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

    All right, y’all, welcome back. I am so glad to be here with you today. And I am so glad to be talking to my guests today, Dr. Ryan Van Patten and Dr. John Bellone from the Navigating Neuropsychology podcast. If you haven’t heard Navigating Neuropsychology, in Ryan and John’s words, it is a voyage into the depths of the brain and behavior. It’s a podcast all about the clinical [00:01:00] aspects of pediatric and adult neuropsychology, and they are just knocking it out of the park with content and guests each time. There’s a link in the show notes to navneuro.com. Definitely encourage you to check out their podcast if you’re interested in neuropsychology.

    They also have just written a brand new book called Becoming a Neuropsychologist that’s available now for pre-order on Amazon. There will be a link to that in the show notes as well. And that book provides a lot of the framework for our conversation today. So we talk about the path to becoming a neuropsychologist. First, defining neuropsychology and neuropsychologist, and then talking about the ways to get there, the Houston conference guidelines, the difference between a neuropsychologist or a clinical neuropsychologist and a “regular testing psychologist” or [00:02:00] school psychologist, for example.

    So we have a great conversation. Very open. And we touched on a lot of topics that I think many of you will find helpful if you’re early in your career or if you are later in your career or mid-career, even like myself. So we spent some time talking about what folks might need, who want to go back and re-specialize in neuro-psychology, what that would look like, and how to do it. So there’s a lot in this episode for everybody really across the career span.

    Let me tell you a little bit more about John and Ryan and then we will get to the episode.

    John graduated with his Ph.D. from Loma Linda University. He did his doctoral internship at Yale and then his postdoc fellowship at Brown University. He’s board-certified through the ABPP. He currently works in a group practice in Southern California [00:03:00]in both outpatient and inpatient rehab settings. He’s also the backup neuropsychology consultant for the Anaheim Ducks NHL team.

    His career goals are to provide excellent neuropsychology services to adults and older adults with a variety of conditions and concerns. He has broad clinical interests, but he’s particularly passionate about reducing the risk for cognitive decline and improving overall health through lifestyle. He’s lectured extensively on the power of exercise, healthy diet, quality sleep, psychological wellbeing, and staying cognitively and socially active have on maintaining and improving cognitive functioning now, and as we age.

    Now, Ryan got his Ph.D. in Clinical Psychology from St. Louis University in St. Louis, Missouri. He completed his doctoral internship at Brown University and then a postdoc fellowship in neuropsychology at the University of California in San Diego. He is currently a neuropsychologist at Massachusetts General Hospital, Spaulding Rehabilitation Hospital, and Harvard Medical School in Boston, MA.

    His career goals include working as a clinical scientist, writing grants, and carrying out large-scale research projects in a variety of topic areas related to neuropsychology and geriatrics. Ryan also plans to spend a significant portion of his time teaching and completing clinical neuropsychological evaluations.

    So these guys know their stuff. Like I said, they have literally written the book on what we’re talking about today. So without further ado, here’s my conversation with Dr. Ryan van Patten and Dr. John Bellone.

    Ryan, John, welcome to the podcast.

    Dr. Ryan: Thanks so much for having us. This is great.

    Dr. John: Yeah, I’m really happy to be here. I’m a [00:05:00] longtime listener, first-time caller.

    Dr. Sharp:  I see. Yeah, I love it. I know we’ve had these circling orbits for several months now, and I’m just grateful and excited to be able to talk with you all in person and do some overlapping here. It’s really exciting.

    Dr. Ryan: It’s impressive that you’re this one-man show Jeremy, it takes two of us, me and Bellone.

    Dr. Sharp: It’s wild. I couldn’t live without my VAs and support from other people for sure. But it’s funny on the other side though, I’m like, oh my gosh. If I had to run all these decisions by somebody else, we’d never get anything done.

    Dr. Ryan: There’s plenty of that on our end. You have no idea how many headaches I’ve had running things by John.

    Dr. Sharp: I can only imagine my God.

    Dr. John: Mistakes that I have averted because of that now.

    Dr. Sharp: Thank goodness, right. And yet, despite all of that, you have managed to write a book together as well.

    Dr. John: Yes. [00:06:00] We were masochistic enough to take on that challenge.

    Dr. Sharp: Yeah, that’s pretty incredible. That’s a big part of the interview today and as a framework for what we’re going to be talking about as y’all have this book coming out, which I think needed addition to the field. And I know you said this in the introduction to the book, but something that I wish had been around when I was going through grad school because I think my trajectory would probably have been quite different if I’d come upon a resource like this. So, I’m excited to talk with you all about it. It’s a great piece and there’s a lot of good info in there. So we’re ready to dive in.

    Just right off the bat, I mean you all are, I think early safe to say early career at this point?

    Dr. Ryan: Yes.

    Dr. John: Very much.

    Dr. Sharp: Tell me, how do [00:07:00] you start to undertake something like this at this point in your lives?

    Dr. John: Right. Well, we had been doing the podcast Navigating Neuropsychology for two years now. And we had been getting lots of emails and questions from student listeners of the podcast asking us about how they could pursue a career in neuropsychology. And we just got tired of saying, well, there’s really no comprehensive resource that really describes the process from the ground up. So after, I don’t know how many emails we got, we decided, you know what, let’s just write the book on it, Ryan, and solve the problem ourselves. We wanted to provide a north star, so to speak, to guide students through the process.

    In terms of finding time for this at the time, neither of us had families or children. So we had a little bit more time. I don’t really have a [00:08:00] good answer. We just saw the niche that needed to be filled. And like you had said, we had wanted this resource when we were going through… we would have wanted something like this when we had gone through the process. So we just wanted to provide this to students. And we took on nights and weekends of writing as usual. I don’t know Ryan, what’s your thought?

    Dr. Ryan: Well, I think we have a mixture of interest in nerdiness and stupidity in order to do something like this.

    Dr. John: Perfect combination, true.

    Dr. Ryan: Yeah. But more seriously, I think neuropsychology is a fairly well-delineated field with professional organizations, journals or certification and APA division 40 of neuropsychology. So we’re very proud of that. But to become a neuropsychologist and to get into the field is not so well delineated. John [00:09:00] and me or everyone we know that we talked to, they all say, well, I just got lucky. I took the right course. I took a biopsychology course. I happened to learn about it through indirect means. I was in the right place at the right time.

    And that’s concerning because that means we’re missing people who otherwise would be very interested in neuropsychology, but just an undergraduate in particular, don’t learn about the field because it’s not in the […]. It’s just not talked about the way psychiatry- people know the term psychiatry or psychology more broadly. So we’re hoping that this book can make it easier for people who are interested and motivated, no matter their demographic background or socioeconomic status that they can have the chance to pursue neuropsychology. We both love the field and find it fascinating and interesting. So we want for people [00:10:00] to have the chance to become a neuropsychologist.

    Dr. Sharp: Yeah.

    Dr. John: And I’ll add that we’re particularly missing people who are less privileged and underrepresented like Ryan alluded to. So, we hope that this will also help diversify the field which is much needed.

    Dr. Sharp: Yeah, I’m glad that you brought that up. I was going to touch on that as we went along, but here we are. So we can dive into that.  As far as the content of the book and maybe more of the marketing of the book, if you’ve gotten that far, how are you planning to widen the net and find more folks who might not otherwise be exposed to neuropsychology?

    Dr. John: A lot of this is on our editor and the publishing company. One of the reasons why we went with a well-known publishing company is so that they could adequately market and get it where it needs to be. We’re hoping it will be in all university libraries and public libraries and widely [00:11:00] distributed. It’ll be available hopefully on Amazon and everywhere you can buy books. And in terms of getting the word out, we’re active on social media, some of us more than others, right? We’re also planning on trying to get the word out to students there. We know a lot of students are in Facebook groups and on Twitter and Instagram, things like that.

    Dr. Ryan: Yeah. I think it would be really beneficial if we can get this into universities so that undergraduates can learn that. Certainly graduate school in neuropsychology, I hope it would be helpful to grad students. But even earlier on, for me as a senior in high school, as a first-year in college, a freshman, that’s when it would have been most beneficial. Hopefully, we can promote the book in those settings.

    Dr. Sharp: Right.

    Dr. John: And it’s also a way for people to know if they don’t want to choose the field. We laid out all the pros and cons as [00:12:00] I’m sure we’ll get into the reasons to choose it and some challenges to working in this profession. So that freshman in college let’s say, who stumbled across the book, they can have an educated opinion of whether or not they think that this will be a good path to pursue before they take on the student loans and things like that, get too far into it and realize maybe later that it’s not the best fit.

    Dr. Ryan: In addition to that, our primary audience potentially would be undergraduates, graduate students, but we’re very appreciative of the chance to come on your podcast, Jeremy in great part because we think that it’s not just college students who would benefit. Psychologists, people who are already established who might want to retread, who might find that they’re very interested in neuropsychology even if their specialty training was not in neuro-psychology, I think could really benefit. It’s never too late either.

    [00:13:00]Dr. Sharp: Right. I’m excited to get into that portion of it. And I’m glad that y’all are happy to talk through that. I get a lot of questions about that in our Facebook group, just how do you go back? How do you basically rewind time which is impossible? So, in lieu of doing that, what can we do?

    But yeah, I think about going into undergraduate myself, I knew that I wanted to be a psychologist. I really didn’t have any idea what that meant though. And I didn’t know that assessment was even a possibility until I got to grad school. And even then, even though we have advisors, they’re not advisors in the sense of like high school or even college where they’re like, here’s how you pick a career path exactly. And here’s how you go about doing that. You get locked into whatever your advisor does. And if that’s not a person who isn’t a neuropsychologist, then you might be out of luck. And then it’s almost too late if you get to the end of grad school. So [00:14:00] yeah, I think it’s going to be super valuable.

    You talked about your target audience for the book. It is an undergraduate and graduate student, right? And then there is quite a bit of material for folks who are already psychologists just to wade through in terms of the state of the field of neuropsychology and what it is.

    Dr. John: True. Right. If I could just add to that. So we broke it up into two parts. The first part is more of a background on the field. What is neuro-psychology? What cognitive domains do we test? What patients do we see? What settings do we practice in? So, it’s really just an overview of the field for someone who maybe is interested in it and doesn’t know much about it.

    And then the second part is really the roadmap or the blueprint for how to get from undergraduate all the way through advanced training, postdoc, and beyond. So even for people who don’t want to pursue this [00:15:00] field necessarily, I think part one could be helpful just in laying out all the ins and outs of the field.

    Dr. Sharp: Absolutely. I’m curious just about y’all’s personal story. For each of you, how did you find your way into neuropsychology and why do it?

    Dr. John: Ryan was a produce boy before he went into neuropsychology. So he has an interesting story.

    Dr. Sharp: Produced like at a grocery store?

    Dr. Ryan: Yes.

    Dr. Sharp: Okay. So solid foundation.

    Dr. Ryan: Right. Got another difference between the sweet potatoes and the red potatoes. A very good life skill. So, I can go first. I think my story is similar to a lot of people in neuropsychology. In undergraduate, I was a psychology major. I was also pre-med. [00:16:00] My plan was to go into neurology. I was very interested in the brain and also behavior, but I had no idea that neuropsychology existed for the most part of my undergraduate.

    And then I just so happened to take a course in bio-psychology and my wonderful professor was, I was fortunate enough that he spent about 15 minutes during one class period talking about careers that use neuroscience and biopsychology and he happened to mention neuropsychology. He showed one of our tests, the Wisconsin Card Sorting Test on a slide. And I was immediately so fascinated. It was the perfect blend of my interests that I had no idea was even available. So from there, I really pursued it. Even though there weren’t neuropsychologists at my undergrad institution, I got lucky enough to get into a graduate program that had a neuropsychology concentration.

    Dr. John: Those 15 minutes were enough for you, Ryan?

    Dr. Ryan: That [00:17:00] was it. Yeah, I’m really glad I went to class that day.

    Dr. John: The one class you went to.

    Dr. Sharp: That’s great.

    Dr. John: And I guess mine is similar to Ryan’s into the traditional route. So early on I was really interested in both philosophy and neuroscience, which is a whole another story. I’ll give you the short version of my path. I was interested in philosophy and neuroscience and then I took a biopsychology course in college, and I found that it was the perfect blend of those two fields. My professor really focused on the philosophical aspects of neuroscience like, consciousness and whether or not we have free will and at the end Graham, and I just love that. It was such a good blend of my two interests. And that class coupled with a research lab that I had gotten involved with led me to apply to psychology Ph.D. programs that had a neuropsychology emphasis.

    And then grad school just [00:18:00] further solidified my passion for the field. And the fact that I could continue to study the brain, contribute to scientific knowledge, make a profound direct impact in people’s lives, and then make a pretty good salary while doing all that, I just couldn’t beat it.

    Dr. Sharp: Right. Yeah, it’s amazing when you find that perfect overlap of all the Venn diagram circles. That’s super cool. And both of you at this point are doing some research and some practice, if am I remembering, right?

    Dr. John: Ryan is doing both.

    Dr. Sharp: Yeah. Okay.

    Dr. Ryan: I am more research-focused and John is more clinically focused. We’re both interested in both, but right now in our professional lives, I would say I’m on the research side and John is on the clinical side more so.

    Dr. Sharp: I see.Well, that’s one of the benefits of this degree. I think it is the flexibility and that you can work in a variety of settings. So, can y’all run down some of the common places that neuropsychologists might end [00:19:00] up?

    Dr. Ryan: Yeah. Great question. So we have a chapter on where you might find neuropsychologists out there in the world? I would say, there are many answers to this question, but there are probably three settings that are most common: universities, private practice or group practice settings, and hospitals.

    And then within hospitals, there are a lot of specific types of hospitals that end up being very important for what the job of a neuropsychologist looks like. There are academic medical centers, the hospitals that are affiliated with the university, there are VA hospitals where we’re obviously working with veterans, rehabilitation hospitals where neuropsychologists are part of interdisciplinary teams and work with patients with brain injuries such as traumatic brain injury and stroke. A lot of cognitive training as well as assessment, psychiatric [00:20:00] hospitals where obviously we’re working with people who have a pretty severe mental illness.

    And so each one of those individual settings can look very different. Our job looks different. And we discussed in the book how neuropsychology is an amalgam of many different things. There are different pieces to the training. Depending on where you work, you might capitalize on one aspect of training more so than another. If you’re at a psychiatric hospital, then you’re really drawing on that training and psychopathology, mental illness, those types of things. If you’re at our rehabilitation hospital, you’re drawing on training that you received in cognitive rehabilitation, how to help people recover as best as they can. So I think it’s helpful to get a lay of the landscape in terms of all these different types of places where we can end up.

    [00:21:00] Dr. Sharp: Yeah. The variety of hospitals is striking. I mean, you never think there are that many hospitals, but there’s a lot of hospitals out there that we can end up in, right?

    Dr. John: That’s true.

    Dr. Sharp: So, I think it suffices to say that there are any number of situations that we might find ourselves in. My question, we switch back and forth with the Facebook group. It’s like this Royal I guess as a field, but there are a lot of questions about how did you research in private practice?

