So again, promo code testing psychologist for 20% off any courses on her [00:02:00] website.

    We cover a lot of ground in this episode. We touch on lots of things. We talk about why it’s important in general, to just have autism as a differential diagnosis on our radars. We moved to how we can actually screen for autism in adults and Theresa gave some specific questions and ways that she does that during the interview that I think was super informative. She talks through her preferred battery for assessing autism in adults. And we also touch on the topic of self-identification in adults with autism and how that fits into the clinical picture and the pros and cons of self-identification.

    Before I transition to this incredibly engaging conversation, I want to mention again, the Mastermind groups through The Testing Psychologist. [00:03:00] We’ve got a beginner practice group and advanced practice group and an intermediate group all enrolling for the next cohort. These are group coaching experiences matched to your level of practice development with the intent of connecting you with other practice owners, giving you some accountability, and just helping you reach some of those practice goals in your testing practice.

    So if those are interesting to you, you can get more info at thetestingpsychologist.com/advanced or thetestingpsychologists.com/beginner and or thetestingpsychologists.com/intermediate. So check those out if you would like, and you can schedule a pre-group phone call to talk to me and see if it’s a good fit.

    All right. Without further delay, here’s my conversation with Dr. Theresa Regan.

    [00:04:00] Hey, Theresa, welcome to the podcast.

    Dr. Regan: Thanks, Jeremy. I’m so glad to be here.

    Dr. Sharp: Well, I’m glad to have you. I’m very excited to talk with you. This is a topic that has been touched on in the past, on the show, but we’ve never really done a deep dive into adult autism and everything that entails. So, I’m thrilled to have you here. I know that you’ve been doing this work for a long time and think pretty deeply about this area. Grateful to have you.

    Dr. Regan: Yeah, it’s become a big part of my practice now.

    Dr. Sharp: Sure. Well, I know we have a lot to get into, but I always like to start off and just ask folks, of all the things you could do in this world of psychology or neuropsychology, why are you focusing your time and energy on this?

    Dr. Regan: Well, I always say I came into the adult autism [00:05:00] piece from the back door, which has been good, as far as my experience. So I never predicted that this is where my practice would go, but I’ve been working in a medical setting as a neuropsychologist for 22 years, and I see teens and adults in geriatrics, and I’ve really done lots of things in this medical context. And it wasn’t until my husband and I had our son that I kind of was versed unexpectedly in the world of autism.

    He was diagnosed at the age of 5 but a lot of things happened before that. And what I realized was that as I’m seeing patients in the hospital setting, all of a sudden, I would think, I know what this is, this is autism and it’s not diagnosed. And I realized how huge it [00:06:00] was for patient outcomes for clients’ conceptualization of themselves for the medical issues that we’re seeing in our setting. So it became very real on a personal level and then very real on that clinical side of things. And so I really devoted a lot of focus to that. And that’s what I’m doing for my practice now.

    Dr. Sharp: It sounds like the experience that a lot of us have to some degree or another, there’s a personal component that plays a huge role. I know for myself, I got a lot more interested in pediatric assessment once I had kids of my own, even though I was interested before that. I got really interested after that.

    Dr. Regan: Yeah.

    Dr. Sharp: Yeah, I hear you. It’s an interesting way to come into it. Like you said, through the back door, to see it in your son and then recognize it in your patients in the hospital, [00:07:00] we don’t hear that a lot. I don’t think, especially with adults and older adults, which sounds like…

    Dr. Regan: I know. I think having that day-to-day knowledge because I had book knowledge before, right? I had been to a few conferences on it. I had read some books on it, but to live it on an everyday basis and go through the diagnostic process and the therapeutic process and advocating for your kid, gives you a feel for a thing that is just different than book knowledge. And that really translated.

    There were a few things that were pivotal. One, I remember working with a woman in her 50s and I was doing a headache assessment. And she said, “I’m here with my 2 kids [00:08:00] and my daughter’s 3 kids and they’re going to wait somewhere else for me because they need a quiet space because they’re on the autism spectrum.” That cued made a think, I should really dive into whether she has qualities as well.

    And I always ask people on the spectrum, “What do you eat?” When I asked her what she would eat, she said white mashed potatoes. And there was this pause as I waited for her to continue. And no, that was it. And she was being treated for diabetes and other things. And this is a huge missing piece, not only in her social life but in her medical care. And it just blew me away that the team wasn’t aware that there were all these texture issues for her.

    So it just became so meaningful. And when you advocate for your [00:09:00] kid, you want to advocate for everybody who’s been messed and is kind of searching for some answers for themselves.

    Dr. Sharp: I love the way that you say that. When you advocate for your kid, you want to advocate for everyone. That’s a really cool sentiment to be able to spread that or pay it forward. I’m not sure what the phrase is exactly but spread that advocacy as far as you can.

    Dr. Regan: Yeah. I know what it feels like to be a family member too. And so I can connect with that piece of things whereas if I were just assessing from an academic point of view, I may not have that ability to connect with a larger family unit.

    Dr. Sharp: Of course. Well, we have a lot to talk about, I think. [00:10:00] I’m so excited to pick your brain about how you approach adults on the spectrum or autistic adults. Let’s see. Could start with just this idea that, when we spoke ahead of time before the recording, how you are just such a big proponent of almost always having autism as part of the differential diagnosis picture and always being on the lookout for that. I wonder if we might be able to start there?

    Dr. Regan: Yeah. One of my messages to clinicians is not that everyone has to assess for autism because that is a very specialized clinical practice, but one of the things that strikes me as that almost inevitably, autism has never been on the differential. It’s not that it’s been assessed and [00:11:00] ruled out, it’s just never been considered. I think there are various reasons for that, but I’d love to give your listeners some reasons why it’s super important to have that in the differential.

    I have four reasons here I just wanted to share.

    1) And one is that it really makes a difference to know whether something has a neurologic or what we have a more traditional call, a mental health-based. I know those get obscured at times, but I’m going to take an example outside of autism just to illustrate. So if we have a client that comes and has memory concerns and we’re doing an assessment. If we find out that their memory concerns are due to Alzheimer’s, we’re going to have a different conceptualization about how we can serve them and their family.

    [00:12:00] Then if the memory issue is secondary to dissociation from trauma, we’re going to have different goals. We’re going to have different therapeutic things we might do with that. And the same will be for any mental health condition, that if the behaviors that we’re seeing have this neurologic base, that’s important to know because it’s going to adjust what you expect to happen. It’s going to adjust what techniques might be more or less helpful. And of course, Alzheimer’s is degenerative and autism isn’t, but you can still see that it’s important to know if there’s this physiologic anatomic piece just as the starting point for your intervention with someone.

    Dr. Sharp: Sorry, I’m going to jump in right away. Sorry, I’ll interrupt a little bit more than I would in real [00:13:00] life here, so I can ask some questions that people might be interested in. But just to clarify, this is a very naive clarification, but I want to make sure I am on the same page with you that you’re saying autism is a neurological condition versus a mental health condition?

    Dr. Regan: Absolutely.

    Dr. Sharp: Okay. Just making that super clear for anybody who might be…

    Dr. Regan: Yeah. So autism is a neurologic condition that impacts behavioral patterns and emotional regulation and different things like that. And so it is important whether you’re a medical professional or a mental health professional or a family to understand whether there’s a neurologic base. And the base doesn’t mean that nothing can be improved. It means that we would use certain techniques to get the best outcome, but also that you’re not going to do talk therapy with someone [00:14:00] and then see a neuro-typical individual that they’re wired in a certain way, and we should help them understand how they’re wired. We should come alongside them to support their needs and to learn how to communicate their needs.

    And so, that’s kind of a different approach as opposed to, you know, I’ve had some clients that were in marital therapy, for example. You tell the person the same thing over and over, and they can say, “Yeah, I totally get that on an intellectual level, but the behavioral pattern just doesn’t shift.” And so that’s one of the things to consider if you do have a neurologic base that there might be a certain way that this person is wired. We could increase their comprehension of that. We could increase their communication about that.

    We could increase some of their skills and strategies for [00:15:00] connecting, but we’re not going to have a goal that they’re going to be neuro-typical or they’re going to be rewired to love the sensory experience and to love crowds and all these things that maybe they’re not wired to really dive into it and to understand what their gifts are. These are the things that you just have such a great command of, and these are the areas that you struggle. And that’s what we do for clients in general. But if there’s a neurologic piece, we should be able to determine that and articulate that.

    Dr. Sharp: Yeah, I’m right with you. So tell me some of the… You’ve touched a little bit on the downsides of not recognizing that but are there [00:16:00] other cases that you can think of or ways that we may be doing harm to a client by attributing these behaviors or presentation to mental health?

    Dr. Regan: Totally. I think that one of the biggest areas of harm is that if there isn’t the behavior shift we expect, we really rely on educating them about why their behavior should change. We rely on consequences and incentives and overtime when that isn’t as successful as we would like, there is this cycle and whether it’s between a couple or a parent and a child, this cycle of shame and helplessness, and on both sides, the [00:17:00] family is like, “Don’t you love me enough to communicate better?” Or the person is like, “I’m doing the best that I can do. And I just don’t know how to, to shift that.”

    Some people would say, well, why is it important if it’s a neurologic base and we’re not going to completely rearrange that? It’s really important for their understanding of what makes them tick. Like, am I someone that’s that I’m inadequate and I’m not bringing what people need from me, or am I someone that’s wired in a particular way? And I could describe that and I could use my gifts. I could compensate for personal things. The understanding is huge.

    I had a couple in their 60s that I happened to interact with within the hospital. He was a [00:18:00] hospitalized patient and she was there and I was asked to see them for something completely different. But I could see that his neurologic base was autistic and that it was interfering with his medical care and his doctors were confused and his wife was frustrated and she said, “He’s always been this way. And that it’s really frustrating that it’s hurting his health now.”

    I was able to talk with her about that conceptualization, and three years later, she wrote me a note and said, “That was the most impactful doctor’s appointment I have ever had.” And it was just a chance that I happened to interact with them. But having that true conceptualization means a lot to people because we’re always asking what does this behavior mean, right? [00:19:00] What does it mean about them? About me? What does it mean about my parenting? What does it mean about their regard for me? And so to know what a behavior pattern means is really important.

    And then in the medical setting, there’s just a lot of medical ramifications. I’ve worked really closely with the dementia clinic because we see patients come in in their 60s, 70s, 80s, 50s, and these behaviors are baseline autistic behaviors and they haven’t been diagnosed and they’re at risk because they haven’t been correctly diagnosed for misdiagnosis, whether that’s dementia, I’ve had people undergo ECT because it was presumed that they had such a bad depression.

    We want to [00:20:00] avoid treatments and conceptualizations that aren’t accurate and we want to empower people to understand how they’re wired and how it’s a better outcome and improve their wellbeing.

    Dr. Sharp: Sure. Well, I know that we are trying to tackle for reasons that we need to be considering autism and we’ve only talked about one, so let’s go for it What else have you got? Why should we be thinking about this?

    Dr. Regan: Well, actually avoiding incorrect diagnosis was one of them. Another one is that there are usually three needs for intervention on the spectrum. One is the regulation of attention, alertness, and emotions. And for that, I really love to use sensory strategies. And so I wouldn’t think to do that if I didn’t know this was a person on the spectrum who could use these strategies to regulate their [00:21:00] neurology. And we’re not going to go into that, but it’s just an illustration that the intervention you use should be impacted by the knowledge of the correct diagnosis.

    And then another area for intervention is social and relational. And again, just having that correct conceptualization of why is this behavior happening? And the third area for interventions that a lot of people need help with is this difficulty with adaptive behavior. So individuals on the spectrum often have higher intellect than they do everyday independent behavior, whether that’s holding a job or self-care, and understanding the neurologic conceptualization and diagnosis will help us gear our interventions toward these three areas and also use [00:22:00] neurologically helpful strategies like the sensory ones.

    And then I would just say the fourth thing I would mention is that the largest genomic study about autism risk in this last year estimates that at least 80% of the risk is genetic. And so if you’re working with people who have behavioral patterns in a family unit, having that awareness that they may share some neurologic qualities can be helpful to the outcome.

    Dr. Sharp: Sure. I appreciate you diving into that. And I think there are many reasons that we should be considering autism, at least as a differential, at least to have it on the radar. I don’t know if you’ve experienced this, but I found in our practice that there are many cases where unless someone is coming with the question of, do I have autism, it’s easy for [00:23:00] practitioners to miss it, right?

    Dr. Regan: Yes.

    Dr. Sharp: I’m totally on board with you in adding autism as just another area to screen for or look for in those initial interviews.

    Dr. Regan: Yeah. A lot of the people who come in and are undiagnosed won’t come requesting that particular assessment.

    Dr. Sharp: Right. So I should have mentioned this earlier before we totally launched into everything, but it’s never too late. Right. So, dispelling this idea that autism only happens in kids or does not persist to adulthood, that sort of thing. I mean, I think we’re seeing a big upsurge in diagnosis in adults, especially older adults, at least that’s what we’re seeing. So folks over, let’s say 50. I’m not sure. How does that match with your experience?

    Dr. Regan: Yeah, the research is really confirming that the rate of [00:24:00] in the population is about 2% and that’s across age group. What differs across age groups isn’t the presence of autism at that rate, but it’s whether someone is diagnosed. Still, the latest data on 8-year-olds that the CDC published last year is that we’re missing 1 in 4 in the United States. And lots of estimates about adults would estimate that we’re missing up to 90% of adults because it just wasn’t on the DSM radar until the 80s and it really just hasn’t been on our radar either as adult professionals, right?

    It wasn’t on mine until I really had that personal day-to-day experience. So most of the adults on the spectrum certainly are undiagnosed or misdiagnosed with mental health conditions.

    Dr. Sharp: Yeah. Can you speak just for [00:25:00] a second about… I don’t know if you call it anecdotally or if you do have research around this, how would I phrase this? …sort of the recognition of autism in adults, in hospital settings, or in medical settings especially among neuropsychologists? I could see that being a little bit of like a Bermuda Triangle where it just sort of gets lost, but I could be totally off base.

    Dr. Regan: I think it gets lost in our culture in general. I had a dementia referral years ago. This is when that aha moment was going on for me. It was an adult female in her 70s probably. And then the assessment was completely clean, but she did have an unusual behavioral profile and I thought autism should be in the differential. And I called the physician who referred and [00:26:00] just said, Hey, I’m wondering if we should include that in the differential. And he said, “Well, I don’t care about that. I’m not a pediatric physician.”

    And I just had to pause and say, that’s really our thought process a lot of times.

    1) You don’t see that in adults.

