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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.

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Hey everyone. Welcome back to another episode. I am excited to bring you a fantastic guest today.

Dr. Nicole Vienna is a forensic psychologist and expert witness based in Los Angeles. She worked for ten years in correctional mental health within the Los Angeles county jails and juvenile halls before making the transition to private practice as an evaluator in 2015. Nicole is appointed to the Los Angeles County Adult Superior Court Panel of Psychologists and Juvenile De1linquency Panel of Experts. Her forensic areas of interest and expertise include malingering, trauma, neurodevelopmental disorders, and youthful offender evaluations in high stake cases. That last one is exactly what we’re talking about today.

We’re chatting all about youthful offender evaluations: what they are, what they entail, why they’re important, some history, context, and case law surrounding them. So we cover a lot of ground here. Nicole speaks in a nice succinct manner that is also quite warm and educational at the same time. So, a fantastic interview. I really enjoyed this one especially in an area that I don’t know much about. So, if you’re a forensic practitioner or just interested [00:02:00] in forensic evaluations of this type, stick around. I think you will learn quite a bit this time.

If you are headed into the summer and you have license renewal coming up, I just want to remind you that you can get CE credits for listening to The Testing Psychologist podcast. You can get those at athealth.com, search for The Testing Psychologist. And if you can use the code TTP10, you’ll get a discount on any CEs that you purchase, not just podcast episodes, so a pretty sweet deal.

All right, without further ado, let’s transition to my interview with Dr. Nicole Vienna.

Hey Nicole. Welcome to the podcast.

Dr. Vienna: Hey, Jeremy, thanks for having me.

Dr. Sharp: [00:03:00] Yes, of course. It’s good to see you.

Dr. Vienna: Good to see you as well.

Dr. Sharp: Thanks for coming on. We’ve known each other for a little while now, maybe a year. Time goes by fast.

Dr. Vienna: Yeah.

Dr. Sharp: Before we totally dive into the topic and content for today, I’ll give a little plug for your own podcast, which is specifically focused on the forensic world. I definitely recommend people check that out. I’ll put the link in the show notes and everything, but I’m going to pull just a little slice of your expertise today for our general testing podcast.

I always like to start with why this is important. So, out of everything you could do in psychology or in assessment or even in forensics, why this?

Dr. Vienna: This is important to me because I truly believe, and this is obviously backed in science, [00:04:00] that juveniles adolescents are fundamentally different from adults. So we can’t treat them the same as we do adults in the criminal justice system hence why they have their own system, the juvenile justice system.

And on a personal note, I have a sibling that went through the juvenile justice system, had some mental health issues and I really got to see from an insider perspective how the system treated minors at the time. And this was several years ago. This was in the 90s. And juvenile definitely shifts and changes every two years depending on laws and statutes and where you’re at in the country. Of course, they’re different, but I got to see what it was like for the family to go through that and my sibling himself and I thought, wow, there needs to be a lot of work done here and we really [00:05:00] need mental health experts to come in and help educate the trier of fact, help educate the attorneys, and really produce more research in the area of adolescent brain development. That’s so important in terms of sentencing for juveniles. So personal and professional interests.

Dr. Sharp: That’s usually what it is for a lot of us, right?

Dr. Vienna: Yeah. And it was interesting too growing up because I came from a law enforcement family. So it was very interesting. You got two sides of the coin both in the household and it’s like, “Whoa.” It was quite interesting.

Dr. Sharp: I bet. I cannot even imagine what those conversations might have looked like or sounded like.

Dr. Vienna: Lots of debate in the household. To take it another step further in my current adult life, I’m married to a police officer now. So much more interesting conversations now happen at the dinner table.

Dr. Sharp: Right. You’re living [00:06:00] it. 

Dr. Vienna: Yes.

Dr. Sharp: This might be off script a little bit. Feel free not to answer if you don’t want to. That’s totally fine. What were some of the things that you noticed with your sibling going through this process? Can you remember anything that stuck with you right off the bat that you thought to yourself, this needs to be different or this isn’t fair or I don’t like this, anything like that?

Dr. Vienna: Yes, I want to say the time that stands out most to me is in sentencing juveniles. In my sibling’s case, there really wasn’t much consideration into some of the factors that we see that are really important to look at in youth like their immaturity and the family home environment. So, that was the biggest one. It just wasn’t talked about. It was just a lot of blame and there wasn’t much [00:07:00] consideration about why this behavior was happening. It was just, this happened now there’s a consequence. That’s it.

Dr. Sharp: So no consideration of circumstances or the factors?

Dr. Vienna: Exactly.

Dr. Sharp: Would you say, and I’m just going to give the caveat, as with any area that is outside my area of expertise and this certainly is, I will ask a lot of potentially dumb questions. So bear with me and the audience bear with me. But do you feel like there are differences there in terms of consideration of circumstances, environment, et cetera when you compare adolescents or juveniles to adults? I mean, do you think the standards should be different for adults compared to juveniles?

Dr. Vienna: Yes, because what we know from neuroscience is that the brain is different. We see in research that the brain [00:08:00] isn’t fully developed until age 25. In the past 10 years of research that I’ve reviewed, there is even more research now that points to the brain not being fully developed until closer to 30years, like the late 20s. So, kids are just fundamentally different from adults.

And that is exactly what the APA along with the American Psychiatric Association, and I believe it was the National Association of Social Workers that got together and did an Amicus Brief for the court in a significant case where they cited this exact language that the brain of a juvenile or an adolescent is fundamentally different from adults. And therefore you cannot hold juveniles or adolescents to the same standards. Adults have their brains fully developed and kids just aren’t because of many factors.

Dr. Sharp: Sure. Well, I know that we’re going to dig into lots of things here.

Dr. Vienna: Yeah, I don’t want to jump ahead, sorry.

Dr. Sharp: I know. [00:09:00] I’m getting ahead of myself too. I always do this. Let’s back way up. A lot of this will be for me but hopefully for the audience as well. Just setting some groundwork, when we say youthful offender evaluations, can you just define that? What exactly are we going to be talking about for the next hour or so?

Dr. Vienna: Youthful offender evaluations can mean a lot of different things across the country, especially in forensic work. We’re always giving that disclaimer that things can vary by state and even county or the jurisdiction you’re in because it’s guided by case law and constitutional law which we all know constitutional law is the same across the board, but statutes and case laws are not.

Youthful offender evaluations are pretty much those evaluations where an evaluator is doing a comprehensive mitigation type of [00:10:00] evaluation. We in California tend to refer to these as Franklin hearing evaluations because it falls into a significant court case, the Franklin court case, which piggybacks off the Miller Court case. Franklin’s court case was in California, the Miller case I believe happened in Alabama.

So, we are looking at youth who have committed a very serious crime. And again, different states have different laws and different ways of sentencing but I can speak for California. We’ve had so many changes even in Los Angeles county where this has been different, but basically, a Franklin hearing evaluation is where we are evaluating the youth and looking at the different, what we call the Miller factors at play that could potentially have a significant impact on their sentencing.

So it’s a youth that has committed a serious crime [00:11:00] such as murder that might be tried either in adult court. Austin, California, right now, specifically in Los Angeles, no juveniles are being tried in adult court for anything. And that was through one of our Prop 57 passages. And then specifically in LA County, our new district attorney has said, we won’t even have a consideration of them being tried in adult court. They are just going to be tried in juvenile court. And that is it.

So, we’re putting together this really mitigation packet for a future parole hearing. So this youth will eventually get a parole hearing. The parole board and some others involved with the state and some psychologists will eventually look at this packet and they’ll want to see the growth that has happened or the lack thereof, the maturity, those kinds of things, [00:12:00] rehabilitation potential so they can be considered for release from prison at some point.

Dr. Sharp: Got you. I have two questions to clarify. And again, if you don’t know, that’s totally fine, but how common is that across the country for there to be a blanket statement that juveniles are not tried in adult court?

Dr. Vienna: Are you asking, is it common across…?

Dr. Sharp: Is it common, yeah? Is that unique for LA county or California to not?

Dr. Vienna: No, there aren’t some states in some jurisdictions where juveniles are not tried as adults. In a lot of the States before our new da came in, they followed what we used to follow, which was that juveniles before they’re directly filed in adult court, district attorneys and the juvenile would have to have a hearing to be considered for the [00:13:00] players to decide in the courtroom whether or not that kid or juvenile should be tried in adult court if they’re fit to be tried. We call them Transfer hearings here in California or fitness hearings if the juvenile is fit to be tried in adult court or if they should be remanded to juvenile court for potential rehabilitation as a minor.

Some of the case laws like the cases I was talking about, like the Miller case and the Franklin case, especially the Miller case, the Supreme court held that it was the 8th amendment that prohibits juveniles to be sentenced to life without parole, we call it LWOP- life without parole or their functional equivalent. With that, some states redid their juvenile sentencing policies for those six significant crimes and other states didn’t. So it just depends on what state you’re in. I’m not familiar with all the states, but I know California we’re a [00:14:00] little bit more progressive and the juvenile system is really focusing on rehabilitation.

Dr. Sharp: Sure. It seems like it should, just to my untrained eye. 

Dr. Vienna: You would think that, but in these cases, like in the Miller case, for example, this kid was, if I remember correctly, my gosh, he was 14 at the time and he had these circumstances, he came from a home where I think his mom was an alcoholic. I don’t know if dad was even in the picture. And he was basically in and out of the foster care system. I think it was Alabama. It could be Arkansas, but it might be Alabama. I think it’s Alabama. Yeah, Miller V. Alabama.

He was in and out of foster care. He was abused. There was significant child abuse cited in the court opinion. He was using drugs and [00:15:00] alcohol himself just as his mom was. We noted her to be an alcoholic. And I think there was a boy or some boys that were trying to sell drugs to his mom in their trailer or something.  And so, he followed the guy home with a friend and eventually killed him, and then left the scene. And I think he returned to the scene to try to cover up the evidence. And through that, he lit a fire. So he was charged with murder, I think in the course of arson or something along those lines.

So he’s 14 though. And they tried him. I think the district attorney filed directly in adult courts. He was tried in adult court. Murder and in adult court holds significant ramifications, meaning you’re going to get a sentence equivalent to the crime that you committed. So for a 14-year-old to get life in prison without the [00:16:00] possibility of parole is pretty significant when the brain isn’t developed, right?

Dr. Sharp: Sure.

Dr. Vienna: But that’s what the court initially held until the appeals and so forth. So then, through appeals, that’s when they held that. The 8th amendment says that you cannot sentence a juvenile to life in prison without the possibility of parole because it violates the 8th amendment. So then we have some case law, right? Now it’s changing how states are seeing juvenile cases.

Dr. Sharp: Sure. Yeah, it’s interesting to look back with the benefit of hindsight to say, oh, well, thank goodness. Of course, that makes sense. A kid who’s 12, 14, 16, gosh, it’s just remarkable and sad that that has not always been the case, right?

Dr. Vienna: Right. And that’s why case law is so [00:17:00] important, especially in forensic work. To understand these cases, read the actual opinions so you’ll know how to start and formulate your evaluation for these mitigation cases.

Dr. Sharp: Yes. I want to bookmark that. I would love to hear more about how deeply you dive into case law and just legal opinion and things like that. I think that’ll come up during the course of our discussion. I hope it does.

In the meantime though, I did want to ask just to clarify, at what point in the process are you conducting these evaluations? Is this a post-sentencing or pre-sentencing or post-incarceration? I’m not sure what the right term is. Where exactly are you doing these?

Dr. Vienna: Post incarceration or are they on their way out? In California, some of them are youthful [00:18:00] offender evaluations, like I said, the Franklin hearing evaluations. So Franklin, let me just really quick the Franklin case. The Franklin case was a California case, and you can cut me off if the story’s too long. I think it’s just helpful to put it into context for people.

So, Franklin is similar to Miller but he was 16. He again had circumstances that were going on in his life. He lived in a really impoverished, violent community in the projects, I believe in Richmond, California. And he had some kids that were just targeting him and they were threatening his younger brother, I think. Somehow through all of that and some other factors, he ends up getting a gun from, I think his brother or his friend, and he wants to protect himself. And then he wants to make a showing, like don’t come mess with me or my family, et cetera.

And these were, [00:19:00] I  think in the case they documented these kids that were targeting him as gang members. So he had gang members picking on him and his family and threatening them. Anyways, he ends up getting ahold of a gun and he goes with a friend to threaten these kids or do a show of don’t mess with me. And through the course of that, he got out of the car that he was in and he just shot at the person that was threatening his family and his younger siblings.

So he just shot at him several times and the kid died. I think he was a kid. The other kid died in the course of this action. So he was, the same thing, tried as an adult at 16, but what happened in his case is that they did uphold that in appeal. I think it’s in the appeals court that they upheld his 8th amendment rights were not violated because California, again, you have to pay attention to your State’s Penal Codes and case law and statutes.

So [00:20:00] in California, there’s another… this is why we dive deep into case law and stuff like that. In California, we have Penal Code sections 3051 I believe, I should have written that down 3051, that says our parole boards here in California have to consider psychological evaluations and risk assessments as part of like a… when they come up for release …potential release, that hearing that the board of California parole has for these youthful offenders, which I think comes around I want to say they’re age 25, somewhere around there. 23, 24, 25.

So they have to consider, the board of California, I’m sorry. I was going to say the Board of Psychology and California, the parole board has to consider psychological evaluations and risk assessments to see whether or not this youth, maybe now an adult has [00:21:00] gained some maturity, has rehabilitated in prison. They have to consider these things, right? 

Therefore the Franklin case, the court said, no, it didn’t violate his 8th amendment rights because we have Penal Code 3051 that says he’s going to get a hearing when he’s like 25 to consider his release from prison. So there you go. And we just need to look at the psychological evaluations and the risk assessments, hence why attorneys, when they are going in for sentencing for these youth, so it’s at the sentencing phase, but I have attorneys that contact me from the beginning because these evaluations can take a long time, but they’re used at a specific hearing called the Franklin hearing and it’s really around the sentencing time.

And it’s really just so you can put, or so the attorney can put together a record of youth-related factors that [00:22:00] may have impacted this juvenile at the time of his offense. They want to put together this giant packet to be looked at in the future. So, it may not even be looked out for like 10 years.

Dr. Sharp: Until they come up for that parole.

Dr. Vienna: Exactly.

Dr. Sharp: Yeah, I got you. So just again, for some context, how much time, I know this probably varies, but what’s the range of time that may have elapsed between the offense and the evaluation/sentencing process?

Dr. Vienna: Well, it depends on how quick your courts get through things first of all. And with COVID right now, we’re a little behind on things, but generally, I would say I’m getting appointed to my Franklin cases about a year after the sentence, maybe 8 to 12 months. It just depends on how early the attorney wants it or how early they want to start it.

[00:23:00] There are some retrospective Franklin hearings if you will. So because of our State bills and assembly bills that have passed, we’re looking at offenders who were sentenced years ago maybe violating the 8th amendment rights where they were sentenced to life without the possibility of parole before all these case laws came up and before new propositions came up. And so they are now being looked at retrospectively. So we may be evaluating someone that’s 40 to 50 years old, who was sentenced at 17 to life in prison. We’re looking way back so you could get it then, and they’re in prison. It’s pretty trippy. You’re looking way back.

Dr. Sharp: Yeah, that seems very challenging for a number of reasons

Dr. Vienna: It poses a lot of potential [00:24:00] challenges. Looking at records from back then, how reliable are they? How much weight you’re going to give to each source? Can you even get records?

Dr. Sharp: Oh, of course. Yeah.

Dr. Vienna: A lot of things.

Dr. Sharp: Right. It sounds like if I’m understanding right and you please tell me if this is off base, but it sounds like there are two uses for an evaluation like this. It’s coming into play there during the immediate more acute sentencing phase and it’s going to be held for down the road whenever they come up to possibly be released to serve as almost like a baseline. Is that a good conceptualization or would you change that?

Dr. Vienna: Yeah, it’ll serve as a snapshot in time when you’re doing your mental status exam, for sure. Which is really important. It is going [00:25:00] to serve as a record of mitigating factors specifically related to youth. So we’re doing this, look at what their brain looks like, where their brains at the time of the offense. So, you’re tying in a lot of neuroscience. You’re really commenting on what we call the 5 Miller factors, or I think there are 4 or 5 Miller factors that you can count on.

So things that are specific to youth at the time of their offense. These ones I did write down, so I didn’t miss any of them. 

The first one, consideration of the juvenile’s chronological age. So how old they are and the relevant hallmark factors to that age, right? A 10-year-old is going to be different than a 14-year-old versus a 16-year-old versus a 25-year-old.

So we want to look at their chronological age and things like immaturity, failure to appreciate risk and consequences, family and home environment [00:26:00] like I mentioned earlier really important because the juvenile can’t get out of certain situations. They can’t live in a dysfunctional household, maybe if the court removes them but then they’re dealing with possible dysfunction in the foster care system or child abuse like the Miller kid.

So, we want to comment on all these different factors and also the kids’ role in the crime. Did they play an immediate role, a supporting role? Were they influenced by their peers? Were they under the influence of drugs or alcohol? Or even if they weren’t under the influence of drugs and alcohol, just by using drugs and alcohol at that time, we know that interrupts spring development in general. So even if they were sober at the time of their offense, it still plays a role. So we need a comment on that.

And then last, of course, their potential for rehabilitation. It goes in a nice little packet and goes off with them. It goes in their parole file and then it [00:27:00] gets reviewed years later. Now, sometimes attorneys will retain us not to do specifically a Franklin hearing evaluation, but nonetheless, a youthful offender mitigation evaluation where they will use it to try to mitigate the sentence.

So like a murder case, but another significant case, maybe it’s a carjacking case or an attempted murder case where they aren’t going to necessarily get sentenced to life in prison, but they’re looking at a significant time.

Dr. Sharp: Right. So, these evaluations may be used in the sentencing process, the results could be considered?

Dr. Vienna: Absolutely. And that’s why they’re so important. It has the potential to impact that juvenile’s life big time.

Dr. Sharp: Oh yes. That’s a very important role. Are these matter, of course? I mean, is this standard of care for any [00:28:00] case like this? Is every youth in this situation going to get an evaluation like this?

Dr. Vienna: In California, I know at least in LA county it’s pretty standard. If the attorneys aren’t doing it, then that could be a problem down the road of possibly getting ineffective counsel. It is pretty standard out here. Like I said though, in these cases where the inmates are 40, 50 years old, it didn’t happen because we didn’t have the case law at the time, or we didn’t have the statutes in place.

So, attorneys are coming on the cases now saying, okay, we need to get this established. We need to get a Franklin hearing done. And it happens. They retain an expert. We go in and we do the evaluation and they have it on record. And then they go back and I think it gets remanded to the sentencing court and the sentencing court hears it.

Dr. Sharp: Okay. Well, thank you for providing so much background. I think that is important just to [00:29:00] just understand exactly when this is happening, why it’s happening, where it comes from.

Dr. Vienna: Yeah, all I hear at least in California, it’s a new thing in the past two years. Like I said, the Miller case happened in 2012. The Franklin case happened in 2016. We people here in California, how we had Prop 57 passed two years ago which meant that DA’s were no longer allowed to directly file in juvenile court. So we had all these new laws and cases passed. So it is fairly new.

So when evaluators are being asked, even juvenile evaluators that work the juvenile court circuits, a lot of us, when we first started doing this were like, what is that? What do you want? What are you looking at? So we really had to dive into the cases and see what they upheld and what are factors that we should consider in the evaluation? What do we need to comment on? What are we looking for?

Dr. Sharp: Yes. I think that’s a nice segue [00:30:00] to the practice of these evaluations. What do these actually look like? I’d like to spend some time on the practice, of course, what this looks like clinically and how you conduct the evaluations and the report and everything. But I’d also like to spend some time before we wrap up, of course, on how to break into this area and how you might get referrals, just the business side of things.

Let’s start clinically though. Well, where do we start? Where do you start clinically with an evaluation like this?

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

Dr. Vienna: Good question. Clinically, you are probably going to start collecting records. The attorney hopefully will get you what you need, but if not, it’s always helpful to talk to someone that has done these evaluations so we know what records to request. You’ll collect all of that stuff.

You’re going to want to interview the family, maybe treatment providers [00:32:00], and definitely the inmates or defendants or juveniles themselves depending on where are you getting retained in the case. If you’re getting retained on the juvenile side where the adolescents like 17, 16, or if we’re doing a retrospective one on someone that’s 40 or 50 years old, you’re you’ll interview them.

In the cases I’ve worked on, my attorneys have retained a forensic social worker or what they call an investigator, which is super helpful. So I actually tell the attorneys if they can get one of those on their cases because the forensic social worker will go out and interview the entire family. They’ll also review records and they’ll pull together and the defendant or the juvenile, they will put together this really nice steak, social summary for you, which is really important because we’re looking at that as one of the factors. So they’ll do [00:33:00] that and you can just review it. And then, of course, you should probably do your own clinical interview. It’s up to you.

Sometimes I know some evaluators will go back and re-interview family members and some won’t. I do it on a case-by-case basis. If I feel the psych socials enough from the social worker, I won’t. I may just consult with the social worker or if it’s an investigator, usually they’re retired police officers or detectives that are on some sort of panel and they do this investigation. It looks very similar to a social worker, a little less clinical, but it’s essentially the same thing. You’re getting information from all these sources. That’s what they’re doing.

So I just play, like I said, case by case basis. If it’s pretty thorough, I’ll just consult with them. If it’s not, and I have more questions as I’m reading through their Social psychology and there are gaps on pretty important things like trauma histories, mental health history, family dynamics, family, generational trauma, I’m going to go interview that person myself because I want that [00:34:00] information. It’s just another source. We look at multiple sources when we make an opinion, multiple sets of data. So, you’re going to spend a lot of time in that area.

Now, because of incomplete brain development with juveniles, some attorneys want a full neuropsych done. If you’re not a neuropsychologist, no problem. They’ll retain a separate neuropsychology expert. If you happen to be a neuropsychologist or someone with a good amount of training in neuropsychology, they’ll have you do it.

I have done full neuropsychs on my cases because I’ve had training in that. And it really speaks to where their brain is at in development in terms of executive functioning, the incentive processing system. And you can really show that in the data. So again, another source to support and a potential opinion.

Dr. Sharp: Yes.

Dr. Vienna: So that’s where you start. Testing really just [00:35:00] depends on what the attorney is asking for. If there are neurodevelopmental issues, of course, the attorneys are going to ask for it. If there’s someone that has an intellectual disability or special education in school, again, it’s another mitigating factor that we need to talk about.

Dr. Sharp: Of course. So let me go back and break down those components a little bit. I’ll go back to the beginning. You said if you’re going to request records, what records are you requesting? What’s important?

Dr. Vienna: I may be different from my colleagues on this, but I like to have a ton of records. It’s the way I approach the Triple P too. I couldn’t have enough information. I just wanted to have it all. So, I ask my attorneys to give me, for sure, I need school records. If they were involved out here, we call it the department of children and family services. So it’s the child welfare system. I’ll ask for those records unredacted because sometimes they’ll send it to you [00:36:00] with big black blocks because they block out all this info about child abuse. And I’m like, no, I need that stuff. So, unredacted DCFS records.

I ask for juvenile mental health records. If they’ve been an adult jail or prison, I asked for what we call their C file and their jail mental health records which is a really great source of information because you’re getting snapshots of their mental status through mental health records if they’ve been seen by a clinician. And that’s really helpful to see where they were at in terms of maturity and overall brain growth or incomplete brain development, where they are. The person looking at them down the road for the parole hearing is going to be able to see whether or not they have potentially rehabilitated, grown a little bit in terms of maturity. So it’s really important to get those records and document them.

Those are the big ones. I’ll also ask for [00:37:00] any, if it’s neuro-psych related, of course, I’m going to ask for all of those provider’s records like assessments. If it’s special Ed, I need the actual evaluations, not just the IEP notes. I want to look at what the psychologist said. And then any medical records that are relevant. Things that are irrelevant, I don’t need, but if it’s related to the neuropsychological diagnosis of neurodevelopmental disorder, I need it. I want to review it.

Dr. Sharp: Of course. I like records too. I agree with you. More information is better than less because I have so many questions when I’m doing evaluations and it’s helpful to at least have those sources of information, and then you can figure out if you need it or not.

Dr. Vienna: Yeah. And you’ll get the hours. If it’s important to the attorney to have you review it, they’ll give you the hours to review it, which is nice.

Dr. Sharp: Sure.

Dr. Vienna: Sometimes attorneys will. I have mixed feelings about attorneys. Sometimes they’ll say, [00:38:00] I don’t think you need to review all of it, just this page and this page. I’m just going to send you pages 5 and page 10 and they’re skimming through the records. Some of my colleagues, I hear they like it because it really cuts down on their time, but I’m still responsible for the opinions I make. And I don’t want an attorney to decide what’s important and what’s not in terms of psychological records or mental health records.

So I err on the side of caution, I just say, send them all to me. Can you get me the hours? And we go from there. Now, if we don’t get the hours, then I’m going to make a note of that in my report that the court did not approve the hours. Here’s what I got. Here’s a summary of what I could do in those hours.

Dr. Sharp: That’s good to know. I’ll definitely want to circle back to the hours and how you budget time for something like this. We’ll pin that.

As far as the interview, you mentioned this a little bit, but sometimes that might [00:39:00] be farmed out it sounds like to one of these forensic social workers, which sounds like a cool service, but what are you looking for in the interview? You mentioned trauma history. Like what is crucial to obtain during this interview?

Dr. Vienna: We’re looking at not just the mental status of how they are in front of you at the time, but we really want to look at those factors relevant to youth. So we want to look at brain development. So that’s where the neuropsychological testing is. Some attorneys want full batteries. Sometimes maybe you’ll just do some executive functioning stuff, but you’re looking at brain development, okay?

We’re also looking at the big one family and home environment. What is it like where they’re growing up at? Who were their adult influences, their caregivers? [00:40:00] Is there any child abuse? Are they exposed to violence in their community? What peers are they hanging out with? We know adolescents are susceptible to peer influences. We want to know what’s going on in their social lives.

Trauma is really important. We know from research again in neuroscience that child abuse, physical abuse, especially sexual abuse, significant repeated acts of these can cause changes in the structure and functioning of the brain. So we want to assess for that. We want to assess for generational trauma. Maybe it’s happening because this is what’s happened in the family for years on end. Again, the youth cannot really get themselves out of that situation. So, how are we supposed to hold them at the same level of accountability as an adult that has the choice to leave? So we’re looking at those kinds of [00:41:00] factors.

Dr. Sharp: Can I ask you a question real quick, Nicole?

Dr. Vienna: Yeah.

Dr. Sharp: I’m generalizing here. Tell me if this is totally off base, but I could see with kids who are in these situations that it might be hard to get a hold of caregivers or parents or folks who can speak to some of these factors. Do you find that’s true or are you able to get access to a lot of these individuals?

Dr. Vienna: It can be difficult sometimes because parents might be…  And in some cases, it’s really rare. I haven’t had any contact with the parents because you don’t know where they’re at. The kid might’ve been left or abandoned early on in their life and they’ve grown up in the foster care system. So we try, maybe the clinicians that have been working with them or if they have foster parents. Even if you can get ahold of them, something we have to consider is the reliability and the weight that we give to their report. [00:42:00] So that’s why we want to look at multiple sources, not just maybe one parent, but two parents if we can, caregivers, grandparents, therapists’ reports, we want to look at it all. So, it can be difficult.

Dr. Sharp: Right. Another random question. I think when I talked with Chris Mulchay about Custody Evaluations, he mentioned, I think it was him who mentioned social media records. Do you ever consider social media records in some of these cases?