    I’m curious if you all have run across any folks who have managed to bridge the gap between those two? Aand if not, that’s okay. But that’s just something that popped into my mind. It’s a topic that’s come up before and I’ve never had a great answer or a great model for how to do that.

    Dr. Ryan: Yeah. Great question. I think the first idea that comes to mind is if a clinician in private practice can also affiliate with a nearby [00:22:00] university, that’s a great way to then become involved in what’s going on at that university or a large hospital might be running a randomized clinical trial. So in your community, if you have an institution to affiliate with, that’s a great option. If not, I’ve seen people in private practice, exclusively who develop very large clinical data sets based on all the patients they see. It takes a long time. It takes years. But imagine you’ve been at this in a setting for 10 years, and if you are methodically tracking the patients you see, you could start to develop a large neuropsychology dataset with lots of demographic cognitive data that could be really useful for research.

    Dr. John: Yeah, that’s actually something that I planned to do. I track every patient that comes in. I have a spreadsheet that’s de-identified and [00:23:00] just has the diagnosis, the etiology, and some other relevant factors. I’m pretty early in my career, but I plan on using that data set eventually as part of my informed consent. Each patient that I see, I have them sign something to say that I can use their data in aggregate in a future research endeavor if I wanted to. So, I’m planning ahead for that, but the data sets just are not developed sufficiently at this point.

    Dr. Ryan: Independent testing psychologists could even collaborate together. If John develops this dataset, Jeremy, if you had your own testing data set, if I had one, theoretically, we could go the route of big data and put them together if we gave similar measures. And multi-institution research is always preferred if possible  for better generalizability, larger sample sizes. So that’s something I [00:24:00] would encourage people to think about.

    Dr. Sharp: That’s a great point. Yeah, I wouldn’t be surprised if some folks started to get on board with that, or if you got some outreach around them because I know that there are a lot of folks who miss that research component. When you go into private practice, I feel like a lot of us just say goodbye to research. And that’s a shame. I know that there are ways to do it, but there may be more hurdles when you’re in private practice than if you’re embedded in a hospital or academic institution.

    Well, these are good ideas. Well, I wanted to talk with you all and really get into some of the nuts and bolts. One of the pieces that you all tackle in the book is not just how you define neuropsychology, but then you also make the distinction and go further with the definition of a clinical neuropsychologist. So I wonder if you could talk through both of those, and then I would love to lead into how [00:25:00] those differ from just a “normal testing psychologist ” and see where that takes us.

    Dr. John: Yeah. And maybe we should put two disclaimers before we start this, where Ryan and I, we’re not representing any larger organization here. Certainly not all neuropsychologists, we’ll give you our opinion. And this is based on talking with many of our colleagues and really thoroughly reviewing the literature and the relevance to organizations. But we do not represent anyone else. Also, the information that we’re going to give, it’s specific to the US because the training and requirements for becoming a neuropsychologist really vary drastically from country to country. Jeremy, I know that you recently did a few episodes in international testing psychology, which I thought really interesting, but it’s clear that there are differences in training.

    [00:26:00] If there are any international listeners, Jeremy or your episodes are great. We also have a resource specific to neuropsychology training in different countries. They can go to navneuro.com/global. And we broke it down by country. We have different articles and links to organizations.

    Dr. Sharp: That’s great. I’ll put that and all other links and resources we talk about in the show notes just for people to check out.

    Dr. John: Excellent. Ran, do you want to talk about the definition of neuropsychology first and then we can talk about clinical neuropsychologists?

    Dr. Ryan: Sure. Yeah. So there are different definitions of neuropsychology out there, but the one we use for the book that’s pretty simple and a good place to start would be, the scientific study of how the brain produces behavior and then how behavior is altered. If something atypical happens to the brain, this is often called the brain-behavior [00:27:00] relationships. When you think neuropsychology, think the brain behavior relationship. And then there’s the science of that and the clinical practice of that. I would say that’s neuropsychology. John, you want to tackle clinical neuropsychology?

    Dr. John: Yeah, so that’s obviously the field. So the fields will be broken up really into broadly two arms; research and clinical. And they overlap a lot. But there are neuropsychologists who practice solely in clinical settings. And there are some that do just research. And most of us do some combination of the two as we alluded to before, Jeremy, your question.

    But in terms of the definition of a clinical neuropsychologist, it’s important to know that not only does this vary from country to country, but even within the US, the term neuropsychologist is not unanimously agreed [00:28:00] upon. And it’s not protected either. So as far as I know, in all states and provinces in Canada, you must hold a license in order to call yourself a clinical psychologist to protect a term clinical psychologist. The neuropsychologist is not protected in the same way. There’s no license associated with it.

    And Jeremy, when you talked with Dr. Debbie Anderson and her conversation about Australia, she alluded to how this is contentious and can be a thorny topic. And I think that’s the case everywhere in my understanding.

    Dr. Sharp: Right. Yeah. So the clinical part just designates those who focus and actually practice versus doing research?

    Dr. Ryan: Right. So our conservative approach to defining a clinical neuropsychologist in the US would be, this is someone who is eligible for board certification in the field. [00:29:00] There are a lot of organizations to become familiar with and acronyms related to board certification neuropsychology, but the American Academy of Clinical Neuropsychology or AACN is an advocacy organization that really pushes the sponsors’ board certification. And then the American board of professional psychology or APAP is the larger board that provides board certification in psychology. and the American board of clinical neuropsychology ABCM is the specialty board for our field.

    Dr. John: Alphabet soup here.

    Dr. Sharp: Oh, absolutely. Yeah, it wouldn’t be our field without a bunch of acronyms.

    Dr. Ryan: Right. So to reiterate, we consider a clinical neuropsychologist as someone who is eligible for board certification. Then there are a lot of rules and hurdles that must be crossed in order to be eligible as menial reports certified [00:30:00] yet, but you can be board certified and we can get into that if that’s helpful.

    Dr. John: Well, my hunch is that in the next 10 or 20 years, it will be the case where only people who are board-certified in clinical neuropsychology are going to be able to call themselves a clinical neuropsychologist. But it seems as though we’re inching that way towards protecting the term which I fully support, but we’re definitely not there yet.

    But from our perspective, at present, at least like Ryan mentioned, we feel that the only people that are very likely to pass that credential review process. And that’s the threshold that we set in our books. So we can jump right into discussing what it takes to pass the credential review, Jeremy, or we can take it however you want?

    Dr. Sharp: Yeah. I think that’d be helpful just to define that. I mean, I would guess that people are familiar with the Houston conference guidelines for the most part, but I’m sure there are some folks [00:31:00] out there who aren’t and would really benefit from knowing about that. So let’s talk through that a bit. What are those eligibility guidelines?

    Dr. Ryan: John, can I jump in real quick? Just a caveat before we get into the Houston conference is that we defined a clinical neuropsychologist, but that would be different from a research neuropsychologist. So I think there are a lot of clinical scientists or research neuropsychologists out there who may not be eligible for board certification because their interest is primarily or solely a research career and they’re doing work relevant to neuropsychology.

    So in my opinion, it’s very valid for them to call themselves research neuropsychologists or just neuropsychologists, which is separate from board certification, which is a clinical credential.

    Dr. John: Yeah, we’re very clear. The term is clinical neuropsychologist to [00:32:00] distinguish between the two. Jeremy, to go back to your question. So the Houston conference guidelines are drawn on heavily by the credentialing boards to determine eligibility for board certification.

    In 1997, prominent members of the profession held a conference in order to determine a model of integrated education and training in the specialty of clinical neuropsychology. The resulting policy statement, which is commonly referred to as the Houston conference guidelines, laid out what’s expected at different levels of training in neuropsychology. And the most concrete recommendation was that a two-year structured postdoctoral fellowship in clinical neuropsychology is really necessary in order to practice clinical neuropsychology.

    And this two-year formal postdoc would include mostly clinical work pertinent to neuropsychology but [00:33:00] also formal didactics and also research training as well. The guidelines also recommended that graduate students begin developing the foundation of brain-behavior training in their words and the guidelines to a considerable degree. So already in doctoral training, we expect people to get neuropsychological training and then to further really specialize the capstone experiences that two year postdoc at the end.

    The documents are really easy to read, so we would highly encourage any listeners who are interested in these guidelines in the fields to read the full five pages. It’s easy to just Google Houston conference guidelines. We also have a direct link at navneuro.com/hcg. So we can include that in the reference list or if you have your own link, Jeremy.

    Dr. Sharp: Sure. I can put that in there. I feel like the Houston conference guidelines have been pretty well known, but then you also talked about it in your [00:34:00] book the taxonomy for education and training and clinical neuropsychology, which was new to me. So I would love to hear more about that.

    Dr. John: Yeah. Ryan, do you want to take that or I can talk through it?

    Dr. Ryan: Go ahead.

    Dr. John: The Houston conference was in 1997, then the guidelines were published in 1998. So the fields really didn’t do much in terms of advancing training, laying down on paper at least until very recently when several different bodies in neuro-psychology came together. I’ll back up a second. So it was APA, the American Psychological Association that’s made it I think mandatory to layout for each of their specialties within psychology or at least the [00:35:00] ones that offer board certification in my understanding, layout a taxonomy that could help clarify to prospective students what training a graduate Program and internship and postdoc offers.

    And so they laid out different levels of specialty training. This is the taxonomy. And they are in different degrees of intensity from the major area of study that is the heaviest in terms of that specialty. And the next level would be an emphasis, then just experience and then just exposure.

    And so major areas really mean that the program is focused in neuropsychology, for example. And there are other specialties that have this taxonomy. And then it just exposure means maybe you have a class in neuropsychology or there are certain criteria, but it’s just very small amounts of training. And this is not [00:36:00] caught on just yet because it’s so new. The paper was 2019. It was pumped in 2019 by Glenn Smith and the clinical neuropsychologist Snarky, which we can include in the show notes. And this really laid out the taxonomy in detail and some competency areas and other things in the fields.

    And this was going off of another article by Sperling and colleagues in 2017. So we can include these in the show notes, but it’s really just a way for students to know exactly what they’re getting in terms of what programs will program can say in their materials, in their brochure. We offer a major area of study in neuropsychology. And then students know, okay, I’m getting at least 50% neuropsychological training, and this is really lining me up versus programs just saying they have a concentration or that they offer neuropsychology training, which is a little vague and not uniform across programs.

    Dr. Sharp: I see. 

    Dr. Ryan: So, [00:37:00] the Houston conference guidelines are the framework, the skeleton. The taxonomy is very consistent with the guidelines and adds to them. I think flushes them out more, provides more specifications, like John said, more training programs to use in order to implement the guidelines.

    Dr. Sharp: I see. So it’s not like the taxonomy is not going to replace the guidelines by any means. It’s more an elaborating or filling in the gaps and defining what’s laid out in the guidelines. Is that a good way to understand it?

    Dr. Ryan: Very much so.

    Dr. John: Now, there are other guidelines in addition to the Houston conference guidelines, which are set out by ABC and the American board of clinical neuropsychology. So that’s the board that operates the board certification exam in neuropsychology, ABC. They have some other requirements in addition to the Houston conference guidelines, which [00:38:00] I can run through pretty quickly if you want me to, Jeremy.

    Dr. Sharp: Yeah, I think that’d be helpful. Go ahead.

    Dr. John: So the fellowship must reflect… in order for someone to be board eligible, …the fellowship must reflect a structured and sequenced set of clinical and didactic experiences. That’s the language that they use. And the fellowship has to provide onsite supervision of all clinical cases. They have to put the learning needs of the postdoc ahead of the operational needs of the program.

    So it’s not just something that you can do while working at your normal practice and say, oh yeah, I was getting supervision. You have to demonstrate to the board that this was a formal structured program and that you were doing more than just someone would do in doing Private practice or group practice.

    Dr. Sharp: Can I jump in, sorry, just for a second. I think that’s an important question. Because I know there’s a lot… I don’t know, maybe I’m making assumptions, but my perception [00:39:00] is that there’s a lack of formal postdocs and fellowships. And a lot of folks do end up in a private practice setting even if they are headed in the direction of getting boarded. So, do you all have thoughts or ideas about how they can vet private practices and what they might need to ask for if they’re going that route to make sure that it’s as structured and formalized as possible?

    Dr. John: Yeah, I do. In the book, we mentioned that it is possible. Many people do end up stitching together their own fellowship so to speak. They are kind of creating their own fellowship that provides the requisite training. And that’s fine as long as you meet all the criteria. It is very important.

    The onus is really on you in these situations. So, if you go to a formally established program, like the one that’s an APPCN member, or if it’s APA [00:40:00] accredited in neuropsychology, or even there are many programs that are not APPCN or APA that are still very well-established in terms of a neuropsychology fellowship.

    So really if you do those programs, it’s obvious to the board. Okay., we’ve seen so many people come through this review process and that program is already embedded in good. There’s an extra burden so to speak on the person who does create their own fellowship because the board wants to know if you’re really following the guidelines or if you’re just giving them lip service.

    And so the most common approach I would say is to find an open position at a local group practice. And you would be under the guidance of the staff neuropsychologist at the practice. And so it’s really important that you get the requisite didactics, you get some scholarly activity, you get interdisciplinary [00:41:00] interactions with nearby universities or at the practice itself.

    And I’ll say two other things. So if you want to go that route, we really strongly recommend that you document all of your training in case the board asks for it, or you document your didactics, you keep syllabic or email exchanges from professors or people who you got didactics from getting in writing upfront from your supervisor that they’re going to adhere to all aspects of the Houston conference and ABCN on guidelines and criteria.

    We think that’s really important because the supervisor might say, oh yeah, we ascribed to the Houston conference guidelines and then it becomes obvious that they’re actually not following them to a T. So getting that in writing, I think is important. People that are interested in this can also consider emailing the ABCN [00:42:00] credential review committee chair directly. And we’ll give you the link to that email in case questions remain after they look through the guidelines and the ABCN application and other website materials, but this is definitely an option.

    As you said, Jeremy, there are not many neuropsychology Postdocs. It might be hard for people to find, especially if they’re geographically restricted. I will say it’s a little bit easier to create your own fellowship if you are in a metropolitan area where there are lots of neuropsychologists and universities that you can do didactics at and things like that.

    Dr. Ryan: That was a good answer, John. I would maybe boil it down to say that if someone’s this considering fellowship at a private practice where it’s not so clear that this is an easy path or a straightforward path to board certification, the two [00:43:00] resources I would start with would be the Houston conference guidelines and the webpage of ABCN- the American Board of Clinical Neuropsychology. That is where you can find the criteria that will specify what your fellowship needs to have in order for you to be eligible for its certification.

    Dr. Sharp: Sure. That’s helpful. I think there’s some embedded advice there for any boarded folks who are maybe trying to create or run a postdoc in private practice as well. I know there are those listeners out there too.

    Dr. John: Yeah. There’s nothing inherently wrong with that. As long as you’re getting all the training and you’re meeting these criteria, nothing wrong with that.

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

    So we’ve been talking a lot about the training and the boarding process. I’m not going to get into the whole exam process and what’s involved there. I think some great info and your book and there are [00:45:00] books independently about how to do that. But I do want to try to tackle this question that I hear so much, which is, how are clinical neuropsychologists different from someone who just does a lot of testing and as an assessment specialized psychologist? So y’all can take that in any direction you want and we’ll see where it goes.