    2) You expect that if an adult is on the spectrum, they’re already diagnosed.

    3) You think it’s easy to say, well, that’s not my area, so I don’t do that.

    But the 2% in the general population, when you talk about a medical setting or a mental health setting, it’s going to be significantly higher. And how high? I don’t think we know because we’re not catching the diagnosis, but I know Kaiser did a study and they looked at all their medical records and I think it was 0.0, 1% had autism there for adults. And that’s significantly [00:27:00] lower than the 2% that you would expect. So certainly, I think, medical settings are, and I think we can do better in schools. We can do better in mental health settings.

    So hopefully having it in the differential is one step toward that culture shift where we think about it and adults, and we know that it’s important and impactful. And we know when to send somebody on for an assessment.

    Dr. Sharp: Sure. I think that’s a great segue then to talk about how we can do better in these initial interviews or screenings. It sounds like you have some thoughts on things we need to look out for or ways that we can be more mindful of autism.

    Dr. Regan: Yeah, I’ve been doing diagnostic assessments now for adolescents, adults, and aging adults for so long that I just have questions that really [00:28:00] give you a lot and aren’t particularly specialized, but it really helps. So I thought I’d share some of those. What I always do with the client is I ask who they’re closest with in their life. And I have them pick about three people usually, and I’d like one to be a peer and at least one to be family, so that can cross over. Even with that question in itself, you might get some good information.

    One time a gentleman said, “Well, probably closest to my mother, although she’s dead now.” So you can sometimes get some quotes that help you and you say, well, okay, that’s good information that he conceptualizes his closeness like that. Another thing that that leads to is the ability to say, why are you close with this person? And sometimes the [00:29:00] individual on the spectrum will respond about proximity. So physical proximity. Well, they live next door or I live with them. They’re in my class. But they don’t really have a connection or an awareness of this person’s internal life as somebody outside of themselves. Like they have this whole world, this whole life outside of you, but they don’t really have that conceptualization.

    I ask them what emotions these people have had recently, or when they were interacting with them. And that’s good too because you get, again, tapping into this awareness of the internal experience of another person. And some people will say things like… and I’m thinking of a woman who was extremely brilliant, very kind, really no behavior problems, but I said, [00:30:00]  “What emotions has your mom had recently?” And she said something like, “Well, probably all of them. I’m sure she has some, but I’m not really sure what they are.”

    Then this leads to this question of, well, how could you tell what someone’s emotions are if they don’t use the word for you? And that can lead just into a good discussion. Like how do they detect that?

    I also ask what the person’s interested in that the client’s not interested in. Again, a lot of times I see them connecting on their special interests, but lack awareness that this is a whole person and they enjoy things you don’t enjoy too, and what are those?

    I also like to ask how other people would describe them. That can be a really helpful question. And sometimes I’ll get things like [00:31:00] I have no idea. You’d have to ask them. I literally have no idea how other people would describe me. I’d never asked them. Or you’ll get things like, they probably say nice or smart or you’ll get a physical characteristic, like tall. How do they describe you as a person? Sometimes there’s a little categorical thing they’ll say, like nice.

    And then I will ask, well, how does person A how might they describe you differently than person B? So let’s say, they talked about mom and a peer that they were close to just with in their life. And how might they describe you differently? And it’s often difficult for people to realize that others might view them differently not because they’re different, but [00:32:00] the other person they’re interacting with is different. I know this person across a different context than I know my mother, and they might view me differently because of that. And this is how they might do that. So having them say differences can be helpful as well.

    Dr. Sharp: I like that question. How would those two individuals describe you differently?

    Dr. Regan: Yeah, because they’ll be able to tell you pretty well how they would describe them the same, but really get on that difference part.

    Dr. Sharp: Sure.

    Dr. Regan: So those are some questions that are really helpful. I would say another super helpful thing that I’ve really begun to focus on is the difference between someone’s narrative about their life and the actual behavioral data. So a client or collateral is going to give you their interpretation, their conclusion [00:33:00] about the behavior, but you want to know that that’s their conclusion, but you really need the data. And so what I would suggest is that when someone says something that’s a narrative like if they say my daughter’s really controlling, that’s their narrative. And don’t take that as data. That’s not data.

    So then say, what does controlling look like in your daughter? Give me some examples of controlling. One mother said, well, she insists on loading the dishwasher in a particular order, and with all this symmetry and certain spacing and she makes everyone else in the house do it too. Well, that’s good behavioral data because that’s different than saying someone wants to control me as a person. They want to control their environment. And that may fit into this lining up of objects criteria or this inflexibility [00:34:00] criteria that we have in autism.

    If somebody says, oh, she’s so social, well, I want to know what social means. So it’s different to say someone’s social because they’re great at relationships versus they’re so social because they talk and talk and talk for forever and they go up to indiscriminate people and talk to them and they don’t know when to stop. Well, that kind of social is not good, right? That’s part of the thing we’re looking at. Can somebody take turns in a conversation? Can they match the conversation to the listener and understand what the listener needs? So those kinds of distinctions between narrative and actual data, I would really focus on that quite a bit.

    One of the things that’s very helpful too, in adults, let’s say you don’t have a parent to get that developmental history, what [00:35:00] I find helpful is asking them, what were your parents’ stories about you? They often know that and a spouse often knows, or a sibling knows. So, all the stories they kept telling where this one time, blah, blah, blah.

    So for example, a couple that I was working with said, one of his mom’s stories was that every night before he went to bed when he was like 2, 3, 4, he’d be on his hands and knees on the mattress and he’d rock back and forth and he’d hit his head, bang his head on the headboard. And they took a photo of the headboard and the whole finish was worn off because of all the times that he would rock in bang before he could regulate himself to sleep. Well, that’s a good headbanging example. And those kinds of things often are tales [00:36:00] that parents will say, oh, this kid did this or that all the time. And that can kind of give you a sense of what their regulation was like and their interaction.

    Another thing I would say is it’s really important to know that someone’s intellectual knowledge does not always hang with their ability to pull something in actual life. So a lot of people on the spectrum are really good at memorizing information. So if you tell them the rules, the expectations, what they should do, they can recite that pretty well. But what they have difficulty in doing is pulling that off and actual day-to-day living.

    And so lots of people can say, well, if I’m here having difficulty in a relationship because I did something wrong, I should say, sorry or I should be nice. To make a [00:37:00] friend, I should be nice. So then again, you can get into this, well, tell me about a time you did that. So give me this example. So knowing that their intellectual knowledge in their behavioral patterns probably don’t line up, they really probably have a disconnect. So I’d like to hear them actually explain. And a lot of times people will say, well, I’m not sure I’ve ever done that, but that’s what you should do. So, those are kind of good things to keep in mind for the interview. And then I have some…

    Dr. Sharp: Can I jump in and ask a quick question, or it may not be a quick question. We’ll see where we go with this. But I find it really difficult. Sometimes we work with a number of agencies around here that provide adaptive services for folks, both kids and adults and whatnot. And we run into this question a lot where we’ll do an evaluation with an adult and their [00:38:00] IQ is off the charts. Maybe there’s some variability, but they certainly aren’t falling below the intellectual disability cut-off, but their adaptive scores are very, very low.

    And I find I have to fight hard many times to reconcile that for these agencies that provide services. So I wonder for you, do you have thoughts or even ways that you might try to make that case to explain to folks why the IQ can be so high, but the adaptive can be so low sometimes?

    Dr. Regan: That’s pretty well established as consistent with the diagnosis that the research shows that, that the DSM says that that, that intellect is often quite a bit higher because autism is a neurologic condition of behavioral patterns and you can be brilliant [00:39:00] but have this neurologic wiring that does make the day-to-day living really difficult.

    What I do in my reports is I list a bunch of research about adults missing a diagnosis because I also get pushback from agencies about, well, if they had it, it would be diagnosed already. I list things from the DSM in my report that explain why assessment and adulthood is important and also from the CDC made a statement about that last year as well. And then I will talk about this difference between intellect and knowing something and pulling it off because I see that impact schools too, like the schools will say, oh, he knows that he can’t get up during class, but [00:40:00] he does it anyway. And therefore it’s not a knowledge deficit. It’s that he’s noncompliant.

    Well, for example, this is a kid that asked seven times if he could straighten the pencil holder to be symmetric on the teacher’s desk with something else. And she said, no, and eventually, he didn’t melt down, he got up, he made it symmetric and he sat down. So there has to be this greater understanding in the culture that our understanding that intellect can affect daily living started in the 1800s. And so we have lots of laws and things that are now wrapped around that, but we’re so far behind it understanding that the brain wiring impacts behavioral patterns.

    We understand that for post-concussion or post-traumatic brain injury, we understand that for [00:41:00] dementia, but on a developmental level, we’re just not really getting that people can present with behavior patterns that are neurologically based. So I just really write out all my arguments, all the research that I combined, just the information that I see missing. So a lot of my recommendation sections is educating the person reading the report.

    Dr. Sharp: I can get it. Yeah, I see that. Yeah, that makes sense to me.

    I know we’re going to talk about a battery, which I’m excited about, but are there other things that we should be on the lookout for or hidden questions that we might ask that might help us identify potential autism?

    Dr. Regan: Yeah, there’s lots. We don’t have time to go into everything, but I guess the last [00:42:00] general thing I would say is that a lot of people come in with multiple mental health diagnoses that are actually tapping into one little piece of autism. And if you look at all the diagnoses together, well, that is autism, you know?

    So you might have someone with social anxiety and OCD and eating disorder and anxiety and you just get this whole list and you can say, well, I hope somebody ruled out autism because that sounds like inflexibility, ritualistic behavior, difficulty with social interaction. And so you will see that that’s a flag for me. Like if I have seven diagnoses on there and they all kind of tap into autistic qualities, then that’s a flag that I should delve more into that.

    Dr. Sharp: Well said, [00:43:00] especially seeing an adult with the alphabet soup of diagnosis, that’s an immediate, like really, really, can it really be all these things?

    Cool. And yeah, I know there’s so much we could go into as far as associated features and diagnoses and comorbidities and all of that. It’s just a lot, but maybe this will be a little teaser. Do you want to move to the battery and what you’re actually doing?

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    Dr. Regan: Yeah. The basis of my approach is to gather information from multiple sources. As a neuropsychologist, I’m used to that where I want to gather a [00:45:00] bunch of data. I want to see what pattern the data falls into. If there are repetitive themes. And whether you look at a questionnaire, instructions, or instructions for a diagnostic interview or instructions from the DSM, they’ll all really emphasize that you have to use multiple sources of information to make this conclusion. So I would never make the diagnosis on the basis of one cutoff score. It really has to be this pattern that has evolved from multiple sources. 

    I spend about an hour and a half with the client to do the interview and to do those kinds of questions we reviewed. I do some role-playing with them. I also will meet them with the collateral. Go ahead.

    Dr. Sharp: Yeah. I was just going to ask about role-playing. What does that look like?

    Dr. Regan: I found different things interesting, so I’ll ask them [00:46:00] to pretend that we’re at a Christmas potluck at the snack table. They’ll go ahead and start a conversation with me. So I look for back and forth. I look for reciprocity, in the same way, they went with the kids’ diagnoses. So if they say, oh, I can’t wait to get my Christmas gift. It’s a PS4 and I might say, it sounds like you like video games. I really like reading. And then kind of see if they pick up that reciprocal exchange.

    Some people know, you know, they can be polite and kind of say, oh, that’s nice. Other people will say and like, “Uh-Huh. And there’ll be this pause. Like I’m not really sure. Or they’ll say, yeah, I’m hoping to get this video game with my console or something like [00:47:00] that or where they’re not really exchanging. So, I do that conversational thing.

    I also ask and I find this really helpful. So I will demonstrate a shift in my prosody. So I might say something like, “Well, that was fun” and see if they can tell me how the meaning changes. And then I ask them to shift their prosody for me. So I asked them to say, “You did a good job with that.” And then after they do that, I ask them to say it sarcastically.

    I also ask them to show me emotions in their face. Show me what afraid looks like, show me an afraid face. And I really feel like in some of these folks, there’s almost like facial expression apraxia where they just don’t… [00:48:00] there’s like this disconnect where well, I know it in my head, but I can’t produce that. I look for that because you will find people who are kind of like with aphasia, how someone might have better comprehension and expression and vice versa. I do find that in autism where someone might have a pretty good range of expression, but their comprehension is really poor or vice versa. So I try to do comprehension and expression. So I try to get all things in real life, examples too, like from the collateral from the client, but I do add some role play to get some data.

    I will meet with the collateral separately, and I do an interview kind of teasing apart the narrative from the behavioral data. I get a developmental history. [00:49:00] I know that any questionnaire I use, any diagnostic interview that I use is always supposed to lead me back to the criteria. So I have the criteria in front of me and I gather data multiple ways, and I try to see what pattern evolves and how it matches the criteria.

    So I’m always going back to the actual criteria and these things are ways that I get a lot of data that I can sort through and look for a pattern with. I do like the social responsiveness scale, but there’s a lot of good questionnaires that you can use again, to gather that data. I use some sensory questionnaires…

    Dr. Sharp: Can I back up real quick, Theresa?

    Dr. Regan: Yeah.

    Dr. Sharp: With the other questionnaires before we move on to the sensory realm, are there any other sort of [00:50:00] narrow-band autism questionnaires that you like for adults aside from the SRS? We love the SRS and use it a lot, but is there anything else out there that you…

    Dr. Regan: I don’t have another questionnaire. I would say that I work with a team of neuropsychologists and I’m the only one that does the full assessment, but the team has gotten really good at noticing the flags. And I would say where we get, most of our flags are in the interview. Really that behavioral data is important. And even when you’re interpreting the questionnaire, it’s important to see how it matches that hero data, because someone may or may not be a good historian on the questionnaire, but they may give good examples in data.

    So I actually don’t have any. I’m not married to one questionnaire probably because I don’t use… I look [00:51:00] at the cutoff scores, certainly but I find the questionnaires to be avenues. Like I’m going to try some role play. I’m going to get behavioral data. I’m going to get questionnaire stuff. I’m going to look through IEPs or medical records. So I’m using these multiple sources to see a pattern. I see all the questionnaires as having some limitations, but I do like the SRS.

    Dr. Sharp: Sure. So you were talking about the sensory element as well.

    Dr. Regan: Yeah, kind of the same thing with the sensory questionnaires. I’ve used the adolescent adult sensory profile, and I’ve also used the sensory processing measure too. And I only use one for each client. And again, I’m just aware of their helpfulness and their limitations. So, I haven’t found [00:52:00] any questionnaire that’s going to really do a good job with all 8 sensory spheres that we need to assess. So that’s the five that we usually think of as well as the movement which is vestibular, body awareness which is proprioception, and interoception which is the awareness of what’s going on in the body.