Dr. Vienna: I haven’t asked for them on my list. One of the next training I plan to go to is social media, I forgot what it’s called, but it’s through the American Academy of Forensic Psychology. I think they have a workshop coming up on how to use social media in forensic evaluations because that’s just not something I’ve done.

Now, I have had to review records that [00:43:00] included social media accounts of juveniles in some of their cases because I have to look at discovery. It’s in there. I haven’t specifically asked for it but I have seen some. And I think would be important too. Again, it gives you some insight depending on what the messages are, what’s posted, I guess. It can give you some insight into what they’re thinking, what’s going on in their brain, how they’re making decisions or lack thereof.

Dr. Sharp: Of course. And then as far as the testing, I don’t know if there’s a whole lot else to say about testing. It sounds like you’re just trying to get a good sense of what their brains are up to. Is there anything specific or any special considerations with these forensic evals from the neuroscience side?

Dr. Vienna: I think the attorneys that I’ve worked with if they’re asking for neuropsychs, it’s usually because the kid has had a history of being diagnosed with some sort of neurodevelopmental [00:44:00] disorder.  Like, they had a prior history of regional center or the intellectual disability diagnosis or they’ve had something in that area.

So again, we’re just coming in as the neutral third parties to confirm those results and see where they’re at now compared to where they were before. So as a neuropsychologist, you’re looking at the pattern of brain dysfunction or deficits and seeing if that correlates with some behaviors, maybe specifically in our cases, how it is related to the crime-related factors that are going on.

And for youth specifically, we’re looking at the frontal lobe. That’s really important because it’s the last to come online and develop and more connections happen as we get older. And so, we’re looking at how they’re making decisions, reasoning and judgment, their inability to look to the future and process long-term consequences or consider long-term consequences, [00:45:00] all the things that your frontal lobe does not quite online yet with adolescents. So, we’re looking at all that kind of stuff.

Dr. Sharp: That seems super important.

Dr. Vienna: And the ability to modulate emotions. We can’t forget that. Even on adults, I’m looking at that, but we’re looking at, can they regulate, can they modulate, what kind of coping skills do they have or lack thereof?

Dr. Sharp: Right. Now, I don’t necessarily know that we need to dive deep into battery selection. That feels like a big can of worms to open, but anything to stay away from, or are you using standard Wechsler instruments, personality, MMPI, MCM, MACI, that sort of stuff?

Dr. Vienna: Yeah, in short, it definitely is a can of worms. I have talked to some of the child custody evaluators. It’s like the same thing with them, but definitely, in forensics, we’re using [00:46:00] measures and instruments that meet the standard, meaning that they’re used by people in our field and they have hopefully they have good inter-rater reliability. So you want to stick with those.

I am using standard Wexler measures in mine. So, I’m using the WAIS often the WISC, and the WRAT. And in my neuropsychological batteries, I tend to do full, comprehensive neuropsychological batteries. That’s a long list of tests, but again, they’ve all passed and are considered scientifically sound by our community. So, no problem there.

Personality measures is a very big can of worms, especially with juveniles. The attorneys, at least in my experience, do not like them because if a juvenile hits, even an adult, you give an MMPI to an adult and they hit on the anti-social scale based on their [00:47:00] behaviors. Any district attorney that sees that is like, oh no, go, they’re “bad.” They’re not capable of rehabilitation because you can pull up research, personality disorders are the hardest to treat, so they don’t want you to give personality measures.

Now, I tell my attorneys that sometimes it can be very helpful. It could be very helpful in terms of diagnostic clarification. It could be very helpful, especially if we’re doing a risk assessment. If you want me to consider whether or not this person can be a danger to society if released, we need some of these clarifications. So, sometimes we will even give a PCL-R. I mean, we have to have a good amount of sound data here.

I talk to the attorneys and they’re usually pretty open to it. Most of them are going to know where their clients are going to hit at anyways. So they kind of already know [00:48:00] and better to have a good evaluation than just one that’s going to make them feel better because that’s not going to help them in court.

They make us look bad. And they know that. I’ve worked with some really good attorneys. They’re pretty open to what I suggest. They trust my expertise if you will.

Dr. Sharp: Good. They should. So tell me about the report. What does your report look like? Is this lengthy, is it brief? What are the important components? And I think most importantly for me, what kind of recommendations or opinions are you offering at the end?

Dr. Vienna: My youthful offender evaluations, whether it is specifically for the Franklin hearing or it’s just purely for sentence mitigation on maybe a less serious offense than murder [00:49:00] like we talked about earlier, mine are pretty comprehensive because these are so important in juvenile court. And I do comprehensive evaluations because I explained the importance of them to the attorneys and the attorneys pretty much know.

I make sure that I get the hours needed to be able to do a comprehensive evaluation so I don’t have any factors barring me from wanting to include everything that needs to be included and give myself enough time. So, they are pretty lengthy reports. They’re some of my longest reports as compared to maybe a competency evaluation. Those evaluations for me are like maybe 3 pages, maybe 4.

A youthful offender mitigation type of evaluation, my minimal running time 15 pages. I don’t think I’ve done one more than 15 pages. And when I say 15 that’s because we’re doing a full neuropsychological, so I’m integrating my results. I’m not doing it like a standard clinical eval where I’m like, here’s what test I used. Here’s what the test [00:50:00] data says. And then down here, I’m going to repeat that, summarize it, and write the opinions. I’m just integrating that into my opinion. So 15 pages, I can get you out at neuropsychological evaluation.

Now, it could even be longer if you’re attaching a full risk assessment to if they want. Can this person be safely released into the community? What’s their risk of re-offending? You’re attaching a risk assessment that may make it longer too, but mine typically are about 10 to 15 pages.

Dr. Sharp: And what are the primary components in the report?

Dr. Vienna: Primary components, of course in mine, you’re listing your relevant sources of information- where you pull data from, listing the records that you reviewed. I include in mine, I’ve given the defendant or the juvenile informed consent or they did an informed consent. Most of the time I get court orders, so they’re court-ordered to participate. They [00:51:00] have the right not to, and we go over all that and the limits of confidentiality. So, I have a little blurb that explains that.

And then I also include somewhere just at the outset of my report the referral question, I guess in clinical practice, you call it a referral question. So it’s similar in forensic reports. And I cite why we’re doing a Franklin hearing evaluation or a youthful offender evaluation and relevant case law statutes, just to explain what I’m doing. It also helps keep me within the referral question, right? I’m not trying to go outside of the referral question. I’m staying within the scope. So that’s important. You should have something in your report that covers that.

And then after the sources are listed, I’m going into… I have to be honest. I’ve changed my reports l in the past two months. I used [00:52:00] to do a whole background information section like you would do in clinical practice. So we’ve got birth history, developmental milestones, mental health scores, or whatever, et cetera.

Now, I’ve almost changed that and I followed practice by another colleague of mine who told me all about this findings-based report, which has now been, I guess, it’s a workshop by some folks in the American Academy of Forensic Psychology who are moving towards these different approaches to reports to streamline them and make them very concise to the point where we’re not repeating information.

So, I’ve incorporated it. It was really hard because I’m like, “No, I want to include everything. I’m very detail-oriented. I don’t want to miss anything.” But changing to that made me realize I’m not missing anything. I’m just not including things that aren’t relevant to the factors I’m [00:53:00] looking at like the Miller factors, the family background, their home environment, and their brain development. I’m not missing anything because I’m addressing that in finding number one.

So, I’m looking at all these factors that we mentioned, the Miller factors, and I address each one of them in a bullet point. So if the kid came from like impoverished, violence-ridden community, I’m going to write that. And this is not in any particular order. I’ll write that finding one, so-and-so grew up in an impoverished neighborhood exposed to community violence. Then I’ll list out what I normally would have put in maybe the Psychological Social sector of the report. I’ll list it all right there. And that’s it.

I’m not doing any opinion in that first section. I’m just listing my findings. So same thing, if we’re including a risk assessment or the neuropsychological testing, I’m going to list my findings here. Boom, boom, boom. [00:54:00] In the next section, I’m going into my opinion section. And then I comment on each one of those findings. So if I had five findings based on the Miller factors, I’m going to have five different opinions. I mean, it’s all going into one grand opinion because at the end I’m doing a 1 to 2 paragraphs summary, then it’s the grading it and tying it into neuroscience research, everything should be based on that.

There are some really great sources I think you’ll list in show notes of people to read their research on adolescents and juvenile brain development. So I’m listing my findings, then I’m going into a different section about opinions, and then I have a summary section that kind of ties it all together. Those are the important parts. And it’s really a streamlined approach. Before I would list out a whole background section and now it’s like, okay, we’re going to round this up.

Dr. Sharp: I like that. If someone wanted to learn more about this findings-based [00:55:00] approach, could you just Google findings-based report writing or where is that?

Dr. Vienna: Not to my knowledge. I don’t think so. I heard about it from a colleague that does forensic work as well. I signed up for the class through the American Academy of Forensic Psychology. They do a report writing class quite often. And I think I did two of them from two different experts and they provided us samples of what that looked like for them.

And then I, of course, tailored it to my state and county because of course, I had different case laws and statutes that we abide by than they do because they’re in different states. And then I incorporated my informed consent blurb and stuff. So I made it my own, but I took the skeleton from doing a finding-based section and then do an opinion section and then do a summary. Take the class. [00:56:00]Some are 4 hours and some are 8 hours. Great information and sample work.

Dr. Sharp: I’m very intrigued. Yeah, I’ll put that in the show notes. We’ll dig around and try to find one of these classes or a link to the AFP and see if we can help people find that. That sounds very intriguing.

So it sounds like a lot of the report is driven by these Miller factors. You’re sort of in investigating or looking at those in the background and the history or the findings. Are you writing an opinion for each of them even if they’re not relevant? I don’t know if that’s the right word to use. I mean, are you addressing all 4 or 5 in every one of these evaluations that you do?

Dr. Vienna: Yes.

Dr. Sharp: Okay.

Dr. Vienna: And usually in my experience, the kids or the juveniles that I get and even the adults, most of them that I’ve evaluated have [00:57:00] all of the factors. Now, if they don’t, then I won’t comment on it. If it’s not relevant then you won’t comment on it. In my experience, I haven’t had one person yet that has not had anything in one of those areas.

Somebody said, a forensic psychologist, and I can’t remember his name right now, it just stuck with me, but he said, every person that is in the criminal justice system has experienced trauma, but not every person that has experienced trauma is in the criminal justice system. I found that to be largely true.

Dr. Sharp: Just anecdotally, it seems like it would hold true. I’m sure you know the research better but it seems.

Dr. Vienna: Right, which is why it’s important to really read the research by Steinberg and some of these others, like Elizabeth Kaufman, who does a lot of work in incomplete brain development with [00:58:00] youth, and then what the trends are with the crime committed earlier than later. All those factors are important.

Dr. Sharp: Of course.

Dr. Vienna: They’re going to seek your opinions in the opinion section. So when we’re writing about Johnny was abused by his father and then sexually abused by a cousin and an uncle, we want to look at the research that is behind child abuse, sexual abuse, and what the correlations are to different kinds of crimes and offending. And you can make a really good sound opinion if you know the science behind that or the research behind that.

Dr. Sharp: Sure. So speaking to the opinion just to sort of close the loop with the report, can you give a ballpark of sorts or an approximation of what this summary opinion might sound like? What are you putting in those final two paragraphs generally speaking? [00:59:00] What’s the tone or content of that?

Dr. Vienna: The tone is neutral. I would say…

Dr. Sharp: Sorry, maybe tone isn’t the right word. It’s aggressive. It’s very provocative. No. Sorry, tone is not the right word. What’s the general content? We’ll just stick with that. What are you communicating in those last two paragraphs?

Dr. Vienna: We’re basically summarizing the youth history and we’re summarizing the relevant factors if not all five that are present, but you’re summarizing the relevant factors and they’re tied to brain development, their potential for rehabilitation. It’s just a giant summary and you really want to base it, like I said, in the research. And so, what I use is, I actually, [01:00:00] parallel and quote some of the Amicus Briefs that the APA wrote. They made some pretty strong statements and of course, they put together this nice packet for the courts of adolescent brain development. So, I am citing these things in my summary. I’m tying what I found in that youth and the relevant factors to what we know in the research about bringing them relevant.

Dr. Sharp: Got you.

Dr. Vienna: Yeah. And then maybe you might be speaking to their risk of re-offending if that’s a secondary question asked by the attorney.

Dr. Sharp: Okay. I was curious how firm you might be with these opinions.

Dr. Vienna: If you’re citing them, you better be confident. When we’re making a comment on risk, you’re using structured professional judgment tools like the HCR-20 [01:01:00] or the SAVRY if you’re evaluating a kid under 18, but basically, you’re looking at historical factors that aren’t going to change. They’re just present in history. You’re looking at clinical factors that might be a little bit more dynamic and you’re looking at risk management factors. So, you’re using structured professional judgment tools to support your opinion. It’s not just saying like, Hmm, I think that Johnny will have a medium risk. No, it’s going to be tied in the data and in the research.

Dr. Sharp: Right. Well, let’s talk a little bit about the business side of things. Let’s assume someone has the training to do these evaluations. We’ll just let that be a given. How does one launch a practice around this? Who are you connecting with? Where do you get the referrals? [01:02:00] What does that look like?

Dr. Vienna: I started my practice. It was a clinical practice and I was seeing clients for therapy. I was forensically trained. I was just doing forensic evaluations on the side building that kind of practice. I think I started out by making connections through my practicums and my internships. Because I went for a forensic program, I really geared all my training towards obtaining forensic sites.

So I did practicums at the jail, an internship, a post-doc in the juvenile justice system. And through that, I met other clinicians that had gone into private practice that had previously worked at the jail. I met and worked with different judges because we had certain programs in the jails.

I worked in where we had to evaluate…We did some evaluations with folks that were incompetent to stand trial. We did more of the restoration side of it. [01:03:00] So you have to write reports to the core, interact with an attorney. So you make the connections there. And then from there, I waited my time. In our county, you have to have five years. I think you have to be licensed for five years or postdoc for five years to be able to apply to be on the court panel.

And when you’re on what we call the court panel, you’re on this list where attorneys, public defenders, district attorneys, because you can get retained on both sides and I do, and you can be listed on here. And then that’s when the attorneys often look at the pool of their experts to come in and do these evaluations.

From there, then I also have met some private defense attorneys because they maybe used to work at the county public defender’s office, or they were former district attorneys and they saw my report. So when they have their own firm, now they’re like, “Hey, can you come take a case from us?” So it just building slowly.

That’s pretty much how I built my practice. [01:04:00] I think in about… I opened my practice in 2015. I got on the panels in 2017 and then it just took off from there. And now I’m turning the corner now and doing a little bit more private defense work, but still a lot with the district attorney and the county public defender’s office.

And I’m largely based in LA. I’ll do evaluations in the surrounding counties because I’m very close to Riverside, San Bernardino, and Orange County, everyone in an LA knows these counties. So I’ll go that way and do my evaluations for who calls first. And I put them in order on my calendar. That’s pretty much how I do things.

Dr. Sharp: That sounds good. Well, it reminds me, it just keeps coming back. It’s like build relationships and do good work. And that helps.

Dr. Vienna: Absolutely. I probably worked harder than I ever had at any agency job when I first started my practice, even now, but now you have [01:05:00] a little bit more help if you hire staff and you get a team put together, it makes things run smoothly.

Dr. Sharp: Right. Well, this has been super helpful. It’s just personally interesting to me to be able to talk about an area that I don’t know much about, and I’m hoping that other forensic folks out there are taking away a lot of information from our discussion.

Dr. Vienna: Well, if I could add just one more thing. So not just applying to be on your court panels and starting there working private defense firm cases, but you also want to get the appropriate training. Especially for these evaluations, if you’re working with juveniles, a lot of times we’ll see reports by psychologists that work solely with adults and they really miss the big points about incomplete brain development.

So it’s really important that you not only have [01:06:00] forensic training, like knowing how to administer certain forensic measures or assessments, and then just our general clinical measures and assessments, but you also have enough training in adolescent brain development and adolescence in general. Knowing about the maturity issues and the things that happen during development.

So having that plus your clinical expertise really allows you to make opinions that are, like I said, based on science and ethically sound. So get the training from sources like Concept and the American Academy of Forensic Psychology, the APLs. You want to get adequate training and of course, consultation or supervision from people that are already doing these evaluations. That piece is really about.

Dr. Sharp: Thank you so much for highlighting that. I think a lot of us hear about different areas of practice and it’s easy to get excited and want to leap into things, and it’s so important [01:07:00] just to make sure that you’re doing so ethically and with solid training.

Well, let’s see. I think we’d be remiss if we didn’t mention two more things. I mentioned your podcast at the beginning, but can you just tell people exactly what the name of it is and what kind of stuff you talk about on your podcast?

Dr. Vienna: Sure. I have a podcast that I started two months ago. It might’ve been even last year. It’s called The Forensic Psychologist podcast. It is a podcast that I started really to help educate and support students and early career psychologists going into the field of forensic psychology.

I started it because I was getting a lot of emails from students across the country that found my website or I hire interns and psychologist assistants throughout the years. So, of course, my ads, whether it’s on [01:08:00] LinkedIn or Indeed, they’re finding and they’re like, oh, I’d love to do this, but I don’t know what I need to have education-wise to be able to apply for this.

Clearly, in my job description, I’m like, you need to be this, this, and this.

So I’m like, “There are so many questions.” I’m like, “Wow, how come we’re not talking about this? And how come even students in grad programs know very little about the field of forensic psychology?” So I thought, hey, let’s put out some information and really give people what they’re looking for in one place.

So, I have two episodes out. I think we’re on like episode 10. I really do it about once a month because forensic practice we’re so busy, but I try to get out one at least once a month, sometimes two if we’re lucky. And we talk about, I say we, sometimes I’ll have guests, sometimes I do it myself. So we just talk about different kinds of forensic evaluations and go over the basics.  [01:09:00] We do broad overviews.

I plan in maybe season two to go a little bit more in-depth, but I just wanted to introduce the kind of forensic evaluations that we do. So I’ve done some interviews on these Franklin hearing evaluations, competency evaluations, child custody evaluations we have in the works, and immigration evaluation. So all different kinds of forensic evaluations, kind of like how you interviewed me, broad overviews, what kind of training do you need? What kind of ethical considerations are there, et cetera. We talk about that stuff.

A little bit about the business side. We’ll get into that more maybe season two. Everyone I’ve interviewed has graciously agreed to come back. So I’m like, I will call you. I’m going to call you.

Dr. Sharp: Right. When you get a good guest, you want to lock them in.

Dr. Vienna: I’m going to do a round table, hopefully, and we’re going to discuss the business because it’s a little different than clinical practice. [01:10:00] My systems changed completely when I did my forensic practice full-time and dropped my clinical caseload. So, it’s a little different.

Dr. Sharp: Yeah. Well, I’m going to totally leverage this to ask you to come back and talk about the business side of forensic practices.

Dr. Vienna: Yeah, I’d love to. That’ll be awesome.

Dr. Sharp: Awesome. The second thing that we got to mention is that you are a Master Scuba diver, so not related to forensic practice at all, but pretty cool. I just wanted to acknowledge that. And I’m curious how you chose to do that and how much time you’re putting into that these days.

Dr. Vienna: I am an avid scuba diver. I got certified when I was 18years old on a study abroad trip in Australia. I got certified out at the Great Barrier Reef before it got destroyed. It’s growing back now but it took a pretty big hit over the past two years.

I got into it just [01:11:00] because I grew up by the beach. I love the water and there’s a whole world underneath the ocean. And since then, I’ve achieved different certifications. And now I’m at the top. I’m maxed out, I guess, at the RESCUE dive level. So I’m a master scuba diver. I have completed a rescue diver course specialties, et cetera.

I’m actually doing photography now underwater. So if anyone finds me on Instagram, it is a nice blend of forensic-related topics plus my scuba diving photos. And people are like, “How do these two go together?” Here’s how. Just as clinicians, that work with people that have trauma or just people in general, in forensic work, we do a lot of evaluations and a lot of work if you’re on the treatment side with people that have experienced so much in their life. We see human suffering and you [01:12:00] have to have a way to process that.

And for me, having scuba diving vacations or I live locally to the beaches so I’m able just to jot down there, which is nice. It helps provide some balance and some lightheartedness to the work I do, right? It’s a break from carrying all the trauma. You’re going out in the water and seeing all the beautiful things underneath. It actually helps with anxiety, too, learning how to scuba dive. There’s all kinds of research on that and the breathwork that goes into it.

So the two are connected. That’s how I break away. And I actually talk about it a lot with my attorneys. I noticed the young ones that come in, they’re so inundated with the kids’ trauma and I’m like, “You need to take some breaks sometimes.” I take a vacation every three months. I may not go on a big vacation, [01:13:00] but I definitely take 1 to 2 weeks off every three months and I just disconnect.

Dr. Sharp: I love that. That’s a nice note to end on. Take vacations, people.

Dr. Vienna: Yes. My attorneys, they’re like, Nicole, you were just on vacation three months. I’m like I know, but do you know what we’ve been working on? Do you know how many murder cases we’ve had? I need the break. You should take one too.

Dr. Sharp: Absolutely.

Dr. Vienna: Yeah, it’s good self-care.

Dr. Sharp: Well, I so appreciate your time and expertise, and willingness to chat with me for a little bit. This is great.

Dr. Vienna: Of course, anything.

Dr. Sharp: And your contact information. We’ll put that in the show notes, of course. So if anybody wants to reach out, they can do that. Hopefully, this is just round one and maybe we’ll talk again in the future.

Dr. Vienna: Absolutely. Thanks for having me.

Dr. Sharp: All right, everyone. Thank you so much for listening as always. If you have not subscribed or followed the podcast, [01:14:00] now is a great time to do so. Always grateful for those subscriptions and follows so that you don’t miss any episodes that come out.

We are headed into the summer, got plenty more clinical episodes and business episodes coming up.

So stay tuned and don’t miss any of those.

Like I mentioned at the beginning, if you need CE credits here as your license renews, ours renews every two years in August. So we are scrambling to get those CE credits. You can get those at athealth.com and just search for The Testing Psychologists.

All right. Until next time. Y’all take care.

The information contained in this podcast and on The Testing [01:15:00] Psychologist website is intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric, or medical advice, diagnosis, or treatment.

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

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[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.

All right, y’all. Hey, welcome back. I have a very meaningful and relevant episode here today, where we are diving into the topic of financial planning for practice owners.

I am very fortunate to be talking with Ariel Ward. She’s a certified financial planner and financial advisor at Abacus Wealth Partners. She has over a decade of experience in the field of personal financial services and in helping [00:01:00] clients develop financial clarity. She’s passionate about helping business owners grow their net worth and make better decisions with their money. Ariel also helps her clients to find their goals, stay focused on what’s important and work toward building a more abundant finance future.

I have a great connection with Ariel. She has been our personal and business financial planner over the last few years. She’s done incredible work with us, she and her team at Abacus Wealth. I just feel lucky to be able to pick her brain and share some of her knowledge with the rest of you.

In this episode, we really just a nice overview of financial planning. We talk about what that even means. How a financial planner is different than an accountant. Why financial planning is important. Why saving for retirement is important. Different options for retirement savings depending on what kind of practice [00:02:00] you have. How much to save. When to start. At the end, we get into a little bit of a discussion around investing startups like Robin Hood and Wealthfront and Betterment. Some of these apps you may have heard about and compare and contrast them with a more traditional model of having a financial planner or an in-person resource.

I think there’s a lot to take away from this episode. I don’t know that it is geared toward those of you who are in the advanced stages of financial management in your practice, but I encourage you to listen. It’s a great primer on a lot of the basics. We really get into some details that I think you can take away right off the bat and implement to get your finances under control and start planning for the future.

So, without further ado, let me [00:03:00] transition to my conversation with Ariel Ward.

Hey Ariel. Welcome to the podcast.

Ariel: Jeremy, I’m so excited to be here and ready to talk to you about money.

Dr. Sharp: Yeah, I’m ready to talk about money too. We’ve talked a lot about money here over the past two years. For anyone who doesn’t know, I don’t know if we’ll put this in the intro, but we have been working together for 2 or 3 years, and you’ve completely turned around our financial situation and it’s been pretty incredible. So, I’m excited to talk with you and share some of your knowledge with everyone else. So thanks for being here.

[00:04:00] Ariel: You’re welcome.

Dr. Sharp: Let’s start off. I always ask anyone who’s on the podcast as a guest, why this work? Why is this important?

Ariel: That’s a great question. The work I do is helping people come up with a system for their money that’s going to help them have a lot of clarity around financial needs decisions they make throughout their life, and also help them build that long-term wealth that we all know you need to give us security and opportunities in the future. And I am really passionate about doing this kind of work because, first of all, money is important. We all need to talk about it more with our family and have more clarity around why we’re making the decisions that we do make with our money.

For me personally, I have gone through all kinds of attitudes around money: [00:05:00] ignoring it, spending too much of it, hoarding too much of it, and have found myself in a place where I know what I want to do with my money and I know why I’m doing what I’m doing with it. And so, I want to help my clients come to that place as well. So that place where they know what path they’re on with their money decisions and they also know exactly why they’re making a decision with their money. Why are they saving? Why are they spending money to remodel their house, all of those kinds of things?

I think when you have that kind of clarity and you have a plan for yourself around your money, it just frees up a lot of brain space. It can help you have a little more joy in the work that you’re doing since you know, that the effort you’re putting into your work is building this long-term wealth in security and opportunities. And just also gives you the ability to have the freedom to have fun with your family, go on vacation, and not [00:06:00] be worrying about where that money is coming from. Things we do with our money touches all parts of our life. And it’s just really important for us to all get a handle on it. And so, that’s why I do what I do. I want to help people know why they’re doing what they’re doing with their money and feel good about it as well.

Dr. Sharp: Yeah, I think that’s super important. You touched on a lot of things that resonated with me during that time there. The idea that we do things with money but do not know why I think is really important. I think a lot of us know, there’s a lot of emotion tied up in money and we talk about money mindset. You work with a lot of mental health professionals. I’m sure you see this a lot. But yeah, we carry attitudes about money from our family of origin or growing up or experiences or whatever it [00:07:00] might be. And we do things with money for unconscious reasons. So I love that you’re highlighting that process and bringing clarity to that process.

There’s so much that we can talk about here. I wonder if we might just start with the basics? You’re a financial planner, right?

Ariel: Yeah.

Dr. Sharp: So tell me, what is a financial planner and how does that differ from say an accountant or like these days, I think there’s an increase in external CFOs. How does a financial planner fit into the whole picture as far as managing our money?

Ariel: Well, a financial planner, first off, is someone who… Typically if you’re calling yourself a financial planner, you’ve completed the [00:08:00] certified financial planner designation and gone through some coursework studying, wills, estate planning, all of that stuff, insurance, investments, cash flow( this is all the personal side thinking through these things) and retirement. The big question for everyone is how do I save for retirement? So taking that information you’ve learned and the financial…

What I do as a financial planner is take all the knowledge and try to apply it to individuals or family situations. A big part of what I do as a financial planner is coaching and accountability. There’s so much out there now on Google, books, whatever. You can probably dig in and find the answers you need. But as [00:09:00] as a financial planner, what I’m helping you do is put together the to-do list items. So sure you need to set up an estate plan and then also the why. Why is this important to you personally? What effect is it going to have on your life and how can we get you to move forward to taking steps on these to-do list items in your financial life?

In a big picture way, what I’m looking at, I always start with looking at cash flow. Where are you spending your money? And is it how you want to spend your money? Is it reflecting what you actually want to do? So if you really have a goal that you want to take a big vacation with your family every year, is what you’re doing with your money reflecting that or is it getting spent in other ways that that’s always just going to be a dream that you get those big vacations and never a reality.