    Dr. Ryan: That’s a really good question. I imagine you get that a lot Jeremy given your podcasts, The Testing Psychologist, right? So I think I would first differentiate between psychological tests and neuropsychological tests on the one hand, and psychologists and neuropsychologists on the other hand.

    So in my mind, neuropsychological tests, that term is typically used to describe tests of cognition, attention, processing speed, working memory, et cetera. [00:46:00] Psychological tests are often used by neuropsychologists, but these also might be called broadband inventories of personality and psychopathology, something like the MMPI or the PAI. So these tests are often self-report, there are some projective tests like the Rorschach, but they’re typically measuring what I call psychological symptoms more so depression, resilience, anxiety, stuff like that whereas neuropsychological tests, again, definitions are never ubiquitous, but neuropsychological tests are often synonymous with cognitive tests.

    Then there are psychologists and neuropsychologists. Neuropsychologists are all psychologists, neuropsychology is a specialty or subspecialty underneath psychology. And we’ve talked about how we think about defining and clarifying who would be a clinical neuropsychologist, that someone who [00:47:00] is eligible for board certification in clinical neuropsychology or who is board certified.

    So to get to the part of your question, Jeremy. You could have psychologists who are not yet eligible for neuropsychology, who are doing a fair amount of testing and that can look different depending on the setting. They might do psychoeducational testing like for ADHD and learning disabilities, testing those academic skills. They may do psychological testing to inform treatment in which case it may be more of psychological tests that I mentioned like MMPI and PAI. They also might do at least screening some more cognitive testing. So I would say both psychologists and neuropsychologists can do both types of testing.

    If a testing psychologist is very [00:48:00] interested in being assessment-focused and especially doing a cognitive assessment heavily, then in my opinion, I would recommend that they work toward board certification because the training that neuropsychologists get in the cognitive tests, psychometrics underlying them, brain-behavior relationships like functional neuroanatomy, psychopharmacology, all those areas are really helpful if someone is doing a fair amount of cognitive and neuropsychological testing.

    Dr. John: Yeah. And I can add to that, Jeremy, if you want me to.

    Dr. Sharp: Of course. Yeah.

    Dr. John: I would say that all neuropsychologists are testing psychologists but not all testing psychologists are neuropsychologists necessarily. And the difference really lies in the degree of training in behavior relationships as Ryan just laid out. Both coursework and clinical experience [00:49:00] and really the formal two-year postdoc that followed the criteria that I mentioned before.

    And I liken this to the difference between a primary care physician and a neurologist where the PCP will have some degree of familiarity with brain pathology. They probably conduct aspects of the neurological examination. They often incorporate that into their wellness visits, but this is the area that the neurologist specializes in and has completed a formal residency and fellowship. So it’s really the fellowship that specializes in the neurologist relative to the PCP.

    And I know it’s really a fine line. I’m sure there are many people who have received a general assessment heavy training that might be able to pass the ABCN and credential review potentially and would be just as good as a neuropsychologist at the clinical work. [00:50:00] But really if we’re going to lay down definitions and to protect the quality of the fields, on average at least, I think we really need to… this is what the field has distinguished as meeting criteria is really that formal postdoc in neuropsychology. And you have to have 50% of your integrative neuropsychological evaluation and services, the clinical neuropsychology on fellowship. That’s one of the other criteria with ABCN.

    Dr. Sharp: Sure. I appreciate y’all diving into this. It’s a tricky topic. I’m like, what word describes this? I said, a little tricky, but it’s fraught like there’s a lot of discussions. I don’t know. Maybe y’all are a little bit protected from some of this because you are clinical neuropsychologists.

    In my world, [00:51:00] I think there’s a lot more diversity in terms of neuropsychologists, there are testing psychologists. There are school psychologists who do a lot of testing. There are school neuropsychologists. So there’s a lot of discussions like, what exactly is different?

    I wonder if we could drill down a little bit into the training because that’s the piece that seems to really distinguish the fields or the specialties? I know that this is going to vary depending on the setting and supervisor and any number of variables. But I wonder if you can talk at all about what is happening in that fellowship that is different than others, let’s just say assessment heavy training settings where someone might be administering the same tests, making the same diagnosis. Is there any way to describe what is different than the fellowship? 

    Dr. John: There’s [00:52:00] neuropsychology dust in the water that we drink.

    Dr. Sharp: Are you selling that?

    Dr. John: Yeah, we should bottle that up.

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

    Dr. John: And like you alluded to, it’s going to vary so much based on the setting and the supervisors. I’ll say two things then Ryan you can add. We can speak to our own experiences on fellowship. And then what we know about our colleagues, which we’ve talked to many of them for the podcast and for the book as well about this. But I mentioned the degree of neuropsychology-specific training is really important. So that 50% is very important. I don’t think that by definition people who don’t get that neuropsychology at 50%, neuro-psychology-specific training on fellowship would be eligible. So there’s that.

    And part of that means that the patient populations that you’re seeing are [00:53:00] usually more neurologically oriented. So we see a lot of stroke or epilepsy, brain injury, multiple sclerosis, things that affect the CNS primarily. We do see broad psychopathology as well, and the gamut of emotional and behavioral disorders and disturbances, but really we are seeing mostly neurological types of diseases and injuries. I’ll say that for most people.

    There’s also, I mentioned the structured didactics specific to neuropsychology. That’s one distinguishing aspect that general psychologists don’t typically get. We have a seminar series in neuropsychology. We often have opportunities for grant rounds in neurology and neuroradiology. I had that on my [00:54:00] fellowship. I had the opportunity to shadow a neuropathologist and do brain cuttings all throughout my training, actually from my doctoral training internship, and beyond. So those are just a couple of ideas that I have. There’s also typically a neuropsychology-related research component to a fellowship which also just helps solidify the neuropsychology aspect.

    Dr. Sharp: Sure.

    Dr. Ryan: To add to that, I would emphasize what you said, John, about brain disorders. I think that is such a large part of neuropsychology training. We spend so much time, of course, on our assessment measures, the psychometrics standardization, what it means to test someone’s thinking memory, emotional functioning, but then becoming very familiar with Alzheimer’s disease, [00:55:00] epilepsy, the symptom profiles, the way they look cognitively, what’s going on in the brain and neuropathology, neuroanatomy, there’s the neuro of neuropsychology certainly comes out a lot during the fellowship.

    One other thing that I’ll add in terms of clinical psychologists broadly and then neuropsychologists is that I think neuropsychologists have a lot to offer. Clinical psychologists, like someone who specializes in treating depression or trauma, we have a lot to offer them in terms of assessment as we’ve been saying. And clinical psychologists broadly often do a lot of intervention and they have a lot to offer us in terms of us becoming more intervention oriented. More neuropsychologists are becoming interested in addition to assessment, also cognitive training, any treatment we can provide to these patient populations.

    [00:56:00] And we draw a lot from certainly cognitive behavioral therapy, motivational interviewing, these other psychological interventions that are pioneered by clinical psychologists of other specialties. So, I think there’s a great back and forth. We work well together and inform each other.

    And then getting back to your specific question, Jeremy, to be honest, I’m not aware of what an assessment-heavy fellowship might look like. That’s not a neuropsychology fellowship. Do you have experience with that or do you know people who are in assessment-heavy fellowships that aren’t neuropsychology?

    Dr. Sharp: That’s a good question. I think about maybe like certain VA postdocs that I’ve heard of. I have heard of folks going through where it’s not necessarily marketed as a neuropsychology fellowship [00:57:00] or neuropsychology post-doctoral, but they’re doing a lot of testing. They’re doing a lot of assessments. And maybe that’s just a semantic issue. Maybe it is the same and there’s just not calling it that or describing it that way.

    Dr. John: Sorry, I just want to jump in because maybe those people would be quite like I mentioned before, maybe they would be eligible for board certification. Just because the fellowship didn’t call itself a neuropsychology fellowship, it doesn’t mean that the board won’t pass you through. You can look at the HoustonConference Guidelines, the other criteria and see if maybe your fellowship did meet that.

    I think it’s a very fine line that we’re drawing between assessment heavy and neuropsychology. Typically, the distinction that we see is between a general psychologist- someone who got a little… by definition, every psychologist has had some exposure to assessment, but usually it’s just in grad school, and then they just [00:58:00] focus on therapy, and that’s what they specialize in. And so that’s a much more clear distinction between a general psychologist who mainly practices psychotherapy versus a neuropsychologist. So it’s a harder line to draw.

    Dr. Sharp: It is. Yeah.

    Dr. Ryan: When I think of an assessment-heavy fellowship that’s not neuro-psych, for some reason, I just imagined someone administering like 150 Rorschach all the time, but…

    Dr. John: That would be a personal nightmare. That’s the 12th ring of hell that I’m just skipping rocks all day. I will also say Jeremy though just to further solidify the difference between if there is an assessment, general versus neuropsychology distinction, it’s a little bit indirect in terms of the postdoc, but I think the other thing that postdoc gives you is the eligibility to go through the board certification process, and going through the [00:59:00] ABCN certification process itself makes you a better neuropsychologist. I can speak personally to that.

    I know we don’t want to get into the ins and outs of the board certification process, but after the credential review, once you pass that, then you have a written exam where it’s specific to neuropsychology. There is some psychopathology- it’s just generally on the exam, but that was quite a process to study and pass that exam. And then you submit practice samples. You submit two sample reports to neuropsychologists to vet which is also a process to go through that. I just passed that recently. And now personally, I’m preparing for the oral examination.

    Going through all the diseases, again, all the symptomatology and all the pathogenic features of each disease process, the underlying neuropathology, the functional neuroanatomy, [01:00:00] it’s just further solidifying my knowledge in neuropsychology. And I think that process in itself of going through the board certification process has already made me a better neuropsychologist. And when I’m finished, it will have made me a much better neuropsychologist than I could have been otherwise.

    And that’s why I said earlier that I think eventually, we’re going to have a protected term of clinical neuropsychologists where it’s going to mean that you have to have gone through a board certification process.

    Dr. Sharp: Yeah, it just makes sense. It seems like we’re headed in that direction, certainly. So can you all speak at all to how that training informs say interpretation and intervention recommendations when you’re testing because I hear that a lot too? This idea of like, we’re giving the same tests, [01:01:00] we’re making the same recommendations, where’s the distinction here?

    And it seems like a lot of it rests in this background knowledge and training that isn’t necessarily right in the forefront of a report. Does that make sense? And so I think it’d be helpful for people. I’m really trying to help you validate this because people are like, “I think I’m a neuropsychologist” and I’m like, I don’t know.

    So, I’m just trying to really drill down into how this training is different and then how it shows up in your interpretation or report writing or recommendations.

    Dr. Ryan: Well, that’s a great question, Jeremy. And like John has said, I think some of those people might be eligible or very close to being eligible if they have a lot of assessment experience. So we’re not here to say that they are not eligible. I would definitely encourage those people to check [01:02:00] out the ABCN and Houston Conference Guidelines to see where they’re at.

    I think one thing thus far we have underrepresented is neuro-psych report writing. John just mentioned it. And it’s right to your question, Jeremy. That’s something that we’re doing extensively in fellowship and learning even before fellowship is all the steps to this process, the testing interview, the behavioral observations, that’s a skill in itself. And then really importantly, is putting this all together in a package that our medical colleagues or the referral source, whoever that may be, can really digest. So I would say learning report writing is a huge skill that comes along in neuropsychology. And a big part of that as you mentioned is recommendations.

    So a lot goes into recommendations. I think everything we have touched on this far, [01:03:00] knowledge of brain diseases, the specific brain disease that this person may have, interpreting neuropsychology data, and then going from your conclusions, your interpretations to how can we use this to help this person as best as possible, being aware of resources in your local community, and then larger national resources- something like the Alzheimer’s association. This is just all stuff that we spend a lot of time working on, thinking about, talking about, going to lectures on.

    And so there’s nothing that I’m saying that your listeners may not already have. That’s why we say that we’re not here to exclude people. But we know from experience that if you go through the process of [01:04:00] neuropsychology training, you will get a lot of exposure to this stuff. You’ll talk and hear and learn so much about providing recommendations that could be as helpful as possible to the individual patient you have that I would say that’s a huge part of neuropsychology.

    Dr. John: Yeah. And I can add. And just to further hammer in, we are not the gatekeepers. We’re just the messengers of the guidelines and criteria that have been laid out by the heads of our field and the organizations.

    But I’ll just add to what Ryan said that it’s not just the report writing process. We lend our specialty neurocognitive knowledge to that process, but maybe even more so, it’s in the feedback sessions that I find myself really tapping into the functional [01:05:00] neuroanatomy. And whether it’s talking about Alzheimer’s disease and sometimes patients don’t have any interest in understanding the underlying etiology and neuropathology.

    But every so often I get patients who are really interested in their families. They have an adult child who’s really interested in the brain disease process, the prognosis for how quickly this disease is going to progress, what distinguishes Alzheimer’s disease from Lewy body dementia or Frontotemporal dementia, or maybe they’ve done a Google search and they’ve looked into it, or maybe they’re considering a particular medication.

    And although we don’t prescribe and it’s not our specialty, we have knowledge in the medications that are specific to cognition. I’m thinking of the Acetylcholinesterase inhibitors (AChEIs) and an NDA, [01:06:00] antagonists, things like that. So I find that my knowledge not only applies to the report writing process and talking with referral sources but also in the feedback session themselves quite frequently.

    Dr. Sharp: Right. Yeah, I think it’s good to have some of these examples. I want to pause and I just want to say that I really appreciate y’all’s willingness to talk through this because I think it’s hard to set it up without it becoming a us versus them conversation. And that’s not my intent by any means. And I know it’s not y’all’s intent, but these are questions that come up. And I think it is important to really illustrate what is different here because it is different.

    Dr. John: Right. And we’re not establishing a hierarchy. There’s no valence here. We’re saying there are different [01:07:00] specialties within psychology, neuropsychology is one of them. And in order to be a specialty, you have to have some definition of your field and some training criteria. And so we’re just laying them out here.

    Dr. Sharp: Of course. Yeah. I think I’ve interviewed a woman named Stephanie Nelson who y’all may know of or not. She’s a pediatric neuropsychologist with the pediatric sub-specialty. She goes on my podcast and she posts often in our Facebook group. And there are those moments when I catch myself thinking, this is pretty comparable. Like I have a pretty similar skillset. And then she in particular and others, but she in particular, will offer some explanation of a question, and I’m like, “Oh goodness, this is way different.” Like she is coming at this from a totally different place. And we have to honor that. There’s some pretty extensive knowledge going on there.

    Dr. Ryan: Yeah, thanks. I have that experience with [01:08:00] so many other experts and professionals like trauma psychologists. I’m interested in PTSD and have some rudimentary knowledge of treatment and such, but I could sit down and have a conversation with a friend of mine who works primarily treating people with PTSD and just be blown away by their knowledge and the connections they make but I wouldn’t. So, I understand where you’re coming from.

    Dr. Sharp: Yeah, it’s nice to see all these. We all have our specialties, right?