    So there are limitations to that. The adolescent adult sensory profile gives you four general scores for sensory avoidance, sensitivity, low registration, sensory seeking. One of the problems is, a lot of times people on the spectrum will have high sensitivity in one sense, but have low registration in another. And if you’re averaging across sentences, you still may miss that if they even themselves out, if that makes sense, like you’re getting an average across senses. So I try to be aware of that limitation there.

    The [00:53:00] sensory processing measure is fine. It does give you a score for different senses, but at the same time, you’ve got five questions or something per sense. And so, it’s not going to ask every way that that could be established. We’re also trying to look at unusual fascination with certain senses, which I don’t find that any of the questionnaires really delve into the fascination part.

    Again, as long as you know it’s a tool to direct you back to looking for these patterns that match the criteria. So I think they’re useful tools. I always use an element of questionnaires to balance out the other information that I have gotten. I use a measure of adaptive behavior usually [00:54:00] especially if the person is needing community services or if they’re a teenager or young adult that’s really falling behind their peers in that area, I’ll try to measure that out.

    Again, I don’t have a favorite. I use Vineland sometimes. I use the Independent Living Skills sometimes for people that are a little lower on money awareness and things like that. A lot of the adaptive behavior stuff comes out in the interview as well.

    I do find one flag for me is that a lot of my patients on the spectrum don’t drive. And I would say that’s more for young adults. So I did look in my clinic this year, that my patients from 16 to 20 that had average to very superior IQs, [00:55:00] 80% of those patients weren’t driving or would only drive one place. They were very driving avoidant. I see that as part of the sensory processing and some of the rigidity or inflexibility piece that makes driving difficult. You have all this fast-changing information coming at you. So, that can be a flag too as far as their adaptive behavior.

    So that’s my general approach. I try to gather as much information from as many sources and then go back to the criteria.

    Dr. Sharp: Cool. I have two questions with that. The first one is just two areas that we didn’t touch on or maybe we’re not part of that is:

    1. Cognitive. Do you care about cognition? And if so, what do you do?

    2. One of those standardized interview methods or measures [00:56:00] like the ADOS or the MIGDAS or anything like that?

    Dr. Regan: I’ll start with the second question. I don’t use that for adults. I don’t find it as enough behavioral data for me to do it that way. I try to take concepts from the ADOS. We’re looking at reciprocity. But I really find that for adults, for geriatrics, I don’t get enough age-appropriate information I think with that measure in particular.

    For cognitive, I do find it very interesting to see the cognitive data. And I don’t always do that. I tend to do it with… I do cognitive data with all students. So all high school and college students [00:57:00] for my age group. If there is a flag for a cognitive issue during the interview, like if they say, oh…. if there’s a flag for possible dysgraphia or some developmental thing that can hang with some problems in everyday life, I might go after that if they describe cognitive concerns.

    And also, as I said, a lot of people that come into our neuro-psychology clinic for cognitive concerns, that they’ve identified or for dementia evaluation, we end up liking that. So we will do that dementia evaluation. And what’s really interesting to me is that in our whole clinic has just commented on this, that you really are apt to see an uneven cognitive profile, not a specific profile [00:58:00] necessarily, but this unevenness and what may be specific is sometimes you’ll see that the processing speed index and the working memory index might be lower than the first two for the WAIS.

    But across cognitive level, you’re likely to see unevenness. You’re likely to see executive function difficulty, although that’s sometimes difficult to capture in the office environment. I don’t usually see the Wisconsin Cards being a problem. I don’t usually see […] being a problem. So I’ve stopped giving those. I will often give the CBT or T.O.V.A.or something for reaction time and visual attention.

    I will give the WAIS. I’ll give memory, like the CBLT compared to logical memory. Sometimes I see a big [00:59:00] split in those areas where executive function may reduce the CBLT or for other patients, it seems like the story doesn’t land anywhere. Like it’s a story about people, and this happened to them and their rope memory for facts might be super. So I like to know what their brain processes. Whether there’s a difference in verbal and spatial memory.

    One of the things that we’ve remarked on so often is that, so, let’s say I do a cognitive evaluation with a 42-year-old. We will look at that and say, if I saw this in a 65-year-old, I would say, this looks like dementia. Like there is a surprising unevenness [01:00:00] that a 30 point split or a really, really problematic ray or street drawing that you kind of assume there’s going to be this homogeneity to someone’s profile. And although intellectually you know that developmentally there might be some unevenness, it really drives it home when you see these profiles for people with developmental issues.

    As an adult neuropsychologist, I never realized how impactful that can be to have that uneven profile. So we just often say, oh my goodness. Look at this disparity. I did not predict that. So a lot of times I do find it helpful. And then I can comment on how this person learns best with this kind of information.

    So a lot of times the cognitive data is important [01:01:00] because it is developmental as well.

    Dr. Sharp: Of course. Thanks for diving into that. My other question, as far as the battery, you mentioned the need for collateral information and I totally agree. I’m curious how you go about that with older adults especially… well it really, any adults, we have trouble getting collateral information, but especially older adults where parents might not be alive anymore. They may not be partnered. How do you approach gathering collateral info in some of these evaluations?

    Dr. Regan: I think it’s different across settings. In a lot of places where I did my training, we had less collateral available as well. I feel like in our setting, we do pretty well with that, but of course, it’s not always available. [01:02:00] I also have the medical record to search through which electronically I can put a word in and get some of that. So even if nobody’s looked at it before, I might see all of those diagnoses. Like, the headbanging example is actually in the medical record before I asked it, but nobody had really followed up on it, so sometimes I get that.

    I often will have somebody like a sibling or a spouse that can tell me those childhood stories. I’ll ask the adult for very specific stories about their childhood. So there are times that even without collateral there is so much specific information and data that I definitely will diagnose that. And what’s really nice to look at in the DSM is the 8 or 9 pages of supplemental [01:03:00] information about autism diagnosis.

    I know a lot of people would probably have easy access to the main criteria on the internet, but if you have the actual DSM and can look through that supplementary. So they do say that if there is an older adult and collateral or developmental history isn’t available, the diagnosis should not be withheld just for that reason, if there’s reason to give it and you can go ahead and do that. Other times though, I will just say, there are the presence of some autistic characteristics or developmental aspects of his profile and not enough data is available to know whether he meets the threshold for that diagnosis. But the presence of these patterns is probably still neurologic and developmental.

    [01:04:00] In the research, they might call that like the broader autistic phenotype that someone can have characteristics. So I sometimes describe it like that. Like this is suspicious for whatever, and I don’t have enough specific data, but if this falls within the developmental realm, that may be helpful. So I might give a recommendation based on that.

    So at least it’s in there in the differential. Even if someone doesn’t have collateral and developmental information, I would like to know if it’s in the differential so that when I see them, I know what I need to know. You know, like saying what do you eat or how is your sleep? So I at least put it in the differential or say these may be characteristics.

    Dr. Sharp: That’s fair. Nice. Any more to say on the battery before we transition to [01:05:00] another area?

    Dr. Regan: Nope. I think that’s a good summary of my approach.

    Dr. Sharp: Yes, I agree. I think it’s always super informative to hear what other people are actually doing for these assessments. So, I appreciate you talking through that.

    Now, I do, I do want to touch on this idea that has gotten, I think, more and more speed. It’s gathering speed over the last several months, maybe a year or two years, but this idea of self-identification on the spectrum versus diagnosis on the spectrum. I’m curious what you think about this. I mean, this is kind of an ill-formed question, but it’s something that is popping up a lot in the professional community, and this idea of individuals sort of self-identifying as autistic [01:06:00] and pursuing an assessment that may or may not confirm that. I’m curious about your thoughts on self-identification.

    Dr. Regan: I think that there’s just value in talking about the pros and cons to that approach. I don’t think it’s an all-or-nothing good or bad. I think one of the pros is that you do have people who are searching for a sense of self and what makes me tick and I’m on this journey to understand myself. And I think that that search is generally a good one that I would encourage. Of course in clients that we see, perhaps the search becomes overextended, but in general, we encourage people to try to think about themselves and how they interact with other people. What’s their [01:07:00] conceptualization? What makes you tick? So I do think there’s value in that.

    The practical pro is that there are not enough professionals to do the assessments. And so a lot of times there are barriers as to where would I get this anyway? What would it cost? Is this person expert enough to process with me what criteria are met and what criteria aren’t met? So there are some practical barriers, even if someone’s wanting a full assessment.

    Some of the things to think about as far as cons would be that, we’ve touched on a few of these already. One is that autism is a neurologic state. And so in [01:08:00] diagnosis, we’re really answering the question of whether this neurology is present. And that does make a difference for conceptualization and for what a medical person might want to know, and how you might approach relationship issues. So, self-identifying with the characteristics may be one thing, but it may be nice to know how your neurology works. And if there’s a difference between your self-identification and how your neurology is wired.

    So that would be one pro getting a further assessment from a specialist. The other thing I would say is that one thing that a professional should give the individual is not just a yes or no about the diagnosis, but to [01:09:00] add to their conceptualization and to say, yeah, you think this diagnosis really fits you in, this is your pattern within the criteria. You have these strengths, you have some struggles here, and I also noticed that your nervous system does this. I’m wondering if it’s because of this issue and this is what I would recommend.

    So a professional who knows what they’re doing in that area should add something. That should always be the case, right? As specialists or clinicians, we hear the person’s narrative and we are available to say, Hey, I really think this part of the narrative fits you, but let’s shift to this other part. I’m not sure if this fits you as well, let’s consider this.

    So I think getting the additional insight about the nervous system and recommendations is something that’s really important that I find that [01:10:00] people value the most during our feedback where they’re like, oh, I didn’t know that this characteristic hung with ASD. I thought of this as separate. Well, now, that’s the same neurology. That’s the same pathway. So helping individualize it and personalize it should be something that we’re doing. And then of course, if this person is in need of accommodations or something official in a workplace, for example, or at school, in a medical setting, you know, I need a private room or something for this neurologic baseline, then having an official diagnosis helps with that.

    So I just think there are pros and cons as long as people understand that this is how I [01:11:00] learned to conceptualize myself through this journey and I think these pieces fit. I think that’s valid to consider. We’re probably missing more than just the layer of, is it neurologic in nature, and what other input could have a professional profile?

    Dr. Sharp: Sure. Can I ask you a hard question that you may choose to totally ignore or just not answer? Here’s my question. When we’re talking about adding this layer of an official diagnosis from a neurological perspective, you’ve used that word a few times and I think we agree autism is a neurological state, right? So how do we do that when we don’t have precise instruments or metrics to do that? Like there’s no blood test, there’s [01:12:00] brain scan or anything like that, all we have is subjective data, either our own or the individual self-report or collateral report. How do we add this “neurological data” knowing that we don’t have precise tools to do that?

    Dr. Regan: I think the first thing I would say is I feel like this is one of the things I’m so grateful about in my neurologic work that because I’ve seen neurologic changes with infectious brain issues and immune reactions and dementia, it’s just a blessing to be able to say, I recognize that. I’ve seen that in Parkinson’s [01:13:00] disease, or I’ve seen this ritualistic behavior in a new onset infectious immune reaction where the person did a similar thing. And I’ve seen stereotype behaviors. They’re different than repetitive behaviors. They’re not equivalent.

    So I think part of it is that we see, and my experience in the hospital has been, again, such a blessing because I’ve worked on acute rehab. So with traumatic brain injury, with stroke, and their day treatment program. I’ve worked with infectious issues. I’ve worked with cancer. I’ve worked with Ms. I’ve worked with movement disorders. I think having that helps me say, that’s neurologic. I’ve seen that. And I know what that is in a patient that [01:14:00] has a new onset stereotyped movement or whatever. So I think that’s been a blessing to me.

    If you’re not sure about what a neurologic behavioral pattern looks like, then yeah, you should get that experience before you do the assessment. It’s the flagging that I think we could do better with.

    My other response is a couple of things. So one thing is you never want to base a diagnosis on one behavior or report of behaviors. You want there to be this, a mass thing of examples that fit a pattern, and it’s the pattern that kind of falls together. And what I have found really interesting is that even patients coming with a request for an assessment often don’t really understand the diagnostic criteria enough to produce number [01:15:00] one, specific behavioral examples.

    They may come in and say, I have a hard time reading people’s facial expressions, or I jiggle my leg over and over. Well, that’s not really a compelling neurologic feature, but they don’t know how to produce specific examples across multiple sources of information that really fall together.

    And I’m surprised at how many don’t actually know their criteria. So they may say, “She’s great non-verbally. She picks up on all this stuff.” And yet they’re also saying, “Oh, I think she’s definitely on the spectrum.” And so I do have situations where I find myself uncomfortable feeling like I’ve seen that neurologic piece. And then I don’t diagnose that. I’ll just say there may be some [01:16:00] characteristics here, but it’s not clear that a full criterion is met.

    So there’s no reason that you have to nail that down. I’ve had some interesting experiences with about 5 clients I would say that I felt uncertain and I also was able to follow them over time, and that was really helpful. Then I get to see this in action across life events. And that really helps me. So I don’t feel like I have to nail it down, but when I see or hear an example that they don’t even know relates to this spectrum, then I’m like, “Okay, that’s neurologic and it hangs together with these other things.”

    Or I say, gosh, I think this person is invested in this [01:17:00] conceptualization and that may or may not be the diagnosis, but I just don’t have enough to say that it is. And so then I just don’t, or I’ll say this could remain in the differential over time once some of their trauma issues calmed down. Or I might say regardless, this person would benefit from social skills and relationship training because they really do struggle to understand how to relate. So regardless, this would be, but there’s not enough to say that there’s a neurologic diagnosis here.

    Dr. Sharp: That’s fair. I appreciate you diving into that and thinking through that a little bit. These are hard questions, right? I mean, we just want to balance.

    Dr. Regan: Yeah, they are. And I think that’s a reason that people don’t want to make the wrong diagnosis and it is specialized. That’s why I think just encouraging clinicians to feel empowered to consider it in the differential [01:18:00] really would be a great step. And then if there’s not enough there, it can just be in the differential, but it may be something that really changes things for that client.

    Dr. Sharp: Absolutely. My Gosh, our time has flown and we barely scratched the surface, but I really appreciate you digging into so many areas here with adult autism assessment. I know that you have a ton of resources for folks, and we’ll make sure to put those in the show notes. If folks want to reach out or get ahold of you somehow, what’s the best way to do that?