The same thing with the retirement saving for a house, all of those things. It’s putting together the actions you’re taking with that goal or value you [00:10:00] have for yourself, can we put those together? And if you’re not already doing it, how can I help you take the steps to do that? How can I hold you accountable? What’s going to be motivating for you? Cash flow is always where we start.

The other things I help with are helping clients come up with a retirement plan. So if you want to retire someday, or even if you don’t want to retire and you want to keep working forever, how can we create those opportunities for you to do either one of those things: keep working forever and also have this backup plan in case that doesn’t work out because of health reasons or whatever, or hit the goal of retiring at 50 or 60, whatever it is for yourself and thinking through how much do you need to save? Where should you be saving it? How should it be invested? All of those parts.

And then also helping you implement that plan, set up the accounts, when should you put the money in? How much should you be putting in? And then, all the other parts I talked about- insurance, reviewing what your insurance looks like, [00:11:00] what do you need to change, estate planning. I look at everything. We can’t do it all at once. It’s more of a process of going through the building blocks to getting to every part of your financial life.

Dr. Sharp: Yeah. That was one thing I appreciated about our work together is that it is very comprehensive. We were doing okay, but I think we were pretty aimless in our goals and what we were doing. So, pulling everything together and really helping us be deliberate about what we did with the money was really important. I’m guessing our situation is pretty similar to a lot of practice owners where there’s like some student loan debt and maybe like some car payments and maybe some retirement, but how much should it be? And then the practice expenses.

There are so many pieces to pull together. It was hard for me, even as a numbers-oriented [00:12:00] logical person to sort through on my own and know where to best allocate the money that was coming in. And that was one of the most helpful parts, I think, was just having some clarity around that and having you help us define our goals. That was really cool.

Ariel: Yeah. And that’s a big part of what I do is be able to be that outside unbiased third party looking at your money. Even as a financial planner myself, I need my own financial planner because I may know all the right things to do, but taking the initiative and getting myself to do them, it’s helpful to have another person there saying, “Ariel, why didn’t you do this? Or you need to make sure you put your money in your account by this date, take a look at your insurance so you make sure everything’s set for the year”.

Dr. Sharp: Right. Well, and there were times too where you were almost like a marriage counselor for us. My wife and I,  as you know, were in very different places with what to do [00:13:00] with our money in the beginning. And she’s like, “We’ve got to live our lives now and let’s just spend our money and I’m like, no, we have to save everything, but I don’t really know why.” Anyway, helping through that, that was nice.

Ariel: Yeah, definitely. And that’s super caller with couples too. One person has one attitude and the other one has the opposite attitude with money. So it’s finding that in between that’s going to make both of you somewhat happy with the end result.

Dr. Sharp: Nice. Yes, that definitely happened. We’re in a good place.

Just to clarify, and this is a question that I had when we got started too, but can you distinguish a little bit. How are y’all different from an accountant? I get that question a lot, like, oh, I already have an accountant, why would I need a financial planner or someone to take that role?

Ariel: A CPA is really helpful when we’re talking about tax questions or maybe how certain expenses are going to affect your business. A CPA can give [00:14:00] you a lot of clarity on what should I expect on paying taxes here? Should I be paying estimated taxes, that sort of thing? Most CPAs I work with are very much present-focused, so focused on what can happen this year.

The way I work with CPAs is, I want to know what’s going to happen this year, but let’s think of the big picture long-term strategy. What are some things we can start doing today that might save you on taxes in the future? And then, the way a CPA and a CFP might work hand in hand is way in the advice. The CPA is suggesting you do this right now, maybe that is putting $50,000 into a retirement account. I know over here on the personal side that you maybe you have a ton of credit card debt or some other really big goal that at this point in time is more important than the tax savings.

So, [00:15:00] CPA is very important and can give you a lot of clarity on your taxes. I’m here to look at the big picture long-term planning. How do these individual decisions affect that big picture plan?

Dr. Sharp: Got you. Thanks for talking through that. I think it’s easy to get lost in all the different financial professions folks that can help us.

Ariel: So many titles.

Dr. Sharp: Yeah. Well, and when I’m coaching practice owners too, there’s also this just being conscious of recommending so many services. I’m like, well, I think you do need an accountant, but a financial planner would also be helpful. And you also need this thing. And they’re like, why? Why do I need all these? Why do I have to pay for all this stuff? But it really goes a long way. I think everybody plays an important, distinct role. That’s what I wanted to clarify.

Ariel: Yes, I agree.

Dr. Sharp: Well, let’s actually dig into some of the strategy here. To lay some [00:16:00] groundwork though, you work with a lot of practice owners, so I know you can speak to this, but can you just say why financial planning is important for us as self-employed business owners compared to a normal person who works a job and gets a retirement match and those sorts of things?

Ariel: Sure. I think the big difference between being a business owner and being an employee is that, as the business owner, you are responsible for bringing in the revenue that’s going to support your household or pay your salary for yourself. You’re also responsible for employees if you have them.

So you have a lot of financial pressures to get everything right not only to support your own household but to make sure that there’s consistency for your employees in their households. So, on that first point, there’s a lot of personal pressure for you to get things [00:17:00] right financially.  And as an employee, definitely, you want to do the things to keep your job and keep that salary coming in, but most employees don’t have that extra pressure of, I also need to bring the revenue in to make my salary happen.

And then the other part, if you’re an employee of a big company, it’s likely that you have some sort of retirement plan. Somebody has already thought through what kind of retirement plan would be right for my employees. All you have to do is sign up and start contributing. Probably your employer is also contributing on your behalf. So you already have that bonus for retirement as an employee.

Business owners, it’s all up to you. If you’re going to have a retirement plan, it’s up to you to figure out what kind of retirement plan is the right one for me. If I have employees, are they suddenly eligible? It just becomes a lot more complicated when we start looking at the financial picture of a business owner versus someone who’s just an employee of the business.

And then the other part of it which we touched on is that [00:18:00] personal cash flow. Making sure you have bumpy cash flow. So one month you’re making $50,000 and the next month, that’s $5,000, how are you going to make that work out on the personal side so you’re not feeling both stressed within the business, but stress out at home because you don’t have that regular steady cash flow to support the mortgage, food, everything you need to survive?

Dr. Sharp: Right. Yeah, I think that’s a big question that a lot of us struggle with, especially in the beginning, but maybe over time too, is just how much to pay ourselves. I hear that question a lot. How much do I pay myself from my business? And it’s hard to figure that out unless you have some formula that kind of fits your salary into the bigger picture.

Ariel: Yeah, that’s always the number one question when I’m working with somebody who has a newer business in the first three years of business ownership is, am I paying myself the right amount? What should I be paying myself? That’s a [00:19:00] big question to tackle. And can it be consistent given what I’m bringing it in right now?

Dr. Sharp: Right. Do you have a general philosophy on that? I know it might be hard to nail down a specific number or percentage of income or something like that, but do you have a general philosophy in how you tell beginning practice owners how to navigate that?

Ariel: Yeah, I think the longer you’re in practice, it becomes a little easier to figure out what you should pay yourself. But let’s say, if you’ve been in practice at least a year, what I would say is hopefully at this point you have bookkeeping and you can go back and look and see, what did my revenue look like over this last year? What did my expenses look like? And what’s the average number there? So your average revenue was $10,000 a month and average expenses, $5,000 a month, you should be able to expect about [00:20:00] $5,000 per month profit. Obviously, that’s not going to be, since things change so much in group therapy practices, that’s not going to be actually true when you go into your second year.

So what I like to do is definitely taking a percentage of that. So something that can be consistent. I usually start with around 60 or 70% as a baseline. So, you can maybe start taking $3,500 a month as an owner’s draw every month and let the extra cash build up in your business, which will leave you money for it to pay for taxes. And then you might supplement that with taking, you know, when you see that the cash in your business is built up, there’s a little extra to take out as a quarterly draw. So that’s a good way to start. It’s just, what could you start relying on a regular basis for the next year and then plan to take a quarterly distribution,.

For any newer [00:21:00] business owner, that might be a good way to get some consistency and then be able to have an extra chunk every quarter, every six months or so.

Dr. Sharp: Got you. Nice. So just to make that super concrete, if you’re bringing in $10,000 a month in total, just gross revenue, like that’s all the money that comes in, your expenses eat up about $5,000 of that- So that might be like rent and testing materials and your EHR software and things like that. Do you include taxes and expenses when you are talking about it in this context?

Ariel: In the context of the bookkeeping, it’s not an expense, but it is if you’re going to take an owner’s distribution and you have that $5,000 a month profit, you’re probably going to want to keep 30% of that for taxes. And you can do that in a number of ways. [00:22:00] Usually, I have business owners set up tax savings account within their business. If you’d rather do it on the personal side, that’s okay as well because ultimately you’ll be paying the taxes on the personal side. I find keeping it within the business helps you mentally know that it’s hands-off. It’s not something you can take home and use for a personal goal as well.

Dr. Sharp: Right. So going back to our little examples, so we have $5,000 in profit and then you said about 50% is a good place to start just to be safe. So somebody would take home $2,500, set aside some for taxes,  and leave the rest just to build up.

Ariel: Yeah. So maybe you could take in $1,500 and putting it into the tax account which would be 30% of that $5,000 and then the rest, just letting it sit in. You can have a separate profit savings account. It gives you both the buffer in your business just in case there’s some unexpected expense during the year. [00:23:00] And then if that expense doesn’t happen, you have it for later on the year or the year-end distribution, quarterly distribution.

Dr. Sharp: Got you. Cool. Well, let’s see. Let’s get into some more detail here. I mean, as far as a general strategy for, let’s just say retirement planning. I feel like that’s a big focus for a lot of us. And being self-employed like you said, we have to steer that ship all the way to the end. So, when you think about retirement planning, how do you conceptualize that for a practice owner? What do we need to have in our minds to be focusing on?

Ariel: Sure. I think on a very basic level, first of all, deciding when you set up a retirement plan, do you want to include your employees? If your goal is to include employees and that’s something your employees [00:24:00] are asking for as an employee benefit, you might approach this topic a little differently than if your goal is I really need to focus on putting away as much as I can for my own retirement. If I have to include the employees, we’ll work it out, but ultimately, I want to put away as much as I can for my own retirement.

There are several different types of retirement accounts. And depending on what your goal is, focusing on your own retirement or incorporating your employees, you might take a different approach.

Dr. Sharp: I wonder if we might break this discussion up into starting with just a solo practice owner who maybe has no aspirations of owning a group practice, it’s just going to be them, and then we can have a discussion about group practice owners who both want to do a retirement for their employees, and maybe don’t want to do a retirement for their employees. Could we put that structure on it? Would that make sense?

Ariel: Yeah, that makes perfect sense.

Dr. Sharp: Okay. How about a solo practice owner? What [00:25:00] does that look like as far as retirement options and planning?

Ariel: As a solo practice owner, it’s actually a little bit easier for you since you just really have to focus on what’s going to work for you tax-wise and then for your long-term plan. First of all, just getting any question out of the way of how much should you be saving or when should you start doing this? My goal for a solo practice owner would be to find out…

First of all, go back to that debt question. If you have a lot of high-interest credit card debt, I’d focus on paying that down first before contributing to retirement. That’s going to make a bigger impact long-term than starting this retirement plan. So once that’s out of the way…

Dr. Sharp: Can I ask you a question real quick?

Ariel: Yeah.

Dr. Sharp: Sorry, I’m going to jump in. I’m going to ask a lot of questions, I think. When you say high-interest credit card debt, what qualifies as high interest?  How high does its interest need to be to supersede the importance of saving for retirement?

Ariel: I [00:26:00] would say anything that’s over 8%.

Dr. Sharp: Okay. So just to put that in context for folks. I’m breaking it down super simple, but most credit cards are going to be at least 12% to 15% interest unless you get some smoking credit card deal somehow. So pretty much any credit card debt, is that safe to say, is going to be over 8%?

Ariel: Yeah. That’s probably safe to say that almost any credit card debt is going to meet that criterion.

Dr. Sharp: Okay. I just want to make that because I had that question too. This is just one of those basic things. I’m like, we know we should be saving for retirement, but these high-interest credit cards really eat away at that. The math doesn’t work out. Emotionally, it seems to make sense to save for retirement, but math-wise, you’re getting a much better return by paying down high [00:27:00] interest debt.

Ariel: Right. And that’s where the financial planner comes in because we combine those emotions and the math at the same time to help you make that rational decision on doing what’s right for your situation.

Dr. Sharp: Sure. Okay, so we pay down the credit card debt first?

Ariel: Right. Pay down the credit card debt first. So once you’ve done that, the next approach is deciding where are you going to save for retirement? And when we talk about retirement accounts, we’re usually referring to a type of account that the IRS allows us to set up that gets us a tax deduction and also lets us put money away and grow without paying taxes on it. So a tax-preferred or tax-deferred retirement account.

As a solo practitioner, the two best options would be a SEP IRA or an Individual 401k. [00:28:00] So with both of those accounts, you can put up to $57,000 away in one year into one of those accounts. And so that the actual amount you could contribute is going to be based on how much money you’re earning in that year.

The difference between those two accounts is that the SEP-IRA is actually a very simple structure. There’s only one contribution and it is an employer contribution or it’s strictly based on your net profit for the year. And so, what you can contribute is going to be… You can contribute up to 20% of your net profit or 25% of your salary if you have formed an S Corp and you’re paying yourself a salary. So those are the two max numbers. And the SEP-IRA, you put the money in the tax year, you get a tax deduction that year, you’re going to invest this money and then over the longterm, so between now and when you [00:29:00] retire, hopefully, that money is growing and you’re not going to be taxed on the growth.

So you’re typically on investments. You might pay taxes on that growth over time. When you retire, you’ll be able to take the money out, use it for retirement, and you’ll be taxed in retirement income taxes. So, as a business owner, it gives you the benefit of having a reduction in your tax bill and being able to put away a large amount of money at one time for your future retirement.

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

Dr. Sharp: So you said with a SEP IRA for a solo practice owner, you can put aside 20% of net profit. Is that right?

Ariel: That’s right.

Dr. Sharp: Okay. So if you’re, again, just to make this super concrete, if somebody is making, let’s say $100,000 a year, has $20,000 in expenses, then we’re looking at 20% of $80,000 to put into a retirement account. Is that right?

Ariel: Right. So that person can put away $16,000. They also aren’t going to pay taxes on that $16,000. So that’s the immediate benefit.

[00:31:00] Dr. Sharp: Got you. So it reduces your taxable income as well which is nice.

Ariel: Exactly.

Dr. Sharp: Great.

Ariel: An important thing to know about the SEP-IRA is if you do end up bringing on employees, you can keep contributing to the SEP-IRA as long as your employees haven’t worked for you for more than three calendar years. So you have a buffer. If you change your mind and you start hiring people, you have about three years before those new hires would suddenly be eligible for a contribution. So that’s another good reason that SEP IRA is a good place to start because you have that longer timeline than other types of retirement accounts before employees would be eligible.

Dr. Sharp: Got you. Okay, great. And then the solo 401k.

Ariel: The solo 401k. So most of us have heard about a 401k. It was probably the most popular retirement account type. A solo 401k is a 401k that is strictly designed for [00:32:00] solo business owners. So, the idea is you’re only making a contribution on your behalf and you don’t have any employees.

With a solo 401k, we have that overall contribution limit again at $57,000, but there are two parts to it. So it’s a little different than a SEP IRA. There’s the employee contribution, which would be $19,500 for one year and there’s also the employer contribution. And with the employer contribution, you have that exact same percentage. You can contribute 20% of your net income or 25% of your salary if you’re paying yourself a salary. So those two numbers, $19,500 plus the 20% or 25% will make up your overall individual contributions limits.

So, this account, if you suddenly have a really [00:33:00] high income, so let’s say you went from earning $80,000 net income to $160,000 net income, with the SEP IRA example, you’d be able to put away $32,000 in a year, but with the 401k example, that same $160,000 net income, you’d be able to put away significantly more. You’d be able to get to $51,500 for the year.

So you can see, opening the 401k is a really great idea if you know, suddenly I have had a great year and I’d like to do something with this money that’s going to save you on taxes and set me up for success in retirement.

Dr. Sharp: That’s an important distinction. Question, does a solo practice owner have to be registered as an LLC [00:34:00] to qualify for something like that or can sole proprietors do a 401k? It seems complicated.

Ariel: A sole proprietor can do a 401k and SEP IRA as well. I think that’s an important point. The 401k paperwork-wise is a little more complicated and maybe thinking through how am I going to make this total contribution happens since there are two parts of it. And that’s where having a CPA can help you with coming up with the numbers on like, this is what you’re eligible to contribute to these two parts, and then a financial planner or investment advisor can help you get the account set up. The accounts set up, maybe it’s the part that’s a little more complicated in the SEP-IRA. There’s a lot of questions on the forum on how you’re going to structure the 401k, but the good news is once you get it set up, it’s pretty easy from there.

Dr. Sharp: Got you. We’ve talked before on the [00:35:00] podcast about S corps versus LLCs, and I’m assuming S-corp is eligible for all these.

Ariel: Right. S corp is also eligible. And that the thing that changes about the S-corp is now your employer contribution amount is based on your salary versus your net income. So, you’ll be able to give yourself 20% to 25% of your salary as a contribution if you’re an  S-corp.

Dr. Sharp: Got you. Okay. I know we’re throwing around a lot of numbers and it can be easy to get lost in the numbers, but I think at least the takeaway, please correct me if I’m wrong on this, but the takeaway here is that for a solo practice owner,  a SEP IRA is a great place to start. A solo 401k would likely allow you to contribute more to retirement if you were in a position to do that.

Ariel: That’s exactly right. Yeah, a SEP IRA is it’s the easiest [00:36:00] place to get started regardless of where you are in starting your business. And then the 401k is the next step up. I’ve done the SEP-IRA and now I’m in the 2nd or 3rd year of business and things are great, I have a lot more I can contribute. So probably, the 401k is going to allow you to contribute more than the SEP-IRA.

Dr. Sharp: Got you. Maybe this is a good time to ask something that maybe I could have asked earlier, but I feel like when I was waiting into all of this on my own, and I often Googled how much should I be saving for retirement? And I couldn’t be remembering. It’s been a while, but I feel like the ballpark was always something like 15% of your income. And I don’t know, is that even accurate? How should people conceptualize how much to be trying to save for retirement?

Ariel: Right. It is kind of a tricky question because that percentage amount is going to [00:37:00] depend on how far are you from your retirement deadline? How much do you already have saved? And then also, we haven’t even got into it, but in terms of investing, how much risk are you willing to take on? I think that ballpark, I haven’t dug into that, but just based on the math, that ballpark would have to be for someone who is in their 20s.

So sure, if you’re in your 20s, you can get away with putting away 15% of your income and probably turn out just fine by age 60 or 65.

I think it probably depends on how old you are in terms of what your percentage is, and also, like I said, how much do you have set aside? I think a better ballpark would be that if you’re in your 30s, probably trying to aim to save 25% of your income for retirement. If you’re in your 40s, you’re going to need to bump that up to closer to 30 or 35%, when you’re in [00:38:00] your 50s, assuming you don’t have anything saved or you have like maybe a few hundred thousand, you’re going to have to get more aggressive.

So it depends on where you’re at on progress towards retirement, but I personally feel like the 15% number is pretty low for anyone who’s not in their 20s.

Dr. Shrap: Sure. That’s good to know.

Well, let’s move to group practice owners then. How do the options differ once we have employees?

Ariel: Okay. A group practice owner can have a SEP IRA. They can also have a 401k. And then there’s this third option that sometimes makes sense called the SIMPLE IRA.

What you want to think about as a group practice owner are first of all, how many employees do you have? How long have they been working for you? Are they full-time or part-time? So all of those factors will help you come up with [00:39:00] which of these retirement plans is going to be right for my group practice. And a lot of the decision on whether or not you’re going to have employees participate in the plan comes down to what’s the overall cost going to be to the business because, with all of the plans, there is some element of the employer contribution on behalf of the employees.

So, if you choose one of these plans, you’re going to be really cognizant of what’s the effect of the bottom line. Is it going to allow me to personally keep running this business and keep saving for retirement and the way I need to save for retirement? To break it down, going back to the SEP-IRA, which is the easiest one, again, even if you have employees, it’s the easiest one to set up. The downside of that is whatever percentage you contribute for yourself, you also need to do for employees, right?

Dr. Sharp: Yes.

Ariel: So you may not do, if you’re contributing 20% of your income, you may not also be able to afford to do 20% to 25% of your [00:40:00] employee salary.  And as I mentioned with that one, you do have that three-year runway were as long as employees haven’t worked for you for more than three years, they don’t get to participate.

Dr. Sharp: Sure. I think that’s important to highlight. I’ve definitely talked with practice owners who were caught unaware of that stipulation I suppose, or guideline and found themselves in a really tricky financial situation because they all of a sudden had to contribute whatever percent.

It was 15- 20% of their employee’s salary and they didn’t know if that was going to happen.

Ariel: Right. So it’s always good to start thinking about what you want to do. If you’re participating in the SEP-IRA, how are you going to pivot when your employees suddenly become eligible for it?

Dr. Sharp: Right.

Ariel: So the 401k example, with the 401k, your employees [00:41:00] would become eligible to participate in that type of plan after they’ve worked for you for at least 12 months and are also working more than 20 hours a week. So there are two parts of the eligibility there. And the same idea, if you are making a 15% contribution as an employer for your own account, you’re going to need to do the exact same amount for your employees. So 15% of their salaries.

The other part of having employees with a 401k that gets kind of tricky is this idea of, there’s this IRS testing that is basically determining if you have this 401k plan set up, how fair are the contributions being made to employee accounts. How even is it between owners or high-income earners and the employees you have who maybe aren’t performing as high of an income?

There’s a way around that which is the Safe Harbor contribution. So matching contribution up to [00:42:00] 4%. So, when you think about a 401k and allowing employees to participate, you should be thinking about contributing at least 4% of their pay so that you can avoid all this extra testing and work that goes around operating a 401k plan.

Dr. Sharp: I see. That’s important.

Ariel: Yeah. So, with the 401k, employees have the same personal contribution they can make with which is $19,500. And then you may also be if they’re eligible, they may now get that $1 for $1 match up to 4%. So that’s what you want to factor in. If you’re going to operate the 401k, you may want to consider that that’s going to add about 4% to the salaries that you’re paying employees right now.

Dr. Sharp: Okay.

Ariel: So again, with the 401k, the good thing about it is that for you personally, as the employer, it’s going to allow you to put away at least $19,500 a year, even if your employees are contributing. So it gives you that higher dollar contribution with maybe a lower cost [00:43:00] on the employer contribution side since you know you’re limited to 4% of their salaries.

Dr. Sharp: Fair enough.

Ariel:  And then the third type which we haven’t talked about yet is the SIMPLE IRA. The SIMPLE IRA is kind of the in-between the SEP IRA and the 401k in terms of the cost to you as the employer, and then also the amount that you can contribute personally.

With the SIMPLE IRA, kind of like the 401k, you have the two contribution parts which are employees and yourself as a business owner. You can put in $13,500 per year into your own account. And then there is that employer contribution part, which is typically what most people do is a dollar for dollar match up to 3%. The SIMPLE IRA does require to require you to make a contribution.

And so the dollar for dollar match up to 3%, is a lower [00:44:00] potential cost to you as the employer than the 401k since you know you’re going to max out at 3%. The other part of it is that with the SIMPLE IRA, it is up to your employees to go set up their accounts. So they really have to take the initiative to go set up the SIMPLE IRA, get you the information, tell you that they want to participate when they’re eligible.

And so what I usually see is that this is like if you want to contribute as a group practice owner, but you don’t necessarily want to take on this huge cost of making employer contributions for your employees, the SIMPLE IRA is a good sweet spot because it takes a lot of employee incentive to get started, and you’re also limiting your costs to a dollar for dollar match up to 3% of pay if employees actually do participate.

Dr. Sharp: Right. Yeah, go forward.

Ariel: And one other [00:45:00] important thing. So with the SIMPLE IRA, your employees can work for you for two years before becoming eligible. Again, it’s right in the middle of that SEP-IRA and 401k in terms of who’s eligible, what you’re contributing, et cetera.

Dr. Sharp: Right. I know we’re getting in the weeds a little bit with the details of these plans, but I think it’s important because this is something that comes up so much, especially these days for group practice owners, there’s a lot of talk about how to make our offers more competitive for employees. We have a lot of competition- companies that are trying to hire therapists. And so, having, having a good sense of what we can offer as practice owners is important.

We, as you know, ended up landing in the SIMPLE IRA territory. That may be fairly permanent. I don’t know. We may be on the way to a 401k. I’m not sure, but it [00:46:00] is a nice intermediate step to offer something, but not a huge impact on the bottom line.

Ariel: And you talked about two important points, which is as the business owner, it’s important that you have a really good understanding of what is available to me to offer to my employees because ultimately understanding these plans if you start a plan, it falls on your shoulders. So it is important to do your research before you start offering one.

And then the second part that you just mentioned, which is that you want to be competitive but you also want to know what your cost is going to be. So having a good understanding of how it’s going to fit into your long-term budget is important as well.

Dr. Sharp: Right. Yeah, I think that’s a trap that a lot of practice owners get into. This is a bigger discussion, but just paying employees too much or maybe just generally not having a good sense [00:47:00] of their numbers and what we can afford to pay our employees or what we can contribute and benefits or any number of other things and then eat into profits or revenue, right?

Ariel: Yeah, definitely, it takes some planning and thinking through what is it that you’re trying to build? What’s your long-term goal there?

Dr. Sharp: Yeah, that’s a really good way to put it.

Let’s see, what else is there to say about retirement planning either for solo or group practice owners?

Ariel: I think the other important thing about retirement planning is what are you going to do with the money once it’s inside this SEP-IRA, 401k, or SIMPLE IRA.

There is a lot of information and noise out there about investing. You don’t want to just put this money in your account and let [00:48:00] it sit in cash because ultimately the goal is that the money that you contributing now is going to grow so that you have an income in retirement, and hopefully it’s growing more than inflation, which you expect to be around 3% in the long run but really it’s growing even more than that.

For most people, the goal might be to get a 7% return or something anything close to that so that they have money in retirement and they can rely on it for the rest of their life. The easiest way to get there for business owners is having some sort of investment plan that includes stocks or bonds, which I understand, that’s a whole new topic we’re switching to here, but that’s the other important part. Once you have the money in there, what are you going to do with it? How are you going to invest it?

[00:49:00] Dr. Sharp: Yeah, that’s a great question. I would have skipped over that whole part because I just assumed that people kind of knew, when you say for retirement, the idea is to put it in an account that will grow and earn interest over time. It’s not like you’re pulling that money out of the account at any point. It’s like you put it in and you forget it and make sure that it’s in hopefully an interest-bearing account or fund.

So let’s dig into this a little bit. I’m trying to think of how to ask the questions. When people think about investing, I have friends who ask these questions, which is funny to me, but I have friends who were like, which stocks should I invest in? And my understanding is that that’s maybe not the best approach to retirement investing. Is that fair to say?

Ariel: That’s very fair. [00:50:00] So with retirement investing, starting with stocks- that’s a good place to start, but it’s the idea of how are you going to just pick one stock and put all your bets on that one stock. This one company is going to take me all the way to retirement and it’s going to be amazing. That scenario is pretty unlikely. We can look back at stock market history and see that the stocks from 50 years ago aren’t exactly, maybe they aren’t around now or they’ve gone out of business or they’re not doing as well as they used to.