    So I wanted to maybe close or start to close with this question of, okay, so we’ve walked through a traditional path for boarding. That is fantastic. Now, what about those of us who totally missed the boat? And this is very personal for me as well. I mean, I did not do even a neuropsych-heavy internship or post-doc, but [01:09:00] came to it in post-grad training. And now I’m left in this weird gray space. So, is there a path to board if you miss the boat on those two things initially?

    Dr. John: Yes, there definitely is. And it’s encouraged by the board. I mean, we would fully support people who wanted to re-specialize and retread. So if someone listening wanting to go that path, the steps that they would take really depend on what specific degree they have, whether it’s even in psychology, or if it’s experimental psychology versus clinical psychology, the first degree, and then what training they have already received and what experience they have. And obviously the closer to neuropsychology and to clinical work, those experiences are the easier that the process would potentially be.

    And there are different ways to think about it at each level. [01:10:00] There are different ways to re-specialize, but I guess maybe first I’ll answer based on assuming that most people listening are licensed psychologists.

    Dr. Sharp: I think that’s true. And I would say, most people if they have an interest in this podcast, I would imagine they are like me where Ph.D. in a Clinical Psych program probably had maybe a neuropsychology practicum or two or three, but didn’t do the formal fellowship, but they do a lot of testing and have testing knowledge. So yeah, maybe we could confine it to that subset because I’m imagining that’s what our listeners primarily are.

    Dr. John: Yeah. And in our book, we list the different levels. So if anyone, maybe a psychiatrist is listening to this and they’re interested in pursuing the field, we lay it out in the book. But so for someone who’s a licensed [01:11:00] psychologist, you’ve already done the vast majority of the work and training. And if you have proper training, you would easily pass the ABAP general reviews of the ADPP general review process, which is the first thing you have to do for any of the specialties in psychology.

    And that would be an easy process, supposedly. Not super easy but everyone who is a licensed psychologist should be eligible for ABAP generally. Once it passes that, then it gets kicked down to the specific specialty board for neuropsychology, that’s ABCN. And so someone who doesn’t have a postdoc in neuro-psychology would not pass that ABCN credential review process. And so that would take a formal neuropsychology post-doc two years. You [01:12:00] can do it half time if that was easier for somebody, but it would have to meet the criteria that we had already talked about.

    And so just to make it super clear, ABCN and other organizations haven’t said explicitly that just doing continuing education workshops and occasionally consulting or getting supervision on the side, that is not sufficient. The boards are very clear on that. So it really it’s that postdoc experience. Before someone did that though, I would encourage them to look at the guidelines and the criteria to see if they feel like they might make a case that they meet those criteria. And if so, then email the board and see, or maybe even submit your application before you go through the whole process of another postdoc. It wouldn’t hurt to just submit to the board I would think.

    Dr. Sharp: I like that. Does that seem like a viable [01:13:00] question to ask? Are there folks who will actually answer that question for you? Like if I were to get off our podcast and go email someone and say, Hey, here’s what my training looks like, should I go back? Is there someone who will answer that question somewhere?

    Dr. John: Yeah. So we actually had the current chair of the ABCN credential review committee review our book, Kathleen Fuchs. She’s the incoming president. At the end of this year, I think she takes over. So, she reviewed our book and she gave us the… we actually had the wrong email address. She said, no, no, it’s this one. Make sure you put this one in the book this week. It’s specifically for the committee chair to answer emails. And Ryan, I know when you were going through your post-doc, you had a question about whether some of your research experience would apply to your eligibility and she answered you right away, right?

    Dr. Ryan: Right. Yeah. I didn’t know her at the time, but Kathleen is great. [01:14:00] And everyone who I’ve interacted with who’s part of the ABCN board has been very helpful, generous with their time. To answer your question, Jeremy, I would say yes, definitely. If you looked at the Houston conference guidelines and the ABCN website, and you think based on my fellowship and my training record, I think I have a case. I’m not sure. Definitely, I would say, reach out to them and lay out your case, your training, your position, ask questions. And our experience has been that they are incredibly helpful.

    Dr. Sharp: That’s great.

    Dr. John: I hope us as neuropsychologist don’t come off as a snobby group or off-putting. My experience with my colleagues and even with the people who were very high up in the organizations, they’ve been so kind and generous like Ryan said.

    Dr. Ryan: Yeah. I mean, we are clinical psychologists, right? I am incredibly proud and happy to be that and the generalist training that we received. [01:15:00] So everyone has their general training or specialty or subspecialty. So we share so much of our training with other clinical psychologists, I appreciated your question, Jeremy, about is this an us versus them? It can feel like that. But I think all three of us agree that it is definitely not.

    Dr. John: I should also say that I know we’re talking about postdocs as if it’s oh yes, just go to a postdoc and it’s super easy. I just wanted to say that we completely understand that it would be difficult mentally, emotionally, financially, potentially to pivot to another career path. And people listening, if they wanted to pursue that, they might consider uprooting themselves from a good job that they’re at and their family potentially, they might have to move across the country to find training.

    They might be going to be serving as a trainee and a supervisee [01:16:00] for maybe longer than they expected. It would be hard to go back into that trainee role after practicing for a while and then you might be waiting years to get back into the practice. So, we completely acknowledge that it’s not an easy thing to do. But I think if neuropsychology is the career that is calling to you as a listener and there’s going to lead to a more fulfilling work-life, then in my mind, the cost is almost certainly worth it.

    Dr. Sharp: Well, I think you raise a really important point that a lot of us have to consider. If you’re thinking about re-specializing, the real question is why. Why would you want to do this? Is it just for personal gratification? Is it for pride? Is it for clinical as a financial? I mean, there are a lot of components to really think through because it’s a huge choice for those of us [01:17:00] who are set, right? I mean, established practice, things are going well. As you said, it’s a big sacrifice in many ways to go back emotionally, financially, and logistically. So really thinking through that question of why you might want to do this is very important.

    Dr. John: I agree. And we included a whole chapter in our book of why choose neuropsychology. And we lay out all the different reasons why our colleagues have told us that they have chosen this field and our own. So, if anyone’s not quite sure they can look at that chapter.

    Dr. Sharp: That’s great. Well, I appreciate y’all talking through everything that we’ve talked about. A lot of our discussion has mirrored your book, which is either out or going to be out by the time this releases. So we’ll make sure to have it accessible in some way. That’s very obvious to folks who want to pick it [01:18:00] up.

    And I will say, I was fortunate enough to be able to look through the draft or advanced copy and I wish I had had it. That’s the highest praise I could give. It’s really valuable. And I think will help a lot of folks along their journey here.

    Dr. John: Thank you. That was the reason why we wrote it. So we’re really happy to hear that.

    Dr. Sharp: Yes.

    Dr. Ryan: Thank you, Jeremy, for the time speaking with us. It’s been great.

    Dr. Sharp: Yeah. Likewise. Thanks, y’all.

    All right y’all, thanks so much for tuning in to this episode with John and Ryan from Navigating Neuropsychology. If you haven’t checked out their podcast, I would definitely suggest you do so. There’s a link in the show notes to navneuro.com. And you can pre-order their book on Amazon right now. I will say that I got an advanced copy and got to look through it and it is really good. It’s really good for anybody out there pondering [01:19:00] your career and trajectory as a neuropsychologist or to becoming a neuropsychologist. So check that out. The link to that is in the show notes as well.

    As always, thank you for listening. If you haven’t subscribed or rated the podcast, I would be so grateful for you to do those things. Subscribing is easy in iTunes and Spotify it’s, follow. So take a moment. And if you enjoy the content, make sure to subscribe so you don’t miss future episodes.

    Okay. I hope all of you are doing well, hanging in there, and looking forward to some rest and relaxation over the holiday season. All right. Take care.

    [01:20:00] The information contained in this podcast and on The Testing Psychologists website are intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric, or medical advice, diagnosis, or treatment. Please note that no doctor-patient relationship is formed here, and similarly, no supervisory or consultative relationship is formed between the host or guests of this podcast and listeners of this podcast. If you need the qualified advice of any mental health practitioner or medical provider, please seek one in your area. Similarly, if you need supervision on clinical matters, please find a supervisor with expertise that fits your needs.

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  • 166 Transcript

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

    This episode is brought to you by PAR. PAR offers the RIAS-2 and RIST-2 Remote to remotely assess or screen clients for intelligence and in-person e-stimulus books for these two tests for in-person administration. Learn more at parinc.com.

    All right, y’all welcome back. It is great to be here with you. I’m guessing that you might be listening on Thanksgiving or shortly thereafter. So I am trying something a little bit different today. Today is not a typical business episode. So if you came for that hardcore business advice, I don’t think today you’re going to get that.

    But [00:01:00] what I would like to do is share an episode of gratitude. Yes, that’s what everybody does on thanksgiving. And yes, it is a little bit contrived. And I typically am not that person who does the thing that you’re supposed to do when you’re supposed to do it simply because I’m rebellious and don’t like to conform and all of those sorts of things.

    But in the context of the year that we have had we, the collective we, Gratitude just made sense. So instead of releasing the first episode in a series of EHR reviews like I planned to, I am going to do a little bit of gratitude episode and see how that goes. I think it’s necessary. I think it’s helpful. And I [00:02:00] hope that some of you take something away from this for yourselves. And of course, the intent is to maybe inspire some thoughts of gratitude and reflection on your part. So without further ado, let’s jump into some gratitude.

    And we’re back. Just getting right into it and putting it out there right from the beginning. There are a few things to acknowledge. One, is that any time someone like me, by which I mean a white guy born with nearly [00:03:00] all the privilege that I could possibly be born with, tries to do an episode like this, it always runs the risk of coming across as entitled and any number of other not so great things which would just backfire and defeat the whole purpose of this episode.

    My hope is that if you have been listening to this podcast for a while, and for those of you who’ve interacted with me personally via coaching or some other way, my hope is that you maybe have the sense that that is not what I’m about. That’s not what I am going for with this although I’m fully aware that it may come across that way. I am going to do my best to not present my gratitude as [00:04:00] something that is just a reflection of entitlement and privilege.

    But I have to acknowledge that before we even get going that to have the luxury of being grateful for things is one that is much harder for some to come by than others. So with that acknowledged, I just have to say that this has been a hell of a year for so many people.

    It has just been completely devastating. People have lost their family members, their businesses, in some cases their lives, and I’ve reflected at many points over the course of the year that I am just fortunate to have all of those things intact at this point along [00:05:00] with many other things.

    But in spite of that, I don’t know if some of you have this tendency as well, but I certainly have a tendency to lose sight of the things that are going well and I can dwell on the things that aren’t going well. I can get into that place of anxiety and fear and scarcity. And for me, that always results in more of a constricting feeling. And I don’t think that’s helpful for anyone, myself included, my family included, my business included.

    And along with that, research would say that having a deliberate gratitude practice just one simple thing that we can do to help us stay balanced and move a little closer to whatever you might call happiness or [00:06:00] joy. So my intent here again is just to pause and reflect and take a little bit of time to recognize some of the things that are going well. And it’s all relative. And again, I just want to acknowledge that that gratitude looks different for different folks. Circumstances are different for everyone.

     But this has meant to honor all of us, the struggles of this year but also just taking a little bit of time to tap into the more positive aspects of our lives. So here we go. This is my list. This is no particular order. This is in no way, comprehensive. These are just a few things that popped up in the top of my mind that I’ll dive [00:07:00] into.

    The first thing, just because it is probably very evident on the recording and very clear from my situation right now, my environment is… the ability to work remotely. A lot of people don’t have that capability, but I have the capability to work remotely at least briefly. And I’ve been able to take advantage of that to escape the cooler temps and winter and snow in Colorado and be somewhere where I can work outside. That might explain the outside noises if any of you have heard the outside noises, birds, planes, et cetera.

    So that is one thing I’m extremely grateful for. I can be susceptible to [00:08:00] seasonal dips especially over the winter mood-wise and to be able to get away to somewhere that’s nice and warm and relatively good weather is something I’m incredibly grateful for. Now, like I mentioned in the beginning, again I was objective, really just born with a large amount of privilege. I have to acknowledge that grateful for that.

    But one of the things that came up top of mind just for me is we have a healthy family at this point. I have healthy kids. My parents remain healthy. I’ve had some scares. I can’t remember if I’ve mentioned on the podcast before that my mom has had MS, Multiple sclerosis for going on 30-35 years since I was relatively young [00:09:00] and she’s immune-compromised, of course, and has had to go into the hospital on three or four separate occasions since all this started back in March for unrelated concerns and just remain thankful that she emerged from all of that without getting COVID and remains in good health for now.

    So a healthy family, a huge point of gratitude. My wife’s family is also healthy and we’ve had the ability to come stay with her family here for a little while. Just grateful to be able to see them.

    Again, in no particular order, I’m very grateful for the PPP loan that came in really, really handy back in the spring when we took an enormous dip in our testing business. [00:10:00] and I was able to secure some of that loan money and keep employees floating without too much of a dip in their income. I feel very grateful for that. 

    Related to my employees and testing, I have an amazing staff. They have weathered a crazy year. They continue to weather a crazy year as we go in and out of quarantine and kids go to school and then come home and stay home. And they just rolled with so many schedule changes, so many changes to our testing protocol, and just uncertainty. It has been crazy but I’m so grateful for them.

    And just the other day, just on Monday I was talking with one of my postdocs [00:11:00] and she echoed my feelings that we just have an amazing staff and I’m so grateful for my team. Also very grateful related to testing that the WIAT-4 has been released and we don’t have to worry about scoring that essay anymore. Can I just get a hands up for not having to score another WIAT essay for the rest of your life? It’s incredible.

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

    PAR has developed new tools to assist clinicians during the current pandemic. The RIAS-2 and the RIST-2 are trusted gold standard tests of intelligence and its major components. For clinicians using Tele assessment which is a lot of us right now, PAR now offers the RIAS-2 Remote, allowing you to remotely assess clients for [00:12:00] intelligence and the RIST-2 Remote which lets you, screen clients remotely for general intelligence. For those assessing clients in office settings, PAR has developed in-person e-stimulus books for both the RIAS-2 and the RIST-2.

    These are electronic versions of the original paper stim books. They’re an equivalent convenient and more hygienic alternative when administering these tests in person. Learn more at parinc.com\rias2_remote.

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

    A little more seriously, this has been an interesting year in terms of business. We had a huge debt testing-wise in the first few months of the pandemic. But along that same timeline, we have had pretty incredible growth in counseling services and that afforded the [00:13:00] opportunity to grow into a local pediatric practice and established some therapists down there for an integrated care model. Super grateful for that and I’m hoping that many of you are also experiencing this where if you have counseling or therapy as a part of your practice, that side is just off the charts.

    Related to the podcast, gosh, there’s so much again to be thankful for. I have an amazing virtual assistant who helps with podcast publishing. She does so much for me. Makes us run the Facebook community, the testing psychologist community is just continuing to grow week by week. I’m incredibly grateful for my moderating team who just works so hard behind the scenes to keep the group on track and [00:14:00] hopefully has helped the group become a safer space over the last several months for people to post what they want to post without fear of being criticized or otherwise rejected or made fun of or any number of other things. We continue to work on that as a moderating team, and I think we’re moving in that direction and Just so grateful for them for doing that work with me.