    Dr. Regan: My email is adultandgeriatricautism@gmail.com or my website, which is adultandgeriatricautism.com

    Dr. Sharp: Awesome. Well, Theresa, this is a pleasure. It was great to speak with you. And like I said, maybe just a teaser, maybe there’s a round 2 somewhere. That’s been great.

    Dr. Regan: Thank you.

    Dr. Sharp: Thank you.

    All right y’all, that is a wrap on adult autism with Dr. Theresa Regan. We were just scratching the surface. There are so many more questions that I could have asked and so many more things we could talk about and go into more depth with. But like we said, this was a teaser of nothing else. I’m hoping that you took away a lot of good info and can check out some of the resources in the show notes.

    And like I mentioned in the beginning, Theresa is offering a 20% discount to any of you who want to learn a little bit more through some of her courses on her website. Just use the code testing psychologist.

    Also, like I mentioned in the beginning, I am currently recruiting for the next cohorts of The Testing Psychologist mastermind groups, intermediate, advanced, and [01:20:00] beginner, all have open cohorts. So if you are interested, you can go to their respective pages, thetestingpsychologists.com/advanced, thetestingpsychologists.com/intermediate thetestingpsychologists.com/beginner, and schedule a pre-group call to see if it’d be a good fit.

    And last but not least, if you have not subscribed to the podcast or if you have friends or colleagues who are not following the podcast, I would invite you to do that so we can continue to grow the audience and grow the reach and keep this ball rolling with testing discussion.

    All right. That’s it for today. Hope you’re doing well. I will catch you next time.

    [01:21:00] The information contained in this podcast and on The Testing Psychologists website are intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric, or medical advice, diagnosis or treatment.

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

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  • 229. Anticipating Office Space Needs

    229. Anticipating Office Space Needs

    Would you rather read the transcript? Click here.

    Whether you’re just starting out or you’re trying to grow, finding office space can be a tricky venture. Many of us assume that we need to leap into full-time office space, but that’s not necessarily the case. Today I’m talking about some ins and outs of finding office space, knowing how much to acquire at first, and figuring out when you’re ready to expand or take on more space. Enjoy!

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    About Dr. Jeremy Sharp

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

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

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  • 229 Transcript

     [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 TSCC and TSCYC screening forms allow you to quickly screen children for symptoms of trauma. Both forms are now available through PARiConnect- PAR’s online assessment platform. Learn more at parinc.com.

    All right y’all. Welcome back. Glad to be here with you as always.

    Today, I’m talking about office space. These days, office space is a hot topic. Whether you’re going to the office or staying away from the office or trying to rent an office or trying to offload your office, there’s a lot of talk about office space. What’s available, [00:01:00] how much it costs and how to find it. So that’s what I’m talking about today.

    Whether you are just starting out or trying to grow, finding office space can be a tricky adventure. I want to talk through some of the ins and outs of the office-based game. Talk about how to find it. Knowing how much to acquire. Figuring out when you’re ready to expand or take on more space and a variety of other things. So if you are in the beginning phases or you are looking to grow, this could be a good one for you.

    Speaking of being in the beginning phases or wanting to grow, if you’d like some support in that process, I would invite you to check out The Testing Psychologist Mastermind groups. I have a beginner practice cohort and advanced practice cohort and a brand new intermediate practice cohort that [00:02:00] is really aimed at folks who have mastered the beginning phases of practice and have a steady referral stream, but they also have no aspirations to grow or hire or really expand their practice. It’s more just about dialing in systems and keeping yourself accountable for some of the goals you’re setting to get your practice to that next level beyond just beginner practice. You can get more information at thetestingpsychologists.com/beginner or thetestingpsychologists.com/advanced or thetestingpsychologists.com/intermediate, and you can schedule a pre-group call to see if it’s a good fit.

    So, let’s get to this discussion about everything related to office space.

    [00:03:00] Okay, everybody. Let’s dive in and talk about office space a little bit. At this point, I have been in practice for just over 12 years. Just past that anniversary. I’ve had a number of office spaces over the years. I think I’ve had 5 or 6. And during that time, I have had a variety of experiences with office space. They’ve been quite different from one another. Different locations, different financial arrangements, different amenities. And I’ve had some good experiences and some not-so-good experiences. I want to tell you the bad experience first and then we’ll balance it out with a good experience.

    I’ve generally done well with office space, finding it, planning for it, occupying it, landlords, et cetera. And [00:04:00] the time when I got in over my head was about 4 years ago when we moved to our current space. This was right after I decided to deliberately grow our practice significantly larger than it was. Actually not right after, this was a little bit down the road for making that choice. I knew that as part of that choice, I needed to find more office space.

    As much as I tried to plan and do it well and budget and so forth, I ended up in an office space that at that time felt a little large. Just to give you an idea, I went from having a space with 3 offices plus an admin area for admin assistant [00:05:00] to a space that had 12 offices. So I roughly… no, take that back. I had 4 offices and then I moved to a 12 office suite. So tripled the space. 4 years down the road, it turned out to be a good choice. We are now busting at the seams and looking for more office space. So this topic is dear to my heart right at this moment. But in the first year or two, that was a real stretch.

    I had gotten little… I didn’t get in trouble necessarily, but I cut it a little close financially, a little closer than I typically like to do. I’m talking a bit about the financial targets for your rent and how much that should cost you each month, but suffice it to say, I took on a little too much and it was made much worse by the fact that right [00:06:00] around that time, I think about eight months after we moved into the new office space, one of our primary insurance panels shifted their payments guidelines and processes and we went gosh, 3 or 4 months without getting paid at all from this panel. Those two things combined really created a little bit of a financial bind that has stuck with me ever since.

    So, that’s a story of going a little too quickly. I think tripling your space is a little tough, especially when you’re going from 4 to 12. If you’re going from 1 office to 3 offices, that does not feel like such a big leap, but 4 to 12 was quite a big leap. Like I said, all’s well, that ends well, but for 2 years there, it was a little touch and go and [00:07:00] not so fun.

    Now, on the flip side, I’ve had many good experiences and those experiences all shared the same thing in common. What they shared was going slow and being very deliberate in acquiring space.

    I talk with people a lot about this when they’re getting started, but I was able to sublet an office when I first started out. That was a really nice arrangement where I was able to get first one day a week, then two days a week, then when I was ready, when I knew that I could feel three days a week is when I decided to take the leap and get my own full-time office. But all of the times that I’ve been able to go slowly and add space as needed, it has worked out much better for me than taking a huge leap.

    Now, those [00:08:00] things are going to change depending on the health of your practice and how much you have saved and what your business plan is, and so forth. But generally speaking, being more deliberate, going slowly, being able to add as you need has proven to be a lot more helpful for me.

    So let’s jump into some general principles of office space.

    In the beginning, like I said, I think it’s great to start slow if you can. As testing practitioners, we are fortunate that a lot of the work we can do from home, especially these days. I’m working with a lot of folks in individual and group consulting and we’re talking about how office space is not the same as it was. You don’t necessarily have to be in the office for all of your appointments and you certainly don’t need to be in the office for the time that you spend writing reports.

    So these days, I’m advising [00:09:00] people to only book the office or look for an office during the days that you actually have to be testing in person. So this goes nicely with some of the things that I’ve said on day theming and time blocking. So if you pick one day a week and say, this is my testing day or two days a week for that matter, you could easily rent an office for a quarter or a third or maybe half of the full month’s rent and still be able to maintain a relatively full-time practice if you’re willing to just go in the office on the days that you actually test in person.

    This has been an interesting shift in our own practice where our folks are full time and everybody typically has their own office, but as the pandemic has set in and we’ve been doing so many remote intakes and feedbacks [00:10:00] and writing, a lot of people are preferring to work from home. So our office space has opened up a bit and we’ve had people start to share a little bit more. But as you’re starting out, if you can only book the office on the days that you need, that’s a great way to start out. So again, you can get away with 1 or 2 days and save some money on rent and do the rest of the home if you have the capability to do that.

    Like I said earlier, I chose to take the leap to a full-time office when I was consistently booking three full days a week. So for me, that was about 20 face-to-face client hours a week. I think beyond that point unless you have a really nice subletting arrangement, you’re going to be paying close to what you would pay for a full-time office anyway. And it might be nice to have some flexibility. So, shoot for about three full [00:11:00] days a week, and then really consider taking that leap.

    If you’re in more of an advanced stage of your practice, I am a big fan of maximizing your space before you decide to expand. What does that mean to maximize your space? One piece is not giving folks their own office if they’re not in the office five days a week. Most of, if not, all of my folks are in the office five days a week or they have the potential to be in the office five days a week, but if they are not, if you have part-time folks, making sure that you are not allocating an entire 5 days or 7 days worth of office space to someone who’s not there during those 5 or 7 days.

    This is going to be a little tricky with employees to [00:12:00] have that conversation about needing to share space, but people get used to it. And I think as long as you make sure that people aren’t moving around all the time, that they do have a dedicated office space and they might just share that space with someone else on the days they’re not there, that can go a long way.

    I think it does get tough, especially with the testing of folks who are having to move around all the time. Although I have certainly talked with practice owners who have just opened almost like treatment rooms where people pop in whenever they need them. And that works well too. Either way, the principle is to maximize your office space. So, try to have as many people in there as possible to take advantage of every hour that you can. This means, if you have someone who typically works in the afternoons into the evening, try to get someone in [00:13:00] thereon in the mornings. If you have people who only work 3 or 4 days a week, get someone in there the other 2 or 3 days.

    One thing that trips up a lot of folks is the weekend issue. So if you have office space and the likelihood is that you’re probably not using it on the weekend, there are many testing clients and especially kids who may not be able to miss school who want to test on a Saturday or maybe even a Sunday. So looking to hire folks who can work Saturday or Sunday, at least one of those each week can be super helpful in maximizing your office space. So general principle there, again, just try to make sure that you have folks in your offices as much as possible.

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

    The other piece to consider here is [00:15:00] the balancing act of growing. When you are looking for office space as a means of growing your practice, you do need more space but you also don’t want to get in over your head.

    What I guesstimate is to try to anticipate your office space needs for 2 to 3 years down the road. And this is where you want to go back to whatever business plan you may have set forth. If you don’t have a business plan or a growth plan, a business plan gets confusing. It’s not that document necessarily that everybody says you’re supposed to create. I don’t really actually have a business plan. Your growth plan. So does it fit within your business hopes to expand? And if [00:16:00] so, how much? That’s really going to drive your office space needs as well.

    First of all, if you don’t have a decent vision for what your business is going to look like 1 year, 2 years, maybe 3 years down the road, then you probably should not be leaping into office space because that might not match and then you could find yourself in a difficult scenario.

    Once you have that in place, try to anticipate your needs for 2 to 3 years down the road. 2 to 3 years is going to be usually the minimum lease that you’re going to be able to sign at least for a longer-term space. There are, of course, month-to-month leases and maybe some year-long leases, but most landlords are going to want you to do about 3 years, many want 5 years, somewhat 10 years. So there’s a lot to anticipate there, but 2 to 3 years down the road, will at least give you a decent ballpark.

    [00:17:00] I feel like it’s an ever-shifting landscape where you anticipate your needs for 2 years down the road. You move into a space that’s a little big but hopefully gets filled up relatively quickly. Then you work on maximizing that space and then you are overflowing the space for six months to a year before you jump to a new lease, it’s sort of like this ongoing cycle of expansion and contraction and having too much or not quite enough. So, just know that that is normal. It is rare for me at least to be in a state of equilibrium with office space because we are constantly growing and that’s just been part of the journey.

    As far as rates for office space, [00:18:00] things to look out for, it’s going to really vary according to region. But I think, we can set some targets for what you want to shoot for in terms of the overall cost of your space. I used to say, try to keep your rent under 10% of your gross revenue between or between 10 to 15% of your gross revenue but since I’ve been working with more financial folks over the years, I’ve come to settle on, you should really be shooting for 7% or lower of your gross revenue being spent on rent.

    Just to give a couple of concrete examples, if you’re bringing in, let’s say $2500 a month, you should be shooting for about $175 in rent. If you are bringing in $5000 a month, shoot for about $350. If you’re bringing in $10,000 a month, shoot for about $700. You get the idea. Shoot for about 7% of your [00:19:00] gross revenue being spent on rent.

    Now, it is going to fluctuate over time as you grow and expand, of course. That’s totally okay but shoot for that 7%. And if you can, when you get stabilized and when you’re doing the math to figure out how many offices you need, how many clinicians you’re going to have, try to keep that 7% number in mind.

    Some other random considerations for looking at office space. These are just questions to ask. You want to figure out if utilities are included. So that includes, of course, lights, electricity and things like that. You also want to ask about things like common area maintenance. Are you paying for the maintenance for the space or are you going to take that on separately [00:20:00] or rather does the building manager provide maintenance or do you have to take that on separately? You want to ask about the internet being included. So you just want to make sure that you have a really good idea of what it’s going to cost.

    Prices for spaces can be a little bit confusing in that they will give sometimes a base rent, but then they also add on what’s called triple in costs. And you want to make sure that you have a really good idea of what the space is actually going to cost you each month and not just go buy one or the other of those numbers because that can be a little misleading.

    I would also want to ask if the lease is flexible and if so, how flexible it might be. I would think about, especially if you have your eye on expansion, [00:21:00] whether you’re a beginner practice owner who wants to expand to another day or two each week, or you’re an advanced practice owner who wants to actually add more office space, I would think about and ask about the potential to expand down the road. So whatever space you might be in, is there room to get bigger if you needed it?

    You also want to ask if this will be a lease or sublease. Small differences there, but if you’re subleasing from someone else like another practitioner which is very common at least in our area, a sublease can be a little more volatile. If the original lessee moves on or breaks their lease, you might end up in uncertain times as you figure out how to navigate that if you are their subleaser.

    So just a few things to think about. I think [00:22:00] negotiating is completely okay, especially right now. In many parts of the country, there’s a lot of office space open and it definitely does not hurt to try and negotiate some of your lease terms. You may be able to get a lower rent. You might be able to get lower maintenance costs. You might be able to get a lower rate if you do a longer-term. There are all sorts of ways to negotiate. You can possibly do a graduated lease where the landlord is enticed by the idea of some money versus no money. I just did this as we annexed a suite across the hall where the rate was very low in the beginning and then gradually increased over 3 or 4 months before we got to the full fee.

    So lots of things to consider. But [00:23:00] when we think about what to take away from all of this, I hope that you might be tuning into the idea of starting slow, maximizing your office space as much as possible, not getting impulsive with adding space just because you think you might need it or because you have ideas to grow without any solid plan. So basically, just be deliberate and don’t be afraid to try to negotiate the terms. Again, keep that 7% number in mind to really keep a healthy financial picture for your rent as well.