So with investing, especially, if you’re investing in stocks, the approach is the more companies you can invest in, the more stocks you can buy at these companies, the better off you’re going to be in the long run, the smoother your growth is going to be. What I mean by that is that, if you go back and look at the stock market over a long period of time, it’s an [00:51:00] upward slope. If we go back and look at the history of an individual stock, we make may see that it’s more of a jagged climb up. And maybe, in the long run, the stock is still increased in price, but you had a lot more volatility or changes in price over time.

So ultimately, the more you can place your hands on these different companies on how they’re going to do, the more likely you are going to get to that 7% to 8% return that you need over the long run. I think this is the question that a lot of people get. There are so many options out there, where do I get started? Maybe it’s just easier to put it in cash. So that’s why I brought up that point and don’t just put it in cash. Don’t just put it in something that’s easy.

One easy approach is looking at buying an Index fund, which would be [00:52:00] a mutual fund where multiple people have put their money together into this fund so that they can buy a whole bunch of different companies. What the index fund part means is that you are going… the manager of that fund is going out to an index like the S&P 500 or it might be the Russell 2000 and buying every available stock on that index.

There’s not a lot of magical stock-picking or say that I have some special insight into these companies, you’re just going, this is what’s available. I can buy a whole bunch of companies at once. Let’s put them all in this mutual fund basket container, and you as an individual investor can participate in that mutual fund by buying shares. So what you’ve done now is by buying a few shares of this mutual fund is you’ve now taken part in everything that’s available in the S&P 500 or the Russell 2000, whatever it is that that index fund represents.

The ultimate idea is that you’re taking this investment money and invest it in a lot of [00:53:00] available companies out there versus one or two that you have some special insight about.

Dr. Sharp: Yeah, which is nice because it’s like they do the work for you and you don’t really have to do anything. I mean, it’s as maybe sounds complicated as we explain it, but literally, when you sign up for these plans, they ask you what fund do you want to invest in and you just pick it and that’s it, the money goes into wherever it goes and someone makes sure it buys that fund and you don’t really have to do anything.

Ariel: Right, it’s pretty straightforward. And depending on what company it is, Vanguard is a great option and they have a lot of educational pieces out there if you want to read more about what you’re investing in. And theree’s a whole lot of guides to help you walk through the questions that ultimately will get you to what type of investment is best for me or which of these mutual funds should I be investing in?  So, Vanguard is a great place to [00:54:00] look for information on that.

I think that the question could I have a lot of clients that you’re asking about, we have heard so much about Beanstalks and people making tons of money on these individual bets. I think ultimately the thing with investing is not getting carried away with what’s on the news, whatever the hottest thing is right now, that’s where we can go wrong as investors is getting swayed by what the media thinks is going to happen next or what 10,000 people on there on the internet have told us is the next hot pick.

It’s really taking a long-term and very diligent approach to investing. Index funds, easy way to do it, easy way to stick with an investment plan as well.

Dr. Sharp: Yeah. I’m glad that you brought that up because I think like you said, these days, all that stuff is in the news and it is so easy to get [00:55:00] wrapped up in like how can I jump on and find the next thing that’s going to make a lot of money in a short period of time. Maybe it’s like some sort of cryptocurrency, maybe it’s these meme stocks. And if you don’t know what that means, that’s totally fine. But these stocks shoot up like crazy because of manipulation. It’s like shiny object syndrome, I think. This is my flaw, I don’t know, unless you have a really, really good understanding of what you are getting into, it’s not really something to like dabble in. I don’t know unless you’re just like very risk-tolerant and you’re willing to say like, hey, I might lose every single bit of this money. I’m just kind of playing around, you know?

Ariel: Yeah. That’s the exact right approach. It’s fine if you want to participate and see what happens, but it’s really [00:56:00] limiting your investment in individual stocks or whatever the hottest trend is to what you can afford to lose.

And I think another thing to think about when we’re watching what’s happening in the news and watching all of our friends make money on these amazing stock picks they made is coming back to like, what is my long-term plan and how do I have a way to get there? And if you can remind yourself, “My long-term plan is retirement. I’m already invested in the XYZ Index fund. That’s projected that it’s going to get me to where I need to be. Why do you need to grasp after this investment? You don’t need to because you’re already on track. You’re already on the track that’s going to get you where you need to go. You don’t have to take the risk to potentially into that 1% chance you’re going to become a multimillionaire overnight. That’s not going to happen because, in the long run, you’re on your path to becoming a [00:57:00] millionaire by putting away money consistently and stayed invested.

Dr. Sharp: That’s so tough. I mean, retirement savings is not sexy, it is not rewarding. It’s like the ultimate long-term reward, delay gratification, but it generally works.

Ariel: That’s the thing I always say about investing. The investing you need to do for retirement is very, very boring and that’s just all there is to it.

Dr. Sharp: Sure. I’m glad that you highlight that. And that’s okay. If people are feeling bored with it, that’s totally normal and that’s fine.

Ariel: Yeah.

Dr. Sharp: I did want to talk just a little bit before we wrap up about the other components of retirement. So, there hopefully might be social security when we retire. I say we people in their 40s, and [00:58:00] some of us might have the option of selling our practices as well. Let’s start with the selling the practice thing. Have you seen many practices or practice owners who have actually been able to do that and have it be some kind of meaningful contribution to their retirement income?

Ariel: I have not had the experience of going with the client through that process yet. Definitely, it is a possibility out there. The way I would approach it as a financial planner in terms of, what is the retirement plan look like if you have this business that you could potentially sell is, you don’t want to have all your eggs in any one basket. You mentioned social security. For those of us who are not close to retirement, it does feel a little iffy whether or not it’s going to be there.

For myself and other people my age, I would not be reliant on the [00:59:00] fact that social security is going to be that stable and therefore USA retirement income source. The same thing with the investments you’re making for retirement, keep doing that and keep doing it consistently. But then again, let’s not put all of our hopes and dreams on that one retirement account supporting us through retirement.

And the same thing with this business that you potentially could sell. Hopefully, you can sell it. It’s going to be an additional either product money you can put into your investments, or maybe alternative you say as the owner and you have a really great management team and you’re able to keep collecting income from it. But ultimately, looking at selling the business as just a piece of the overall puzzle, so sure it can be done. And if you build your business in a way that somebody else wants to take it over, that can be an amazing source of income for your future retired self.

[01:00:00] I think that just overall, I would approach it as one of the parts of retirement, not I’m going to build this amazing business and hope that somebody wants it in the future as well.

Dr. Sharp: Sure. That makes sense. What are your thoughts on some of the emerging technologies around investing? I’m thinking about things like Wealthfront or Robin Hood, like app-based investing. I feel like I’m hearing advertisements for that stuff all over the place and haven’t really looked into it much. What do you think about some of these options?

Ariel: The two that you mentioned, what’s great about them is it’s gotten a lot more people interested in investing in this idea that you can put your money to work for you by buying into different companies. I think that element of it is really great that more [01:01:00] people are interested in how the stock market works and how it can help them build long-term wealth.

Particularly with Robin Hood, with that platform, from what I understand about it, you can buy portions of individual stocks. If you only have $100, you may be able to buy 5 or 6 or 20 different companies with that $100. And so, you’ll get a little bit of diversification for a little bit of money. I would look at a platform like Robin Hood, is it a place to put play money, maybe not for retirement, but if you want to see what you can do to try out some different ideas you have about companies out there that you think may take off in the future, that’s probably a good way to do it with a little bit of money.

The other platform, you mentioned Wealthfront, and then there’s another one that’s similar to it, which is Betterment. What I like about Wealthfront and Betterment is that, if you’re someone who isn’t [01:02:00] working with a financial advisor or financial planner, those two platforms offer a way to have a really well-diversified portfolio and also have automatic contributions to take a hands-off approach to investing. So you can go through their questionnaire and tell them all the details about your finances and your feelings of the stock market and whether or not you’re willing to go through the ups and downs and they’ll spit out and create for you a portfolio that matches up with like your timeline, how much risk you’re willing to take on and what you need to happen with your money. All you have to do is set up the account, start making automatic contributions and they take care of the investing, keeping your account balanced. And they’re pretty low cost.

So something like that, Wealthfront, Betterment, Robin Hood, they can take care of the investing part. The other [01:03:00] part that goes alongside that is getting personalized financial advice. So that might be the only part that’s missing. But if you’re looking for a way just to get started in investing without having to learn everything about it, it’s a really great way to get started.

Dr. Sharp: That sounds good. I appreciate you talking through that. And just to say, I think everything has its place. It sounds like everything has its place and it depends on what you might need. I know I’ve said this already, but for us, having someone to talk back and forth with and bounce ideas off of, and to have you say, no, don’t do that. Let’s do it this way. Just giving us clarity and peace of mind was super valuable for the part of life that we were in. That was, that was really helpful. So it just depends on, on what people might need.

Ariel: Yeah, exactly. Everybody has a different need in terms of financial advice and it’s great that in this new world we’re living in, there are [01:04:00] options for people to start building wealth with specifically investing in stocks without having to pay hundreds of thousands of dollars over their lifetime to get the sale financial result.

Dr. Sharp: Sure. Well, this has been good. I feel like we covered a lot of ground. Hopefully, folks have a better understanding of investment options and why it’s important. If people want to reach out to you or get in touch with you, where can they find you?

Ariel: Sure. One option is you can email me directly at ariel@abacuswealth.com or you can go to our company’s website, abacuswealth.com and we have a get connected site, so filling out that form would connect you with the team of financial planners at Abacus Wealth.

Dr. Sharp: Cool. Well, thanks again. It’s good to see you.

Ariel: Thanks [01:05:00] for having me on. I enjoy being here.

Dr. Sharp: Okay, everybody. Thank you so much for checking out this episode on financial planning. I hope that it was helpful. I know for me that I wish I had had this information 7 or 8 years ago when I was in the beginning phases of my practice or gosh, even 12 years ago when I started my practice. My goodness. I was so lost with finances for the first two years. So hopefully, you found some helpful information here, a couple of resources in the show notes for you to check out including Ariel’s contact info and a book that she recommended as well.

If you have not subscribed to the podcast, I would love for you to do that. If you have, I would love for you to tell a friend or two about it so that we can keep spreading the word and getting more people hooked up with quality information about testing and assessment. [01:06:00] I will be back with you on Monday with another clinical episode, so stay tuned. Enjoy your weekend in the meantime.

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 [01:07:00] host or guests of this podcast and listeners of this podcast. If you need the qualified advice of any mental health practitioner or medical provider, please seek one in your area. Similarly, if you need supervision on clinical matters, please find a supervisor with expertise that fits your needs.

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

This episode is brought to you by PAR. The Feifer Assessment of Writing examines why students may struggle with writing. The FAW and the FAW screening form are available on PARiConnect. PAR’s online assessment platform. Learn more at parinc.com\faw.

Hello, and welcome back everyone. I am thrilled to be here with you today as always, but specifically, today because we have another happy hour episode to share with you. Now, you may have caught the first happy hour episode back in February, I believe. And if you did catch that episode, you know that [00:01:00] this format is meant to be an informal casual conversation among friends and colleagues about everything: personal stuff, professional stuff, testing, non-testing. And I am really excited to share this one with you as well. I think we’re going to try to make this a regular occurrence, once a quarter or so, because we have such a good time talking with one another and hopefully the rest of y’all find this helpful and engaging as well.

As always with relatively new formats like this, please let me know, give me some feedback if you like the happy hour format or not. But my guest today, Dr. Chris Barnes, Dr. Stephanie Nelson, Dr. Andres chou, and Dr. Laura Sanders, again, are back to have a wide-ranging conversation about any number of topics in and out of the testing world.

Some of the things that we talk about are aspects of our testing [00:02:00] process that we feel most confident in. We talk about translating our processes so that our admin staff and assistants can understand and help us. We talk about what to do and how to handle it when we may have been “wrong” in the past with our assessment results. And we talk a little bit about the difference between self-compassion and self-care. So, those are just a few things. There are a number of topics that we get into. My hope is that he might enjoy all of them.

Now, if you are looking for CE credits for your license, you can check out The Testing Psychologist podcast episodes over athealth.com. Just search The Testing Psychologist and you should be able to find most of the clinical episodes there.

[00:03:00] All right. Without further delay, let’s get to this happy hour episode with my friends and colleagues, Dr. Chris Barnes, Dr. Stephanie Nelson, Dr. Andres Chou, and Dr. Laura Sanders.

Hey, welcome back everybody. I am so happy to be here for another happy hour episode with some of my favorite psychologists in the entire world. So, like I said, in the introduction, if you did not check out the first happy hour episode from several months ago, go check that out. I’m guessing we’re going to refer back to some of that discussion, and it’ll give you a sense of these fine folks’ personalities as well. But here we [00:04:00] are for another happy hour episode. We’re just going to roll with it and talk about whatever comes up.

For anybody who maybe doesn’t know or didn’t listen to the last episode, let’s do some brief introductions. Chris, you want to go first?

Dr. Chris: Sure. Chris Barnes here. Kalamazoo, Michigan. I’m a clinical psychologist. And based on our last appearance, I’m really excited to see where this one goes.

Dr. Sharp: Oh yes. Andres.

Dr. Andres: Andres Chou here in Pasadena, California. I’m a clinical psychologist. I’m just here to make everyone uncomfortable.

Dr. Sharp: Great. I’m looking forward to that.

Dr. Stephanie: I’m Stephanie Nelson. I’m in Seattle, Washington. I’m a pediatric neuropsychologist. I have a small clinical practice and a growing consultation practice.

Dr. Laura: I’m Laura Sanders. I’m a licensed psychologist in Colorado and in Texas, and [00:05:00] currently in Colorado.

Dr. Sharp: We’re in the same town, Laura and we still haven’t seen each other in person.

Dr. Laura: I blame you.

Dr. Sharp: That’s totally fine. I’ll accept that blame.

Dr. Andres: It’s by design.

Dr. Sharp: I’m already uncomfortable.

Dr. Andres: Welcome to my life.

Dr. Sharp: Okay. So that just makes me reflect back. I think we talked, it’s been almost six months since our last episode, and that really is sad that we still haven’t seen each other in person. Things have changed since then in some big ways. I think a lot of people are vaccinated and that’s changing some things in our lives, but I’m curious for all of you, what has been happening over the last several months. Have there been any big changes in your practices or otherwise [00:06:00] that you want to share?

Dr. Laura: I’ve gotten back into the office, one day. I’m starting two days a week next week. I’m excited. So I’m starting to see people in real life again.

Dr. Sharp: And is exciting.

Dr. Laura: It’s been nice. But it’s also been an adjustment.

Dr. Sharp: Sure. You were doing remote for a long time, right? You’re one of the last people I knew of to go back into the office.

Dr. Laura: I’m liking staying at home all the time. I’m not going to lie.

Dr. Sharp: It’s remarkable. How’s it been to be back in the office?

Dr. Laura: It’s been nice to have that actual personal interaction in real-time, face to face, but it brings up a lot of doing your mask, if you’re not masked, how far apart do you sit? Then how do you structure things? [00:07:00] So I had to rely on the wisdom of others.

Dr. Stephanie: How have you been doing that?

Dr. Laura: The people I’ve been seeing in the office have mostly been kids. Usually, the parent comes in, we talk, the parent leaves, and it’s just me and the child in there for the bulk of the time. And two times we have unmasked because they were eating continuously or something else happened, and then you have to leave the office, then we put the mask back on. And it feels okay. I’ve got two things running to purify the air. It’s just that setup. It feels okay but also very strange.

Dr. Sharp: That’s a good way to sum it up, okay but strange. That’s similar to what we’ve been doing as well. It feels weird to take the masks off, but also okay. What [00:08:00] about the rest of you? How have the last few months been?

Dr. Chris: I’m going back. Oh, I’m sorry. Go ahead, Andres.

Dr. Andres: I was just going to say, it’s just so crazy. It feels like time flew by so fast. I mainly do therapy, so I’ve been seeing people ever since I got vaccinated and then I gave the option for my clients to come in in person. We’ve been messed up. I had air purifiers going on. My office is big enough that we could sit far enough apart, but just recently with the new CDC guidelines, I’ve been giving clients the option of, I don’t check their records. I just can’t take the word for it. If they feel comfortable to unmask. It’s been fine but it’s weird because some clients have actually never seen my face in person. So they were like, whoa, you’re not what I was hoping for. [00:09:00] What happened? You look better online.

But then the weird thing for me has been testing. And when I do testing, the few times I have done in-person testing, I don’t do a whole lot of testing, but we have worn masks. And then I had this encounter this week where we did an interview with our mask and we were distanced enough, but then I had to come up close for some testing, and then I was like, oh shoot. We didn’t really think this through like, do they need to be masked? Do I need to be masked? And so I just kept mine on for the sake of the client. And then I started thinking like, oh, were they nervous about it? You can’t help but feel a little weird that this thing you’ve been doing for months and months and over a year now you’re not doing it.

So it’s weird, and at the same time, it’s [00:10:00] just interesting. I’m just realizing collectively the experience. Each time I think about it, each time something like this comes up, I think about the collective experience that we all get it. And we have very few experiences like that, right? Like, oh, wow, you can talk about the weirdness of the mask. Everyone goes, oh yeah, I get that. Yeah. So that’s been here. It’s slowly going back to normal, but it’s still weird.

Dr. Stephanie: Andres, you should also clarify that the reason you’re not doing much testing right now is that your therapy practice has really taken off. You’ve really built this thing over the last year and now you’re almost overfull, right?

Dr. Andres: Yeah. It’s funny because my story is that I never intended to be an assessment or testing psychologist. I always thought it was interesting. [00:11:00] In fact, in grad school, it was the topic that I struggled with the most. I remember my professor just looking at me once during a pop quiz. I don’t like that she gave us a pop quiz first of all, and then she had the look of dread that I not getting this and maybe that’s carried on a little bit still.

So I never intended to, but looking back half my training has literally been in assessment. It just worked out that way. And the good chunk of my professional career has been in assessment. And so, I thought that would always be a part of it. And then things just change and you go with it. Exactly the therapy practice has been really building up and it makes sense too. There is a lot of need right now.

Dr. Sharp: That’s fantastic. First of all, though, [00:12:00] who gives pop quizzes in grad school? Did anybody else do that? That’s just silly.

Dr. Andres: It’s cruel. We give pop quizzes to our clients in testing though. Here you go. Pop quiz. Here are some blocks.

Dr. Sharp: That’s a good point. It’s just 27 pop quizzes all in a row. This is true.

Dr. Stephanie: Chris. I feel like last time you were also talking about the balance of testing and therapy that you were doing. What has been happening for you over the last two months?

Dr. Chris: Over the last few months, I’ve gotten a tremendous influx in referrals for testing. And it was interesting because I got a new office administrator, probably February/March, and I said, no new testing until June. Well, here we are in June and I looked at my calendar next week and I have 15 intakes for assessment. And I’m just like, I should’ve seen that one coming. I should have looked at that probably 2 or3 weeks ago.

So now we’re in the process. [00:13:00] I met with her two days ago. We went out to a Brewery and had our first retreat. And I was like, we need to work on this. We need to figure out how we’re going to accommodate this because I’ve been all virtual. And so, I’ve been using an abbreviated battery, which I’ve been able to accommodate just pretty quickly, but now I’m going hybrid next week. So I’m doing intakes and feedback via Telehealth, but I’m going to start collecting data in person.

So unless I can break this popular space-time continuum, we need to figure something out there. And simultaneously, I’m having this idea that I don’t like testing anymore. I do enjoy it, but it’s not scratching my edge like I thought it would. And so, I’m in this weird spot where I have this huge funnel of clients and the business is doing great, but I’m just not loving it.

So I’ve been doing a lot of soul searching over the last few days, weeks, et cetera, to figure out what’s going to happen next. But I’m hoping to be getting back and the in-person data collection is going to change some [00:14:00] of that because that’s the piece that I enjoy is interacting with the client, having that back session with parents or the client themselves, and creating some lexicon of understanding of where they’re at. But seeing 15 intakes in one week, that makes me sick to my stomach even just saying it out loud for the first time.

Dr. Sharp: So you’re not booking any more intakes until September, right? That’s a summer’s worth of evaluations right there.

Dr. Chris: Yeah, that is ridiculous. It is what it is. And it’s like poor management on my end. I’m seeing that was like totally poor management and my side. My admin was just following the rules. No new intakes till June. And here we are.

Dr. Stephanie: That’s the best part about getting an admin, as you suddenly realized, there’s a lot of stuff in your head that you maybe haven’t put out there yet to the world.

Dr. Chris: Sometimes we only think two or three steps into the process, not five.

Dr. Sharp: Right.

Dr. Chris: So that’s my Mess for the next 10 days is figuring out how we’re going to manage that and not piss too many people off along the [00:15:00] way.

Dr. Sharp: That sounds like a nice problem to solve.

Dr. Chris: It’s definitely.

Dr. Sharp: What about you Stephanie? The last time we talked, we talked about your consultation has ramped up and clinical. Is the consultation still a big part of your time?

Dr. Stephanie: It is. It is becoming more of a part of my time. I’ve been able to reduce my clinical work a little bit so that I can start ramping up some of the offerings that I’m able to do. I get a lot of requests for a group consultation experience or people asking if they can buy things that I’ve been putting out there somewhat for free. And so, I’m going to start making those available and I’ll have more time to keep my blog up and going and offer some things like that, which I’m very excited about. I’m also in the process of downsizing my house [00:16:00] and moving and changing my office and all sorts of other things. So, we’ll see. I have big dreams. We’ll see how well I’m able to translate those out into the real world.

Dr. Sharp: That’s so exciting.

Dr. Stephanie: It’s great because the consultation is amazing. The people that I consult with are brilliant and lovely. I can’t believe that I get the opportunity to work with psychologists from all over the country. I wake up excited to talk to these people and to hear about their challenging cases and what’s going on with our lives. So it’s really amazing.

I think Chris, I was in the space that you were in where you’re starting to get a little bit concerned for burnout for yourself are concerned about, is this all that I can be doing right now? Am I going to have a stroke giving the WISC for the 247th time? And you start [00:17:00] thinking about some of those types of things. To be able to have this new invigoration and excitement about your career again has just been amazing. I assume, Jeremy, this is a little bit how you felt when you started the podcast and changing your direction a little bit of this new excitement for a profession that can sometimes drain out up a little bit.

Dr. Sharp: Yeah, absolutely. I love the idea that we can do so many things with our knowledge. The trick though, is that we don’t really get taught that in grad school, which is fine. Grad school is for clinical stuff and mastering our craft. I would love for there to be a few more courses or some education on outside-the-box ways to do psychology. I love that you’re finding your way into that, and many of us are finding our way into that, but yeah, it is exciting. [00:18:00] It’s like, oh yeah, I don’t have to sit in this chair and give the WISC until I keel over. There are other things to do.

And I think, I don’t know, this is maybe going down a rabbit hole, but I’ve been paying a lot of attention to just the surge in technology and mental health startups and all that kind of thing. It hasn’t really reached testing yet that I know of, but to me, that’s just more opportunity. I think the next 5, maybe 10 years, it’s going to be crazy. There’s going to be a lot of different opportunities for us to use our knowledge and who knows, consult on app development or a bigger company. I don’t know. Who knows what it’ll look like. But I like that that door is open.

Dr. Andres: That reminds me of what’s been going around is there are those online screeners for ADHD that they’ll give you a [00:19:00] diagnosis. I don’t know why companies, I don’t want to name them, but it’s coming. I don’t know how valid those things are or reliable or all the above, but where there are opportunities, people are going to try to fill that.

Dr. Sharp: Right. I think it’s the same process that we all do clinically. We’re trying to solve problems for people, right? And this is just another problem. Like there’s a problem that you can’t get an assessment with a qualified person for a year. That’s a problem without paying however much to do so. And it’s not surprising that there are companies that are stepping in and figuring out how to solve that problem in a way. I don’t know if it’s the best way, but that’s what it’s about. So, if we can think creatively, [00:20:00] I’m sure we can solve some of those problems too.

Dr. Stephanie: I love how optimistic you are, especially because the colleges are known for dragging in their heels. Remember how many of us were like, I’m never doing anything online, not even intakes and feedbacks. And then finally a year into the pandemic, we’re like, well, maybe. So I love that you think that we’re all going to be able to rush in and fill this void. But if there is a silver lining to the pandemic, it might be that it has forced us to do some things that we thought we would never do. And that we’re actually starting to look maybe in the direction of change and growth and technology.

Dr. Sharp: Sure.

Dr. Chris: A tremendous exposure therapy process, no doubt. We’ve been forced into it. We’ve had to figure it out. Orange jumpsuits probably aren’t going to happen with the decisions we made, but we’ve had to pivot from some of the things that we’ve done. We just get so stuck in our ways [00:21:00] I think

Dr. Andres: Well, jumping on that. The thing that I’ve been able to walk away with, and I think through the help of some of the guests on your podcast, Jeremy, and just discussions we’ve had in the Facebook group and just even my own process is, how much of, maybe because where am I in my career, I relied so much on like, am I administering this straight battery?

Don’t get me wrong, norming, standardization, testing are all very important, but then the reason why people pay us money to do what we do is not to give them tests, it’s to analyze the data and to assess and interpret. And we can’t forget that. And being forced into the situation, we agree on what’s the minimum we can do and still do our job,? Like using the technology and just realizing that [00:22:00] the tendency to over-rely on measures to get data that we could get otherwise. That’s been a real challenge and encouragement for me, like, okay. I know some stuff and that’s okay. I don’t have to have a measure for every single detail and even then, I think I forgot your quote, Chris, but the data is only as good as how you interpret it. I just totally butchered it.

Dr. Chris: It’s how you get the data, not the data you have.

Dr. Andres: Yes.

Dr. Chris: I also paraphrase my own quote, but whatever.

Dr. Stephanie: Listeners will have just listened to the previous one. That’ll be fresh in their head.

Dr. Chris: It’s funny, Andres, as you say that, it sends shivers down my spine, like, oh my God, am I doing this the right way? Am I not doing this the right way? I mean, there are right and wrong ways, definitely. But there’s this gray area that we have to get comfortable with. [00:23:00] And we’re trained to sit within that. I think we just throw our own stuff on top of it that makes it difficult for us to sit in that gray.

Dr. Laura: Yeah. And to figure out how not to overtop. We don’t need 48 measures of the same thing. Trusting that clinical instinct and all of that, that has been different going back into the testing office. I’m not giving the extent of the things that I used to get. I don’t know if that’s right or wrong, good or bad?

Dr. Sharp: Can you talk through your thought process in moving in that direction? How did you decide not to do that anymore?

Dr. Laura: That’s a great question. I think it’s been partially wanting to avoid exposure, right? So like keeping exposure a little bit shorter. So thinking about how to do it quicker. I don’t know that I have a good rationale, [00:24:00] but I think previously the tendency might’ve been to give several different measures, looking at the same thing to make sure that we’re seeing what we’re seeing. And I don’t know if it’s economical at this point. And I don’t know if it is helpful for the person. And I don’t know if it’s helpful for me. And maybe that’s fun out of having to pair down that battery and really focusing when it’s online.

Dr. Stephanie: I think we’re so trained that the numbers will tell the story and you’ll just be able to look at your test scores on your beautiful tables and it’ll just jump out at you. And that can lead sometimes to over-testing as well, because when the story doesn’t jump out, you’re like, well, I just need to give 17 more tests, and then it still doesn’t jump out.

I think we’re starting as a field to recognize that while testing is important [00:25:00] and it is something unique that we offer, testing is not synonymous with assessment and assessment is a bigger process. I think it’s Hasson Carrier who talked about the riot model, where it’s your records, your interview, your observations, and your testing. Testing is only one part of that. And we don’t necessarily need to make that 90% of what we do. We still get a lot of other information.