    And the last thing, at least for this episode, I mean, I could keep going. And I feel so lucky to even be able to keep going. But again, these are just some things that came top of mind and I tried to keep them relatively related to business. But the thing that I want to end with is having some gratitude for [00:15:00] being continually reminded by my wife, by my coach, and just circumstances in the world that the only thing that we can really control that I can really control. we can really control here in this world is our own choices and reactions.

    So things can be completely nuts. Things have been completely nuts and truly catastrophic and devastating. There’s no doubt that many people are experiencing these things at this point and have been for a long time. But what I keep coming back to is something that has helped me stay grounded and not spin-out [00:16:00] completely as bad as I might have in the past. But this idea that we truly can only control one thing, and that is our choices and how we react to stressful situations, and how we conduct ourselves in our lives.

     And I know that there are circumstances and there are situations, of course where someone may be more or less in control of themselves and I get that. And this is one thing that, again, I work with folks on them in my coaching practice, but also work hard on here in my own life is just controlling your choices. So whatever the world gives us, we can take that and do any number of things, but we have that choice [00:17:00] with what to do in those situations. And I am trying to remember that as much as possible.

    So with that, I will say goodbye for now. I hope that all of you are spending the holiday and the holiday weekend in the best way that you can, whether that’s with family, without family, mourning, celebrating. Whatever this looks like for you, I hope it is what it is supposed to be. And I hope that you are staying centered and grounded and grateful.

    I will be back next week with a book review of Overcoming Dyslexia, second edition. And next Thursday, I will start [00:18:00] a 4-5 part series dedicated to reviewing different EHRs for testing practices. So stay tuned and take care.

    The information contained in this podcast and on The Testing Psychologist’s 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 [00:19:00] 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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  • 166: Gratitude

    166: Gratitude

    Would you rather read the transcript? Click here.

    Today’s episode is all about – you guessed it – gratitude! I don’t usually get into the whole “do the contrived action on the holiday” thing (just ask my wife about Valentine’s Day). I almost released a typical episode (part 1 of my upcoming EHR review series!) but figured that out of all years to jump on the gratitude bandwagon, this was the one. For many folks, this has been an absolutely devastating year. People lost their family members, their businesses, and in some cases their lives. I am fortunate to have all of those things intact at this point, along with many other things, but I have a tendency to forget about that and dwell on the things that aren’t going well. Research would suggest that a gratitude practice is one simple thing that can help us stay positive and experience happiness.

    This episode is meant to honor all of us and the struggles of the year while also taking a little time to recognize what’s still going well. My hope is that you may also take a little time to reflect on even the smallest things that might be rays of light right now.

    Here’s my list (in no particular order and in no way comprehensive):

    • The ability to work remotely and record outside in decent weather
    • An objectively large amount of privilege
    • Healthy kids and parents
    • The PPP loan
    • Not having to score the WIAT-4 essay anymore
    • An amazing staff that has weathered a crazy year
    • The opportunity to grow and expand into a local pediatric practice
    • A Facebook community that is growing by the week, and growing safer for people to post vulnerable questions
    • Stellar co-moderators
    • My virtual assistant who handles podcast publishing
    • A coach who continues to help me work on controlling the ONLY thing I can truly control in a chaotic world: my own reactions and choices

    Featured Resource

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

    The Testing Psychologist podcast is approved for CEU’s!

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

    About Dr. Jeremy Sharp

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

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

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

    [x_button shape=”square” size=”large” float=”none” href=”https://app.acuityscheduling.com/schedule.php?owner=13476033&appointmentType=2843005″ target=”blank” info=”none” info_place=”top” info_trigger=”hover”]Schedule Your Call[/x_button]




  • 165: Unconscious Bias in Assessment w/ Dr. Linda McGhee

    165: Unconscious Bias in Assessment w/ Dr. Linda McGhee

    Would you rather read the transcript? Click here.

    Dr. Linda McGhee is back to share her thoughts on unconscious bias and its role in the assessment process. As you’ll hear Linda discuss, unconscious bias includes all of the implicit assumptions or beliefs about clients that we, as clinicians, bring to testing. This episode dovetails nicely with the episode on stereotype threat from a couple of months ago, presenting the other side of the coin – examiner beliefs rather than client beliefs. Here are just a few things that Linda and I discuss:

    • Examples of implicit bias in testing
    • Behavior as pathological vs symptomatic
    • How to tailor recommendations for different groups
    • The role of racial trauma in our biases 

    Cool Things Mentioned

    Featured Resource

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

    The Testing Psychologist podcast is approved for CEU’s!

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

    About Dr. Linda McGhee

    Dr. McGhee trained for her Doctorate in Clinical Psychology at George Washington University. Prior to completing studies for her doctorate, she received her law degree from George Washington University, after which she practiced law and served in various administrative roles for a number of years. She completed her undergraduate studies at the University of Michigan.

    Dr. McGhee is currently on the clinical faculty for the Washington School of Psychiatry.  She is a former Adjunct Professor at George Washington University and the Chicago School of Professional Psychology where she taught personality assessment.

    Dr. McGhee is a Board Member of the Maryland Psychological Association.  She recently served as the Director of the Teaching and Learning Center at the Landon School in Bethesda. Prior to that, she served several years as a psychologist at Landon. 

    Dr. McGhee’s treatment specialties include anxiety, depression, and adjustment-related disorders. Stressors surrounding academic and high school/college pressures are also a treatment focus. She also treats adults and children coping with divorce, adoption, and identity concerns.

    In terms of assessment and testing, Dr. McGhee specializes in the assessment of children and adolescents for learning problems, emotional problems, executive functioning, and ADHD. Dr. McGhee also uses her extensive background in law and psychology to provide educational advocacy for clients and families including negotiation of IEPs. She also performs testing (WPPSI and WISC) for the purposes of admissions into independent schools.   A related specialty is consulting on school selection, both local and boarding schools. 

    Dr. McGhee speaks publicly and writes about a variety of issues including executive functioning, stress and children, divorce and children, diversity, assessment, and ethical concerns.

    About Dr. Jeremy Sharp

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

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

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

    [x_button shape=”square” size=”large” float=”none” href=”https://app.acuityscheduling.com/schedule.php?owner=13476033&appointmentType=2843005″ target=”blank” info=”none” info_place=”top” info_trigger=”hover”]Schedule Your Call[/x_button]



  • 165 Transcript

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

    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.

    All right, y’all, welcome back. Glad to have you.

    I’m also very glad to have Dr. Linda McGhee back to talk with me about Unconscious Bias in Assessment. You might recognize Linda from episode 123 where she talked with us about just general  Multicultural Competence in Assessment. If you haven’t listened to that, I would [00:01:00] definitely recommend you go back and check it out. Linda talks during today’s episode about how this current episode is sort of a level 2 paired with level 1 of episode 123. So, if you haven’t checked that out, I would invite you to do so.

    So, let me tell you just a little bit about Linda, and then we’ll get right into our discussion.

    Linda is an incredibly accomplished woman. She got her doctorate in Clinical Psychology at George Washington University. But before doing that, she got her law degree from George Washington as well, after which she practiced law and served in various administrative roles for a number of years. She did her undergraduate at the University of Michigan. She’s currently on the clinical faculty for the Washington School of Psychiatry.

    She is a former Adjunct Professor at George Washington University and the Chicago School of Professional Psychology where she taught [00:02:00] personality assessment. She’s currently a Board Member of the Maryland Psychological Association and served as the Director of the Teaching and Learning Center at the Landon School in Bethesda, Maryland. Before that, she was a psychologist for several years at that school as well.

    She specializes in anxiety, depression, and adjustment-related issues. Stressors surrounding academic and high school/college pressures are part of the deal as well. And as far as assessment, she specializes in the assessment of kids and adolescents for learning problems, emotional problems, executive functioning, and ADHD. She also does some advocacy using her law degree to help families navigate the IEP process.

    In addition to all these things that I’ve already mentioned, Linda also does a good bit of public speaking and writing on a variety of issues, including all of the above, as well [00:03:00] as diversity assessment and ethical concerns.

    As you’ll hear during the conversation, Linda also offers multicultural competence training specifically around culturally competent assessment. And there’ll be links in the show notes if you’re interested in contacting her.

    Before we jump to the conversation, I would like to invite any of you advanced practice owners out there to consider joining the Advanced Practice Mastermind group. We’ll be starting on January 7th at 9:00 AM mountain time. We have one spot left. And this is a group for practice owners who are ready to take their practices to the next level and really want the accountability of being in a group of peers who can hold your feet to the fire and help you reach those goals in your practice. You can learn more at thetestingpsychologists.com/advanced.

    All right. Let’s jump to my conversation with Dr. Linda McGhee.

    [00:04:00] Dr. Sharp: Hey, Linda. Welcome back to the podcast.

    Dr. McGhee: Thank you, Jeremy. Happy to be here.

    Dr. Sharp: I’m happy to have you back. Thank you so much for reaching out and being willing to come back on after our first conversation.

    Dr. McGhee: So, after we had our first conversation, and you put this note on the first conversation that we were at the beginning of the George Floyd. The George Floyd murder had taken place. The killing of George Floyd had taken place, and we were in the process of digesting it. And you and I both agreed that it would be a good time for me to come back and talk about some things that came out as a result of that.

    Dr. Sharp: Yes, I totally agree. In so many ways, it feels like that was yesterday and a lifetime ago. There’s so much that has happened since [00:05:00] then.

    Dr. McGhee:  And it definitely seems like 12 years for me. But I’m happy to be back because one of the things that you and I were talking about earlier is that I was very passionate about us as psychologists bringing our whole selves to the practice and challenging ourselves to do better with regard to race.

    And the by-product of me calling the arms my peers was me challenging myself to do more, to step out there more. The same thing I’m urging other people to do. To enter into some slight discomfort and to be a positive force for change. I feel like psychologists we’re at the forefront. The whole country is undergoing all of this mental instability. And even as testers, we can do our part because our [00:06:00] decisions impact a whole lot of people.

    Dr. Sharp: Oh my gosh. Yeah, they sure do. Well, I have to say too, I’ve been watching you on social media and email and all those things, and it’s been super inspiring to see you really walking the walk. I know that you’ve been doing this work for a long time, but it seems like you’ve stepped it up over the last six months or so and

    Dr. McGhee:  I have.

    Dr. Sharp: you’ve got a lot out there. And it’s just such good content. You’re really doing the work, which is amazing.

    Dr. McGhee: I started off in this career already having another career. When I first got into it, people talked to me a lot, Jeremy. You and I have talked about marketing, but I’ve always felt like it’s important to have something. I now feel like I have some things that I want to say that I feel comfortable talking about not just some market myself. I have a harder time separating [00:07:00] myself from the brand.

    Dr. Sharp: I would argue, that’s how you know you’re in the right place. It’s like the passion and the business intersect with what people want to hear. And I think all three of those things are happening right now for you, which is really cool to see.

    Dr. McGhee: It is. I’m very fortunate.

    So when we were talking, one of the things that I wanted to talk to you about is that in addition to the things that you’ve seen, one of the things that I’ve done is, I’ve done a lot of training and reading on trauma, but I’ve also taken a diversity inclusion program at Cornell.

    And so the idea for the day sure came out of that, which is to talk about not… we talk about racism, but racism as a byproduct of the building block of it, which is unconscious, which you’re thinking in your unconscious about the personnel it’s across from you. The categorization system that we all use [00:08:00] because it makes our brains work easier, right? Because to categorize things makes our brain work easier. But sometimes we put a bias on people because we’ve been taught and conditioned to think about people in a certain way. And we all have it. So, that’s how we came to this topic today. I want to talk about racism, but I was also wanted to talk about how we get there.

    Dr. Sharp: I love that. Yes. So maybe…

    Dr. McGhee: Go ahead.

    Dr. Sharp: Yeah, I was just going to say maybe if you’re ready to just dive into it, maybe you can do that.

    Dr. McGhee:  Okay. Our world view impacts our practice. And so, the unconscious bias exists in all humans not just psychologists, and that race is a central part of our functioning in this country. And it requires us to be intentional about addressing [00:09:00] it. It doesn’t go away even if you’re a good person. It requires that you have what I’m now calling intentionality to deal with it. And that our requirements and our profession to be ethically competent requires us to educate ourselves on race and cultural competency.

    And so those are sort of like my five guiding principles. And then the last one I’m just tacking on is, but it’s not easy. And I’m acknowledging that. For everybody who’s out there listening, who’s trying, who definitely is uncomfortable with the situation that we find ourselves in as a country and as clinicians and that wants to do better, to break this down a little bit so that it’s easier to understand.

    Dr. Sharp: Yeah, I think that’s going to be super helpful. I think a lot of us would obviously agree with [00:10:00] that idea that we have these unconscious biases that come up in our work, but then what happens after that is a little murkier. And so any guidance that you might have will be valuable

    Dr. McGhee: So, let’s start with just what it is because we talk about these terms and sometimes we don’t know what they mean.

    Dr. Sharp: Sure.

    Dr. McGhee: So an unconscious bias which is sometimes called implicit bias is a snap judgment basically. It results from mental shortcuts, pre-existing knowledge. And they make us very efficient in interpreting incoming information, but it happens below our level of consciousness. It’s about what and who we see. And the judgments tell us who is likable, who is safe, who is valuable, who are [00:11:00] right, and who’s competent.

    As clinicians, we have this duty to be culturally competent, whatever that means. And the APA, in one of the principles, requires us to respect the rights and dignities of all people. And so we have this sort of a competing notion of we already have these categorizations in our brain, but we have a duty to be culturally competent. And how do you marry those two things?

    Dr. Sharp: Right. That’s the challenge.

    Dr. McGhee:  Yeah. So, let’s start just a little bit with just some basic theories on race. One is that, when you think about race, you think about the individual, you think about their group, and you think about their experiences. [00:12:00] That’s from Sue & Sue’s tripartite model on considerations of race. You think about the individual, you think about their cultural group, and you think about the experiences that they have across cultures.

    As humans though, when we are challenged on our unconscious biases, we go through stages. It’s almost like grief. So first we deny that we have biases because we think of ourselves as good people. And then we defend the status quo. When it becomes indefensible, we minimize it. And then we finally come into a sense of acceptance, adaptation, and integration. We accept that we have biases, w`e try to adapt them so that we can meet our ideal of being a [00:13:00] good person, clone more closely, and then we integrate them. All of this takes mental practice, energy, and intentionality.

    Those stages came from this theory called Bennett’s Developmental Model. And it has to do with intercultural subjectivity. How do you integrate the idea that your bias is interfering with you clinically? And how do you work yourself through that? It’s interesting.

    Dr. Sharp: Absolutely. I would guess that there are a lot of us, this is how it goes according to this model, it’s hard to even acknowledge this is happening in the first place. And it’s easy to get stuck in those first couple of stages.