    All right. There’s a lot more to say on rent and leases and build-out and all sorts of things. We could really go down several rabbit holes with this, but I wanted to just touchback in [00:24:00] here as we’re sort of coming out of the pandemic and people are getting back to the office, kids are going back to school, et cetera and talk a little bit about leases and renting and what you might want to look for.

    Like I said at the beginning, if you’re a beginner practice or advanced practice owner or an intermediate practice owner and you’d like to join an accountability group where you get coaching and support and homework and people to help you reach the goals that you have been trying to set or reach in your practice, you can check out The Testing Psychologist mastermind groups. I facilitate all of the groups. So, you get me and 5 other psychologists who are all at the same stage of practice. You can learn more on their respective web pages: thetestingpsychologists.com/beginner, thetestingpsychologists.com/intermediate, or thetestingpsychologists.com/advanced, and you can schedule a pre-group call to [00:25:00] chat with me, totally complimentary, and figured out if they would be a good fit or if it would be a good fit.

    Okay, y’all. Thank you for listening. I’ll make sure and catch you on Monday with another clinical episode. 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. Please note that no doctor-patient relationship is formed here, and similarly, no [00:26:00] 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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  • 228. Making Meaning with Your Clients: Translating Millon Theory into Clinical Impact w/ Dr. Seth Grossman & Dr. Robert Tringone

    228. Making Meaning with Your Clients: Translating Millon Theory into Clinical Impact w/ Dr. Seth Grossman & Dr. Robert Tringone

    Would you rather read the transcript? Click here.

    I am honored to have Dr. Seth Grossman and Dr. Robert Tringone on the show today to talk about the Millon family of instruments. Not only were Robert and Seth personally connected to Ted Millon for many years, they’ve continued to play major roles in the development and authorship of the instruments and those oh-so-nuanced interpretive reports. I couldn’t think of anyone better suited to have this discussion with me. Here are just a few points that we discuss:

    • Ted Millon’s personality and legacy
    • The origin and development of the Millon theory of personality
    • How to tie the theory to the instruments
    • Interpreting the Millon instruments
    • How to make sense of the interpretive report

    Cool Things Mentioned

    Featured Resource

    I am honored to partner with PAR for 2021 to bring you featured items from their catalog! Listen to each episode for specific product recommendations and links. Learn more at www.parinc.com.

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

    About Dr. Robert Tringone

    Robert Tringone, PhD, received his doctorate at the University of Miami where he studied under Dr. Theodore Millon. Through their joint research ventures, Dr. Tringone served as a Personality Disorders Adviser to the DSM-IV Axis II Work Group.

    Dr. Tringone works at St. John’s University in the Department of Wellness on the Queens, New York campus, and maintains a private practice for children, adolescents, and adults. He serves as the Coordinator of Inventory Training for the Institute for the Advanced Studies in Personology and Psychopathology.

    About Dr. Seth Grossman

    Seth Grossman, PsyD, is a licensed psychologist in the state of Florida. He is the founder and clinical director of the Center for Psychological Fitness in the Fort Lauderdale region, as well as a member of the clinical faculty at the Florida International University Herbert Wertheim College of Medicine.

    For nearly two decades, Dr. Grossman worked under the leadership of the world-renowned personality theorist, Dr. Theodore Millon, co-authoring several books, scientific articles, and personality tests with Dr. Millon. Most recently, Dr. Grossman co-authored the Millon Clinical Multiaxial Inventory-IV (MCMI-IV), the latest revision to Dr. Millon’s widely used measure of adult psychopathology.

    About Dr. Jeremy Sharp

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

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

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  • 228 Transcript

    [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.

    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.

    Hey everyone. Welcome back. My guests today really need no introduction. I will introduce them, of course, for the formality of it, but my guess is that the vast majority of you have used at least one of the instruments that these guys are responsible for developing and evolving over the past several years.

    Dr. Seth Grossman and Dr. Robert Tringone [00:01:00] are two of the lead psychologists of the Millon Personality Group, which is the entity now overseeing the development and continuation of Dr. Theodore Millon’s unique theoretical conceptions of personality and, of course, his instruments.

    They’re the chief co-authors of the MCMI-IV and MACI-II respectively and contributors to other tests and publications in this arena. They’re both working clinicians who regularly integrate assessment and treatment. As students and later collaborators with Dr. Millon, they come to the podcast to shed light on some of the most overlooked parts of the Millon Inventories: the theory, its usefulness, and understanding the developmental challenges and lifespan conflicts inherent in so many psychological difficulties. They are also going to tell a few stories about working with Ted Millon, who was larger than life, but very [00:02:00] attuned humanist.

    So as I alluded to, there is a lot of content in this episode. We start talking about Dr. Millon’s personality and his legacy. We talk about the origin and evolution of his theory of personality. We spend a good bit of time tying the theory both to the instruments and then translating the results to clinical practice, including how to make sense of the interpretive report and other notable factors to consider as we interpret this data.

    So Seth and Robert are very personable, easy to talk to, and just have a wealth of information to share with us. So if you’re doing any kind of personality assessment with adults or teenagers and adolescents, I think there’s a lot to take away from this one.

    I won’t keep you in [00:03:00] suspense any longer. Let’s jump to my conversation with Dr. Seth Grossman and Dr. Robert Tringone.

    Dr. Sharp: Seth, Robert, welcome to the podcast.

    Dr. Seth: Thank you, Jeremy. Thanks for having us.

    Dr. Sharp: Yes, I am honored to have you guys. When you reached out, I think I did a little happy dance here in my office. I looked around and was like, “These guys really want to come on the podcast?” I have been using these Millon instruments for years, and y’all’s work has really been pretty important in my own and many other psychologists’ lives. So, like I said, I’m [00:04:00] just honored to have you here and excited for this conversation.

    I know that we have a lot that we can dive into. I want to start just with maybe a little context if you could call it that. Y’all have a unique situation and that you both have had a fairly close relationship with Ted Millon, and his influence is a big part of this story. So I wonder if we might just start sharing a little bit about him and your relationship with him and how that plays into the rest of what we’re going to talk about today.

    Dr. Seth: I think that Ted Millon was probably of all the influences of all the people that you would think of as academic heads who were almost untouchable. He was very interpersonally engaged with the [00:05:00] people that he worked with. Particularly, there were select students for one reason or another that he really attached to and saw promising and felt like we were the people that would really engage with his ideas.

    So, it was a real pleasure to be able to work with somebody who was that much of a master in that much of a human being. Robert proceeded me a little bit, so I’m going to pass it off to him to tell a couple of his stories first. And I’ve got a few of my own. So please take it away.

    Dr. Robert: Sounds good. That’s right. I was a graduate student and had the great opportunity to be a graduate student of Ted’s. I remember that I was intimidated by him before I even met him because he sent a letter to the incoming graduate students and said, these are the books that I want you to get for my [00:06:00] course. And they were his books, the disorders book, the first edition, and some others.

    And the reason I was intimidated, it’s like, I just went through four years of undergraduate psychology courses and took many and never heard Ted’s name. And I said, what’s going on here? And I took a trip because I’m from Long Island, I took a trip into Manhattan to Barnes and Noble because we didn’t have Amazon and so forth in those days. So I take the trip to Barnes and Noble in Manhattan. And I inquired, “Do you have these books by Dr. Theodore Millon?” And they said, “Yes, come with me.”

    So we left the main area of Barnes and Noble and we went into the back and all of a sudden there were shelves of his books in the back. And I said, “What is going on? How could I not know about Ted?” But it was just a remarkable way [00:07:00] to start trying to get my bearings on what happens here and how big he was in the field. And then, in meeting him in my first year of graduate school, he was in my mind, intellectually intimidating and also physically. He was about 6’4.

    So, you would look up at Ted and you would listen to Ted and he had the baritone voice. And you were mesmerized by what you were hearing. And from early on, I remember thinking to myself, this is really incredible. I’m beginning to see how I can look at people and how I can begin to formulate how things are going for them and how to help.

    Over the years, it was incredibly rewarding to sit side by side with him talking either about clients because he was my supervisor from time to time. He was my [00:08:00] dissertation chair and we collaborated for DSM on the pre-adolescent inventory on the MACI-II and those side by side conversations. And just how attuned he was to me, to my family. He was just a warm and welcoming person over the years. It was a rough start on my end to feel so intimidated, but then to find out that he was so down to earth and took me under his wing over the years was an incredible relationship. I’m always grateful for it.

    Dr. Sharp: Yeah, he sounds like a larger-than-life personality just from what you’ve said so far. And it really sounds like an ideal situation as a grad student, I think. At least from myself, I know I was looking for that and hoping for that. It [00:09:00] sounds like you got it.

    Dr. Robert: I was very fortunate. He was always encouraging. And whatever meetings we had, whether it was supervision, dissertation, data analysis, it always ended with “onward and upward” always been a positive search for more knowledge, for more information, and just in life. “Okay, that’s where we are right now. Let’s keep moving onward and upward.”

    Dr. Sharp: You need to hear that as a graduate student. And what about you, Seth?

    Dr. Seth: I was just thinking with that onward and upward, that’s also, oftentimes when you knew suddenly the conversation was over.

    Dr. Sharp: Okay. That’s the signal.

    Dr. Seth: Every so often it was. We were in the middle of something quite heavy, but he had something else to do or that’s all he had to say about the subject, and “Okay, onward and upward.”

    My story with him was, is a little bit different than most graduate students. And [00:10:00] that is because we had a family connection from way back. He was not only my mother’s professor in her graduate experience. She didn’t go on to become a psychologist. She stopped at the master’s level, but this was back when he was an assistant professor at Lehigh University back in the 60s and also was her clinical supervisor at a State hospital nearby.

    So this was a long-time family friend. I got to know this man throughout my childhood but didn’t know that he was really particularly any sort of a big deal. He had moved on to Chicago by that point. I was still in Pennsylvania. Every so often he would visit our hometown. My mom was one of the stops that he would make to say hello. And indeed there was a 6’4 huge man to me, a 5-year-old, who was saying, “Hey, look, I just learned how to play Checkers.” And his first words to me there were, [00:11:00] “Well, you should learn how to play Chess.” I was like, “But I’m 5 years old.”

    So time to time he entered my life. One of the next big ones was when I was in college. My undergrad was not in psychology. It was actually in theater and I was fashioning myself to be the next great Arthur Miller, the next great director, and writer of our time. I was directing my first play. That’s something that I had written, but something I had found about a father and son relationship where the father was institutionalized, and the suggestion was he was schizophrenic. And his son who was a theater director was coming to take him out for the day to take him to a show to try to connect with his father.

    I didn’t know much about psychology at the time, but I had an inkling that just somebody with psychosis was not the whole story for this particular character. And one day I was talking to my mother about that, and she said, “You should call my friend.” [00:12:00] And had she not more or less forced me to do it, I don’t know that I ever would have, but I ended up calling Ted Millon and discussing what ended up being the schizotypal personality and got to start to understand, okay, there’s more to it than that. A lot of what the person’s expression isn’t necessarily just this loss of reality, it’s who they are and how they relate to that loss of reality. And it really fed my understanding of that.

    And then flash forward, some years later, I had decided to change course and go into something ordinary and reliable like psychology, not really the case, but it’s a…

    Dr, Sharp: You called it.

    Dr. Seth: That’s what I thought it was going to be. Interesting how that’s turned out. But once again, Theodore Millon enters my life. It’s 1995 and he says to me, ” You should come to my workshop in New York City. It’s APA. I’m going to be doing a day-long workshop.” I ended up going, not knowing much of [00:13:00] anything about anything, two classes in on my masters. He had just published Disorders of Personality, 2nd Edition I believe, or he was about to. And he had just changed everything from the bio-social learning theory over to evolutionary theory.

    And he began talking about this starting off the day by saying, “Everybody sit down. We’ve got a hell of a lot to get to.” And we did. And within the first 20 minutes, questions were being asked, people were scratching their heads. And to me, I don’t know if it’s just me, but to me, I understood what was going on. And I was answering these questions in my head.

    Dr. Sharp: It just clicked.

    Dr. Seth: Yeah, not much had really clicked yet in psychology at that point for me, but that did. The way that he was talking about personality and the way that basic motivations, which I’m sure we’ll talk a lot more about, it’s the theory behind the tests, how that really gets into who the person is. And then I said, yeah, I [00:14:00] think I know what I’m doing for the rest of my life…

    Dr. Sharp: That’s amazing.

    Dr. Seth: … after I was listening to that. And then, as the years went on, got to Miami, Florida, got to his home, got to look at… Robert and I talked about this before the interview, …the environment that we were in, not just at the university, but at his house, of not just psychology, but all of the sciences, all of the arts, just a rich environment. Classical music playing everywhere that you walked. When he invited me in, I looked around, I went to what I think was really kind of the dining room area looking at all these different art books. And I felt almost like there’s a presence of Ted behind me watching me look at this. And in fact, I turned around, and then there was a sculpture, which was a bust of his head. And I said, “This is unique. This is like nothing you could possibly even dream up.”

    Dr. Sharp: Yeah, that’s one way to put it. I’m trying to think how I would even [00:15:00] react in that. I mean, it sounds like you are in a movie set like he’s a character or an archetype or something.

    Dr. Seth: I think that’s largely. I really do. We could probably spend the entire hour and a half just talking about what the experience was like.

    Dr. Sharp: Oh, I bet.

    Dr. Seth: Easily. This is just scratching the surface of the kind of an experience that this was.

    Dr. Sharp: Right. What an experience as grad students and early career folks.

    Dr. Robert: I would agree. Sculptures around the property, within the house. Art everywhere, drawings, paintings, the classical music in the background, and he had his own library. It was a separate building. I’d never seen that many books in one place besides a library or Barnes and Noble. There it was. And books from 100 years before in different languages [00:16:00] that he had read. It was an incredible experience to have.

    Dr. Sharp: A true academic. That’s amazing.

    Seth, this might be a bridge to jumping into some of the theory, but I wonder if you can remember back in that workshop that you spoke of when you said that it was just clicking in those first 20 minutes, can you remember anything about what he was saying or the nature of the theory that you said, oh yeah, I get this. This makes sense?

    Dr. Seth: Yeah. He tied it into the idea of evolution against something I knew absolutely nothing about at the time, other than the basic argument that you’d hear every so often about Darwin and monkeys versus intelligent design, which wasn’t even called that at the time. It was just probably what most of us were brought up with.