Dr. Sharp: Right. I did an interview the other day. I don’t know, depending on when this is released, if it will be before or after. So, I might be spoiling an episode, but we talked a lot about the realm of culturally and linguistically sensitive assessment. My guests talked about this concept of dynamic assessment and it’s like there are the norms and then there are not the norms. And there’s a lot of [00:26:00] assessment that happens outside of norms when you’re working with certain populations which it’s just one piece in the puzzle of my conceptualization of testing and how it’s evolving. And it’s like, what are we doing here? What are these tests actually telling us? How important is this standardization all the time? I don’t know. It’s these big questions, existential testing questions that I think we’re like touching on right here. We’re questioning our batteries and what’s that test…

Dr. Chris: Test essential.

Dr. Sharp: There we go. Yes, you heard it here first.

Dr. Andres: You know what’s been messing with me tremendously is when you find out how they do the norming. It just messes with me because then I’m thinking about a new test and I’ll look at the manual like a good psychologist should, but most of us often don’t. I will [00:27:00] look at it and go, oh, you know what? This has been with 99% white male college students, the norming and in somewhere in the Midwest and I’m here in a really diverse area in California. Does it apply? Maybe. And then we just go with it and we think everything’s fine.

So even the idea of norms is just like, again, I believe in standardization, I believe all norms are important. I’m not going away from that but we have to interpret that in context. But then when I read these manuals, I’m like, oh my gosh, the sample size was like a hundred people and I am just going to base it on this number? No way. We have to interpret it into context. And we have to confront that.

We’ve been talking about this a lot, like the imposter syndrome, like, wait, now I have to do the interpretation. I have to wrestle with the data, make this make sense in the context of this client, and [00:28:00] the criteria and all that stuff. And it’s very different from other fields when a technician draws blood and goes, well, it’s clear here, this is some disorder. We don’t have that luxury or the ability and then we have to go back to that. So it’s unnerving a little bit especially when you look at how these tests are developed.

Here’s another thing and I might be stirring the pot a little bit is a lot of the research on these measures are done by the people who make the tests. Huge conflict of interest. And maybe that’s just the way it is because there’s no funding for it but, of course, they’re going to release research that supports the use of their tests. And it’s still good research. It’s important but we have to think about these things a little bit. I don’t know. These are the things that keep me up at night. Yeah, I’m just kidding, but not really.

Dr. Stephanie: I think [00:29:00] you’re really hitting on the fact that the numbers do not tell the whole story and you can’t get rid of the numbers. We need those. You can’t do testing without some normative basis. But so much of what we do is so much more. And I was sitting here reflecting on the fact that we’re all at this point having the exact same conversation.

And I think something about The Testing Psychologist Facebook page has actually helped with that. Like people will put up cases and they’ll include some numbers that are de-identified and there are 40 different interpretations of them. And you realize like, oh wow, the numbers don’t. Like, if the numbers told the whole story, there would be 40 of the same interpretation. And there definitely isn’t. And so I think some of us being able to come together a little bit more as a field and looking at test scores from multiple different perspectives in that group has actually helped us start to question what we’re doing and how to make it deeper without losing the statistical and normative basis that makes it special. [00:30:00]

Dr. Sharp: Yeah. There’s so much to unpack here, I feel like. I mean, that idea that we use… Well, we have to keep in mind these numbers are not skills in and of themselves. They are proxies for these skills that we think we are measuring, right? And then it’s a whole other question of whether that even translates to the real world.

Dr. Stephanie: I’ve been calling them behavior samples. You’re getting behavior samples. And so, I was using an analogy of like, if you want to see if someone’s anxious, you might record them over a day and then just stop the tape at 10 different times and see if they look like they’re anxious at that time. Sometimes they will be and sometimes they won’t be, but you’re looking at the overall pattern.

And so, sometimes when people are trying to interpret, say, they’ve given a lot of executive functioning tests and there’ll be like, well, some of them are normal and some of them are impaired. How do I [00:31:00] interpret that? And it’s like, well, we have behavior samples. Just like a person wouldn’t be anxious 24/7, that doesn’t necessarily mean they don’t have an anxiety disorder. You’re getting these little snippets of how they approach executive functioning tasks. And some of them are going to be fine and some of them are going to be a problem. And you’re looking more at that pattern and how that fits with the referral question that they brought in.

Dr. Chris: And it’s kind of like a Costco when they have the samples.

Dr. Chris: We all just talk at the exact same time.

Dr. Andres: Okay.

Dr. Andres: That’s awesome.

Dr. Sharp: I’ll moderate. Laura, you go first.

Dr. Laura: I just was saying, that was beautiful. That made a whole lot of sense.

Dr. Stephanie: Thank you. Andres started with Costco samples.

Dr. Andres: Costco samples, right. If you’re going to buy a month’s supply of pizza, you better sample it and see if it’s good, right?

Dr. Stephanie: So you have to sample all the samples and decide?

Dr. Andres: Yes.

Dr. Sharp: What else? Chris.

Dr. Chris: You raise such a great point about the referral question. And I think that that is one of the, I don’t want to say it’s the [00:32:00] most important, but I do think it’s that initial lens that we have to start seeing everything through. When you’re doing your interview, you’re weaving and bobbing through, where’s the confirmation data, where’s the disconfirming data? And then the data we actually collect, the numbers that also we have to interpret, that’s either a confirming or disconfirming as well. So I just love the idea of refining the referral question. Hey, I want an evaluation. Okay. For what and why? And who really wants this? Is it the physician? Is it the parent? Is it the client? Is it whoever?

And I’ve really seen myself move towards refining that referral question even more because it helps facilitate what I do next. And then that data is the data and y’all know how I feel about the data. And it’s just data. And you have to make sure you’re using your brain to understand it. That’s really helped me a lot lately because we don’t have to figure it all out. We just have to answer one, two, maybe three questions along the way. And then that sets the next person up in the process to be better at their job too, whether it’s the physician or a [00:33:00] specialist or what have you.

Dr. Sharp: That’s an interesting point. Yeah, though we don’t necessarily have to be the truth, the capital T truth. We’re just doing our job at this moment and hopefully answering the questions we can answer and pointing people in the right direction.

Dr. Chris: At the very least, we just rule a bunch of stuff out. And that’s good.

Dr. Sharp: Yeah. I want to throw a question out there that may be hard to answer. We’ll see where this goes. So the question is, what part of the testing process are you all most confident in? By which I mean, which part do you feel gives you the best, most reliable information in the assessment process? Now, these could be specific measures. It could be the interview. I’m just curious. Of the whole testing process, where do you feel most confident in what you’re getting?

Dr. Andres: When the client gives me their [00:34:00] name and birthday.

Dr. Sharp: That’s a great answer.

Dr. Chris: I think the interview is our best tool. I think that weeds out and rules in so many things immediately. And then that fuels the data collection that we have moving forward, which is, I don’t wanna repeat myself but that’s just extra data to help confirm or deny our hypothesis.

Dr. Stephanie: Well, Chris, I’m going to push back on that and say, there’s a lot of research suggesting that clinical interviews, we’re not that great at it. So what do you do to protect against bias or drift in your interviews?

Dr. Chris: Use the data afterward to help confirm or deny the interview. I don’t think that after an hour, hour and a half, two hours of the patient, we know what’s going on, but we have a better idea of what’s going on. And that helps fuel our final conclusion.

So I’m picking wine and I love like the sommelier movies. They do a blind tasting. And so, they smell it, they look at it, they taste it [00:35:00] and it helps narrow down country, region, grapes, style, et cetera. And I feel like that’s what we’re doing in our assessment practice where initially we have someone coming in and they say, I have ADHD, or my doctor sent me, or my wife is mad at me or whatever, and we have to start narrowing down, country and then region. And so the way we do that is through collecting some data. And those are the measures that we use. So I think that that is the biggest weed. The weed out is the interview, and then it just refined the next level of possible conclusions you can derive.

Dr. Andres: So jumping on that, I’ve been obsessed with Stephanie’s secret question when it comes to the interview, like, what’s the question I’m really answering here and really weeding that out. Even at the intake, I do initial consultations. I don’t know what you guys do, but [00:36:00] because I might not even be the right person for that referral. And that’s been tremendous for me just trying to get to that secret question and just pulling from the therapeutic assessment model too, is that helps inform or help set up the tone for the data I’m going to collect later.

I think Steve the originator of Therapeutic Assessment talks about, if you want to talk about validity is, it starts with how we interview, the rapport that we build, that’s all going into if our tests are going to be valid, right? And I do a lot of personality testing and that’s huge in that.

And it’s so clear when I used to teach grad students, the bulk of the time that the measures would come back with some questionable validity. And why is that? It’s because these students haven’t built that skill yet. And they’re just like, oh, I’ll just give this test. They’re going to be honest with me or honest with themselves. [00:37:00] Not that clients necessarily lie on purpose, right? They do but most of the time it’s just a lack of awareness. And in there they’re like, what do I do now? I don’t have any data. And then I go, no, you have plenty of data. Let’s go with that.

But also you have data about how we approach this and that’s the thing I’ve been struggling with. Like, okay. Just really pay attention to it from the very beginning. What’s the rapport I’m building with this client? Do they feel comfortable here? Am I seeing where they’re struggling? And by answering the question they want to be answered, is it really going to help them?

Just answering if they have ADHD is not necessarily helpful. I’m sure we’ve all encountered this. We can go online and do that. Just fill out that questionnaire. Okay, you have ADHD. Good. Enjoy your wonderful life. So, yeah, the extra questions, the deeper secret questions, and also how am I going [00:38:00] setting up the data that I am going to collect to confirm the information or disconfirm the information I’m getting in an interview?

Dr. Laura: Yeah. I totally wanted to say interview, but now I don’t. Thank you.

Dr. Chris: I’ll still say interview.

Dr. Stephanie: Laura, what would you say instead.

Dr. Laura: Well, I was thinking about it while you guys are talking. And I think the Wechsler tests are pretty good. It’s easy. I’ve done it a trillion times. I’m not really paying attention to the questions that I’m asking them, I’m paying attention to the behavior and what’s going on in the room. I’m getting the data but also that behavioral stuff. And I feel like maybe that is where I get a lot of information, like more than I really realized.

Dr. Andres: I’m curious, what tends to come up in terms of what you pick up? Like, what are you looking [00:39:00] for when you, I’m totally putting you on the spot. Now you have to think about it, but I’m curious about that because everyone has a different way of looking at observations. We don’t teach that in grad school. It’s really hard to teach in grad school, right?

Dr. Laura: Yeah. Just the pushback that you get or don’t get. Like how excited they get about a task or how frustrated they get, how much they’re talking themselves through things, how much they’re saying to me about it and commenting, are they getting up out of their seats? Are they leaning close to the blocks or close to the things to really inspect it? Just all of that different commentary that goes along with it. And are they getting anxious about it? Are they saying self-defeating things or I can’t do this? I’m so stupid kind of stuff. All of that. And this is kids mostly. I don’t think I’ve ever seen an adult do many of those things.

[00:40:00] Dr. Stephanie: I’m obsessed with systems. So I have a five-step system that I use but that’s like step number four. And I think of that as like the therapeutic assessment model of how does the problem come into the room? How does it show up both on your tests but also in giving the tests? If the person says that in their everyday life, they have trouble solving unstructured tasks or they’re struggling with their self-esteem, or they feel like everyone can do things more easily than they can, which I think is a feeling a lot of us can relate to, how does that problem come into the room that you have, especially this room that you’ve set up, that you’ve done with a thousand other people?

Like Laura has given the WISC more times than probably anyone on earth? So she knows what it looks like when something different is coming into the room. And how do you use that systematically? How do you gather that data so that [00:41:00] you’re looking for themes and you’re looking for singular really unique responses? And you’re looking for representative responses that really reflect the problem the client is having. And thinking of that is just as important as the actual numbers that you got.

Dr. Laura: I had a kid the other day come in. It was an anxiety/ADHD sort of referral. He had long hair and every time that something got hard, that bang would come and cover his eye. And it was so interesting because it was every time something got hard. I could really tell what he liked and didn’t like based on where the hair was. And just interesting.

Dr. Sharp: It’s such a good example. Well, I like this idea too. We talked last time about process versus content. We have the content- the scores that we’re getting and the answers that we’re getting, the literal information, but then the process is so fascinating and being able to tap into that.

I [00:42:00] told you all those stories in our group chat two weeks ago about this ADOS that I gave. This was the most unique ADOS I’ve done in going on 20 years now. That stood out. Even though the answers themselves weren’t completely off the wall, the way and the process was just like, oh my goodness, this was notable. So, pay attention to the process.

Stephanie, I’m going to turn your question back to you. When you asked about how to control drift and bias in interviewing, do you have a means of doing that for yourself?

Dr. Stephanie: Well, I think the thing that I most often try to do is when I’ve done my first two steps where I figured out, like, why now? Why is the patient coming in now? What’s prompting this evaluation currently? And then I’ve looked for what Chris was talking about with the referral [00:43:00] question, the ostensible reason that they’re here. And then I’ve looked for what Andres was talking about, the secret questions, my third step is, now I need to expand my hypothesis pool. And I try and come up with 20 different hypotheses. Obviously, some of those are going to be in the DSM. And a lot of them are not necessarily things that are going to be in the DSM. They might be about the individual’s temperament or about the environment kid match or about life circumstances and how well the parent was able to attune to the child or a variety of other things.

And I try and have 20 different Ideas by the time I’m ready to try and bring the problem into the room so that I am protecting myself against drift, and I’m not just saying like, oh, there’s a family history of bipolar. So that’s what I’m going to be assessing. Yes or no. I try and use my interview to generate the hypothesis instead of trying to [00:44:00] confirm or deny them. Like, it’ll keep my list from being 40 hypotheses based on the things we’ve talked about in the interview, but I’m using it more for what else could be going on here. What things can I test in the testing?

Dr. Sharp: Yeah, makes sense.

Dr. Laura: Are you writing this all down? 

Dr. Stephanie: Yeah.

Dr. Laura: Are you jotting down your notes and then striking them out? I think that would feel good.

Dr. Sharp: With a feathered quill?

Dr. Stephanie: I keep it in the chart. I’ll definitely write myself little notes of like, no, or, oh, this one’s still on the table or things like that.

Dr. Andres: I’ve had an experience where something like that would have been very helpful for me because the client did the research and figured out every diagnosis they could have been having. And they asked me for one to look into and I ruled it out, but [00:45:00] they already did that on their own. So this is one of those things where they were seeking their diagnosis. Had I had that list, I would have been able to answer when they said, but what about this disorder? Did you look into that? And I’m like, I did but it wasn’t on the radar because you weren’t asking you about it. This was earlier on in my career, but that would have been helpful. Yeah, I could show them my list and go, Hey, see, I crossed them all out. I did my homework.

Dr. Stephanie: I think it also helps remind me that I’m a psychologist and not just a neuropsychologist. It helps remind me to look for example, at things like normal temperament variations. I think a lot of people who are maybe introverted in a world that’s more set up for extroverts or who aren’t very conscientious in a world that values conscientiousness or who are neurotic in a world that values people who are more emotionally stable can feel very different and feel like [00:46:00] everyone else can do things more easily than they can, or that their skillset isn’t valued.

I think we’re often pathologizing that when that may not necessarily be what the message that they need. They actually may need a message of like, no, this is normal and it’s okay. This is why it feels bad. This is what will help support you. So by forcing myself to come up with 20 different diagnoses, they can’t all fit in the DSM. So it requires me to think about other concepts that we know about like development, normal personality variation and stages of life that people are going through.

Dr. Chris: It just reminds me of how we think about this from a business perspective like, what are we selling? What is our product? I believe hope, answers, a glimmer of some understanding, et cetera. And so, it doesn’t have to necessarily fit so nicely into the scientific method and all those things. Now, we can’t be dumb. We can’t let someone look [00:47:00] at like a tomato plant and say, well, what do you see? And therefore that means, but I think we have to speak with some confidence based on how we understand data and statistics and give people this is where we’re at. These are the potential outcomes, these are the potential recommendations, and these are all the different things that we can jump towards based on the information we have and simultaneously we can rule a bunch of things out also.

Dr. Stephanie: The way you marry your therapeutic perspective with your business sentence just never fails to blow my mind. I love that you’re thinking about the therapeutic aspects of giving hope and things like that but then saying like, well, that’s a good business decision. That’s amazing, the way you put it like that.

Dr. Chris: I feel like I had to learn that the hard way though. I wasn’t taught that stuff. I was like, let’s look at the data. This is what we should do. This is empirically validated, yada yada yada. And that came across differently than I want to do. I’m not poo-pooing those things, but we do way more than that. And when we can take it from the [00:48:00] 20,000 foot to the 50,000-foot view of what we’re actually doing, I think we give so much more value to the people we’re working with which is why we do what we do anyway, is to provide value. And sometimes I just think we understand what value we’re really doing. We’re just doing it because we’re supposed to do it in certain ways.

Dr. Stephanie: How did you learn it and how do you teach it to other people?

Dr. Chris: I think it was two years ago. I was doing just doing testing and this stuff, and I just had this moment. I was like, “What the hell am I doing? Why am I doing this?” And I started in therapy and gravitated towards assessment. And once I started really thinking through what value are we giving here? Sure there’s the diagnosis, there are recommendations, there’s consultation with a medical provider potentially, a school system potentially, but you can provide so much more than that. And it takes like two Iotas more energy. It takes hardly any more energy for us to have a real therapeutic conversation with someone about what this really means instead of you meeting the criteria for [00:49:00] X disorder and your invoice will come in the mail and I’m going to chat with the school psychologist or the provider and peace out if I see it. Well, I think that we can provide so much more value than we ever give ourselves credit for.

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

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

I think that’s such a good point. It reminds me of hundreds of websites that I look at. When I’m consulting with folks, I always do a website review and so many websites list the testing process and go into all those details about the testing process. And I’m like we are going to like sell the outcome. Don’t sell the nuts and bolts. Sell what the person is going to walk away with: what they will feel and how you’re the bridge between how they feel now and how they will feel later, which is hopefully better in some way.

Dr. Chris: Earlier the question was, what do we feel most proficient at? I said I loved the interview. Thanks, Stephanie, for pushing back on that one. Being pushed back by [00:51:00] Stephanie Nelson on a podcast is an instant panic attack, by the way. But the thing I feel the best about, however, is that feedback session. There’s nothing more fulfilling than having that conversation with someone and having some numbers because I think the people we work with want to see data. That’s what they’re coming for. And then having this data and wrapping a realistic, not some fantasy story around it and saying, oh, now I get it. And then validating that person’s experience because they’ve probably known it all along.

And now we have this information to suggest like, Hey, like you’re not capital “C” all over the place right now crazy. You’re not all these things that you thought you were. We have some understanding of why you’re having the experience that you’re having. And there’s just something really fulfilling as a clinician about that. So it’s always fun to talk about what we think we’re good at and what we enjoy the most because everyone I talked to they’re very rarely aligned.

Dr. Andres: Can I jump on that. I know exactly [00:52:00] that feeling you’re talking about. When you help affirm the client’s struggle and give answers to them, it feels really good. And now, I’m going to swing you another way. There’s a temptation now that I want to give every client that experience. And so I’ve been wrestling with this a lot. There’s been a lot of discussion in this in the Facebook group about this.

The hot diagnoses right now are, and I’m mindful of how this could sound. So I’m giving a lot of caveats here, but at least for me, I know a lot of people have been talking about this is that I get a lot of referrals now. People asking for adult autism evaluations, adult ADHD evaluations, and I struggle with that because we’ve talked about how statistically it’s really slim that someone enters into adulthood, but it could [00:53:00] happen. And I’m also looking at these clients and going, you’re really struggling. I want to help you. I want to help you understand that. And then all that kicked in with that feeling when you affirm of the client when they are struggling with these things and it feels good.

I came in the field not to tell people that they’re wrong, but I want them to feel better to get better, to help them. And so I’m really wrestling with that. And there’s a lot of hard questions to ask about that but I’m curious how you guys approach these things. And even as I’m saying that, there are so many conversations that could be held about this. That’s been a challenge for me. Seeing like, okay, maybe I’m looking at this incorrectly. Maybe there is value in affirming clients. And I do believe there’s value but then is there also harm to? I’m trying to balance that and I’m not just counting either department.

There’s not [00:54:00] going to be a perfect answer of course, but I love to hear you guys’ thoughts on this and concerns. I feel like I’m dodging the real questions we’re trying to ask. Is there really an influx or have we missed these diagnoses into adulthood, particularly autism and ADHD? And is it really being missed out that much? Statistically, I feel like maybe that can’t be true but at the same time, we get a lot of these calls. How do we handle this? How can we do good for our clients?

Dr. Stephanie: Well, we know from the Facebook group. And I know from my consult work as well, that the five of us are not the only ones having this conversation. This is a conversation that every single person who’s listening right now is having with their colleagues or in their own head, or in the group of like, how do we answer these hard questions about [00:55:00] diagnosis, diagnostic accuracy.

The position that I’ve come around to is that people will contact me and say, like, I’m really eager to get this diagnosis. I try and take the pressure off of that and say, we’re probably going to get the diagnosis wrong. Just statistically based on what clinical judgment says, the research on critical judgment, we’re probably going to get the diagnosis wrong or slightly wrong or not be complete enough. But if you do a thorough and empathic and deep evaluation, you can’t be wrong about what the client needs.

You might be wrong about the actual name of what’s going on for them or you might miss some of the processes going on, but if you do your evaluation right, you can’t be wrong about what they need to move forward. The new story that they need, the roadmap that will help them move towards [00:56:00] solving some of the problems that they have in their life. And so, I’m trying to let go a little bit of the question of being right because for me, really that’s for my own ego of being right and having figured out what’s going on and more about, well, what does this client actually need?

Knowing that they have diagnosis X, they could have found that online and then read a book with all the recommendations for diagnosis X. That’s not enough. They need this roadmap and this story that helps them move on to the next step. And so that’s what I’m trying to focus more on.

Dr. Chris: Absolutely. I have that exact conversation with people during my intakes, which I’ll have 15 times next week, unfortunately, and then I’ll be on vacation, but we worked so hard for diagnosis. In my feedback sessions, I talk about the diagnosis for 30 seconds because it only fuels what happens next. And I think that part of our job is to educate folks through this [00:57:00] process that, that diagnosis only means as much energy as we give it as a society because everyone says, oh, I have this, I’m an ADHD or I’m this I’m blah, blah, blah, whatever. And that’s only so good as what do we do next?

And my feedback sessions are talking about data for 10, 15 minutes depending on how much engagement there is. We talk about the diagnosis for 30 seconds. And we spend a tremendous amount of time of like, what’s next? What other resources do we engage in this process? Who else can we pull on board? Who else do you already have onboard that you’re wasting your time and energy and money on? How do we have this discussion rather than about how do we effectively utilize everyone’s resources, time, energy, money, all of those things?

I’m a big fan of energy management. And I just see that translating into the work that I’m doing with folks moving forward. And it’s funny because I’m a stats mind, that sounds weird to say because it’s been so long since I’ve even talked about it, but I love data so much but we only use it just an [00:58:00] infinitesimal amount in our work. We’re really setting people up for success and we’re just using that data to provide that using our own clinical judgment along the way.

Dr. Laura: What do you do though, with the person that is fixated on the diagnosis?

Dr. Chris: I had this conversation last week and it got escalated. This person was pissed off. They’re like, “I have ADHD” and I was like, “You totally don’t.”

Dr. Laura: It doesn’t feel good at all.

Dr. Chris: It’s 2021. We all feel like we have it. There’s no evidence to suggest historically. You’re not meeting symptom counts. The intensity and the impairment are not there. Just ran through all of these reasons based on the DSM, showing them the DSM on my camera at one point. And they’re just pushing back. And I said, so let’s pretend I’m a radiologist. And I see something that’s abnormal on a screen and in some imagery and you want me to call it cancer when I don’t think it’s cancer? I’m not going to do it. It’s going to do you harm in the long run. This is something else.

And I think that our most efficient use of everyone’s energy here is to [00:59:00] address the anxiety that’s in the room. Let’s first get all of us, me and you down from a 10 to a 6. And let’s talk about this more objectively that treating you with an anxiety disorder with stimulant medication is going to be pouring gas on fire right now. This is going to do harm and I’m not going to go down that route. And so sooner or later, I think when you just use these different avenues of understanding. It helps tone it down a little bit, but people are still pissed off because they’re so convinced that they have that diagnosis.

Dr. Sharp: It sounded like a broken record here, but it’s, again, a process piece. So, in that moment I’m like, What is happening for this person that it is so important to have this diagnosis and trying to get some questions around that and pull the therapeutic part into it, into the feedback and really connect with whatever part of them is [01:00:00] desperate to have that diagnosis. What would that mean for them? What’s it mean to not have it? Does that rewrite their life story? Are they having an identity crisis? Who knows what’s going on, right?

Dr. Andres: Yeah. I learned way early on in my career that I want to figure that out even before we even do the interview. I had a bad experience with that because I didn’t figure it out, what does it mean to have this diagnosis? I won’t get into it now, but just asking, talking it through, like how would this explain things for you? What if I told you this wasn’t it? I think Stephanie likes to ask, what’s the worst thing I could tell you and those kinds of things, and to really get to the bottom of it so that they understand that I really care about their struggles. [01:01:00] Not that I get the label, right?

And then I get a sense and we could have an honest conversation, direct conversation, like, okay, if you just want the label, I’m not the person to give you that. There are a lot of people that could help you with that. And maybe I’m wrong. Maybe I’m just not the person who’s fine-tuned enough to your specific struggles and that’s okay. And so that’s how I approach it.

And one thing that’s been helpful to me, I’ve been conceptualizing a lot of things from a trauma perspective. Just thinking about this past year, like that’s one thing we all have in common. We just went through some pretty major trauma, I would say. And I’m talking about, there’s a lot of debate on what that term trauma means. I’m just talking about trauma and in terms of having this lived experience [01:02:00] and this reaction and emotional reaction to this experience. But that’s really changed the way I’ve been working. I’m like, okay, how is this explaining what this person’s experiences have been? And just thinking through like adverse childhood experiences and all that stuff.

And that’s helped with this kind of referrals, helped my clients really understand, of course, you’ve been struggling, of course, this is the way you’ve had to survive. And that’s a lot of trauma language. This is what you needed to do to help you survive, but it’s not working anymore. And we’re trying to figure out why it’s not working and what’s a better alternative. And I’ve been thinking a lot about that. And then the pandemic is a gateway to that. Yeah. We know that now you’ve been faced with even more trauma and these things are coming up. Let’s talk about that.

Dr. Chris: Have you guys been dealing with all of this over the last [01:03:00] 18 months?

Dr. Stephanie: The trauma?

Dr. Chris: Yeah. I can say we all have a collective experience but as clinicians, we haven’t really had any time off. I was just having this conversation with my wife this morning. This whole idea of burnout and being bruised over the last few months that we in the medical field and as healthcare providers, we pivoted very quickly because we could. And so we didn’t get the corporate two-week vacation. When all the states shut down, we didn’t get all these things. And we’ve been on go for probably over ago for the last 15 to 18 months. I’m curious to how you all have been handling those things, or if you’ve been handling those things.

Dr. Andres: I’ve actually taken more time off than I ever had in my entire life. It’s been weird. I think I said this last time is that there’s this quote that the pandemic exposed a lot of our underlying conditions. If you did not like your house before, or you definitely do [01:04:00] not like it now. If you do not like your spouse before, that all comes up.