    Dr. McGhee: And it just doesn’t have to do a race or culture or [00:14:00] citizenship status. It has to do with a lot of things. And it has to do with how we’re raised. Like I was raised in a conservative Midwest. And so, in my practice of psychology, there are other areas that I had to deal with because of the way that I was raised in a Pentecostal church around sexuality and all these things. So, we all have things that we work on, but race and culture are unique, particularly for African Americans and some native Americans, it particularly has to do with the history that’s embedded in all of us because of the history of our country.

    So how it pertains to what are some examples of unconscious bias is that:

    1) I’ll just toss out a few. They’ve done these studies after study and a lot of teachers and professionals that deal with children in school [00:15:00] settings have been known to be less likely to predict successful outcomes for black students. So their expectations are lower going in without anything else.

    So think about this. If your child comes into the room and the teacher already has an expectation that they won’t be a high-performer, think about how that impacts the way that they teach you or the way that they assess you.

    Another really broader one is similarity bias. We tend to enjoy working with people that are like us, that look like us, that come from our neighborhoods, and also tried and true.

    And finally, one of the really general ones is [00:16:00] confirmation bias. So we have a theory in our mind and that forms our hypothesis and they can form my hypothesis around testing. And then we set out to prove that hypothesis, right?

    Dr. Sharp: Absolutely. That happens so much. It’s an active fight to not let that happen.

    Dr. McGhee: Sometimes you’re writing the report and the data… I spend a lot of time on my data. And it’s on my dining room table now, a home office. And I would have a different result. The data wouldn’t support my hypothesis. It takes me a couple of drafts before I’m like, “McGhee, you’re just wrong.” That is a beautiful hypothesis, erudite, and outstanding in nature, but ultimately incorrect. And so, we have to constantly be checking [00:17:00] ourselves in terms of race and culture on whether or not we’re confirming the bias that we haven’t confronted the underlying bias that we talked about.

    Some that are more specific to race are just the idea that people prefer names that are closer to their own names. And in many instances, a lot of Anglo names are very different from a lot of African-American names or names that are from people from other countries. It just feels like that we’re more attracted to names that sound like our names. And that impacts your judgments and all kinds of things. So it’s just very, very interesting.

    One of the things, just a quick aside, is that when I’m doing workshops at schools is to ask people to be careful and [00:18:00] make sure you pronounce the child’s name right. Because that’s just a sort of like you’re giving them agency, and you’re giving them personhood by saying and recognizing their name. And you can ask them how to say it, but please work on saying someone’s name right that’s in front of you for testing. It is one of my pet peeves.

    Dr. Sharp: Sure, that’s a very simple way though that we might miss out`.

    Dr. McGhee: A couple of other things that I have come up with just from my doing this for 12-15 years. One is that, from studies, we give black boys and black girls, we give them what I call adultification bias. Based on their age, they’re presumed to be more adults, less innocent than their white peers.

    What happens is that that [00:19:00] sort of works out sometimes to be like less in need of protection, and less in need of nurturing if we’re making them more adult. And so for black girls, that intersects with the girl part of the black girl, and it leaves them particularly uncovered.

    The historical construct of black boys is that we sort of view them as deficient, and not up to par, sometimes dangerous. And so the same thing holds true for black boys, is black girls are viewed as less innocent than their like-age white peers.

    Also their size. They’re thought of to be older if they’re large. [00:20:00] And they’re thought to be more mature. I have a 6’5″ son, and he’s been like that for a while. And I worry about his interactions with the police because he was really young and really large. I feared that he would be thought of as an adult.

    So a couple more things are that we do not understand trauma as testers in a way that I think that we should. And I am definitely including myself in this group because we think about conduct and we understand it to be pathological as opposed to symptomatic, which is why I’ve always not loved the ODD conduct disorder diagnosis.

    Dr. Sharp: I’m right with you.

    Dr. McGhee: Then children of color are often seen as what they do [00:21:00] not what has happened to them. This is a whole definition of trauma that we tend to definitely overlook. And there are some conspirators there that help us along the way. The teacher may not know, or she might not have asked why young men might appear to be angry or silent or just not speaking up.

    A lot of times parents hide things. And honestly, they hide things from white people because they don’t trust the information is going to be used in their child’s best interests. And they fear being stigmatized. We’ll talk more about that later.

    Another way that has to do with autism that I think unconscious bias comes up and some other diagnosis is the tendency not [00:22:00] to classify behaviors as autism in children of color. And this is as opposed to intellectual disability, which is which people are more likely to get than autism. So for some reason, even though the science is clear the incident rate is the same across races is that we as clinicians are missing that diagnosis with African-American children. They’re being diagnosed later. And so, the outcomes are challenged because of that. And even people, this goes across having resources.

    Dr. Sharp: Hmm. Why do you think that is? And not to go down too much of a rabbit hole, but with this autism, in particular, what’s getting missed and kids of color or black kids in particular?

    Dr. McGhee: I think the idea of a 4 and [00:23:00] 5-year-old being in class having behaviors that are outside of the norm or viewed as behavioral in children of color. And so they get directed down the route of conduct. You need to make him sit still. Why is he moving like that even though it might be clear that it’s repetitive, right?  A clear sign.

    Also, I think access to programs because every state has the Child Find, the really early services. And I think if you don’t have access to that, a lot of children on the spectrum are diagnosed that early, and it becomes very, very clear. And so, I think that a lot of people of color miss the opportunity, and then they’re already in school already. So, you’re already a couple of years behind, believe it or not, because your peer, [00:24:00] a child with autism might have been diagnosed at 3 years old and you were diagnosed this 6 years old. What I tell my clients is that we don’t have three years to wait. I think that’s the case.

    Dr. Sharp: That’s so true.

    Dr. McGhee: The last thing I want to talk about before we talk about addressing it is that these two notions I think that diagnosticians have is that they think that because we’re clinicians, we’re not subject to unconscious bias because we know better. We know about races. We know about race theory. We know about trauma. And so we used to feel like that we’re somehow exempt. And that is not true. Everyone has an unconscious bias. We’re all products of the society, how we grew up. And so, a lot of times when I talk to clinicians, they’re looking at me like, “I already know all of this.” But I’m like, “But you don’t see your own [00:25:00] blind spots. No one does.”

    Dr. Sharp: That’s so true. Sure.

    Dr. McGhee: And then I get this defensiveness around the test data. Well, the actual test data should be paramount. That’s the fairest system. Let the test data speak. And my thought is, we don’t do that for anyone. We do not. We interpret every child that comes in. And we should be interpreting everyone that should come in. So, my thought is, the test data is the test data. I tell people to report the data, but I tell people to contextualize the data. We do it for everyone. We should do it for everyone. And it should be used per what it is.

    Now, me [00:26:00] personally, I have always done in before it these hard words. I’ve done sort of a strength-based approach where I try to like, because testing, whether it’s educational, executive function, or emotional, which are the three branches that I particularly specialized in and specialize in, I get a lot more data from everything other than the test data than I do from the test data, or at least as much.

    So let’s think about what we actually mean instead of just spouting off of the intellectual point.

    One is, how does the child come into the room? I did hundreds of  WIPS and WISC for admissions testing for private schools.  And I would see kids that already [00:27:00] had the confidence of the world. And I saw some kids come in with their shoulders slump. This is at 4 years old. This goes to show you how much these things are embedded when the children are little. When they come into the room, do they seem nervous? Are they shy? Do they feel judged? A lot of kids of color are already under the gun. They’re already being scrutinized.

    So, you just sitting across from them and just beginning your testing without trying to get behind what’s going on with them is going to yield a result that may or may not encompass their strengths.

    How do they act adversity when they start getting things wrong? Do they pull themselves together? Like all of these things, we use to assess, right?

    And so, they have nothing to do with whether or not you can pull the right matrix reasoning, multiple-choice, or a pattern. It’s just like, but if you get [00:28:00] number 7 wrong, did you just fall off a cliff and not get any right, or do you like sticking it? Or are you gritty? Even if you getting them wrong, do you hang in there, and then you might get one of the hardest ones right? So then that tells Dr. Sharp a lot. That tells Dr. Sharp that something is in there. He got the hardest one right but he missed 1 through 8. That’s a whole different score than someone who got the same score but just went down to their discontinue point and just discontinued, right?

    Dr. Sharp: Yes, absolutely.

    Dr. McGhee: My point being is that we don’t just look at test data. We look at the entirety of the child. So why shouldn’t culture, what’s going on in the home, parenting, the whole nine yards come into play? [00:29:00] But again, how does it come into play? And all of these things are not easy at all. I’m fully admitting that.

    Dr. Sharp: I appreciate you acknowledging that. Well, there’s a lot to say about that and this whole journey that we go down as clinicians to combat some of these biases, and just acknowledging that it is hard and it is a journey is important.

    Dr. McGhee: When I taught kids assessment at George Washington in Chicago school, one of the things that we did was when we dissected the cases, we always talked about, okay, what’s the cultural component? And then it was just such an organic setting to be able to say, “Yes, you considered culture well, but you need to make that diagnosis though because the data supported.” Now we [00:30:00] need to talk about why this person got here, how this person got here, but you call this diagnosis. So I was able to help them to titrate culture in a way that we don’t really have out there in the field. And we don’t have the comfort level to have this conversation, right?

    Dr. Sharp: That’s the thing, right. I think a lot of us probably know we should be doing better or different, but the comfort to have those conversations is not always present.

    Dr. McGhee: And so then we need to talk about sitting in that discomfort because the way that I’ve gotten better about thinking about it, teaching about it, and getting feedback about it is by doing it. And it is not comfortable.

    It’s not comfortable necessarily for me to talk about it. So I had to overcome internal thoughts myself too [00:31:00] in order to get out here, as you said earlier, to claim this platform for assessment. It involved its own psychological process. I think most of the people that are so enthusiastically on your site each and every day, which I love, by the way, Jeremy. I don’t have a lot of Facebook time, but yours is a go-to place, but I think most of the people on your site are growth mindset, people. They’re work in progress and they know that they are, right?

    Dr. Sharp: I think so.

    Dr. McGhee: When I was on your show before, I talked about this book by Dolly Chugh, The Person You Mean To Be where she talks about accepting yourself as goodish as opposed to good because it still gives you a ramp, right?

    Dr. Sharp: Yes, I love that.

    Dr. McGhee: And so you’re doing the [00:32:00] self-analysis, but then you’re also letting go of being a good person in exchange for a goodish person. And so, when you start to think about it and you accept that you have it, then the idea is like, okay, so what’s next?

    Dr. Sharp: Yes. I like that.

    So before we move on, I don’t want to forget this. I wanted to ask you, it sounds like a lot of this stuff tails with the stereotype threat kind of stuff that I talked to Josh Aronson about a couple of months ago, I think. How are those related? Are they distinct concepts? Are they the same? Can you talk through that at all?

    Dr. McGhee: Yes. An unconscious bias is a categorization system that sometimes results in bias. The stereotype threat is the idea that [00:33:00] I fear so much that I’m going to meet the stereotype that I in effect undermine my own progress, and I almost regress to the stereotype because I fear it so much.

    An example of that is what a lot of African-American kids do when they go to college. And I did this myself. I went to the University of Michigan in Ann Arbor. And when I was struggling, I isolated because I didn’t want anyone to know that I was struggling because of the shame of struggling. For other people in other cultures, it’s sorta like, well, I’ll go to office hours. And now that I’ve raised my own child in private schools mostly, and I treat the children that go to private schools, I now know that they’re trained from when they’re kindergarten to go and ask the teacher and to be the first [00:34:00] person in line for office hours.

    And I don’t know about you, Jeremy, and I don’t know how things are out there as opposed to the East Coast, but I’ve driven many mornings for my child to get an extra study session. And so all of those things have been ingrained in him as opposed to a kid who doesn’t come up in that setting like myself, who went to public school and even the University of Michigan is a public school, but it’s kind of like pebble beach. It has a public golf course.

    It’s not really a public school. Do you know what I mean? It’s an elite public school.

    So I stayed in my room. So what happens is that you stay isolated from your teacher because you don’t want them to know. You get help later. You’re already more likely to be struggling financially. You’re more likely than not to feel like you’re not adequately prepared.

    And I want to just give a shout out to the Steve Fund, which I work with a lot who are an [00:35:00] organization. I’m one of their mental health experts that works with mental health with kids of color in college. So this is where I’m getting the data from. And they have done all this research and all this compilation of research.

    So I’m already always likely to feel all of these things, but I’m more likely to meet the stereotype because the anxiety about this stereotype combined with other sociological factors means that that threat that the student feels, it leaves them more likely to meet the stereotype, but they fear meeting the stereotype.

    So, the stereotype threat is more in the eyes of the person who is the subject and the unconscious biases in the minds of everyone about other people. Does that make sense?

    Dr. Sharp: Yeah, two sides of the same coin that seems like. And there’s some relationship there. Yeah, certainly.

    I [00:36:00] did want to ask you as well, you said, which I think is so important is that a big part of this process is just being willing to sit in the discomfort that comes up. And so I’m curious for you, how do you do that? How do you handle that personally when you’re uncomfortable? How do you work through that, fight through that, persevere when you know it’s important?

    Dr. McGhee: Like most nerdy people with three degrees, I try to learn my way out of it sometimes. I’ll try to read more and understand more about it. But ultimately as therapists, we know that you just sometimes have to sit with it and just be uncomfortable. The political and racial situation in this country right now is very uncomfortable for me. It’s uncomfortable for me to talk about. It is [00:37:00] uncomfortable for me to exist in. I am at a sort of a low level of anxiety about it. I worry about my child. And a lot of people, particularly people of color feel like that right now.

    Sometimes the discomfort, you just have to sit with it and figure it out. Like Joy DeGruy who wrote Post Traumatic Slave Syndrome, she says that you have to think about using your privileges to make things better. So she is talking about like being in the discomfort, but then also ultimately figuring out how to take this discomfort and do something that’s positive out of it. But as you will know, running from it and denying it doesn’t always work.

    So, in terms of [00:38:00] of unconscious bias, you have to learn what they are and that you have them and assess which biases are more likely to impact you. I talk to people about race a lot apart from unconscious bias. And I ask them about how race was talked about in their home. And so they either have this answer, right? The answer is typically like, “We didn’t talk about it.”

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

    So, first, you learn where your unconscious biases are. That you have them and you acknowledge and accept that. And it doesn’t have any reflection on you as a person. And then you assess how it most likely impacts you. And again, we were talking about growing up, how is race discussed in your home? When did you have a concept of yourself as a racial being?

    And so interesting. I just went to this training by Dr. Ken Hardy who’s an [00:40:00] expert in this field. And he says that most black children are aware and cognizant of racial themselves as black when they were 2 to 4 years old.

    But when he asked as groups of white people, adults, a lot of them were not aware of themselves as white people, not aware of racial difference because wear themselves as white. And so there are adults. So they could sort of show you how race is sort of metabolized in this country. But his theory is that you go from race socialization, how we’re socialized on race and that leads eventually to race trauma.

    But going back to the central point, so you assess what biases impact you. How did you talk about race? Were you comfortable talking about race? Was your mother or father or somebody who was staunchly [00:41:00] you treat people this way, you don’t treat people this way, good or bad, but how you’re used to dealing with it, and then you kind of figure out how it impacts your work.