    Never really thought of it as an application to a lot of other sciences. And what he was talking about, this is where we [00:17:00] segue into what the theory is, was how it was that we shared motivations with pretty much the entire natural world that lives, that a couple of basic imperatives, which he admitted some of the concepts he borrowed from Freud and from other places, but the unfinished project of Freud, formulated together to basically show how a person and their personality is constructed and how they deal with the world around them.

    I think I just recently listened to another podcast where one of our contemporary colleagues was answering the very basic question of what is personality. And answered in the way that I think it’s often spoken about today, which is, just everything about you. That’s not really operational. What was really operational about this was that he outlines in the theory three basic motivating forces that follow the idea of how it is that a person first [00:18:00] survives and then adapts to their environment and then ultimately faces the question of, how do I prolong those like me because I’m not going to live forever, replication?

    So at the first level, you have, do you try to get everything you possibly can out of life or do you try to play it safe, which is a basic pain versus pleasure idea. Then once you have resolved that for yourself, of how it is that I’m going to stay alive or try to get as much out of life, then I have to adapt to an environment in some way. Do I try to make an environment my own, act upon it, or do I just fit into the best fit that I can possibly find? And that’s more of a passive role, so active versus passive. And then ultimately the basic question of how am I going to nurture? I got to nurture myself. I got to nurture others.

    And when he put that all together, he used a lot more words than I [00:19:00] just did. And one of the things I’m really trying to do in my career, and when I try to work with these ideas is to shorten that as much as possible and make that as relatable as we can.

    I started to realize you put all these pieces together, almost like a color wheel in a way depending on where somebody lies on any one of these elements. It’s like they’re kind of careful. So they’re sort of pain-oriented and they’re always scouting their environment to make sure that they’re going to be safe. So it’s very active. You have something that’s sort of like the avoidant personality. Or if you have the same thing, you’re very geared towards that pain orientation and instead, you take on the attitude of, I’m just going to have to put up with this because you can’t escape. That’s more of a melancholic or depressive personality.

    And then what I often talk about, I have a profile that I’ve made up that I use in my training but I’ve seen this person many [00:20:00] times in practice is, what if you have somebody who’s got both an active and a passive orientation, they’re conflicted on that level? Well, then you have somebody who is probably going to some level, maybe not to a psychotic level, but to associate, to pull away, to not really know what to do with themselves. And that’s the person who walks through life and has avoidant but also depressive characteristics, not necessarily a diagnosis on either direction. They could be, but depending on where they are and how strong that orientation is.

    But somebody who is going to have a lot of difficulties because they can’t really gear for themselves whether they should be defending or whether they should just be letting things go, and it becomes something of a mess and assessment becomes identifying that, therapy becomes what do you do about it.

    So to me, I didn’t understand all of that when I sat there in that first lecture way back when [00:21:00] but I was kind of getting the bare bones of that at the time of this really tells a lot about people. I imagined, if you put that into operation, that’s going to mean a lot.

    Dr. Robert: If I can add, and that was well done Seth, to outline the polarities. Around that time, maybe just two years before that, Ted had outlined what he saw as the structure of clinical science, which was then referred to as personology, which had four components to it. And I like how Seth had mentioned that some of Ted’s ideas have become unique because he synthesized from so many different areas, whether some of the ideas of Freud because Freud had similar polarities that he talked about but dealt with instincts instead.

    I think of the example that Seth just gave, Karen Horney in terms of whether somebody moves towards someone, [00:22:00] moves away from someone or against someone, these can be found in different components here. The idea that he was taking evolutionary ideas and then trying to have personolgy or psychology become part of the sciences and how that becomes the second component of these four parts of first being the theory, the second being the taxonomy that other sciences were more mature than psychology, especially in terms of personality that you wanted to learn how could you look at the same areas, the same domains across all of the subjects, these being people, rather than other areas of science that looked at other entities, but you would look at them according to certain domains. So those ideas were in the early 90s and then were explained and broadened in the disorders book second [00:23:00] edition.

    And the third part, of course, is now that you have a theory and you have a taxonomy, and these are the entities that you’ve wanted to find. Now we go into the instruments. How do we operationalize these constructs, these entities so that we can measure them?

    And finally, what Seth was alluding to before is, okay, now that you have all this information and you have measured and identified how someone may be in different areas, it becomes, how do we intervene? How do we make a difference in their lives?

    Dr. Sharp: Yes. Just going back a little bit, I love the idea of touching on each of those and I know we’re going to spend a lot of time on the instruments and how to apply them and so forth, but can y’all think back or were there conversations with Ted about how or why he arrived at the theory the way he did? I mean, why out of all the ways to [00:24:00] conceptualize personality, why these evolutionary principles and how did he get there?

    Dr. Seth: I don’t know if he ever really gave so much of a roadmap to exactly where he went from psychology to evolution other than it was a sister science and it was more mature and also explained that his rationale for it was that it encompassed everything about personality. If you think about that active versus passive modality, and you think about what happens in a rain forest for the different trees and how they defend themselves. Some of them have spikes, some of them excrete a poison, some of them excrete a little milk and that feeds ants, the ants guard the trees. That’s a passive orientation as opposed to as active as the plant life can be, and some of them may be more so if you’re talking about fly traps and so on, but most of them are relatively [00:25:00] passive, but some of them have their own way of surviving by an active mode like that, by doing something that directly affects the predator, same with personality.

    So it had a lot of those parallels, but I think one of the most important elements to think about with that though, is that if you try to operate from just within psychology proper and organize your whole theory around, let’s say your favorite school. Let’s say it’s interpersonal. Let’s say it’s psychodynamic. Let’s say it’s behavioral. Whatever it is, you’re organizing around just one of those branches. And then you’re sort of adding in either an integrative or an eclectic way, all right, I’m behavioral but I also include some psychodynamics in what I do, or I’m very rigid and I admit that sometimes people have a way of thinking about things. So I add some cognitive work into that.

    But if you’re coming at it from evolution, and I have [00:26:00] the giveaways that I gave you, the PDF that I guess we can have to accompany this podcast, I have one of the slides that show how there’s the evolution in the center of it. And from there, you can organize all the different elements of what we consider to be our schools of thought in psychology rather than center on any one of them. And that gives you the flexibility that somebody might be left-brained and intellectual and linear in the way of thinking. And that might be the best way to intervene in certain ways because it’s the language that they speak, but then you can sort of begin to get the right brain in and reconnect some of the split-off effects if that’s the way that particular person is.

    And that’s very different from somebody else who might be much more emotional, much more abstract, much more right-brained and [00:27:00] there, you’re going to try to get some logic and rationale into something that might otherwise be just very affective and very chaotic.

    So you’re not subscribed to it by the basis of what your basic belief is. You’re more subscribed to who the person is or the way Ted used to say it, the theory of the person. So, that’s what evolution gives you, or finding something that’s outside of psychology proper in this case, it is evolutionary theory and it brings you closer to the person I think.

    Dr. Sharp: Well said. Yeah, it seems like it frees us up a little bit to operate outside the balance of specific orientations, which I think we can all agree is nice sometimes. It’s hard to live with those bounds. Goodness. I remember we had a hell of a time during our oral exams in grad school because we had to defend a particular theoretical orientation and it was [00:28:00] always this process of mental gymnastics to fit our clients into a particular orientation.

    Dr. Seth: One of those all additional lines. Yeah.

    Dr. Sharp: Sure.

    Dr. Robert: Ted did have a funny line at one time. And because he incorporated so many different schools all within these 8 domains, we would have conversations and he would encourage students to read as much as possible. He did not want people just to get locked into his way of looking at things. He thought that it was so important to understand an individual from different perspectives and then to figure out, and in which instance, which particular theoretical approach or formulation would apply best.

    What was funny was that he said, essentially, I can’t remember it verbatim, but basically that everyone would be right some of the time, but he thought that he would be right more of the time.

    [00:29:00] Dr. Sharp: He sounds a modest individual. That’s great. 

    So one of the things that you said in some of the notes I wanted to elaborate on a little bit if you could, and that’s the idea that you said that he believed that personality is, you’ve phrased it as the psyche’s immune system. Can you say more about that? That’s a really interesting concept.

    Dr. Seth: That’s directly from him as well. He often led workshops where he began with this metaphor of describing developments in medicine and what we roughly call modern medicine, which would put us back in the mid-1800s or so starting off with symptom control. And that most of the medicine was directed at and conceived of as dealing with symptomology.

    And then he jumped right to the idea that that’s where we are here in psychology. That we deal with anxiety [00:30:00] and depression and post-traumatic stress disorder and somatic symptomology, and everything is syndromes. And that we’re not really looking at the bigger context. And then he would go on to describe the medicines’ recalibration and looking at infectious microbes as well as lifestyle behaviors. And that gave you more of the context.

    By then, you’ll start to see that first, he was talking about access one and symptomology, and then as the metaphor continues, you start to say, Hey, that’s the old Axis III and Axis IV. When we used to think of things as Axis, which was really influential in having DSM–III and DSM-IV go that direction. And now it’s no longer the case, but we still think of it that way in this school of thought. So there’s the medical and the psychosocial component of it.

    And then he said, well, what about when we looked at Madison and said, what do you do about this problem? And he pointed very clearly [00:31:00] to the evolution, if you will, of HIV in the last part of the 20th century, that all of a sudden we were dealing with something where it wasn’t just the symptomology and it wasn’t just the environment and the microbes, but the body’s inability to be able to deal with any of that. And he said, we knew what the immune system was, but the immune system was never so important as when we started to look at this particular problem and see how that related to all of the problems.

    And then he proposed that in psychology, the appropriate place for personality is looking at it as though that is the psychological immune system, how a person deals with things, how they interact with their environment, how they decide what’s important and what’s not important, how they deal with other people, all those different elements of how personality expresses is how a personality defends itself and acts as its own immune system. That’s where that idea came from.

    And so [00:32:00] when you look at it MCMI-IV or you look at MACI-II, you look at on the same page, not only the symptomology but also who that person is and how they deal with that symptomology. So there’s that interaction of what you’re dealing with and what your immune system is, which in this case is personality.

    Dr. Sharp: Sure. Thanks for diving into that. That resonates. I appreciate the explanation.

    I’m really excited to dive into the instruments themselves and start to bridge the gap between theory and practice. So, I’ll ask a very general question and hope that y’all can take us in the right direction, but where does that even start? I mean, where did you start or did Ted start with taking this theory and then turning it into these instruments that we know today?

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

    Dr. Robert: Well, that part of it actually predated [00:34:00] both of us.

    Dr. Sharp: I see.

    Dr. Robert: The MCMI-I was published in 1977.

    Dr. Seth: And that’s not even the first of that instrument. There was something called the MISRI, originally. The Millon Illinois Self-Report Inventory. When he was in Chicago…

    Dr. Sharp: That’s a terrible name.

    Dr. Seth: It was awful. As you can imagine, this was geared directly to the academic community. This wasn’t going to be published. And a publisher would say, there’s no way that’s going out that way. We’re talking about the early to mid-1970s. This is post his writing, my Modern Psychopathology which is really what put him on the map. That was his original psychopathology textbook that really introduced a lot of the ideas and formulated what were existing personality disorders, which of which there weren’t that many of them in a new way, and then [00:35:00] introducing a pretty good set of them as well through that bio-social system.

    And then ultimately not being able to have a clean way of representing those and MMPI or a Rorschach, and then leading us to the first for the MISRI, which we know how that worked out. And then ultimately the MCMI to try to reflect what was in that theory. And I don’t think that initially it was intended to be so much a commercial test. I think there must’ve been some idea about that, but the original intent really was as a research instrument.

    Dr. Sharp: I see. I feel like the Millon instruments that are fairly well-established are, but correct me if I’m wrong, do not hesitate to do that, have the reputation of certainly being geared more toward assessing psychopathology or more severe [00:36:00] folks. Was that the intent going into it or was there any, as far as y’all know, any discussion around, like, how do we measure normal “personality” or non-pathological personality. I’m curious how that all shook out, or if it was deliberate.

    Dr. Robert: You want to talk a little bit, Seth or?

    Dr. Seth: I can as well. So just pass off when you would like to.

    Dr. Robert: I’ll offer my thoughts and Seth can follow up. I always look at the instruments as a family of instruments. And they really started off as clinical instruments with a strong research component initially, so that we had the MCMI and then we had the MAPI, which is the Millon Adolescent Personality Inventory, which was a predecessor of the MACI- the Millon Adolescent Clinical Inventory. But they started off as clinical instruments to be used [00:37:00] in clinical settings.

    And then as the theory evolved and so forth, Ted did develop an instrument called the MIPS is the acronym there. And that’s based more on normal personality and trying to define how these constructs and concepts could apply in different types of settings. So I think within the family, we have these different measures. How we look at it clinically, the instruments do identify issues that may represent vulnerabilities, susceptibilities for people. How is it that when I work with adolescents, some can face very similar circumstances within their families? Let’s say there is something going on. There could be separation, divorce. And then how is it that one adolescent moves through it never untouched by something like that, but is able to [00:38:00] manage, to stay on track and to move through life and so forth and somebody else could be virtually devastated by it and lose sight of their future and what their goals are and so forth? And it comes down to…

    Sometimes we can have people experience something similar across the board, but they’ll react to it very differently. And those are the personality patterns that we’re looking at as to which ones may be able to manage those types of circumstances and keep going and which others will really struggle at that point in time.

    We’ve also looked at it, and then Seth can step in, in terms of the model has changed over time from prototypes to subtypes and then to dimensions. And that, from my vantage point, I think Ted had this too. He talks about that. The healthier personalities are more adaptive and more flexible. And it’s [00:39:00] not just within the polarities that there’s this balance of 50/50, but that depending on what the environment is that someone finds themselves in, how well can they adapt to it so that they can maximize their games from their successes from that, and just sometimes manage situations?

    Sometimes one environment may require us to be more assertive. Another environment may require us to sit back and reflect on things. Different relationships that we have with different people. How do we manage each of those in our closest relationships to work and colleague relationships and so forth?

    So, we look at it along a continuum as well. So for adolescents, in particular with me, I may identify that somebody has a particular personality pattern or a particular personality type. We don’t diagnose personality disorders for adolescents with the [00:40:00] MACI or MACI-II. So we will look at it in terms of, okay, these may be issues that are going on that are perpetuated in some manner, but depending on the environment, any personality pattern or type can be adaptive. And to understand that, where can it be applied in an adaptive way?

    So I think we have things covered both clinically, through normal, through adaptive to maladaptive is how I see it. And that there are no specific cutting points to define one has crossed the threshold but to be able to see things as broadly as possible that there may be difficulties, but sometimes those things that are the very difficult traits in one setting can sometimes be adaptive in another one.

    Dr. Sharp: Well said. Awesome. Anything to add to [00:41:00] that, Seth?