Dr. Stephanie: Worst Dr. Seuss’s book ever.

Dr. Andres: I know, right.

Dr. Sharp: Oh, man.

Dr. Andres: Yeah.  And for me, the pandemic exposed how hard I was working, how much I was taking work home, and how much I was missing out. I’ll try to share this experience without getting too emotional. One of the things I’ve been up to is I’ve been doing some training in trauma and EMDR, which I still don’t understand. Anyone out there wants to talk to me about it, we could talk. I was totally skeptical but then after this training, I’m like, what is going on? It’s like voodoo magic. But we won’t get into it because this is about testing. But I had this experience where [01:05:00] in California, we had a recent shut down because of the holidays, and then I had to watch my kid for a week. And it reminded me of early on the pandemic where I had to watch my kid and work during his naps. And it was just overwhelming.

Anyway, through this training, you do your own EMDR process, whatever to process, whatever mini trauma that we went through. And I had this memory come up of my kid walking to me on video. I have this on video. It is one of my favorite videos of him just walking for the first time. And it was really cute because he’s the cutest kid in the world, obviously. But then this realization came that I would have never had this video of him walking to me if it weren’t for the pandemic. I would have been at work [01:06:00] editing a million reports. Now you’re trying to squeeze in as many intakes as possible and all this stuff. And I would have missed out on this moment when he was walking.

How many people would get that experience of videotaping their kid walking in the middle of the day? And it was this profound experience I had. And it’s really shifted the business and the income. It is important but for me what’s important is why am I doing this is to help my clients, to help my family, to support them. And also ultimately, I want to be there for them. And the pandemic has really exposed that for me.

And so, then we’ve taken more time off than ever. I’m more present for my clients doing better work than I ever had. So it has been weird. It’s been weird for me. I’m not used to this, especially from a [01:07:00] cultural perspective, it’s all about like, I got to work really hard all the time and move to the next step. So it is a long answer to that, but yeah, I’ve actually taken more time off. It’s weird.

Dr. Sharp: Well, I don’t think I can match that meaningful experience. My kids have been walking for a long time and now they’re just shouting more than anything at me, but similar experience. We took probably three weeks in November to do a road trip from Colorado to Arizona and stayed with my mother-in-law during that time and had Thanksgiving with her and everything.

In the past, even though I’m always focused on vacation and time away and that sort of thing, I would have never said okay to leaving for three weeks. That was never really an option but we did it.  [01:08:00] We pushed. My wife, thankfully she pushed me to just give it a shot and it worked. It wasn’t terrible. It was really nice. And now I’m trying to carry that forward to think, maybe we could do that again. Maybe we do that this fall. Maybe we do that over the summer. It just opened the door to what’s possible in terms of slowing down and taking a little time away. So, I’m in the same boat.

Dr. Andres: I’m also realizing as I say this, we’re all in private practice and the people who work for agencies are like, well, what do I do? And so, I don’t want to discount that this might not be the situation you’re in. So people listening, I’m sorry.

Dr. Sharp: A good point.

Dr. Stephanie: Well, I think for me, I’ve been thinking a lot about… personally, I’m a little bit on the struggle bus right now. Like right now is a difficult time for me. I’ve had a lot of deaths [01:09:00] in my family and things like that. What I’ve been thinking a lot about is the experience that I think so many people, not just in our profession, but just so many people are having right now, which is that life is really hard.

A lot of times we only see the highlight reel of everyone else, and we don’t see that everyone is struggling and that it’s hard for all of us. We can all walk around feeling why can everyone else adapt and function and manage and I can’t. What’s wrong with me? Why do I feel so different?

And it’s really helped me empathize with that question that I think a lot of our clients are coming in with of like, what’s wrong with me that everyone else seems to manage? And it’s given me a lot of empathy for like, there’s nothing wrong with you. Life is just really hard or there is the usual amount of stuff wrong with you. None of us are paragons of virtue [01:10:00] all of the time. And really just empathizing with that question that I think a lot of us even just wake up with of like, why is this so difficult all of the time, or why does it feel like there’s something wrong with me? And it’s helped me get in touch with that a little bit more.

Dr. Chris: I think that speaks so highly to like how our clients are showing up too. These people that are coming to us rather, it’s like, damn life is hard right now. And it’s hard for everyone. And because it’s been going on for so long, I think that I’ve witnessed a significant increase in the intensity of the presenting stuff. And fortunately been reflective enough because people force me to be reflective in my life that I can see that I’m also adding intensity to my own stuff, and then projecting that onto their stuff and saying, oh, it’s so intense. It is intense and we’re also adding everything to everything and we have these magnifying glasses all over the [01:11:00] place.

So the reason I asked that question y’all is that I don’t know how to handle all this stuff. This has been a rough year. I hope that folks listening can also hear y’all aren’t alone. There’s a lot of people struggling out there. Even as clinicians who have to have their shit together, who have it together between 9 in the morning and 6 o’clock at night, and then go to bed at 8:30 and wake up at 8:30, things are tough.

Dr. Stephanie: I think about you a lot, Laura, like bandaging all this while being in a place that’s new to you that you really haven’t even gotten to set down roots because of COVID. How has that been for you?

Dr. Chris: And snow.

Dr. Laura: It’s been hard. And the stupid weather is acting down. It’s very hard. I need some heat. How have I managed? By the seat of my pants Like when we ask questions about [01:12:00] what are your goals for the next six months? I’m like, still be here, still be doing this, like beyond the treadmill.

I started to go to therapy because it’s hard. I don’t know. You hold it together for your clients, and then there’s nothing left over afterward. And there’s so much empathizing with like, your kids are home. You’re still working. Oh my God your husband’s still working too. And your kid has special needs. Oh my gosh. I can’t even imagine like, just layer upon layer for everybody right now. It’s just hard. Everything is hard.

Dr. Chris: Whoever came up with the #thestruggleisreal five years ago, I wonder what they think right now?

Dr. Stephanie: Little did they know.

Dr. Sharp: Right. I [01:13:00] finally figured out that the answer is not just to keep working and try to be more productive.

Dr. Laura: No. 

Dr. Sharp: That’s not the answer.

Dr. Laura: It’s not.

Dr. Sharp: Well, that’s my default. When things get hard or I start to feel stuff, I’m like, let me get some things done and maybe start a new project and take on a bunch of things that I don’t need to actually.

Dr. Stephanie: That’s always when I decide I need to learn Japanese, right then. That’s my way of coping.

Dr. Sharp: Totally.

Dr. Andres: What were your guys’ hobbies at the beginning of the pandemic? You know that first few weeks when everyone’s like, oh, let’s bake bread and learn new martial arts and learn how to do construction. I don’t know, whatever.

Dr. Laura: We did yoga for like two seconds, the whole family, and then like two seconds. That was that.

Dr. Sharp: Nice. Well, I decided to do two [01:14:00] podcast episodes a week, which we’ve seen where that’s ended up.

Dr. Laura: What’s happening in your world, Jeremy? What’s going on?

Dr. Sharp: What is happening in my world? I have gotten myself too busy. I am not taking my own advice. So over the last, probably 2 to 3 months. It’s just on all sides.

I’m in the process now of unwinding with my coach/therapist. Why now? And why are you making these choices? I took on too much clinical work, committed to two joint projects that I probably don’t need to be involved in. My kids are super busy with their sports schedules. It was just poor timing all around. And these are all opportunities. [01:15:00] So it feels strange to complain, like, oh, I’ve taken on too many of these really amazing things that so many people would probably want to be doing but that’s where I’m at right now. So I’m super busy. I’m working on the weekend this weekend for the first time in I don’t even know how long, so it’s not great.

Dr. Chris: Do as I say, not as I do, right?

Dr. Sharp: Yeah, totally. Well, there’s that part too. I’m feeling fraudulent because that’s not practicing what I preach. So that’s a layer as well that just gets mixed up that makes things hard.

Dr. Stephanie: Well then, what advice would you give to someone else who is having that same problem?

Dr. Sharp: Right at this moment? Pprobably to be kind to themselves and work through it and use it as a [01:16:00] learning experience to shape future behavior.

Dr. Andres: So what measurable steps are you going to take this week, Jeremy?

Dr. Sharp: Oh Christ. Stop. Who’s next?

Dr. Stephanie: But that does bring up the point of self-compassion and how hard that can be. We talk to our clients about it but how hard it can be to actually apply it to ourselves. Like I’m feeling so much compassion right now for all of you guys, but it’s so hard to direct that inward. Sometimes we really do get on this treadmill and don’t necessarily give ourselves credit at grace and all of those things for the stumbles when this treadmill was going too fast.

Dr. Andres: Do you think that’s unique to assessments psychologists/testing psychologists?

Dr. Stephanie: I think it’s unique to this group. No, I’m just kidding.

Dr. Andres: Probably. Well, I’m just curious of your thoughts [01:17:00] because I come from more of a therapy background where it’s encouraged. I don’t know how many people actually follow through with it. I know therapist burnout is huge or really high. But it’s encouraged to go seek your own therapy. And I wonder for those of you that do primarily just assessment, I’m curious, your experience of that and like how much that’s encouraged, where does that fit in doing your own work?

Dr. Stephanie: Well, I want to make a distinction between self-care and self-compassion. We’ve been talking a lot about self-care, but for me, it’s ended up being like this to-do list of other things that I’m not doing. Like, oh, I’m supposed to be somehow making time for my own therapy and going for a walk and meditating and doing a gratitude journal. And it’s just more things that I’m not failing at. And I want to shift the conversation at least for myself more to actually [01:18:00] self-compassion, grace. Recognizing that I am doing the best that I can more than I want to talk about like self-care and chores that I need to do. Does that distinction resonate with anyone else?

Dr. Sharp: Oh, for sure.

Dr. Andres: Absolutely. Now, I’m just working on it.

Dr. Sharp: That’s good. This is maybe related. I think it is. My coach said it really simply, she said something like the world doesn’t need anyone feeling any more shame. The world doesn’t need any more shameful people right now. That doesn’t help anything. So just bend your brain around to be self-compassionate.

Dr. Andres: Is that evidence-based, Jeremy though?

Dr. Sharp: I’m sure it is. Yeah.

Dr. Chris: I think this is where imposter syndrome plays a significant role though because I’m doing the best I can and what if it’s not good enough? What if it’s like [01:19:00] negligent? What if I’m just really screwing up right now? And so I think that we have to try to balance that perspective. It’s a constant rebel I think we face as clinicians because we have these licenses and we have these degrees and we have all these things. The big brother is always watching. We’re still human. We’re making mistakes and all this stuff. And then we add this extra layer of, oh God, I’m not good enough. And now here’s the opportunity that I’m going to prove that I’m not good enough because I didn’t do this or I didn’t do that.

Dr. Stephanie: I think some of that might be a shame talking a little bit. I think our idea of the level at which we’re failing sometimes when we’re not doing our best work, I often tell people not every report can be your best report, just statistically that doesn’t work. Sometimes you’re not going to be able to do your best work but if you have… none of us are really going to fall much below a minimum but that breaks up the whole idea of [01:20:00] like other professions do this better. Like physicians have impaired physician programs for when you need help and you realize like, wow, I’m falling below even my minimum, and that’s the best I can do. And how do I get help for that? We don’t have that conversation in our field. The idea is you’re just doing a 100% of the time.

Dr. Andres: I read this quote. I think I shared it with you guys before that if you were at your best all the time, that wouldn’t be your best. That would be your average. And I know for those that like sports analogies, my Lakers just got knocked out of the playoffs last night, but even the best shooters in the NBA miss half their shots. And just thinking about that, like what are we capable of? Having that compassion. That’s really hard.

Dr. Chris: That is the whole inner critic idea. We’re just so hard on ourselves all the time.

Dr. Andres: Oh, why can’t I have [01:21:00] self-compassion?

Dr. Chris: I’m just not good at it. Damn!

Dr. Laura: I know. You say that, and I’m like, “Oh my God, what if I’m failing half of the time?” I fail a fair amount of time.

Dr. Sharp: But you can. Here’s the thing. So we’re drifting into chicken soup for the soul territory here, but it’s not what you do most of the time. We’re all going to make mistakes. It’s the next thing. What do you do after you do the wrong thing? And that I’ll anchor it in research to get away from some of this chicken soupy stuff.

There is good research around malpractice in medicine and people getting sued, really being dependent on how the physician responds when confronted with their mistake. I keep that in my mind a lot, actually. We’re going to mess up. We’re going to fail or whatever you want to call it. But [01:22:00] it’s that next thing. Do you stay in that shame cycle or defensive cycle or whatever and get yourself in bigger trouble or can you be gracious to yourself and others?

Dr. Stephanie: That research is fascinating because they’re literally talking about people who’ve had medical errors like the wrong leg cut off and still ended up not suing that physician if their physician does a good job of responding to the mistake that was made. And so, when you put it in that context, I haven’t cut anybody’s wrong limb off. I feel pretty good about myself.

Dr. Sharp: We’re all doing great.

Dr. Andres: So it comes speaking from a therapist. I’m thinking about at least the way I conceptualize cases is the repair is much more important. And that’s the intervention in itself and how we could use that in assessment. So in therapy all the time I’ll tell clients, I’m going to mess up and if you feel comfortable and you [01:23:00] notice it, let me know and we’ll work through it. You don’t get to do that elsewhere. That has been your experience that people will dismiss you when you say that you were hurt or something like that.

Dr. Stephanie: […] My husband and I as well. We often talk about like, we’re going to break it all the time. It’s all about how we repair it. We can not drop things emotionally and break some things. It’s not about trying to avoid breaking things any more than basic. It’s about how we come back together and repair. It’s beautiful. But I may have interrupted you, sorry.

Dr. Andres: No, that’s where I was going. Just the idea of that process is more important at least research-wise and just experiential-wise, admitting to the mistakes and trying to resolve those [01:24:00] missteps if you will. Honoring those missteps.

Dr. Laura: That brings up, like in the Facebook group, the discussion about did I miss the diagnosis and what do I do with that? And that gets so tricky because you can put your product out there and then do your backpedal and say, oh yeah, maybe I’m missed that or go see someone else.

Dr. Chris: Good to see Jeremy Sharp.

Dr. Stephanie: Well, Laura, in your practice you must have a lot of people who come in looking for a very specific diagnosis and you must have some of those uncomfortable feedbacks that we’ve all had where you’re telling something new that they don’t want to hear. So when we were talking about that earlier, I was so curious about what your process is because it must come up for you sometimes. And you can [01:25:00] deflect it with a question if you want. I’m honestly just curious here.

Dr. Laura: Yeah, it happens more than I would like it to happen. It is super uncomfortable and really hard. Hopefully, that groundwork that we’ve been talking about was all laid. And hopefully, we’ve talked about what would this be like for you, but occasionally that has happened. It’s uncomfortable and unsettling. There are cases where I’ve thought consultation or feedback from other people and tell the person, you can’t say it to them. Oh, I talked to three colleagues and they all think you’re not autistic. It’s not just me. Trusting that you put in the work is all you can [01:26:00] do.

Dr. Stephanie: I think it’s so lovely that we’re having this conversation in public because I think everyone who is listening has had that difficult feedback or 15 difficult feedbacks recently where it’s been very uncomfortable. And we may think that we’re the only person that our patients are pushing back against and that’s getting our imposter syndrome activated. And I think it’s so important to be saying like, no, every psychologist who does testing or gives feedback to clients in any way has had that struggles with it, is maybe having it more now and feels these ways.

Dr. Sharp: Can I tell a shameful story to validate and normalize some of this experience? So this was probably 2 or 3 years ago. I evaluated a little girl for autism. I think she was, let’s just say 3, maybe 2.5 years old. I did not diagnose her [01:27:00] with autism and I was relatively confident in that and whatever. I did the feedback. It was fine. The family goes on their way.

I get an email from the mom maybe a year later, let’s say. She was just checking in to let me know that they had gone to our local children’s hospital and the girl had been diagnosed with autism. She just wanted to send me an email in hopes that it would increase my awareness or help me rethink my assessment process to diagnose autism in girls. And that was so difficult. The tone, the whole thing, it was the whole thing. So I just want to say that happens and I still don’t think she has autism.

Dr. Chris: It was handled well, though. [01:28:00] It was handled very well.

Dr. Sharp: Well, sure.

Dr. Chris: Maybe not.

Dr. Sharp: You mean like from a parent’s side?

Dr. Stephnanie: Who is handling it well?

Dr. Chris: Well, I don’t know about how Jeremy’s handling, but I would appreciate a parent doing that instead of saying, you did this and you’re wrong and we’re going to the board and blah, blah, blah, blah, blah.

Dr. Sharp: Oh, sure. Yeah, that’s preferable. I couldn’t tell, but it was challenging.

Dr. Stephanie: Just listening to the story, you feel like that’s shame rise like you got it wrong and you can feel like the only person who’s missed it and it can make you question everything you know about autism or autism and girls or assessment in general. It’s such a horrible feeling. And I think we need to talk about it more as a profession and more about how it happens to all of us and more about…

Also [01:29:00] realizing that maybe you did get it wrong, maybe you didn’t, but I bet your recommendations were spot on for this family. And they must have trusted some part about it that she wanted to, there was part of her that wanted to shove it back in your face but there must’ve been some trust that she’d knew she could protest to you safely. And she knew she could give you this information safely. So there has to have been a part of it that really was valuable for them.

Dr. Sharp: That is a very kind reframe. I appreciate that.

Dr. Stephanie: I don’t even think it’s kind. I think we need to recognize, I think we’ve all been saying that what we offer is not just the diagnosis, and when the diagnosis is wrong or not what the parents wanted, that can feel like the most important thing. I feel like a bit of a broken record that I just keep saying, it’s not the most important thing.

Dr. Andres: Yeah. And just to jump on that, [01:30:00] the one experience that jumps out in my head is not that I necessarily think I got the diagnosis wrong but I missed an underlying secret question of like, why am I struggling, is this my fault, that kind of thing? And looking back, maybe the report didn’t reflect that or the feedback didn’t reflect that and we didn’t assess for that part, those questions. And so I was all confident with my diagnosis but I missed the point of the evaluation. I’m not saying that’s what happened with you, Jeremy, but what jumps out at me is, my client’s reaction to me wasn’t like that. It wasn’t like I felt safe enough to bring this to your attention. It was like, “No, you did harm to me.” That’s how they felt. So I’ll never forget that. I’ll learn from that experience.

Dr. Sharp: Yeah. Well, and I think another humbling [01:31:00] related experience, I think all of us have been doing this long enough where I’m sure you have evaluated kids or maybe even adults multiple times, and you see them at 4 and then at 10 or 7 and 16, and it’s like, ooh, this is way different than what I thought the first time. And both evaluations are probably equally valid based on what’s going on at that moment, but the first several times that happen, that is super humbling to go to the parents and say, you know all that I told you back then and those diagnoses that we were so certain about, that’s going to change a little bit.

So I’ve been on the flip side too. I’ve had to go back and be like, yeah, I think maybe we missed it that first time around, or it was wrong or you were right or whatever it is, like processing the changes that your [01:32:00] kid doesn’t have an IQ of 146.

Dr. Stephanie: Scoring error.

Dr. Chris: I think it’s how you handle it though. You can try to force the story onto the previous hypothesis, or you can say, hey, we messed that one up. What are we going to do about it now? I think there’s this way of like I have to be right, so how do I make it right? Instead of, well, maybe I wasn’t so right. So how do we now move forward and make it beneficial for everyone involved?

Dr. Sharp: Well said.

Dr. Laura: It’s interesting too. I have had a kid recently. This is in the third time I’ve seen them. So the first time very small, some genetic stuff, a syndrome going on but the autism layer on top of that, and it was a PDD-NOS diagnosis. And so then the second time that I saw them, it was not a PDD-NOS because that wasn’t a thing anymore, obviously. [01:33:00] And so it reflected in the diagnosis like autism spectrum disorder, formula, PDD-NOS, like to try to move them into that. And then this time it’s ASC level three. It’s just interesting to see the teams and the diagnostic way that you’re labeling and the conceptualization. And then also this time we have to have the talk about things that aren’t getting better, the IQ piece we need to address now, and add on some additional ID, so it’s not easy. This job is never easy.

Dr. Sharp: It is not easy.

Dr. Andres: Why do we do this?

Dr. Stephanie: Because of what Chris was talking about.

Dr. Sharp: Great question. Well, two of us are drawn to not do it anymore.

Dr. Andres: That’s like the more we listened to this podcast, Jeremy, the more we [01:34:00] are discouraging people from the testing.

Dr. Sharp: It’s the anti-testing psychologist.

Dr. Stephanie: It’s because of the power of a story for a family. Power of a story and a roadmap. We all were talking about that moment in the feedback when you’re able to connect with the person, validate their secret questions, validate their experience, empathize with them, and help them move forward when they’ve been stuck. I think that’s what keeps us all here because it can’t be writing the reports.

Dr. Chris: Not at all.

Dr. Laura: I think it’s the colleagues.

Dr. Stephanie: It can’t be the colleagues either.

Dr. Andres: Personally, it’s the essay composition on the WIAT for me.

Dr. Laura: Yeah, scoring it.

Dr. Sharp: It’s keeping me in the game. I love it.

Dr. Sharp: How many times can you say desk in a paragraph or a question? That’s the worst thing ever.

Dr. Stephanie: Luckily they changed that in the new one.

Dr. Andres: Thank God. 

[01:35:00] Dr. Stephanie: I know, right? Oh my goodness.

Dr. Laura: But it still feels weird when you say it because all I can think in my head is desk, please.

Dr. Chris: Many syllables are desks.

Dr. Sharp: That’s great. Well, we are starting to get close time-wise. Two hours goes by fast when you’re having a conversation. I feel like we’re all in different places and maybe some not-so-great places. And I really like that we can honor all of that and just be real and say like, hey, things are not 100% peachy right now. I don’t know. I don’t want to be too pollyannaish, but I am curious what’s happening in the future, are there things that people are excited about? What are those glimmers in your life right now? What [01:36:00] is keeping you going? And as everyone thinks…

Dr. Laura: I’m going to Florida.

Dr. Sharp: Yeah, you’re going to go to Florida?

Dr. Laura: Yeah, in two weeks.

Dr. Stephanie: Permanently?

Dr. Laura: No, maybe, I haven’t thought about it.

Dr. Stephanie: Fair enough.

Dr. Andres: Start thinking about it.

Dr. Laura: I want to move on. That’s what I need in my life. Just like the vacations, time is marching on, the kids are home, things are shifting. So, that’s what keeps me going.

Dr. Sharp: I love it. When the summer hits, I generally just get hypomanic, maybe even like a mannequin. I’m a hot weather person so I’m just excited to be getting outside. We’re doing a little vacation as well. We have two vacations actually coming up this summer. We’ll get to see family again after having not seen [01:37:00] them for 18 months. Y’all are sick of hearing about my kids, I think, but they are just so fun. They are both just having so much fun. They both play soccer and we’re looking at a nice Summerfield of watching soccer games which I love. People are like, oh my gosh, it takes too much time. And what are you doing? But it is so enjoyable for me.

Dr. Andres: You’re American, how could you like soccer?

Dr. Sharp: Yeah, it should be football, right? That’s the American sport.

Dr. Andres: Yeah, but soccer is football everywhere else. So football is always the right answer no matter what.

Dr. Sharp:  What about the rest of you? Anything. And maybe the answer is no. That’s okay too.

Dr. Chris: My wife and I went to a wedding without our kids for the first time, two weeks ago, like outside. And it was like a beautiful night out in the country, [01:38:00] Southwest Michigan. And it was so reinvigorating for us because we haven’t had a date night in 18 months. We just have not been able to do that. And so we have a few vacations planned over the summer which is really exciting now that we can feel normal-ish again. And we have like these reprieves. One of our vacations this summer is with no kids. So we’re probably not going to know what to do with ourselves. Like who is this person that I’m on vacation with but we’re really looking forward to that siesta from the chaos.

Dr. Sharp: It’s so funny. My wife and I rarely go on kidless vacations. It’s like once every 2 or 3 years or something. We always joke because we’ll get a day into it or so, and there’s always a moment where we turn to one another and we’re like, I do like you. This is awesome. You’re pretty cool. I’m glad we’re hanging out. Awesome. I’m excited for y’all.

Dr. Stephanie: I’m changing everything [01:39:00] about my life. We’re going to sell our house we’re getting rid of everything we own. I’m changing my practice. We’re buying a new RV. People who know me or who’ve ever consulted with me will know that sometimes you’ve seen me inside my office, that’s actually my RV. And so we travel around the state and country a lot and we’re going to be doing more of that. And we’re thinking of maybe even living inside our RV. So we’re selling everything we own and buying a tiny house on wheels.

Dr. Laura: So you could totally do consultation groups everywhere you stop, in-person consultation with Stephanie Nelson.

Dr. Stephanie: Tell me how fun that will be?

Dr. Sharp: And then your RV is a business expense and you don’t…

Dr. Chris: Here we go. Now we’re talking.

Dr. Stephanie: Yeah. This is why I love this group. The business possibilities.

Dr. Sharp: And you also somehow parlay it into becoming TikTok [01:40:00] famous. I don’t know exactly how but I think it’s in the cards.

Dr. Stephanie: Yeah. The van life influencer.

Dr. Sharp: Sure.

Dr. Andres: Are you guys on TikTok at all?

Dr. Sharp: I have browsed TikTok. There was a week because I have older nieces and nephews and so like they’re getting on TikTok. So I like watching but I browsed it for a week and I was like, I cannot do this. It’s truly addictive.

Dr. Laura: I feel too old for it.

Dr. Stephanie: Me too.

Dr. Laura: I don’t know.

Dr. Andres: It’s weird because I’m pretty tech-savvy. So I usually don’t feel old about anything like tech-wise, but now I get it. It is one of the things I know I don’t get into. But speaking of things I’m looking forward to, I’m launching my new TikTok channel. I’m just kidding.

Dr. Laura: It’s called, Get off my lawn.

[01:41:00] Dr. Andres: If I had a lawn. We live in a tiny condo, so thanks.

Dr. Laura: Sorry.

Dr. Andres: Thanks for opening that wound.

Dr. Stephanie: Maybe you can start getting your son on TikTok.

Dr. Sharp: Oh yeah. That’d be awesome.

Dr. Sharp: Never too early.

Dr. Andres: Yeah. For me, I just got some vacations coming up. The thing I’ve been getting back into my life before psychology was graphic design and video. We were on vacation maybe a month or two ago, and just pulled out my little mini video camera device, and started recording and editing some stuff quickly. And I was like, oh man, I miss this. It’s more fun when you’re not feeling pressured to do it to pay the bills. So I’m looking forward to that and thinking about how that could be integrated into assessment and clinical practice, I guess. I don’t know.

People always [01:42:00] ask me about technology. Here’s a common question people ask, it’s like just small things like how do you set up your Google workspace for HIPAA compliance? And maybe I can make a video about that, but those are always dreams I have that never really happen. So we’ll see. But now that I threw that out there, maybe I have to do it now.

Dr. Stephanie: I keep trying to get you to run a business where you help other testing psychologists figure out the technology and you just walk them through it and you show them how to do that. I think there’s a huge need for that. And so I think everyone who’s listening should call you and consult.

Dr. Sharp: Link in the show notes.

Dr. Chris: Ready, buddy. Get ready.

Dr. Stephanie: You’re so good at it. I think it would be great.

Dr. Sharp: Well, that’s a nice full-circle moment, I think. Thinking outside the box, parlaying our skills into something else [01:43:00] that’s fun and not necessarily straightforward. So there you go. So this is awesome. Again, I like this. Hopefully, we can do it again in another few months. I just appreciate all your time and everything that you’ve put into this. Thanks to you all.