    Your reticence to bring something up may be a part of your conditioning system growing up. But it may not necessarily help you when a parent is clearly worried about stigma, but you won’t talk about it. This is one of the I’ll give peel back the curtains a little bit about when black people come into my office, they tell me, I want to own this. This is why I’m paying you X thousand dollars for this testing. I want to own this so I can look at it and decide whether they give it to the school, which is [00:42:00] not an approach that white parents often take. They are protective of data in different ways, but not like I don’t want the system to know anything because I am so mistrustful of a system.

    And so if you as a clinician can not talk about that, then how are you best serving your client? So, you need to figure out how these biases and how you grew up, and how you’re conditioned to speak, how to talk about that in a way that best serves your clients. So like, we were joking earlier about people. I used to work at a school and other people would always come and tell me, I don’t think I’m serving the black kids. And I’m like, okay, so let’s work on it, but then you have to actually do the work.

    And that again, I want to emphasize that this is not easy work. It involves a lot of nuances and subtleties [00:43:00] that are not all that obvious and that you have to get supervision training. Just in a side, you have to read. You might have to consult. And so you have to work on it. And that’s not easy to do because you have to make it a priority as we’re all living our 24/7 lives to take the time to learn. But as I have been saying, this period for me has been a real learning curve and a speaking curve because I have the ability to sit and actually pay attention to a CEU.

    Dr. Sharp: Sure.

    Dr. McGhee: The commute is now taken up with things that I actually want to be doing.

    Dr. Sharp: That’s great. I always think it’s interesting that people, you know, we have this model where we are totally [00:44:00] okay setting aside 3 or 4 days in a row to go to a conference like APA or something like that. But it seems much harder somehow to set aside even an hour a week to do this continual learning and really keep on top of these issues as they arise. For me, that’s a much better model than doing a conference once a year for 36 hours.

    Dr. McGhee: Right. So all the studies on unconscious bias show that just going to a training in and of itself doesn’t do much. You have to do plus. Unconscious bias training plus thinking, getting more training, getting more supervision. A lot of times it means spending time with the other and humanizing the other. So, we have to fight willful [00:45:00] blindness because this is a decision, right?

    Because we as psychologists know better. You have to humanize the other. And that means you’re around them. And that too is a conscious decision. You avoid this thought of like, I just have good intention. So because my intentions are good, I can stop the inquiry there, right?

    Even there are things that we’ve been conditioned as a society in how to treat ethnic minorities that prevent people from humanized others, right?

    We have this savior complex that we’re going to go in and we’re going to save them. We type cares people. This is another word of saying we stereotype people. I’m talking a little bit more about that in a minute about testing. We’re overly [00:46:00] sympathetic, or we feel like that tolerance is enough.

    Remember when tolerance was the catchphrase and now no one says tolerance anymore because to tolerate somebody is just not a high standard.

    So, we talked a little bit about how psychologists feel like they’re sometimes impervious to unconscious bias. Another thing that I see as a major pitfall is that we don’t recognize that microaggressions can be out of our awareness also. These are like the day-to-day things that happen that are injurious to people typically who are oppressed. And they too can be very subtle to the person saying them, but it can be very dangerous.

    I’m [00:47:00] going to give you an example. I get this a lot. People come to tell me about other psychologists. So, it was an African-American kid in my office. I said that I took Chinese and she acted so surprised. Or I said that I was number one in my class and she acted like that was so unusual and made several comments about it.

    And so, that microaggression is reflecting the unconscious bias that African-American children can’t be academic thought leaders. And we’re not even aware of it.

    The other one is, where are you from? That’s been made into memes and all kinds of things, right?

    Dr. Sharp: Oh my Gosh, yes.

    Dr. McGhee:  But it persists, Jeremy. These are things that they’re not just examples. I hear them all the [00:48:00] time.

    Dr. Sharp: I’m sorry to interrupt, but this is important. The where are you from question, I’m sure there are some people out there who are like, what is the big deal with that? Why is that a thing? Can you talk a little bit about why that’s a thing?

    Dr. McGhee: Well, it’s another ring, right? It depends on how you ask the question, right?

    Dr. Sharp: Sure.

    Dr. McGhee:  First of all, I try to give people to have things in writing because sometimes if you have a good background, good referral question from good referral sources already giving you a lot of information, then you don’t necessarily have to have that conversation. But if you’re going to ask the parent, if you’re going to ask the kid or the adult, you can say, not as a leadoff, this should come into a whole series of questions about a person’s background. Or I understand your [00:49:00] parents are from Bangladesh, how did you come? Did you come to this country as a child?

    Where are you from has become a little bit of a cliche. Now in and of itself, that one I have some sympathy for you as opposed to mispronouncing someone’s name because you think it’s straightforward, where are you from? But it implies that you’re not from here. I’m sure you’ve seen the satire videos where the person says I’m from Sacramento because they’re actually literally from Sacramento. 2 or 3 generations might be from Ghana, but they’re from Sacramento. That’s just one that came to my head when I was preparing for this.

    The last thing I want to talk about that’s kind of a pitfall and it’s [00:50:00] really hard for us to think about is this idea that even when we study culture, it’s a push/ pull, right? Because we get these courses and training on this culture acts like this, this culture acts like that, and they may be giving you some data as good, but sometimes it risks perpetuating stereotypes, right?

    So I trust trained dynamically and it was sort of like, you look at the culture, but you treat the person in front of you. That was ingrained in me time and time again. You’ve got to treat the person in front of you. So the person in the stereotype might like this, this and this, but you might have me in front of you who grew up in Southern Indiana, who knows a lot about country music, who is interested in English period movies. [00:51:00] And so you treat me like I am in front of you telling you these things without surprise, right?

    So the problem that I had with a lot of cultural courses on multicultural competence is that sometimes they may perpetuate the stereotype. I don’t like it when they say, well, Asian-American or African-Americans may not come back. They may have actually had the statistic that African-Americans may not show up for the third appointment. But when that’s the only thing that’s in your head, it’s sort of fights that idea of fighting unconscious bias. Do you get what I mean?

    Dr. Sharp: Yes, well, the only thing I can come up with is like, it is hard to fight through that. Like it just reemphasizes that we have to continually be aware of this kind of thing. But I’m [00:52:00] curious if that’s what you’re getting at or if there’s more to add to that.

    Dr. McGhee: So, it is sort of like the course in isolation doesn’t always give you data. It gives you data about the culture, but it doesn’t always integrate the study of cultures with the integration of the individual. Does that make sense now?

    Dr. Sharp: Yeah, absolutely. When we get into that, I know this just keeps coming up, it’s this idea that we really have to be present and be conscious when we’re working with folks. It seems like that should be a no-brainer, but like you said, these unconscious biases are always running around.

    Dr. McGhee:  And we’re [00:53:00] uncomfortable around issues of race. When I was doing this training recently, which is why I think this actually works really well is when you have an outside person come in and help. I said to the people in this practice that I’ve taken through four segments of training is that the black people on your staff are not okay right now. And I went through what they’re going through. The practice owner came to me and she’s like, no one has ever said anything like that just straight up in my face to let her know that we are not okay right now.

    And so when you’re talking to your psych associate, she’s expected to show up at work and do all the things. And she’s doing it, but she’s not okay. That’s information as helpful [00:54:00] for you to know. It’s also helpful for you to know that, you know, like I’ve just treated a kid who is a Mexican-American and he’s been taunted at school online. So it’s useful for you to be able to say, how are things going? This has been really interesting few months in America. Just sure it opens this conversation.

    And then he pours out with the fact that he’s being taunted and called racial slurs at his school. I’ve heard from Jewish kids, the same thing. Vandalism at their synagogue. These things would be helpful for us to know in terms of what we conclude about a child in the assessment. That’s a part of us leading up to the assessment, which is what I guess now we should talk about it a little bit. It’s like, how do you [00:55:00] bring a multiple cultural family into assessment. How do you perform the assessment? How do you make the interpretation?

    And so, I sent and I’ll do it again this time, the article that I wrote about Multiculturalism in Assessment, and a lot of this is in there, but a lot of this is stuff I’ve learned recently. Make sure the process is explained. You do this with everyone, but just make sure a lot of times, especially outside assessments are not well understood. Even the IEP processes for those of you who are testing in schools are not well understood. Make sure you talk about consent in the language of the other person, both the English language that the person understands, but if it’s English is their second language to make sure that the explanation is clear, right?

    You want to also [00:56:00] make sure the referral question is clear. Why are you here? Do you understand why you’re here? I ask the kid that all the time, do you understand why you’re here? Again, this is the fine line. It’s like you don’t want to act like the person lacks knowledge, you might make them be sensitive. I always ask, do you understand? Before I pull out my bell curve, I ask, “Did you want to see a bell curve?” And they were like, “Yes, please.” Because no one has ever actually explained it to them, which is also a little bit alarming that they’ve been tested before and no one has actually explained to them how our test center around 100 and what this means, right?

    So I explain all of that to the parents. [00:57:00] I try to get a good family history. And I have it on my SimplePractice’s form, but I’m aware of other cultures and social economics groups may have not been diagnosed. And even a lot of white groups, if you have people in your family, they may not have been diagnosed. So you want to dig deeper. Does anybody else have issues with focus in your family? Oh yeah, my dad does. Oh yeah. And they’ll say no. And then I’ll say anybody have any problems with school? And they’ll say, oh, uncle Jimmy did 9th grade three times. But nothing would have been diagnosed.

    So then you want to be sure that you need testing to answer the referral question. Because a lot of times I get people, I try to… one of my, Jeremy, for lack of a [00:58:00] better word, superpowers is triage, okay?

    Dr. Sharp: Yeah, that’s great.

    Dr. McGhee:  Okay. So a) That might need testing, but it doesn’t need testing now. If you have several thousand dollars, we need a therapist first.  Because I help people triage resources where the need is and the money because we’re not cheap, Jeremy.

    Dr. Sharp: This is true.

    Dr. McGhee: I have a detailed conversation about who owns the testing before the testing starts.

    Dr. Shap: That’s interesting.

    Dr. McGhee: That comes up in a lot of situations because I’ve tested on behalf of schools, I’ve tested in public school, I’ve tested in charter schools, I’ve tested for Chi Chi private schools. And the question is who owns the testing? One private school that I tested for, [00:59:00] they used the testing in a way that was sometimes not positive.  And so me as the clinician, I had to decide what to tell the people because if they’re using the testing as a means regularly to counsel people out of the school, what is your ethical obligation?

    Dr. Sharp: That’s important for people to know that.

    Dr. McGhee: So they’re paying for the testing, but they’re using it to make decisions. And the parents don’t have very little rights to control the testing. I mean, even those conversations are not comfortable at all. You know they’re paying the fee, so they’ll get a copy of the report. They’ll use the data to make recommendations to you about your future. And they may or may not be consistent with my recommendations. Point [01:00:00] blank. And that’s a hard conversation if the school is paying your fee.

    Dr. Sharp: Yes.

    Dr. McGhee: So you have to parse all of this stuff out, but a lot of times it comes out with regard to culture because of the economics of it.

    I refer out if language is the issue.  My Evansville, Indiana French does not get me to the point where I can test in French, so I don’t do it. But a lot of people use the English version and they make disclosures. But if that language is really not good or the English language capabilities are not good enough where I feel like they can take the vocab test and I’m going to get a real reading of G from the WISC, then I refer out. You’re nodding Jeremy, and they can see you, but this doesn’t always happen.

    [01:01:00] Dr. Sharp: It’s true. Yeah.

    Dr. McGhee: Also what has come up recently is the electronics. Some kids may or may not be exposed to electronics. So if you’re testing on an iPad, I really feel that you should have a conversation about whether that kid is blowing an iPad. A lot of kids are, but a lot of kids aren’t. You want to select an interpreter. If you’re using an interpreter for some particular reason that you haven’t referred, you want to make sure they don’t have a dual relationship with the client. They’re not their sister because that will color the data.

    Doing testing online has come up a lot in terms of cultural sensitivity. I’ve mentioned to you before that I wasn’t sold on the idea. So the testing that I am doing, I am doing [01:02:00] in-person because I am concerned about… and I’m making no judgment, so no angry emails to Jeremy. Okay, y’all? I’m making no judgments. This is a personal decision. I’m concerned about people saying they’re testing people in their homes. I’m concerned about the cultural differences. I’m concerned that a lot of the methods haven’t been tested on groups that are maybe of different ethnic origins. So I’m testing in person. But that’s also a consideration is to think through the cultural considerations before you test someone that’s from a different culture.

    And finally, just like how you collect your data from the part before you do the testing, is that consider culture. So for example, you might have a highly intelligent kid who uses slang or English might be their second [01:03:00] language. Jeremy, you and I may not know what the heck they’re talking about, but that could be highly intelligent people. So be aware of the fact that we make judges about people because they may use non-standard English and not go behind that wall and see.

    Again, talking to the family about stigma. And this is a very hard conversation, I think cross, culturally to have. And it’s one where I think sometimes can have that conversation easier. But you have to get comfortable with it because you have to say, you fear stigma. So where is the cost-benefit of diagnosing your child with a learning disorder now when they’re 6 years old and remedy in it as opposed to like this stigma issue?

    I understand. But I always tell [01:04:00] them, there are reasons why black people are afraid of the educational system in this country. So I sympathize with them, but I push them toward treatment because these issues when you catch them at 6 years are different than when you catch them at 17 years.

    And unfortunately, I get a lot of older children from ethnic groups. They’re past 15 years. And that just pains me to no end, because they’re out of runway. It’s harder to deal with those issues. And I think about how much pain that causes the child, that they’ve known that there’s an issue, that they have ADHD the whole time, and the fear of stigma prevents them from being diagnosed. So that’s one that I feel strongly that all clinicians to be able to talk about and figure out how to talk about it.

    And finally, just one last thing is, people [01:05:00] from different cultures might express emotions differently. They may be more emotional in sessions. And that doesn’t necessarily mean that they got emotional regulation problems or that is pathologized. It’s just that certain cultures may express emotion more and certain cultures may express emotions less. We should consider culture when we’re making judgments about it. And it’s not always the clinical judgment. It’s just that the person could be… you know what I’m saying? Does that resonate?

    Dr. Sharp: Yes, it really does. I’m just thinking about that. That one, in particular, is resonating for me. So just to pause on that and know that a lot of diagnoses that we make are sort of contingent on emotional regulation and how it’s expressed, right? [01:06:00] So, yeah, I’m just pausing. This all makes so much sense.

    Dr. McGhee: And again, this is from 15 years of me thinking about this. This is about consultation because this is the time when Jeremy says, I had this case and he was kind of […] and then I realized it might’ve been defensive, but I want to see if I’m categorizing, let me tell you some facts. And then I say, well, okay, so it seems like that this might be feeding into this and this might actually be a cover for his anxiety. So you do want to talk about it in the emotional section.

    Or it just could be like, this is how he talks about his voice in a conversation. So don’t overemphasize that in the report. I’m not suggesting you never mentioned it. You could say in the behavior observations seemed to be happiest when he was talking about this or [01:07:00] show more emotion, but it shouldn’t necessarily rise to the level of pathology. So does that make it a little bit easier to categorize it in your mind?