    Dr. Seth: Sure. In the most recent variations of the instruments, and this really goes along with the changes in the theory, those differing levels of adaptiveness represented by higher and higher scores on the instruments, they’ve been set out more in ranges now, so that there’s at a point where a pattern is identifiable. Once we have something that says that this is a person who does show some sort of traits within this particular spectrum, say the compulsive spectrum or something like that, we’re not diagnosing a compulsive personality disorder. We’re saying that there are some characteristics here that say that this is something of that pattern.

    Somebody in that earlier range, what we look at as a base rate of 60 to 74, that’s really an adaptive pattern, but we also know that if they get stuck, if they get out into a place where their [00:42:00] personality might be getting them in a little bit of trouble, probably we’re going to be looking at that area.

    So it’s in the range of what we would say, somebody who might seek services and what they might be having difficulty with. And as you go further and further up the base rate scores, you’re going to see more constriction. You’re going to see more of that non-adaptiveness, more of that inflexibility that Robert talked about, and on an onward up towards where you may really be looking at more personality disordered kinds of characteristics.

    I wanted to add just an anecdotal piece here that what Robert said reminded me of a therapeutic assessment I once did on a first responder in her later 20s who was doing a therapeutic assessment with me to really understand a little bit more about this very dysfunctional family she had come from and why she [00:43:00] was so afraid, but sometimes so angry.

    We did a lot of different instruments within the context of that. And one of them was the MCMI-III at that time. And most of her highest scores were up in the 2A, 3, like avoidant, depressive, dependent kinds of characteristics. And then she had a 6B which was in that 60-ish range, which we didn’t at that point characterize as it’s something really to look at more interpretable. But I did. I looked at that and I said, look, let’s try to figure this thing out.

    Dr. Sharp: And what’s that 6B for someone who doesn’t know?

    Dr. Seth: I’m sorry. My bad habit. Sadistic.

    Dr. Sharp: Got you. Just making sure.

    Dr. Seth: And it had switched over to the MCMI-IV. There was forceful and then there was sadistic and there was sort of a point where one switched over to the other. Now, it’s more in those ranges. But at this time we looked at it, which was not as high of a score, but it was the next highest up from the others. [00:44:00] And she said, I think that’s sort of just like my prickly outer shell. And I said, “what do you mean by that?” She said, “When I don’t like something, I can be pretty mean. When I don’t like what’s going on around me, I need to protect myself.”

    And we looked at that and said, that as an adaptive characteristic, as something that you can say, doesn’t just happen, but that you have some more conscious control over, could really be something quite useful for you in your life. And how does that then affect some of the other scales and some of the other characteristics that we were talking about? And it was really productive to be able to look at something that we would usually think of as, oh, that’s a bad characteristic. It’s not better good and enough itself.

    Dr. Sharp: That’s a great example. And I think we can maybe use this as a springboard to a discussion of how to interpret these instruments because I think a lot of us, we take our crash course in grad school, we give a few of these and then [00:45:00] unless you really dwell on these instruments and spend time getting to know them, which granted, everybody should like you’re going to do them. But I think a lot of folks end up just looking down the scales or the subtypes or dimensions. And we kind of look and eyeball it, and oh, sadistic, like you said, that’s got to be bad in some form or fashion without necessarily diving into it and thinking, how does this integrate with the rest of the profile? I think that’s a challenge for a lot of folks if they aren’t.

    Dr. Seth: Most people aren’t really encouraged to think of it that way. I think that the way that it’s trained and usually when you have your objective personality class, you have the vast majority of it’s spent on the Minnesota Instruments. And then some introduction to the PAI, some introduction to the Millon instruments, usually just the MCMI. And [00:46:00] maybe if you have time, a few of the others that are, at one point or another, they were more in Vogue. Like when I was going through the school, California was still kind of [/].

    So, there’s not much more time than to say, here’s something that adds incremental validity. If you think that you are dealing with somebody with borderline personality disorder, well, Hey, give them more. Hey, look, it lit up or didn’t. And I think in large part it’s because a lot of the professors themselves have never really been introduced in that way, how all these things really work, but everybody is introduced the thing against it.

    I use the Minnesota instruments quite frequently, often in concert with Millon’s, but that’s where most of the time is spent. And there’s not a lot of time spent on this theory. And I don’t know that there’s an easy solution to rectify that within training other than to have training available later on [00:47:00] to catch up. But yeah, like you’re saying, most people just think of that here are these scales that seem to match with the DSM and you know what to do then.

    Dr. Sharp: Yeah.

    Dr. Robert: I will add that what we’re looking at ideally is for students and clinicians to learn the theory in terms of these polarities. But at the same time, I still borrow from the biopsychosocial component of it. And in terms of what are the reactions, interactions between parents and children. And that there are a couple of components here that I would want to point out for listeners. And that is that Ted actually has a stage theory component to the theory, and those are neuro-psychological [00:48:00] stages of development. In particular, the first two are similar to others, such as Freud and Erickson related to attachment, related to sensory-motor autonomy, things like that. And then there are other stages and they’re not clearly defined or demarcated, but that they overlap with one another.

    But the bio component is the child is going into this world with certain predispositions. The parents have their own predispositions and expectations. And off we go. There are these dyadic interactions that are taking place. And things are being processed and things are being retained initially pre verbally. And then they develop into verbal interactions. And then the world expands beyond just the immediate family to extended family, to the social world and peers, and so forth.

    And all of the interactions are going on and certain features [00:49:00] of one’s personality may be more successful or met with better success than others. And it depends in terms of how someone’s expectations develop, how they see the world, how they see themselves in the world. And it gets down to also the child and parenting, in particular, and then as they get older into the social world, once again.

    A colleague and I, Neil Baki, he and I go back to our first days together in graduate school. We were in the same year and we worked side by side and he takes credit for it and should get credit for the instrument, in particular, I’m going to reference, which is the Parenting Styles Self-Assessment instrument that we developed. It is a true/false inventory that we wanted to measure and operationalize the ideas that Ted had outlined as to what type of environment creates, adds to certain personality patterns.

    [00:50:00] So we operationalized what he had written in the disorders texts, and then had children take the Millon pre-adolescent clinical inventory, which has seven emerging personality patterns. And then the parents or the guardians would take the other instrument and then we would align them and see what the correlations were. And we would look at things clinically because if parents or guardians or attuned to who their son or daughter is, then things can go pretty smoothly. But sometimes you have mismatches. There aren’t good fits between the child’s emerging personality and the parents preferred style of parenting.

    And when there are mismatches, it can lead to difficulties along the way, maybe related to what we then see as anxiety, sadness, anger, and [00:51:00] things along those lines. So, for students and clinicians to understand that the theory tells us how what we are seeing in the profile may have been developing up to this point in time, what could be going on between the child and adolescent and his or her guardians and parents, and to be listening for how the patterns are perpetuated.

    Because one of the things that Ted would emphasize in supervision all the time would be, now that we know where we are at this point in time, and yes, we can address the more frequent presentations of anxiety, of sadness, of how do we deal with anger and frustration and so forth, but if you just deal with the latter, there’s a good chance that somebody is going to come back at a later point in time at another developmental stage, because it’s still the underlying personality [00:52:00] that’s in interacting in the world, that there may have been a reset through therapy to deal with those certain syndromes or symptoms that have emerged, but helping the person and the parents and guardians to understand this is what’s going on. This could be ways to address so that certain things could be potentially modified, not changed or anything, from a submissive type to more of a spirit of type, but there can be shifts and there can be, again, the developing of greater flexibility into interacting in different situations more effectively.

    But the idea that I often listen for what parents are saying and the very subtle and subliminal ways in which they’re communicating certain things versus more overt ways in which they’re communicating things, but looking how those interactions can potentially perpetuate what’s going on.

    [00:53:00] And we’ve talked quite a bit about the submissive dependent part of the perpetuating patterns. There will be that there is often a lack of self-confidence. There is a lack of autonomy and a reliance on other people. We would want to address those types of things so that they felt more confident about themselves, could identify their own strengths, would be willing to take chances, take risks to push themselves a little bit to see how far they can take it and how independent and how self-reliant they can become not to erase any sense of dependency and so forth. Nothing inherently wrong. It’s just a matter of striking that balance.

    Again, I usually work with children and adolescents and look at, in particular, the transitional phases are the most important points in their lives and how as we’re finishing one phase, are we preparing them for what lies ahead and then helping them to adjust, work forward, become more [00:54:00] effective in their worlds, develop a greater sense of self and so forth.

    So to me, it’s beyond those base rate scores. It’s beyond the interpretive reports that when Ted read wrote them were so eloquent, mesmerizing again, in their own way with the language and have your dictionary nearby sometimes, What did that word mean? But it really is about, this is the person as we see the history leading to what we see in the present. And then we can anticipate where things could potentially go in the future and how we want to intervene.

    Dr. Sharp: Yeah. Well, I appreciate you giving an example or some examples from that developmental perspective. I’m curious from the other side, further down the road, Seth and this might be more of your territory, but if you could [00:55:00] possibly outline an ideal use or process for administering and interpreting something like the MMCI. How should we be going through that process? I hope that question makes sense. I’m trying to think of the best way to ask it, but for someone who really knows it.

    Dr. Seth: Sure. There’s an interpretive sequence. And then kind of like if, yeah, I think this might relate to a lot of people who could be listening. In the preface to Irvin Yalom Existential Psychotherapy book, he talks about his wife and him taking a cooking class and reading ingredients lists, and doing the directions. And then there’s a special something that the cook puts in.

    I’ve tried in the Essentials of MCMI-IV Assessment book to give some hints to that. And that is to try to tie the theory into [00:56:00] this interpretive sequence to try to make it something that is really resonant for the person. Listening to Robert speak about the developmental aspects of it makes me realize that I have not yet scratched the surface and I’ve done a lot of scratching. There’s a lot there. And it all does tie together in this theory. And if you have the bandwidth and you have the ability to really do deep dives into the theory, by all means, do them.

    I’ve liked to be able to try to capture as much of that at a user-friendly level as possible. So the way that I go through something like an MCMI, and I think it’s very similar to how you go through MACI because there’s a lot of the same components. The MACI actually has a couple of additional sections that the MCMI doesn’t actually. One is called the express concerns, which is more about what happens at this particular point in development, typically in a child adolescent’s life. Whereas the MCMI, the front page really just tells you [00:57:00] the symptomatology. And before that tells you the personality patterns as well as validity information.

    So I look at the validity information. I look at critical items. I make sure that we’re talking about something that’s more of a secondary intervention rather than tertiary, where we have to say, okay, we have to have close the books and make sure this person is okay.

    But assuming that we’re valid, assuming that we are diving into the dynamics of who this person is, I start off with the three more pathological patterns that are: schizotypical borderline and paranoid, which are a little different than the others. They’re not comprised purely of just those motivating aims that I talked about earlier. They are breakdowns in the personality structure. Each one gives you some hint as to like [00:58:00] what might be going on in terms of how difficult his personality could be. It’s beyond what we could really talk about here to really get into that, but just suffice it to say, you have an idea of how cohesive the personality is, or if there’s really a fault there that you’re going to have to watch and see how that color arises other parts of it.

    You look at that first and then you look at the more basic patterns. Once you have that down, you go to the facet scales, which we haven’t really talked much about that end of the theory, but that is where we really get specific about behaviors, thought patterns, interpersonal kinds of dynamics, inner psychic dynamics, and biology. And all of that is put together in this great big platform of comparability between each one of the personality prototypes or spectra as we call them now, and each one of those characteristics. Then go back into the symptomatology.

    So it’s really a multiaxial assessment. [00:59:00] But I focus probably most of my time on the personality patterns themselves and going into the theory. And this is where I say, here’s the little extra that is there and you need to know how to do it on sort of a basic level. And I discovered quite by accident. I think I’ve told you in our preparatory meetings that I have a story of the very first time I gave an MCMI-III. And this is where I discovered how to do this completely by accident.

    So, to go back in time, I’m a post-doc. I’ve been at a college counseling center for both my internship and my post-doc, as well as much of my practicum time. And we had a neuropsychological component, and that’s really where the only testing was going on. And most of the time we’re using the MMPI for those cases.

    So, I had never actually given an MCMI to anybody other than people I was related to, if you know what I mean. And I think everybody knows what you mean when you’re going [01:00:00] through your training that way. And we got a referral from judicial services that there was the student that got themselves in trouble in a cultural class, particularly in an African new world studies class where this student who is an older person returning student had gone in and more or less started using racial epithets and started a more or less our race riot, and was given a chance to come to us for anger management.

    And at that time, a relatively new school counseling center that had an internship and a postdoc, but it hadn’t really established itself as APA and all the criteria and all these things yet. So my supervisor and I were kind of winging it in walks, somebody who is in the process at this point, I’m not even sure if they were to present today, this would be better defined, but male transitioning to [01:01:00] female at the time in a mid-transition joint, still identifying as male still. At that point, we weren’t talking pronouns, but use male pronouns, which is why it’s confusing when I tell it in today’s context to keep vacant mind.

    This person was very defensive and was very hostile towards us at first until we assured them that we were on their side and that the only thing that was going to be reported to the university was they came and they were cooperative. And that’s all they ever needed to know. Then we got much more of the backstory and I could easily go into what Robert was talking about in terms of all these developmental points of difficulty.

    Most probably the thing that stood out the most was that this person’s mother who was the only one who really stayed [01:02:00] very loyal and very supportive in the context of a very conservative upbringing in the Midwest for this person who was going through things beyond that, also a lot of substance abuse that had happened in the past brought to this point. And then we had cooperation. We had rapport and me as a Malani who was working on the facet skills at the time and knew this instrument inside and out and never actually give it, it was more than willing to say, let’s get a solid measure. Let’s do this. So I got to give an MCMI.

    Finally, I gave this person the MCMI. They went back to my supervisor’s office. I came back out looking over the results and the next thing that I knew they were here in my hand, and then they weren’t in my hand because this person had grabbed them from me. I was looking through the results.

    Now, the key elevations there. The highest one was 6A-anti-social, the next [01:03:00] highest, almost as high was 8B masochistic. How do you put antisocial and masochistic together? And then the third, which was in a range that was approaching pathology was 2A avoidant personality. Antisocial, masochistic, avoidant, which this person who was very intelligent was very upset about. Why is this thing calling me antisocial? You’re going to call me a criminal and go back to the authorities. I’m going to get in trouble. I’m going to get kicked out of school, on and on and on and on and on. And it’s also masochistic. What does that mean? Are you getting into my fetishes now? What is that?