Dr. Chris: We should do a live recording at the next conference we’re at.

Dr. Sharp: Hey, that is an idea.

Dr. Andres: Very interesting idea.

Dr. Chris: I made the whole conversation an interesting one. So I’m so proud of myself.

Dr. Sharp: Nice work.

Dr. Chris: It’s the law of averages. Now we’re in the normal range within normal limits.

Dr. Sharp: Nice. Well, on that note, yeah, maybe we’ll see one another at a conference here sometime soon. All right. Take care of y’all.

Dr. Andress: Bye.

Dr. Sharp: Okay, everybody. Thank you again for tuning in. Like [01:44:00] I said, in the beginning, send me any feedback you might have about this happy hour format. I got to say, and I’m trying not to bias any feedback but these are really enjoyable I think for the five of us here on the episode. Great to connect with one another. Great to have some conversations around some deeper testing topics and personal topics. I hope that you enjoy it as well. But send me some feedback, jeremy@thetestingpsychologist.com.

I also mentioned if you were looking for CE credits as your license goes to be renewed, you can get CE credits for The Testings Psychologist podcast episodes, specifically the clinical episodes over athealth.com. Just search for The Testing Psychologist, and you can use the code TTP10 to get a discount off of any CEs that you purchase there, not just the podcast episodes.

All right, that’s it for today. Stay tuned for more [01:45:00] clinical and business episodes in the upcoming weeks. Take care y’all.

The information contained in this podcast and on The Testings 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 [01:46:00] 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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[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.

This episode is brought to you by PAR.

The Feifer Assessment of Writing examines why students may struggle with writing. The FAW and the FAW screening form are available on PARiConnect- PAR’s online assessment platform. Learn more at parinc.com\faw.

Okay, everybody. Hey, welcome back. This is the 3rd and final episode of Summer Slam 2021. If you haven’t heard of the previous two, you can go back to the past couple of Thursdays and check out Summer Slam 1 and 2.

Just as a refresher, Summer Slam is a short [00:01:00] series I’m doing just to give you some quick, actionable tips for the summer that you can put into play in your practice and hopefully move the needle quite a bit with some aspects of your practice that are pretty meaningful and important.

So for the episode today, I’m going to be talking about revisiting your rates. I’ll be talking about how to do this both in an insurance-based practice and a private pay practice. Again, the hope is that you can walk away with an action item or two and move forward to raise your rates starting over the next few months.

So, without further ado, let’s jump into talking about rates.

[00:02:00] Fees, fees, fees. What do we do with our fees? My goodness. Today, I want to talk with you about what to do with your fees. This is such an area of concern and confusion for a lot of practice owners that I hope to provide a little bit of clarity and a little bit of a fire under you to move forward and consider raising your rates. So that’s the moral of the story here. Spoiler, I am going to ask you to raise your rates. But here’s some background.

We should be raising our rates at least 3% each year just to match inflation. I’m no economist. So, if any of you out there are like, “No, it’s not 3%” [00:03:00] feel free to let me know. But my understanding is that inflation is going to happen. So, just to keep up with the standard of living and how to live in our society, in the US at least, we should be raising our rates about 3% each year. What that means is if you charge $100 an hour, you could raise your rates to $103 an hour. If you’re charging $200, it would be $206 and so on and so forth. So we’re not talking about huge increases in fees. You could certainly do much more and you could raise your rates much higher than that, but 3% would at least keep up with inflation.

But how do we actually do that logistically and practically?

Well, the first stage or the first step as is true with many actions is to [00:04:00] give yourself a deadline. Now, many people will raise their rates in January. It just kind of goes along well with the new year. It provides a nice demarcation or breaking point to let your clients know. A lot of us revisit and make resolutions around the new year anyway. So, there’s concordance there.

But a lot of people will also raise rates in September, particularly if you work with kids because the school year starts and a lot of the time we’re seeing increased referrals in September, and folks who work with kids are kind of used to  academic calendar. So you could also do it in September.

But don’t get me wrong. You don’t have to wait for anything. I do think if you have existing clients that it is only fair to provide some lead time and then give them a little bit of warning before you raise your rates. I would ballpark 3 months, [00:05:00] I think is always a good timeframe for me to give a warning to any existing clients. A lot of us, if we’re solely doing testing, we don’t really have to worry about that. But if you do have some therapy clients in your practice, then I think that 3-month window is pretty fair. It’s plenty of warning for them to accommodate increased rates.

So, the first step again is just to decide when you’re going to do it. So, if you’re sitting down here and you’re taking a little time in the summer, you could say, okay, I’m going to raise my rates, starting in September or I’m going to raise my rates starting in January. Whatever you pick, just pick it, put it on the calendar, and stick to it.

So how much do you raise your rates? That’s a great question. I do have folks comment about how they get concerned about raising their rates too [00:06:00] much. And I totally understand that. I mean, if you raise your rates 20% every year, I think that’s going to potentially be excessive.

There are a number of factors to consider. One is when was the last time that you raised your rates? So if you haven’t raised your rates in a number of years, the longer it’s been, the more you’re going to raise. The shorter it’s been, I think the smaller and increment you can raise them. Again, we have that 3% baseline just to account for inflation. So, if you’re feeling kind of timid about it, start at 5% and see how that feels. So again, that’s going from $100 to $105. It’s going from $200 to $210. These are really not huge increases by any means.  But if you want to just do the math, let’s say if you’re making $100,000 a year, an extra 5% is [00:07:00] not insignificant. It’s $5,000. That’s quite a bit of extra each month. That’s a vacation. So, you can see even a small percentage is going to make a difference.

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.

So you could start at 5%. You also want to keep in mind what the market rate is in your area. I don’t place a whole lot of stock in the average rates for services in your area simply because other folks may or may not be charging what they’re worth. And if you have an incredibly valuable service like testing, which is often a specialty, I think you can often charge a higher rate than some other mental health practitioners in the community because the service is valuable and it’s often in very high demand. [00:09:00] That’s what determines fees. It’s the market. It’s not other practitioners. And who knows whether they’ve tested the market or not.

So, start at 5%. 10% is also pretty safe especially if you haven’t raised your rates in a while. I’ve known some clinicians that are going to go up even 20% or 30% this year simply because they were either underpriced before or haven’t raised the rates in a long time. So, you can think through what actually works for you in terms of an amount, but pick something and just do it.

Let’s see. Raising rates is important both for private pay and insurance. Private pay, that’s pretty straightforward. You just raise your rates and it increases your revenue. When we get into raising rates with insurance though, that’s a little bit more of a detailed discussion. [00:10:00] A couple of points though. The first is, just very literally with raising rates, you want to do it. Even though your insurance reimbursement may not go up, insurance panels do look at private pay rates in determining their reimbursement and their fee schedules.

So, even if you don’t see that play out immediately in how much you’re getting reimbursed from insurance panels, know that that data is being tracked and can influence future reimbursement schedules. So, don’t just take a backseat and let this slide by because you don’t think insurance cares.

If you want to raise your rates with insurance though, and actually increase your reimbursement, there’s the whole process to do that. It is absolutely recommended. This [00:11:00] is part of my job just once a year sending letters to all the insurance panels requesting a raise request, requesting an increase to our reimbursement.

I did an entire episode on asking for raises from insurance panels. What episode was that? I can’t find it right off the top of my head. Sorry about that. I think it was like 130 or something like that. So, maybe about a year ago, maybe a little more. You can go back. You could search for it pretty easily. I’ll also link to it in the show notes. I’m not going to go into great detail here about how to request increases from insurance panels because I did do so in that episode, but suffice it to say, if you’re an insurance-heavy practice or even if you’re not and you just take two panels, it absolutely behooves you to request increases from [00:12:00] those panels regularly, like yearly. They’re not going to say yes every time, but you got to do it. So check out that episode if you are interested in figuring out more of a strategy for requesting raises from the insurance panels.

Let’s see. What else?

I mentioned giving your clients 3 months of notice if you are going to raise your rates. I think that’s fine. Yeah, I think I’ve hit all the high points today. The main thing to take away is that you just need to raise your rates, period. You just need to raise your rates. This is a common business practice. Rates and revenue are really what drive our practices, whether we are solo or have employees, across the board keeping up with the standard of living and cost of living is super important. So, if for nothing else, [00:13:00] then to match inflation, raise your rates so you’re not falling behind. Summer’s a great time to do that. Hopefully, you have a little bit of extra time over the summer and can sit down and put some thought into this.

This is a pretty short exercise. So, you could easily find an hour to just dedicate to raising your rates and determining an appropriate rate. And there’s going to be some action items from that. You’re going to need to update it on your website and in your paperwork and those sorts of things. But this is a relatively quick process that shouldn’t be too tough for you.

So this is it. I think I’m going to wrap up the Summer Slam series with this 3rd episode. Like I said, go back and listen to the others if you haven’t. We talked in the previous two episodes about revisiting your schedule and revising your battery. [00:14:00] So hopefully, you’re taking away some actionable tips and some things that will just get you thinking, get the ball moving, and help you make some changes that will actually make a difference in your life and in your practice.

Thank you as always for listening. If you haven’t subscribed to the podcast, I would love for you to do that. It’s really easy in iTunes and in Spotify and anywhere else that you listen to podcasts. And we’ll keep increasing the reach and spreading the word about testing.

Well, I will be back with you this coming Monday with another clinical episode. I hope that you have a good weekend in the meantime. Bye-bye.

[00:15:00] 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 an expertise that fits your needs.

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

This podcast is brought to you by PAR. PAR offers the SPECTRA Indices of Psychopathology, a hierarchical-dimensional look at adult psychopathology.

The SPECTRA is available for paper and pencil assessment or administration and scoring via PARiConnect. Learn more at parinc.com\spectra. For a limited time, you can get one free administration and score report for the spectra on PARiConnect by calling PAR at 855-856-4266 just mention promo code S-P-E-C.

[00:01:00] Hey all, glad to have you here. I am happy to share an incredible interview with you today.

Dr. Esther Geva is Full Professor at OISE, at the University of Toronto: The Ontario Institute for Studies in Education. Her extensive research, publications, and graduate teaching focus on:

(a) The development of language and literacy skills in students from diverse linguistic backgrounds.

(b) L2 students or English Language Learners with learning difficulties.

(c) Cultural perspectives on children’s psychological problems.

She has presented her work internationally, served on numerous advisory, policy, and review committees in the US and Canada concerned with assessment and policy issues related to culturally and linguistically diverse children and adolescents. In applied practice, she is interested in community-based approaches to prevention and intervention in minority groups, and options in assessment, instruction for English Language Learners and other L2 learners, and culturally sensitive work with families coming from diverse linguistic and cultural backgrounds.

She has a wealth of experience. What is not mentioned in the bio is that she has co-written a book with Judith Weiner called Psychological Assessment of Culturally and Linguistically Diverse Children and Adolescents A Practitioner’s Guide that will be linked in the show notes.

This was such a rich conversation with Esther. We touch on a number of concepts related to assessing English language learners and culturally diverse learners. This is a little bit [00:03:00] different format than typical in that Esther provided me with a few points that she wanted to make sure that I highlighted before we jump into the interview. And I’ll also recap these at the end, just because these are such primary points that we hope that you might take away.

The first is that when assessing second language learners, which can include L2 English language learners, bilingual, multi-lingual, one has to be concerned about both language and cultural differences. And we do talk about this during the interview, but we want to put a fine point on it here.

The second is that language is complex and takes a long time to develop. So, interpreting test norms should be done judiciously. We also discuss this. Assessing language and literacy in the first language is a good idea. One would be looking for confirmation and consistency [00:04:00] across languages. We touch on this in the interview, but I don’t know that it was as clear as Esther has written it here. So I want to certainly highlight that point.

The next is that when interpreting assessment data, one should consider the age of arrival in the immigrant-receiving country, exposure to and opportunities to acquire the second language, school interruption, language typology, positive and negative transfer.

Now, these are all things that we again touch on, but just to pull them together and create one succinct point here, I think is important.

And lastly, we do talk during the interview about the report, but again, Esther just wanted to emphasize that the report should synthesize the various information sources that you gather. And as a psychologist, she really wants to know if the report has taken into account the nuances provided by considering all kinds of complementary data sources with these [00:05:00] linguistically and culturally diverse individuals.

So, those are just a few points to keep in mind, guideposts, if you will, as you’re listening to the interview. My hope is that you will take away not only these points, but many others from a true expert in this area.

So without further ado, let’s get to my conversation with Dr. Esther Geva on Culturally and Linguistically Diverse Assessment.

Hey Esther, welcome to the podcast.

Dr. Geva: Hi there.

Dr. Sharp: How are you this afternoon?

Dr. Geva: I’m very well. I’m [00:06:00] on sabbatical and was lucky enough to be able to make it to Vienna. So, I am a visitor at The University of Vienna. And it’s a good place to be while you wait for this pandemic to disappear.

Dr. Sharp: Yeah, I would imagine. There are many times over the course of the pandemic that I wish I could somehow go on sabbatical myself to somewhere else. I’m glad that you made that work.

Dr. Geva: Yes.

Dr. Sharp: Well, I’m happy to have you. Honestly, I found your work just by looking around online. I’ve been trying to integrate more discussion about the assessment of culturally diverse individuals and marginalized groups and so forth over the last year or so. And this is one of those cases where you have written or co-written a book on that very topic. So, I’m very excited to have you and dive into some of these.

Dr. Geva: I’m glad you discovered us.

[00:07:00] Dr. Sharp: Yes, thanks for being here. Well, let me start. A typical first question here for listeners, they always know I’ll ask, why is this work in particular important to you right now?

Dr. Geva: If I may rephrase it right now, it has been important for me for quite a while. When I was in graduate school, I started to become interested academically, intellectually in the topic of second language learning. Part of that reflected my own personal history. I was observing my kids who were being exposed to two languages. So, this was all very nice and dandy.

And then, one of the things that happened shortly after I finished my Ph.D., I started seeing the literature work, which was very important, which talked about [00:08:00] biases, in particular, I’d like to give the one example, which I think is a very powerful one, of one of my colleagues Jim Cummins, who did seminal work in the late 70s early 80s where he showed that children in this particular, it was in Canada, that children who were children of immigrants were diagnosed as being intellectually disabled. At that time, they used a different term but it doesn’t matter. And he showed an effect that all they would do is just give them an IQ test and then say, yeah, this kid has an intellectual disability. In effect, what he showed was that in many of those cases of the immigrants, they didn’t have a chance yet to develop English language skills, which was the group that he was looking at, and so they were being diagnosed as having feelings for disability whereas, in fact, it was very possible that they have [00:09:00] there was still not a good command of English, of the cultural aspects of the testing, and so on and so forth. 

He talked about overdiagnosis. Other people at that time also talked about it. People in Sweden. Francis talked about it as well. And so what that get… So at the same time, you sit up from the rise of this idea that there are learning disabilities and then getting better research and then conceptualization of learning disabilities, how we diagnose them, et cetera. People like Jim Cummins talk about the fact that many of those children may not actually have a problem and that it has to do with the fact that there is no consideration of their linguistic proficiency in English.

So when I started to work in this area, I was seeing extra children who were kids of immigrants and who [00:10:00] definitely, for instance, had problems in learning how to decode words, but the system said you cannot diagnose an immigrant child for having a learning disability for five years because first, you have to make sure that the child has had enough opportunities to develop their language skills. So for instance, a same-day immigrant to the US or to Canada, English-speaking Canada, let’s say, you would want to first make sure that they’ve actually had enough opportunities to learn the language before you can then start to say, maybe there’s another problem.

So when I got involved in this area, what I was seeing were kids who actually had decoding problems but the system refused to accept that they were second language learners, but they also had decoding problems. So, that’s what mobilized me to say, well, can we figure out a way of teasing apart those two? The difficulties for instance in doing math [00:11:00] on decoding, can we tease it the part for the fact that somebody is a second language learner?

So that’s what mobilized me to the book, to the course, I’ve been teaching lots of studies, projects.

Dr. Sharp: Sure. I’m always struck by how folks turn these things into a life’s work. And it seems like you have really done that.

Dr. Geva: Definitely.

Dr. Sharp: Then a lot of folks, there’s a personal component as well. I think that’s always a big driver for many folks.

Well, I’m excited to get into some of this with you now. This is a dense, multi-layered complex topic. So, I’ll do my best to touch on the things that are most relevant for folks. But I wonder, could we maybe just start with a little bit of context and talk about… So, [00:12:00] I’ll give some context myself. We’re going to be discussing a lot of aspects of assessment and how to assess English language learners and considerations there, but could we maybe start with a general discussion of the tests that we use and how they are either standardized or normed for individuals who are speaking different languages and how that all relates as we think about assessment.

Dr. Geva: Well, the way I started to tackle this issue was to ask questions. Let’s take something like what we call dyslexia word-based reading disability. The fundamental question I asked myself was, to what extent do you actually have to be completely fluent in English[00:13:00] in order to be able to look at the word and be able to say, that’s the word, high or school or classroom or Spring or whatever? So to what extent do I actually need to know the meaning of the word, in other words, to be proficient in the language in order to look at the page and be able to sound out the word, and maybe if I see the same word a few times, I just remember what it is and I can say spring without having to go spring. Okay?

So that was the fundamental question. And so what we started to do and that ended up being little, did I know, but it was a project, it took us 10 years to collect data. So basically, what we did was a very complex project. We started by tracking children from Grade I to Grade 6. So every year, we gave them the same battery of tests. At [00:14:00] some point we modified the test but we don’t need to get into that now.

And we ask ourselves… and so we had both monolingual children- so English as a first language, and we had children of immigrants to Toronto. Toronto is a highly multilingual place. At the moment, there are about 200 different languages spoken in Toronto as the home language. So highly multilingual. And so we went to the schools, we begged them, can you please allow us to follow those children so we can figure out how to develop their reading, how to develop their writing skills, and how did it also develop on various cognitive processes which we know are associated with learning to read, with problem-solving, et cetera. So it took us 10 years to collect this data. And we ended up with data of about 450 kids who started Grade 1.

So they all start in Grade 1. And [00:15:00] the reason we started with Grade 1 was because we wanted to start with the kids before they started to learn formally to read some other language. So we had the common ground and tested them every year for six years. And because we recruited for 4 consecutive years, additional cohorts of Grade 1 kids, the data collection took 10 years and quite a few dissertations came out of that.

To go back to the topic for today, one of the questions we asked was how long does it take for children to develop English, and in particular, in a moment I’m going to focus on vocabulary? And the other question is, to what extent do second language learners who come from homes where different languages are spoken in their homes and all come to Grade 1 starting to study in English, in this case, in the metropolitan Toronto area. [00:16:00] But it would be different in other places I would say.

How does the development of language skills look like over time? Do they close the gap on various language measures? What does their word reading look like? What does the ability to decode nonwords look like over time? What do the various underlying cognitive processes that we know are related for instance to dyslexia, to what extent do they reflect related to whether they are second language learners or not?

And what we found was that basically, it takes a long time to develop language in particular. And I’m going to talk about vocabulary. So the children get better from year to year on the vocabulary as do most of the monolinguals, of course. But even after six years [00:17:00] of being in an English-speaking environment where for 5 to 6 hours a day, they’re exposed to English, on average, they don’t close the gap on their vocabulary knowledge. So even after six years of being in the educational system, there’s still a gap. And so from that perspective, definitely what Jim Cummins said a few years earlier, was basically replicated. So that’s one finding which we can come back to and talk about what are the implications of that for various assessments.

At the same time, what we found was that on the basic reading skills which don’t require comprehension, for instance, looking at words and being able to decode them being, there’s no difference between monolinguals and second language kids on average. In other words, if I start in Grade 1` and you start in Grade 1, and this kid arrived a year ago from Ghana or Saudi Arabia, they’re all in Grade 1, that on [00:18:00] decoding, on average, they look the same as the monolingual.

Dr. Sharp: That’s fascinating. So can you go back a little bit then and define when you say vocabulary knowledge and how the kids never really closed that gap, what exactly do you mean by vocabulary?

Dr. Geva: One of the measures that we used was the  Peabody Picture Vocabulary Test which is a receptive vocabulary measure. And so basically what the kids see… There are versions of the test in many different languages. So basically in this particular test, the PPVT as it’s fondly known, the kids, for each item, they see four different pictures, a pencil kind of a picture, simple pictures.

And you’ll say to the kid, point to the bird. So they have to point to the bird and not to the cat, okay? That means they know what the word bird means. That’s a standardized, [00:19:00] highly reliable measure, and of course, as the items continue on the test, I can set it as a measure, the items become more difficult, less frequent, and so on.

Statistically speaking from Into associates measurement properties, I’d say, it’s a good measure. And I believe many researchers around the world are using versions of that. So that’s an example of a vocabulary measure. We have some other measures, but I don’t think we need to talk about them now.

Dr. Sharp: That’s fair. No, that’s enough. I was just curious how you were gauging vocabulary. That’s helpful.

This might be a leap, but I’m just going to jump into it. So when you say that there were no differences in decoding then, that makes me and I think maybe we’ll be getting to this kind of stuff, but that, of course, opens the door for [00:20:00] characteristics of dyslexia and how we assess those characteristics in English language learners. But at least with decoding, you said that there were no differences between them.

Dr. Geva: No differences.

Dr. Sharp: Oh, okay.

Dr. Geva: So, there’s this one paper, I think one of the first papers that came out of the project was published in 2000. And we actually show profiles where we compare the profiles of monolinguals and second language learners. And remember, those kids are all sitting in the same classrooms. In a given classroom, we may have, let’s say, 10 monolingual kids and 10 ELL kids and we’ll give them the same measures. So that’s the way to think about this. It’s not as though we go to one school where all the ELLs are sitting together, and in another school, at least in the Canadian context, that does not happen that much, though. I believe in some places in the states, it does happen where France, when around the border with Mexico, where actually most people [00:21:00] speak Spanish, but I believe that a similar result from those places as well. Yeah.

Dr. Sharp: Sure. Do you know if that holds true? Have you looked at some of those other variables involved in dyslexia? I mean, so there’s decoding, but then, of course, reading fluency.

Dr. Geva: Right. So, first of all, if you look at reading fluency, we actually looked at that as well. What we see with reading fluency is, first of all, when we talk about reading fluency, I find that it’s useful to distinguish between reading fluency of words versus reading fluency of connected discourse. In other words, if you just get a list of mixed-up words with no meaning, just each word not related to the word that proceeded or the word that comes after it. So there’s no ability to use linguistic grammatical structures to help you know what the next word is going to [00:22:00] be, right? So that’s one way we assess fluency.

And the other one, most tests actually provide information about both. The other one would be the reading fluency of connected texts. So now, here’s a story, read it as fast as you can. Let’s see how many errors you’re making along the way and how much time it took you to read a particular text. These are the typical ways we assess fluency which are probably true in general.

Dr. Sharp: Right.

Dr. Geva: So what we find with the reading fluency is that fluency reading unrelated words, again, it’s very similar from the monolinguals and ELLs, but when it comes to reading in context, so like, just read that story as fast as you can, then we find as expected, the ELLs are less fluent than the monolinguals. And if you think about it in terms of assessment procedures, I suppose [00:23:00] that you say, okay, you have 40 minutes for this test. Well, one can ask, should the ELs get a few more minutes because on average there’ll be reading less fluently because they’re second language learners.

There are all sorts of questions that can be asked. And I would say it even has implications for how we assess for entry to university, et cetera, right?

Dr. Sharp: Yeah. That’s a great point. So you have, do you have data on long-term development? 

Dr. Geva: I don’t have it up to the university standards, but there are some other studies that are out there. And definitely, you would expect that if you… I think we kind of drift away from children, but there are studies that show that they will be less fluent than the monolinguals. And then we can ask questions such as should one use the exact same administration procedures for first and second language learners?

Dr. Sharp: Yes.

[00:24:00] Dr. Geva: What we’re doing here is we are comparing the monolinguals with the bilingual or the multilingual, but at the same time, we have to remember that if you look within the bilingual group, there’ll be individual differences, right? And from an assessment perspective, that’s one of the things of interest.

So this is a kid who may be reading not as fast as a monolingual kid with the exact same cognitive profile, but they are very fluent in comparison to all the other people in the cohort who are less fluent, who are also second language learners. So it raises questions about the standards and the norms that we’re using.

Dr. Sharp: Sure. Well, that raises a question that I know we were thinking about talking about. So this concept, and this is not exactly the same, but maybe we’re in the same ballpark, hopefully. So the idea of “cultural bias” in our tests, how do you think about [00:25:00] that concept in the context of assessing English language learners?

Dr. Geva: In my work, I have not looked at cultural bias. So the cultural bias, what do we mean by it? We mean by that, I know there are some studies I remember reading when I was a graduate at graduate school where they compared the ability of American undergraduate students to understand a description of an Indian wedding. There are these studies with this comparison to the ability to understand all the customs around Indian weddings versus typical North American weddings. And so they show that there is a difference, right? Yes, so there should be a difference. And if I don’t have any ways of… and I don’t understand what’s the meaning of the custom, and I don’t know how to interpret it, and I don’t know whether the story is about how somebody broke the rules and did not obey what their elders [00:26:00] told them that they should be doing, then I may not understand the story, right? So, definitely cultural background is important.

Bransford, when I was in graduate school, was doing some amazing studies on that. Does it matter? Yes, it does matter. I haven’t been looking at that. It definitely is a relevant thing to consider. But what I’m talking about more is or I’m more engaged in because of my research is, can we use for instance the same, let’s say that you do a GRE and we’re looking at vocabulary, by definition, I would expect somebody who comes from a home and they don’t speak English on average to have a lower vocabulary than a kid with every everything else being equal, right?

[00:27:00] So parental education, exposure to education, everything in the context is the same. I would still expect them to perhaps on average to be less fluent or maybe know fewer words in English, and what will be those words which will make you get into Harvard and not, it will probably be words which are very rare, right? So maybe if I am an English language learner, I may not be familiar with those words. So, then the question is, do we use the same norms or not? And those people in ETS who are studying that topic.

Dr: Sharp: Right. Where are we landing at this point with that question? Are we using the same norms or not?

Dr. Geva: I don’t actually know about university students. I am not aware that we are, but I really am not sure about that. I know there’s a discussion about that.

Dr. Sharp: Sure.

Dr. Geva: So the question really here is about, [00:28:00] I know what the current practice is, but the question is, who are you comparing the child to or the student, in the same case when somebody is applying to university? Are you comparing to all the other kids who are like you in terms of their first language background or you’re comparing them to all the kids who are trying to get into university in a given year?

Dr. Sharp: That’s a great question. Well, extending it downward to elementary school or maybe middle school-aged kids too, I wonder if that, or how that might influence say selection for gifted and talented programs depending on what measures they’re using to screen.

Dr. Geva: Yeah, and once you get into talented, again, here, I could just share with you more clinical observations. I haven’t done research on this, but we also have to be aware of cultural [00:29:00] differences that parents from certain cultures may send their kids to private school. So they learn all the possible words in English, and they pass the GRE. So they pay money to practice. And there are companies that make a lot of money out of that. And if you invest in that, then your child, even though you speak at home in another language, may learn all these esoteric words because somebody enabled you to learn them. Is this fair? I don’t know.

Dr. Sharp: Right. That’s a big question. I don’t know if we can answer that question, is it fair or not? Yeah, but it’s definitely happening. That’s true.

Dr. Geva: I can say that a few times, and that’s my experience in the Metro Toronto area that parents from certain cultures come knocking on our door saying, “Can you train my kid? I would [00:30:00] like for my kid to be recognized as gifted. Can you train him to take the IQ test?” And I say, “Sorry, can’t do that.” But it has happened to me and to my colleague.

Dr. Sharp: I believe it. Yeah, it does raise that question. Again, I don’t think we can answer that question, but if it’s not fair, what do you do about it? It seems clear that it is not fair exactly for using the same.

Dr. Geva: It says if you have the money. So it’s not about ability, it’s about whether you have the money. So, we’re talking about gifted but those issues are also relevant when we talk about kids who have learning disabilities, for instance. So how do we assess and there are all sorts of biases built into the system across the board? One can talk about it from that perspective.

Dr. Sharp: Yeah, can you speak to some of those?

Dr. Geva: Yeah. [00:31:00] There’s a variety of topics that one can talk about. We can start with something like parental attributions. We have done some studies and others have done studies where Francis compared the attributions that parents make, I’m talking about immigrant parents here, the occupations that they make about why somebody has difficulties in reading, for instance.

We’ve done a few studies. One of the studies that was particularly interesting to me at the time was a study where we compared immigrants from Iran to Canada with similar middle-class parents in Iran. And we asked them questions about if a child is not doing well at school, they have difficulties with reading, what do you think might be the reasons? [00:32:00] And how do you know that the kid is having difficulties?

The parents in Iran were middle-class parents so they’re educated. They said the clue that the kid is having problems is that they have lower grades, and the reason is that they’re not trying hard enough. And that was very simple. Whereas counterparts in Canada who we interviewed have begun to acculturate.

So, they started to have conceptions of, for instance, dyslexia, or emotional reasons why somebody is not doing so well at school. I remember some even mentioned some problems and the family, for instance, there are some parents who are not getting along, they’re fighting a lot, et cetera. So they started to also bring in some social-emotional issues why a kid is not doing well.

So what we saw is a general shift in terms of attributions for [00:33:00] just work harder, sit harder, sleep less, just work, study more, versus starting to see some individual differences which can then be addressed. So if I have a kid who has difficulty decoding, maybe I can take a tutor or I can send the kid to a private school where they know how to work with kids like my kid.

Dr. Sharp: That’s interesting.

Dr. Geva: So they’re starting to have a broader and more and more nuanced interpretation of what could be the reasons and that leads to what can be done about it. Can I do something about it?

Dr. Sharp: Right. I would guess then that makes them more open to intervention as well.

Dr. Geva: First of all, they have to accept the diagnosis of some kind of assessment and then be open to intervention. Exactly that.

Dr. Sharp: Right. I love that. As we were talking before we started to record, you brought up [00:34:00] this idea of the difference between testing and assessment. That caught my attention. I wonder if we could talk about that a little bit, and then we can start to dive into some of the specific ways that you assess differently.

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

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

Dr. Geva: I’m a clinical [00:36:00] psychologist. I’m a professor in the Department of Applied Psychology and Child mental Psychology.  We are accredited and there are all these courses we teach, right? So one of the courses it’s kind of the holy grail is how to assess intelligence.

So, lots of effort goes into what is intelligence? What are the different kinds of intelligence? How do we assess it? A lot of focus is on the scoring of tests. So the students are very stressed, of course, for our students to spend many sleepless nights memorizing the criteria, whether an item is a 0, 1, or 2, and how to interpret et cetera, which is why we’re accredited. We do a good job of training students to administer IQ tests. So that to me is on the testing side.

[00:37:00] What we want is that when you administer the test or I administer tests, we should arrive at the same conclusion. So we should apply exactly the same criteria and we should be sensitive to the same issues. So that’s to me on the testing side. And it’s, of course, very important.

However, I would argue to be a good clinician, in this case, we’re talking about somebody who deals with learning disabilities as well. I need to know that you are somebody who understands the broader context, the conditions under which one can look for additional information or modify the administration procedures in ways that will give us more reliable and valid information. I would like to emphasize valid information about [00:38:00] what this child’s strengths are, what are their weaknesses? So, we could take some extremes, a kid who comes from, I’m thinking of… I’d like to give an example.

Dr. Sharp: Sure.

Dr. Geva: I think just recently, I’ll let me just backtrack a little bit. So I’m actually teaching a course called Assessment Intervention with Culturally Linguistically Diverse Children. This course actually ended up being the book that you referred to that I published with my colleague Judith Weiner. Each of the students in that course, and these are doctoral students at that point in the clinical program, have to take the course and each of them has to work with a client who comes from some kind of a linguistic and, or culturally different background.

So this is not going to be your English Monolinguals. [00:39:00] It could be a kid who is in a French Immersion program. These tend to be the more privileged kids, or it could be a kid whose parents have just arrived from Syria as refugees. It could be a kid on the border between Mexico and the US. It could be a kid who goes to a private school which is bilingual or trilingual. Any of those contexts.

Dr. Sharp: Okay.

Dr. Geva: And so, those cases in our insights led us to the book that you referred to earlier. So let’s think now of a client as an example, and that’s not the client that made it to the book. I’m thinking of a client whose parents came as refugees from Syria about 3 years ago, maybe 4 years by now, something like that. In this [00:40:00] case, the context is very interesting. We actually have a project where we are following the kids who have come from Syria to see how they are developing in various domains. And one of the testers who herself is coming from an Arabic-speaking country and who is a graduate student said, this kid has difficulties. This kid is not just a typical kid from Syria. He has difficulties. Please, can you take him to the course and assess him? So we did the assessment.

The interesting thing is, first of all, we can look at it from a systemic perspective. So here’s a family from Syria. We all immediately think of PTSD. We think of trauma. It makes sense, of course. And here’s the kid who’s already been in the system for 3 to 4 years, absolutely has zero phonological awareness. He cannot do anything. Games nothing. He [00:41:00] cannot do it. He’s not learning English.

There are some behavioral issues that we observe. And so we start to assess them. So in this case, we give him the WISC? We actually ended up giving him the WISC, but can we just use standard procedures that we overtrained our students to score? Are the norms relevant? No. Would you try to give the instructions in Arabic if you could just to make sure he understands the instructions? Yes. Well, but then you’re breaking the rules, right?

Dr. Sharp: Right.

Dr. Geva: What if you try to teach him to do something like any of the verbal or [00:42:00] verbal tasks? How would you try to teach him and see if he learns as a result of teaching? So this is where we start to bring in some dynamic assessment approaches to see because we are aware that we cannot just use the norms published for the WISC. It’s not relevant for him. So we try to give it instructions in Arabic. We try to do a test semester to see what it is and the sort of intervention is getting better. And so the picture we’re then gathering is much more complex. It’s not just about his Intel IQ as measured by the WISC but rather, what are his problem-solving skills? Is he learning when we teach him and so on and so forth?

So, this is an example where we break out the rules. And so now we break to an assessment because we really found out whether he has the ability to learn to problem solve is a better nonverbal domain, but just using the [00:43:00] norms, he would be flattened everything. But in fact, it’s not flat when you start to use a flat low, I mean, but when you start to look at some alternative approaches where you see if you teach him, he can actually learn and more so in the non-verbal domain.

Dr. Sharp: Sure. I like that distinction. So testing for you is more just black and white rote administration by the rules, scoring by the rules as we were taught, as the manual states. Assessment on the other hand is maybe more holistic, fluid, nuanced.

Dr. Geva: More nuanced, holistic. Let’s look at how a learner, assuming that he’s come from that same background, grew up in a refugee camp so maybe he didn’t go to school. What if we teach him, can he learn? As opposed to we teach them, he can’t learn HIPAA conduct or not for now.

[00:44:00] Dr. Sharp: Right. That’s such an important distinction. It raises so many questions for me. Do you have a definition of dynamic assessment? You used that term just a minute ago. What do you mean by dynamic assessment exactly?

Dr. Geva: I actually did not make the term. Other people like Vygotsky and others have been using it. Basically, it has to do with their ability to observe as you try to teach a child a skill to see how they learn. How many repetitions, how much additional information you have to provide, and does the child learn when you do that kind of teaching?

Dr. Sharp: Right, I like that.

Dr. Geva: Yeah, that’s a very simplistic definition.

Dr. Sharp: That’s all right. [00:45:00] I was just curious. That stuck out as you were describing this case.

Dr. Geva: If you look at the kid like the one I just described, he didn’t go to school while they were refugees in Jordan before they came to Canada.

If he didn’t go to school then maybe he didn’t have the opportunity to learn. And not to mention the fact that he would be in an Arabic speaking environment and not in an English speaking environment. So he also has to learn English, the cultural differences, maybe he has never been tested before in a formalized way. So there are all these things that we need to consider, not just administering the test, right?

Dr. Sharp: Of course.

Dr. Geva: And in his case, when we gathered all this information, actually we came to the conclusion that he definitely has serious problems in the language domain. [00:46:00] In fact, we ended up diagnosing also with language impairment, well, now it’s called developmental language disorder, DLD. But in the non-verbal domain, he had some strengths. Will he ever get a Ph.D. in psychology? I don’t think so. Will he be able to be a combat mechanic? I think so. So then that kind of gives us ideas about what is his potential to learn.

Dr. Sharp: Right. That reminds me of a case that I saw fairly recently for a kid, not an English language learner necessarily, but a kid who was truly homeless and just completely off the grid until late elementary school. He finally was discovered by the authorities and had never been to school, had never been in any sort of [00:47:00] formal educational environment. And they wanted an assessment just to get a baseline of what his brain was up to. And there were a lot of parallels to these concerns you’re describing.

Dr. Geva: That reminds me of, there was some very serious affair at night studies that were done on homeless kids, street peddlers in Brazil, I think in a similar kind of thing. So you have these kids who don’t go to school, but some of them really understand math much better than the middle-class kids in Colorado and Ontario. They really understand because they have to make money, right?

So they have a much better idea of how much money they’ve made, how many packages of cigarettes or whatever it is they are selling on the street, they have to sell to actually make some money they can get home much better than that. And again, you would expect the individual differences, so they’re able to learn, right?

And some of them are better at learning [00:48:00] those principles, the math and the other ones who make money. And actually, one of the studies shows that the kids who came from middle-class families didn’t necessarily do better on those measures. So they know the procedures, but they do not have this deep understanding of what it means to handle money and to multiply so many packages of cigarettes by some currencies.

Dr. Sharp: Right. Real-world experience goes a long way.

Dr. Geva: Yes. So the kids are intelligent, right? I’ve said they may not do well on a standardized test. Again, with this distinction between testing and assessment, if you give them a standardized measure of math paper, pencil, they will not do well on that. The smart ones will be able to solve those more sophisticated problems.

Dr. Sharp: Yes, this is probably an obvious point, but I just want to highlight that I think a central theme of our discussion here today is just that test scores do not [00:49:00] necessarily equal intelligence, especially in these kiddos.

Dr. Geva: Yes. It’s exactly what I’m trying to say. And to me, it goes back also to dynamic assessment, which is really what you are to see what your potential to learn.

Dr. Sharp: Yes, so that brings me back. I have so many questions about dynamic assessment. The first question, you do, it sounds like a lot of teaching and training.

So the first question is, how does one teach this? This seems like a very difficult set of skills to master, to know when to break standardization, to know how to break standardization depending on the kid that you’re working with. I mean, how do you even begin to develop that skill of dynamic assessment?

Dr. Geva: One way to think about it is in terms of how many dimensions you’re testing all at the same time. So let’s take something like, let’s take the block design non-verbal [00:50:00] test. What are the skills that are needed in order to solve a block design problem? What are the skills needed as you get better at something?

So usually the way we assess it, we say, okay, how long did it take you to match the pattern, or were you able to match the pattern and how long it took you is basically what we were looking at. But as the items get harder, we get more dimensions, right?

Dr. Sharp: Yes.

Dr. Geva: What is if we take the easiest item and we’d say to the kid, look, this block you see on one side is red, and the other side is white. Can you show me another one like that? How many of those can you show me? So you start from the dept and just started with a simpler one. And talk about what is it that you’re comparing, get them to say that, get them to mimic you.

Now let’s try another one. [00:51:00] Can they now do it on their own? One kid will be able to do it. Another one will need maybe two more trials.

Dr. Sharp: I see. Extending the teaching.

Dr. Geva: It’s teaching. Do you learn when I teach you?

A group in Israel actually, so it started with Feuerstein who was a descendant of people like Vygotsky and some of his students who have developed that and they develop something called the learning potential where they actually start to try to standardize those procedures to be able to kind of say, this kid is learning but it takes them so long before they can learn, et cetera.

[00:52:00] Dr. Sharp: I see.

Dr. Geva: Ezuirel is the name of the guy who I believe has written quite a bit about this but kind of creates some standards for how you assess a dynamic assessment.

Dr. Sharp: That’s fantastic. I’ll put that in the show notes and try to find some articles to link to. That sounds great. So then are you building this into the course that you teach? Is this just a matter of procedure?

Dr. Geva: Yes. Well, we do, but we send them to some examples online and to some articles and we talk about it. And when they come back and talk about the cases, they have to describe what procedures they used. And so then the whole group discusses them to see whether there was evidence of [00:53:00] growth or not. But again, you don’t have any standardized norm for that. So it’s more like the observation of can the child… to me, the essence is can the child learn when you teach them?

Dr. Sharp: Yeah. That makes sense to me because that indicates potential. Of course.

Dr. Geva: Yes.

Dr. Sharp: So then I do have a question about that. How do you document these results? Do you even score the measures?

Dr. Geva: We describe them. And it kind of goes back to something you asked me earlier, and it’s sort of how you work with the system. So, maybe I’ll use it as a way of trying to address your question, which is a very important one. I’m thinking of one case [00:54:00] that we had a few years ago of a girl who was born in a refugee camp in an Asian country. And she came to Canada with your family about 2 or 3 years before we were approached at the clinic at the University of Toronto, it’s OISE where I work.

And the social worker kept calling me to say, can you please assess her because we want to put her in a program for kids who are intellectually handicapped. So everybody knew that she’s an intellectual handicap, but the school board needed a number. They needed an IQ number so that she would qualify for the special program, which I’m assuming is the case in many places.

So they actually needed the number. If it’s above [00:55:00] 85, then she doesn’t qualify. She was below 85 IQ, she qualifies depending on how severe the case is. Again, as part of that course, I had a student who worked with her, observed her at school. We tried to teach her how to take the subway from his school to our clinic. She could not learn that. So her brother always had to come and bring her over. A lot of dynamic assessment procedures.

And so now I’m going back to your question. So the report described all the alternative ways that we tried to assess her, observing class, teaching her, using dynamic assessment principles, and how really, she was clearly a kid with intellectual disabilities. And so the report included examples from all these observations of all the different ways we try to assess whether she can learn, things such as…

Another example was, [00:56:00] very close to our department is on campus. There is a survey in a donut and coffee place. The student would take her to see if she could remember how to get there. So every time they met, she tried to teach her to go to that cafe on her own, of course, she would accompany her and see what else she could order. And it was always the same thing. It would be doughnut and chocolate milk and whether she could handle change. So she would always give her a $10 bill to see if she could handle the change. And there was no improvement. She just couldn’t learn.

So that became part of the report. We described how with all these attempts to teach her some small steps in terms of dealing with the spatial information of making it from university to that coffee shop, it was constantly kind of like Dunkin donuts, but a [00:57:00] Canadian version.

Whether she can handle it, it was just not getting better. So all that went into the report actually.

We sent the report to the school, and literally within an hour of sending the report, I get an email saying, can you please give us numbers? So, now we’re back to this testing versus assessment because the policy says we have to establish below the certain cutoff. And I thought we spent so much time on this girl because it was also a learning experience for the doctoral students. I got back to her and I wrote, we’re telling you that she has an intellectual disability. And if you don’t accept that, I’m going to go with that to the human rights commission. [00:58:00] So then they backed off.

Dr. Sharp: Oh goodness. Okay. So you were able to get around that.

Dr. Geva: I was. I just said, look, there’s so much time that we spent on her, but we cannot give her an IQ test. It’s inappropriate to give an IQ test and document so many different ways that this girl, unfortunately, has an intellectual disability.

And by the way, this is part of what we also do. This girl with the same biological parents had a brother who was about to finish high school in Toronto. So, what you get is something we didn’t talk about yet, which is, what is the reference group? So in this case, with this girl, we don’t have a control group, but we have a brother who has the same parents, the same history of being born when in a refugee camp, came to Canada, all came together and he was finishing high school. So [00:59:00] this is a good comparison group.

Dr. Sharp: Right. Gosh, as you talk through this, it makes me realize how flexible we have to be and how adaptive we have to be as clinicians. You think about a reference group of one, but that’s what we’ve got. That’s the closest comparison.

Dr. Geva: Yes. And by the way, the other kid that I talked about earlier, the kid from Syria that we talked about earlier, this kid has 4 siblings. 2 are in high school and they’re doing extremely well in high school. They intend to become doctors. And they probably will.

So again, it’s all this very important thing. What is the relevant comparison group? And in this case, it’s good if you have other siblings. So then, you know, some of them are [01:00:00] doing well, don’t have intellectual disability, don’t have a learning disability, and they are doing well.

Dr. Sharp: Are siblings typically the reference group that you’re using in these cases?

Dr. Geva: We often use a reference group. We use what we can. With a Syrian kid, as an example, because there was this project that’s going on now in Canada that follows the Syrian refugees that Canada took their kids to see how they’re doing and they’re in various domains. So, my colleagues have developed assessment measures that they give to those children. And we can actually compare how our client is doing in comparison to other Syrian refugees on some of the measures. So they are not standardized, but they have good measurement qualities.

So looking at the ability of vocabulary in Arabic, their ability to read [01:01:00] words in Arabic, how they’re learning, to read words in English, how the vocabulary develops in English and so on and so forth, various language and literacy measures. Whenever I can, I do that. I compare the client to the others. So we give them the same measures that we print some and use in our research, and we say, we know how these kids who all came from Punjab background and he was a kid from Punjab who we have as a client. How is this child doing a comparison to other kids from a similar background?

So you have to be open-minded and creative in thinking about what will be a reasonable comparison group.

Dr. Sharp: Sure. That’s the theme here. It seems like it’s just being open-minded and willing to adapt to this work that we’re doing.

Dr. Geva: Yes.

Dr. Sharp: So just going back, I have a specific question with [01:02:00] the little girl who you said you pushed for intellectual disability. In a case like that, do you even attempt a standardized intelligence measure just to say you tried?

Dr. Geva: When we can, we try. We don’t have anything in principle against that. So the two principles here, I think, one is to see whether they can do the standardized procedure. What if you break the rules of the standardized procedures, does that help? That’s good. If it helps, it means that there’s potential for learning, or if it does not help even when you simplified the procedures, we give opportunities to explain the instructions more, to give maybe another example before you start to do the tests. So does that help? So all that becomes relevant.

Dr. Sharp: Right. The way I’m thinking of it in my [01:03:00] mind, you can tell me if this is accurate or not, as it’s like a stepwise model. I mean, you try to administer the test by the book black and white rote administration, that doesn’t work. You do a little more teaching, you provide more support, test limits, extend the time, whatever you might need to do. And then if that doesn’t work, it sounds like at least in this case, y’all move to almost like more of an ecological assessment model where you’re taking her out in the world to see if she can perform real-world tasks. Is that a fair way to conceptualize?

Dr. Geva: I like that. That’s a good scale to think about. Yes.

Dr. Sharp: This is how my brain works. I must organize this information.

Dr. Geva: That’s a good way of describing it.

Dr. Sharp: Sure.

Dr. Geva: I agree.

Dr. Sharp: Yeah. So I wanted to ask as well, let’s see something that you said just [01:04:00] a bit ago that I wanted to follow up on a little bit with this whole principle of dynamic assessment. Does your report then end up being largely, it sounds like what we typically will call behavioral observations in a typical set, does it end up being almost just a long behavioral observations report or is there more standardization to the writeup or what?

Dr. Geva: One of the things that we do is we, actually I don’t have it in front of me here, but actually the same colleague with whom I wrote the book, she has developed an alternative to writing reports that’s more meaningful and accessible, [01:05:00] and that paper that you published a partly, she still has a lot of hits on it on the report writer. It’s called The Report Writer, and it’s organized in terms of questions.

Dr. Sharp: That sounds fascinating.

Dr. Geva: Yeah. We try to keep it, here’s the question, here is what we saw and what the conclusions are, and then we move to the next question. One of the tendencies of our students is to write very long because they document everything. So we try to keep it a bit more succinct to the extent possible and to use appendices for the obsessive-compulsive psychologist at the board who needs to see full data, they can have additional information that’s there.

One thing that we are doing which I think is important to [01:06:00] mention is we also encourage… Well, we get our doctoral students to write a report that’s written to the child, the client. And so it’s sort of a one pager. Here’s what I’m good at. Here’s what I’m poor in. With this Syrian kid we just talked about earlier, actually, most of the information he used was very clever visuals because he cannot read.

And it’s sort of a way for him also to be able to say, this is hard for me. Here’s what I need for you so I can do better. It’s hard for me need to read instructions, but I do well when you read them to me, for instance. So, it’s a self-advocacy kind of a report that we give the clients themselves for them to be able to speak for themselves when they need something.

Dr. Sharp: I love that.

[01:07:00] Dr. Geva: Yeah. So that’s also something that the students do, but definitely, to go back to what you asked in some of those reports, they have both the description, which is along the lines of what you described as well as there’ll be a table with the WISC and here are the scores on working memory and fluid intelligence and so on and so forth.

Dr. Sharp: Right.

Dr. Geva: Yeah, it’s there, but it’s supported by observations that were made on the basis of dynamic assessment.

Dr. Sharp: Of course. Great. Well, as we start to wrap up here and end our conversation, are there any other principles or practices of dynamic assessment that we haven’t talked about that you want to make sure of and highlight?

Dr. Geva: So in terms of the report, here are some of the items that we mentioned [01:08:00] in guiding the report writing. There are all sorts of questions that one can ask, should I report on how I modified the tests? That’s one thing. So if you modify the test administration, how did you do that? Or if you conducted a dynamic assessment. Well, another question that we ask our students to consider as they write a report is should I provide qualifications as to why the results should be interpreted with caution? So for instance, here’s what we found, but given these and these reasons, the results may not be reliable.

Another one is, should I report standardized norms? I gave an example of where I refused to provide this and it does have norms but if the board does [01:09:00] require that, then we provide them usually. But we include the warning that this one may not be reliable and valid.

Dr. Sharp: I see.

Dr. Geva: Another one is, should I report descriptive observations? Again, we say, yes, you should provide this part of the dynamic assessment.

Another question that we sometimes are asked and it’s all kind of revolving around the same issue, should they avoid reporting specific scores because I believe that they may be misinterpreted by the school board, right? So that sometimes at the board said, we absolutely need to have the IQ scores and you want to help the child to get the right program that they need given their ability. Sometimes we have to give the scores,  but we always then include [01:10:00] some provisors about why those should be interpreted with caution.

So, these are some of the things that we guide our students to do.

Dr. Sharp: That’s great. Well, I just want to say, I know that we have barely scratched the surface with this topic. My hope is that folks are really starting to think about how this idea of dynamic assessment might come into practice and when we might consider an approach like that and how we might do it. I will, of course, have a link to your book in the show notes because it has a ton of information in there about how to do this and many other things.

Dr. Geva: I thought… sorry, go ahead.

Dr. Sharp: No, no, no, [01:11:00] that’s all you.

Dr. Geva: I thought that there might be one more distinction that I like to highlight, which is related to what we talked about, and that’s the distinction between what I call overdiagnosis and underdiagnosis. I don’t think we’ve touched on that today. I think that that’s something, again, the psychologist needs to be aware of.

Overdiagnosis is the example that Jim Cummins talked about, 40-50 years ago, which is too many kids of immigrants who get diagnosed as having intellectual disability. So there’s an overdiagnosis. It couldn’t be so many of them are.  I should say at the same time, under-diagnosis and we can talk about it at a systemic level is, and giving an example in Toronto, in particular, a few years ago, and by the [01:12:00] way, the Toronto District school board is I believe it’s the fourth largest in North America. It’s a very large school board. It’s the largest in Canada, but one of the fourth largest in North America.

A few years ago, they were running through various numbers and they realized… So until now, we talked about kids with problems, but what about gifted kids? So, to the other side of the distribution, right?

So, it turned out they did not have any kids who came from African or Caribbean backgrounds who were identified as gifted in the whole school board. So how could it be in a school board that has thousands and thousands of kids who come from that background but nobody is gifted. That’s not possible.

So then you can start to ask some systemic questions such as, [01:13:00] what’s happening? How come the parents from certain groups make sure that the kids get diagnosed, try the best for the kids but other parents don’t know that they should be doing that. So as a result, one of the procedures that’s happening now in the Toronto District School Board is that, in grades 3, all teachers are required to say, I think that this kid and that kid might be gifted. They should be assessed by the system.

So you see a systemic approach to try to correct a clear bias. I suspect that that will be true for the US as well. I don’t know if there’s any work on that, but somewhere there should be.

Dr. Sharp: Sure. I can only speak to some of our local districts, but I know that they are I think doing a pretty comprehensive [01:14:00] job of not only trying to identify English language learners who may be gifted but also assessing those kids as much as possible in their native languages and utilizing measures that are appropriate.

Dr. Geva: Yeah, exactly, because what we’d expect is an in the general population, whether you, your family came as refugees or they are African-American or come from some European descendant, we should see the same percentage of kids who, if they actually have a learning disability in one side, or if they’re gifted, that they should be picked up and receive the appropriate programming. We should expect the same percentages.

Dr. Sharp: Right. And that just relies on the idea that this is normally distributed.

Dr. Geva: [01:15:00] That’s right. Set of cognitive skills, linguistic skills, and that we should find more or less the same distribution. So if it’s tilted in one way or another, from a systemic perspective, we need to ask why. Is this something we’re not doing right? And of course, it has implications, of course, also for what we teach our students when they learn to become clinicians, for instance, or speech and language pathologists, right?

Dr. Sharp: Right. That’s such a good point. This is one of those basic statistical principles, but we miss those things sometimes in real life.

Dr. Geva. Yes.

Dr. Sharp: Well, this has been great. I know there’s so much more that we could talk about, but I hope this has provided at least an introduction and gotten folks thinking about how to do this process differently and how to support English language learners a little better. So, thank you.

Dr. Geva: I hope so.

Dr. Sharp: Yeah. Thank [01:16:00] you so much for coming on and having this conversation with me. It was great.

Dr. Geva: Thank you for inviting me.

Dr. Sharp: Okay, y’all, thank you so much for listening. As you can tell that interview was chock-full of information and case studies and stories. And I really enjoyed how Esther brought these cases to life and illustrated these points through case studies.

Now, again, as I mentioned in the beginning, a few points that we hope that you take away from this interview just to clarify and send you away with some really concrete ideas.

1) When you’re assessing second language learners, both English and multilingual kids, you just have to be concerned about both language and cultural differences and the interplay between the two.

2) Language is complex and takes a long time to develop. So interpreting the test norms should be done judiciously. 

3) Assessing language and literacy in the first language is always a good idea because you’d be looking for confirmation and consistency across the languages.

4) When interpreting assessment data, definitely consider age of arrival in the immigrant receiving country, exposure to opportunities to acquire the second language, school interruption, language topology, and positive and negative transfer.

5) The report should synthesize various information sources. You really want to know that the report has taken into account the nuances provided by considering complimentary data sources like some of the ones we mentioned in the interview.

So, again, thank you for listening. I hope you are all again, doing well and enjoying some kind of summer, whatever that looks like for you. If you have not subscribed or followed the podcast, I would be thrilled if you would do so. If you have, I would be [01:18:00] thrilled if you told a friend or two about it and continue to spread the word and increase the listenership, always a good thing and just grateful for you all. Thank you. Stay tuned, more clinical and business episodes coming up.

Take care in the meantime.

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

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