    Thinking as quickly as I could, I said, hold on a second, give me back with that paper. And let’s put this on the table and I’m going to do something for you. And I covered everything up except for 6A- Antisocial. Then I covered up antisocial and I said, let’s just forget about that for the moment. Okay. Let’s forget that label. And let’s just say, this is everything that I could possibly say [01:04:00] about you. And he’s like, yeah, but there’s so much other stuff. You’ve got to talk about my fetish. And I said, don’t worry about your fetishes just for now. Let’s just look at this one part of you. And I said if this was everything I could possibly know about you, and then I thought theory, right? Where’s the theory on this? This is anti-social is an active self-orientation.

    I try to get as much as I can for myself. And it doesn’t matter what it costs me. A lack of orientation towards pain assuming that things could possibly be damaging even to the self, translate that into therapeutic language. You don’t want to use too much theoretical stuff. You want to try to say, “I would say that maybe you’re the kind of person who wants what you want and we’ll probably stop at nothing to get it.” And that forced the reaction of, “Yeah, doesn’t everybody have that part of themselves?” Yeah. It’s kind of a normal thing, except that it’s pretty pronounced here. Well, that’s not everything that’s about me.[01:05:00] I said, no, of course not.

    And we went over to 8B- masochistic and I said, well, here masochistic is described as a reversal on pain-pleasure so that you seek out things that are actually pretty bad for you and you do it in kind of a passive way. So you just let these bad things happen, which when you boil that down, comes down to how deserving do I really feel? I said, here’s a part where maybe you don’t feel like you deserve much of anything. And he said, well, how does that go together?

    Dr. Sharp: Great question.

    Dr. Seth: How is it that I could be like, I want whatever I want. And then he goes, oh, I do want whatever I want. And I don’t feel like I deserve it. I said, where do you go? And he said, “Well, you know what I do, I just get the hell away from people.” And I said, let’s talk about 2A- avoidant. And we start to talk about that. And that experience was really striking for me because I wasn’t talking about really any of the labels we use. I wasn’t talking about a [01:06:00] diagnosis. We were having a therapeutic dialogue and that has always stuck with me.

    And that’s kind of where I started off saying, there’s a new way to look at this. I don’t think it’s so new. I think people must’ve discovered something like this before, but I’m going to try to systematize this and I’ve tried to do that over the years. It’s very hard to put into an evidence-based methodology because there are so many components to it. There are so many different ways.

    And you think about what I was saying about the color wheel. In your typical color wheel, there’s some variant of red, blue, and yellow, and you put them all together and you get the whole spectrum of how many thousands of colors that we are able to detect by the human eye. Here, you have 15 colors, 15 personalities, how many different possibilities are there, then what could that possibly mean for each one? And not that you’re going to get two identical profiles and [01:07:00] they’re going to be the same person because they won’t be

    Dr. Sharp: Well, I think you’re speaking to… well, there’s this translation piece, like translating all the scores, the profile into something meaningful. And when I think about that, I have to bring up the interpretive report. So that’s y’all’s attempt to somehow synthesize all this information and explain it in a way.

    So I’ve run into people who live by that interpretive report, like Alma, I think we all know this is not the right thing, but, you know, copy and paste it into whatever document. But then, I’ve run into people who throw the whole thing out, and they’re like, “I don’t know what to do with this or this isn’t accurate or right.” And then, people live in the middle. And so I’m curious for y’all being so close to these instruments and the development of these [01:08:00] reports and everything…

    Dr. Seth: I mentioned, we wrote the most recent versions.

    Dr. Sharp: Right. You wrote the most recent versions of these reports. What did we do with these interpretive reports? Is it the Bible? Is it not the Bible? Do we stick by it? How do you conceptualize those?

    Dr. Robert: I like the reference.

    Dr. Seth: I like the Bible reference in a way, in not so much that it’s any kind of gospel, but the idea that the way to really interpret any kind of a gospel of that sort is to listen to the story that’s there and then apply it to the circumstance that you have. But not as this is a literal translation of what’s going on right here.

    More so, this puts you in the ballpark. This gives you some ideas about who this person is and what dynamics may be at play here. So it kind of orients you. It focuses you in a way [01:09:00] to be able to say, this is an example of what these characteristics might be like. And this is why I like a collaborative approach, actually kind of putting myself in the position of here’s the expert on this person and pointed to the person, I’m the expert on the test that doesn’t make me the expert on the person.

    I’m going to give you some examples of what a lot of people look like when they score this way. What do you relate to? What makes sense to you out of what I’m saying? And Robert, I think I cut you off at the beginning. So, I’m going to let you…

    Dr. Robert: bullet points. No, I did have two points to that.

    One is, I think that it is important for people to realize that interpretive reports are really probabilistic statements. So we are taking what we understand clinically from the theory from research and incorporating it into when we have this type [01:10:00] of a profile, this appears to be what many of the features traits and so forth would be. That’s aspect number one.

    Number two, I would say that because these reports are computer generated and I’ve written this a number of times and referenced this a number of times that the computer doesn’t know the context within which this profile has been generated. Now we can try as best we can to understand what the motivations may have been for somebody to create this profile.

     Often in the past, when I taught the Millon Inventories would say, objective measures require someone. It’s not just true false. There are thresholds that each person has in mind as to, I often lose my temper as a made-up example. What does that mean?  Often? You know, somebody who loses their temper [01:11:00] on a daily basis may not actually interpret it because to them, that’s not often. Somebody who loses it once in a while may say, oh, I’m so uncomfortable losing my temper that I think I lose it more often than I should. And they then endorse that type of item.

    We, with the MACI-II to eliminated what was called modifying indices of disclosure, desirability, debasement as to what somebody’s motivations may have been and made all these adjustments behind the scenes and so forth, but never knew the context of it. So I thought it was important with a new instrument to create a way in which we handed it back to the clinician to decide what do you think?

    You know the circumstances that you are sitting with this person and you know the story as much as possible at that point, does the interpretive report fit with what you have found out about this person? Does it help you [01:12:00] understand what’s been going on with this individual?

    I think the third point I would add would be that when the MCMI first came out all those years ago, the interpretive reports were something new because there was integration of scale configurations. It wasn’t just one scale is elevated, let me tell you what this scale means. Oh, this scale is elevated. Let me tell you in a separate paragraph, what this tells us. Ted had done so much of that work behind the scenes by cooperating what were identified as prototypes and then the second or third highest elevations then would create subtypes.

    And that we would be able to have a more refined interpretation and something that was already synthesized by him, by the theory. And then with the newer instruments, now we have all these facet scales that further refine the [01:13:00] personality pattern interpretation. So we can go in so many different directions with each of the components, but it’s so enjoyable to have an opportunity to talk about it and to have people hopefully listening out there and saying, I’m intrigued by all of this. It’s not just a fancy printout. And there really is so much to this. It gives me a moment to stop and think about how this can help.

    Dr. Sharp: I’m glad that you highlighted that because I think to a lot of us who don’t know how these reports are generated, this is going to be wildly offensive but I trust that we have some rapport here, it seems it’s like a horoscope or something like or astrology, like, how did this happen Where are these conclusions coming from? [01:14:00] I mean, of course, we know there is science behind it and it’s rigorously developed. But to hear more of that process is super helpful.

    I do have a question though, and this might be a hard question, so y’all can get mad at me if you want. I think I can handle that. But the question is, so given that there is it sounds like a lot of the interpretation and application rests with the clinician in being able to understand the context and synthesize context with results and so forth. Do you recommend that people lean on that interpretive report or should we just get really good at looking at the score report without the interpretation and not even mess with the parts that might not be applicable? Does that make sense as a question?

    Dr. Seth: Yeah, and I think my gut reaction on that is, [01:15:00] related to how familiar and how comfortable are you with how the test actually works. What the theory is. How much you understand about it. You don’t have to have an encyclopedic knowledge of Disorders of Personality, third edition, to be able to use it. I do think to be effective with it, you’ve got to understand the basics of how the theory works and be able to at least draw some references from that. But aside from that, if you’re relatively new and you want to get more of a flavor and get the colorization of who you might be assessing, what you might be looking at, use and read the interpretive reports because they’re designed to put you in the ballpark and have at least a point of comparison to say, now here’s what we would be looking for with this kind of a scale configuration and these are some of the characteristics that might be there.

    There are two parts to it. There’s the [01:16:00] description of the personality and then there’s also the treatment guide. And there’s more than that as well. There’s also, how does that work with the other elements of the test, like symptomatology, and for the MACI- the expressed concerns. But I think the two big parts are the characterization and then the treatment guide, and I’ll speak just to the MCMI.

    The treatment guide, I tried to fashion after what I was talking about. I tried to set it so that I gave some description of theoretical elements in the first two paragraphs and then moved into what I thought would be a probable treatment course. The MACI-II, I think Robert worked from a slightly different paradigm but has a lot of similar elements to it, I think as well.

    Dr. Robert: I would say that my ideas were to say, okay, now that we have this information about who this adolescent is, I would address, initially this is what it is about this. Maybe the challenges of establishing rapport. [01:17:00] This could be somebody who quickly establishes rapport, but don’t be lulled into thinking that everything’s going to work out just fine.

    Different styles have different ways of reacting to, adapting to new environments. But in addressing the polarities, then getting into some of the domains in terms of what different strategies might someone apply. If someone is elevated on the inhibited avoidance scale, there should be some dimension of, we have to address the tendency to withdraw socially.

    But it’s not simply just throw them in social situations that they’re not well equipped to handle just yet. And they’re certainly not comfortable in dealing with them. How do you strategically address that? How do you then gradually get them to something like an individual therapy would likely be helpful? And at some point in time, they probably [01:18:00] could benefit from a group therapy experience.

    And then as often as possible, I go to the self-perpetuating processes, watch for this. How can we address this? So that in the end, this becomes someone who is much more comfortable being themselves and feeling that they are understood and that they are preparing themselves for life that is ahead. So trying to address all of those areas in those treatment guides. So I think it helps to bring it all together to say, yeah, a lot of research goes into the scales and understanding the constructs, and then it’s okay, hey clinicians here, these are some ideas. And they’re always expressed as ideas and possibilities rather than setting people up. Oh, if you don’t do it this way, [01:19:00] then you’re not practicing properly.

    So these are considerations for that. And the treatment guides are really treatment considerations. That’s why that section on the emphysema on the MACI-II actually is identified as treatment considerations.

    Dr. Sharp: Sure. Yeah, I really those sections or that section in each of the corresponding instruments. It’s always been helpful. I use that information quite a bit. So I appreciate y’all putting the time and energy into it.

    Speaking of time, our time has flown by. I feel like we have barely touched on everything that we could, but my hope is that we’ve dug a little bit deeper for a lot of folks and have helped people understand where all of this [01:20:00] is coming from, the theory and then some of the application and how to use these instruments. I really love them. And that’s why, again, I was so thrilled that y’all reached.

    Dr. Seth: Great to know. And we’re really appreciative of the opportunity to be able to talk about this because I think any talk about this is more than what people tend to get in training nowadays.

    Dr. Sharp: I think you’re right.

    Dr. Robert:  It’s been a great opportunity. We’re trying to get the word out. The pandemic shut everything down. I enjoy, as I’m sure many clinicians enjoy, that face-to-face, we’re in the same room type of connectedness, and in many instances for certainly for 2020, it was taken away from us. But this is a way for us to reach out and we’re always open to people reaching out to us. If there are questions, then we’re open to that. And sharing [01:21:00] what have enjoyed being a part of for our professional lives and having such an incredible person in our lives who then had confidence in us that we would be able to follow through. And everything, I can think I can speak for Seth, everything is about his legacy and making sure that it lives on.

    Dr. Sharp: Well, that’s the part of the story I think that I really tune into is the personal component. Then your relationship with Ted and how that has just shaped, of course, the professional piece, but the two of you.

    Dr. Seth: This has been what really makes it unique.

    Dr. Sharp: It is unique. It really is.

    Well, I appreciate that. We’ll put the resources that you mentioned in the show notes. We’ll put your contact info if you’re okay with that.

    Dr. Seth: Sure, it’s fine. I want to just say audibly, [01:22:00] www.millonpersonality.com is the home of the Milan Personality Group that’s printed on the title slide of that packet that I gave you and home for all things. We’re always in touch with the family who runs the Millon Personality Group. And we’re always looking forward to hearing from people who are interested and reaching out to others. And again, spreading the word. You want to make sure that this is a legacy that really continues to serve the world of psychology.

    Dr. Sharp: I love that. I think that’s a great note to end on. Let’s do that. Well, thank you guys again. I really appreciate it.

    Dr. Seth: Thank you.

    Dr. Robert: Thank you, Jeremy.

    Dr. Sharp: Thanks for listening everybody. I hope you enjoy this one. I really liked talking to those guys. I feel like we could talk forever. To be honest, they are so knowledgeable and just easy to talk to. It was a really fun interview for me to really bring to life instruments that we’ve been using for a long time. I really loved the Millon [01:23:00] instruments and it was cool to be able to dig into the weeds a little bit and really get to know Seth and Robert a little bit.

    All right. If you are looking to grow or evolve or advance your practice, I would invite you to check out the upcoming cohorts of the Beginner Practice Mastermind and Advanced Practice Mastermind. You can get more information at thetestingpsychologist.com/advanced or thetestingpsychologist.com/beginner and schedule a pre-group call to see if it would be a good fit. I would love to chat with you.

    That’s it for today, everybody. I hope everything’s going well. We’re heading back into the fall, which if you work with kids usually means getting busy. So hang in there. Hope your schedules are dialed in and you’re ready to roll. Take care. I’ll talk to you next time.[01:24:00]

    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.[01:25:00] Similarly, if you need supervision on clinical matters, please find a supervisor with expertise that fits your needs.

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  • 227. Writing a Stellar Job Ad

    227. Writing a Stellar Job Ad

    Would you rather read the transcript? Click here.

    Anybody else having a hard time finding clinicians? In my talks with other practice owners around the country, it seems like EVERYONE is struggling to hire. There are many reasons that I believe this is happening, but what it means for us as practice owners is that we have to do more to set ourselves apart from the other employment options out there. One of the ways to do that is with a stellar job ad. Here’s what I’m discussing in today’s episode:

    • Why the typical ad just doesn’t work anymore
    • Two components that can set your job ad apart from others
    • Where to advertise your job

    Cool Things Mentioned

    Featured Resource

    I am honored to partner with PAR for 2021 to bring you featured items from their catalog! Listen to each episode for specific product recommendations and links. Learn more at www.parinc.com.

    The Testing Psychologist podcast is approved for CEU’s!

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

    About Dr. Jeremy Sharp

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

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

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

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