    Again, all of these things that we’re talking about, Jeremy, in this session as opposed to the last session, this is multiculturalism advanced as opposed to want or won. But going back to some basics, in the testing environment, I like to take my time generally. You can probably tell by listening to me that I’m a thoughtful person in terms of testing. I like to get to know the person. I like to see if they’re stressed at the beginning and see if I can ask assuage that a little bit before we get started, because I want good data.

    You want to think about your outline data. Don’t [01:08:00] overrank outline data. Either find some collaboration for it or talk about it, but don’t… I strongly see sometimes like there’s one dangling piece of information that the person puts their entire clinical judgment on. And I think that that’s done sometimes with the cultural groups more.

    Dr. Sharp: Do you have examples of that? Anything that you can think of?

    Dr. McGhee: I feel a lot with behaviors, more so than anything else. It’s just like if the person is talking a lot in class or talking over the teacher and that’s when one data point that seems to come out in the terms of a conduct disorder, or in terms of like, you know, it’s just not even appropriately [01:09:00] developmentally considered in terms of culture sometimes because your average middle school boy doesn’t have googobs of self regulation.

    And so when you think about it with culture, sometimes I’ve seen it explained as developmental with some kids. And sometimes I see it explained as a conduct disorder or oppositionality, that’s more appropriate because I really see conduct disorders as oppositionality as opposed to developmental.

    And again, these are subtleties. The point of what I’m trying to say is that if you’ve gone through and you have support for the oppositionality based on more than one data point, right? One teacher on a Connor’s called them ODD, but the other teacher, the parents and the tutor didn’t. [01:10:00] Then think about that point of data and think about, you know, what I didn’t mention before is, you also have to watch your reporters. Just see if they’re overly positive, overly negative. And sometimes the test doesn’t catch them. The negativity is supposed to be built in, but sometimes the test doesn’t catch them.

    So sometimes with teachers, I either find that they’re flatline. They rate nothing as high or they rate a lot of things as high. And you need to compare that to other teachers, the parents, and other data points. A lot of times when I used to do younger kids, I talked to the teachers. I used to do classroom observation. And I used to get a lot of good information, not just about the kid, about the classroom, the [01:11:00] classroom management, and how the person felt about the kid picked up on the fact that they had made a lot of judgements or had just basically given up.

    In this book that I had just read by Daryl Fujii on neuropsychological testing, he talks about choosing tests that have been validated in the native language and culture. A lot of people use Google scholar to look up the testing history if the person is from another country. Their English is fine, but they want to consider whether the test had been normed in their culture.

    So, when you’re thinking about the post-test environment when you’re giving out feedback, with families that are really concerned [01:12:00] and in their fear stigmas dissection, I personally start off with my bottom line. Sometimes the bottom line is there are issues that have to be addressed. But the bottom line is that there’s nothing in here that is going to severely impact your child’s trajectory if you address these issues because they’re so anxious and upset. And that’s just, again, something that I have experienced is that they’re so hyped up and they come into the session and they start crying before I’ve even started. That’s how much stress is attached to their child being judged in this system that we’re dealing with, in this American system.

    I’ll also try to speak to some strengths because a lot of times a child may not be that great in school. There may be a great artist. And I’ve had a lot of kids in my practice both on the treatment side and the therapy side who are now photographers, artists, musicians, [01:13:00] dancers, and that is what keeps them whole. Emotionally is their strength to get through the fact that there are BC students. But they have strengths. So I also like to talk about their strengths including their family strengths because a lot of times they have cohesive family units that are very invested in their success.

    I also like to think about the awareness and utility of some of the recommendations. This is one of my favorite areas. I think that’s one of the areas that as a profession, I’ve read hundreds of testing reports, maybe thousands, and the recommendations are generally that weaker sections of the reports. And a couple of them [01:14:00] stand out. One is repeating the grade.

    Dr. Sharp: Oh, gosh.

    Dr. McGhee: You’re saying, “Oh gosh,” but it still appears in a lot of people’s reports. So, unless you’re doing something different in that year, consider not putting that in your reports.

    Also key differences in school systems. We all presume sometimes that the people are in good school systems. And then you make a recommendation where there are no services. So, consider where your kid is. I’m in DC where I worked at a charter school that was raided and closed by the police. And I interned and still, we’re friends.

    So I’ve been in the exact opposite ends of the educational spectrum in the [01:15:00] United States. And so there was a vast difference between those two places. And I think that we don’t consider that enough in our reports.

    So finally, Jeremy, I want to kind of sum up and have some parting advice and then talk a little bit about what I’m doing is that we need to look at racial trauma, and we need to understand it developmentally, generationally, and historically. Understand that the things that we talked about here, understanding culture is nuanced. It’s not easy. And it takes a lot of experience to get to where you want to go. We want to see the individual but have some knowledge about their cultural backgrounds.

    Progress is made outside of the comfort zone. And you [01:16:00] have got to put yourself out there to learn. Don’t fear, making a mistake or saying it wrong. Let those things keep you from speaking and acting on behalf of the best interests of the child. Work on skills. Like when I was trying to get of lead better at testing, I worked on every re every kid. I try to learn a new skill. I try to learn a new instrument. Just work on it a little bit at a time.

    I want to just leave the people this advice. Learn to do good, seek justice, correct oppression. And that is from the book of Isaiah in the Bible.

    Finally, what I’m doing is I started this multicultural assessment group on Facebook and we are trying to disseminate information that will help people to do more culturally competent assessments. We are having a [01:17:00] conference. Our first conference will be this spring, but you’ll be hearing more from us. And actually I was inspired to do this by Jeremy and some other people.

    I’m also doing training on race with private practices. And then in 2021, I think I’m going to start offering them online just to individuals that want to attend. But I’m also going to be doing individual consultations with practices who want to do better in terms of multiculturalism, generally, either on the therapy side or the assessment side.

    And finally, I’m going to continue my work in assessment by trying to develop more writings on this subject and in workbooks and some things that I’m going to come out within 2021.

    Dr. Sharp: I love it. We’re ending with a bang here. I feel like the last five minutes is just a call to action in so many ways.

    So I will list all those things [01:18:00] in the show notes, obviously. Just judging from the response to our first episode, I’m guessing people are pretty interested in this content, and I know that you got a big response when you open that multicultural assessment group on Facebook.

    Dr. McGhee: So, I just want to give a quick shout out to Nisha Drummond and Selena Hurd who started the group with me. They’re amazing young psychologists. And so I am just looking forward to big things coming up with them.

    Dr. Sharp: That’s so cool. We’ll have all those links so people can find you and find the group and any of these other resources that you’ve mentioned. I really can’t say enough. Thanks, Linda for coming on again for a round two and sort of taking this to the next level with this discussion.

    I hope it’s not our last and I really wish you well in all these adventures that you’re going on.

    Dr. McGhee: Thank you, Jeremy.

    Dr. Sharp: All right, y’all, thank you so much for [01:19:00] tuning into this episode. I hope that you enjoyed this next-level conversation with Dr. Linda McGhee, all about unconscious bias.

    Like I mentioned in the show notes and in the episode, I think this is a great pairing with the episode on stereotype threat with Dr. Josh Aronson from a couple of months ago, that’ll be linked in the show notes as well, along with any of the resources that Linda mentioned.

    Like I mentioned at the beginning, if you’re an advanced practice owner who would like the accountability of a group and the comradery of peers who are largely in the same place to take your practice to the next level, I would love for you to consider the Advanced Practice Mastermind group. We will be starting on January 7th, which is a Thursday. And it’s a cohort model that will run for 10 meetings over the course of about five months.

    So if you have had some goals for your practice but [01:20:00] haven’t quite been able to bring them to fruition, or if you’re feeling isolated, or if you just want some support as you grow your practice, this could be the right group for you. So, I invite you to check out the details at thetestingpsychologist.com/advanced and you can sign up there for a pre-group call with me to see if it’s a good fit.

    Okay, y’all, have a great Thanksgiving and take care. We’ll talk to you next week.

    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 [01:21:00] 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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  • 164: Financial Wellness w/ Eddie Valls from Wellness Fi

    164: Financial Wellness w/ Eddie Valls from Wellness Fi

    Would you rather read the transcript? Click here.

    Is it just me or is money coming up really strong for others over the last few months? It seems like money and our relationship to it has been a clear theme in a lot of my individual and group consulting meetings. I firmly believe that part of healing our relationship with money is demystifying it in the first place. As a bookkeeper and accountant, Eddie Valls is well-positioned to do just that. In today’s episode, we talk through the ins and outs of practice finance. Here are just a few topics that we cover:

    • What is “proactive” tax planning?
    • The difference between a tax entity and a legal entity
    • Common ways that mental health folks lose money on taxes
    • How to develop a strong tax foundation in your practice

    Cool Things Mentioned

    Featured Resource

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

    The Testing Psychologist podcast is approved for CEU’s!

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

    About Eddie Vals

    A financial and accounting professional with a passion for working with small businesses in helping them to maximize their wealth. Being married to a therapist, it was a matter of time before he would channel his enthusiasm toward helping his wife’s peers in the wellness community.

    Background includes ~ Tax professional at the third-largest accounting firm in world ~ Financial auditor at fifth largest accounting firm ~ Small business and startup bookkeeper in Silicon Valley ~ Market analyst at a tiny firm in East Austin ~ Bachelors in Finance ~ Masters in Accountancy

    Currently resides in Austin where he splits his time between Wellness Fi and family.

    About Dr. Jeremy Sharp

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

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

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

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  • 164 Transcript

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

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

    Okay, y’all, welcome back to the podcast.

    Today we are talking about money. Money is such an important topic and something that’s been coming up a lot in my individual and group coaching sessions here lately and also been coming up a lot in my own practice and personal life over the last few months. So I think it’s a well-timed episode.

    Today, I’m talking with Eddie Valls who is [00:01:00] the founder and a tax advisor at Wellness Fi, an accounting and bookkeeping firm that works specifically with mental health practitioners. You may have heard Eddie on any number of other podcasts but he is here talking with us about a number of things in the tax and accounting world. We cover some basics and then get into some more advanced topics like the difference between a tax entity and a legal entity, common ways that mental health folks lose money on their taxes or deductions that they might commonly miss, and just talking through his philosophy of what he calls proactive tax planning which is a little bit different view than a lot of accountants maybe take. So I hope that you enjoy this episode. I think there are a lot of actionable pieces to take away and things to think about.

    [00:02:00] Before we get to the episode, let me see. We still have a spot or two in the Advanced Practice Group Mastermind which is starting very soon. This is a group coaching experience just for psychologists who’ve really reached beyond that beginner stage. You’ve kind of dialed in the referrals and made some amount of money. Income is fairly stable but you’re really looking to grow higher, streamline and just dial on your processes. The key with a group like this is that you are willing to be part of a group where people hold you accountable and you want to do the work to reach those goals in your practice. So if that sounds interesting to you, I would love to jump on a pre-group call and see if it’d be a good fit. You can get more info and schedule that at thetestingpsychologists.com/advanced.

    All right, let’s get to my conversation with Eddie Valls from Wellness Fi.

    [00:03:00] Hey, Eddie. Welcome to the podcast.

    Eddie: Hey Jeremy, thanks for having me.

    Dr. Sharp: Yes. I’m glad you’re here to talk about one of those things that nobody really wants to talk about, but we absolutely need to talk about. So, I am excited about this conversation.

    Eddie: Likewise. Yeah, money is darn a necessity.

    Dr. Sharp: Right. Yeah. We can’t avoid it. As much as we want to avoid it, that turns out to be really hard. I’ve told the story I think on the podcast before. I grew up in a family where we didn’t talk about money literally ever. And we had only come to find out as an [00:04:00] adult, I think I was probably 30, maybe even older when I was in a conversation with my mom. And she related all these instances of us being pretty close to not being able to afford food or gas. And I was like, “I had no idea.” And then on the flip side, there are times we’re doing quite well.

    So anyway, I’ve talked about how that has flowed into my practice. I had to do a lot of work at the beginning around just confronting money and not avoiding it entirely because that’s kind of how it was.

    Eddie: Yeah, I’ve had a lot of clients come through that they’ve avoided the money piece so much to where it’s causing some issues like too much tax or not being able to afford their lifestyle. So, yeah, we’ve got to face this demon.

    Dr. Sharp: I like the way you put that. Face it and tame it. [00:05:00] But that’s what you’re going to help us with today.

    Eddie: Absolutely.

    Dr. Sharp: So I was thinking maybe we could start, I loved hearing your story off the recording. And I wonder if you could tell that story a bit just how you came to do what you do, being a financial professional specifically for mental health folks.

    Eddie: Yeah, sure. So I’m a typical accountant. If anything, I’ve coined myself as a modern accountant. But I tried to get away from accounting as soon as I graduated. Well, first of all, I chose the study for all the wrong reasons, a stable job, and money. And then when I started that job, that dream job it spiraled into a quarter-life crisis. And so I spent the next 8 years trying to get away from accounting. I really tried hard.

    [00:06:00] And it was working with a life coach to help me identify things that I care about, what motivates me, what gives me enthusiasm. And it was through him that I learned to work directly with people, which is something that you actually don’t do that often as an accountant, like developing a relationship. That piece was a big motivating factor.

    But also working with clients that I actually care about. If you’re in certain industries, I have more issues with it. But there are a select few that really just gets me energized. And the mental health industry is one of those just because there are life coaches working with counselors, they’ve upgraded my life. They’ve helped me identify who I am, what gets me going to relieve me of pain [00:07:00] that has tormented me through the years, and I’m just so better off because of the industry that I’m induced to work with you guys.

    And so it was working with that life coach and helping craft the perfect life or a perfect career for myself that enabled eventually become Wellness Fi, this accounting firm that I’ve designed to fit with your industry and to fit my own ideal work-life.

    Dr. Sharp: Right. I love that. And you said you’re married to a therapist, right?

    Eddie: That’s right. Yeah, she was the one that gave me the in. I got my first few clients through her peers. And that’s where I tested the waters. [00:08:00] Could I do this modern accounting thing with this industry? And it clicked really well. We’re a good fit for each other. My clients but also my wife, we’re a good fit for each other.

    Dr. Sharp: That’s good. It’s good to check that out, right?

    Eddie: Yeah. She’s a marriage and family therapist and LPC. She knows how to work with a dude with ADD, that’s me.

    Dr. Sharp: I’m curious.

    Eddie: She can handle me well.

    Dr. Sharp: It sounds like you both met your matches.

    Eddie: Yeah.

    Dr. Sharp: Well, as somebody who’s also married to a therapist, I know the value and the challenges that can be involved with that. But all in all, great choices I think.

    Eddie: Absolutely. One thing I don’t do for her is accounting. [00:09:00] I do for all my other clients. I just keep a distance. She’s set boundaries.

    Dr. Sharp: Good for her. That’s what we’re all about, boundaries. That’s great. 

    I love that you have this personal connection to the work that you do. I think that that makes a big difference and just adds another layer of meaning, right? It’s not just a job.

    Eddie: Yeah, absolutely. It makes the challenges so much easier to face when you care about the other person.

    Dr. Sharp: Sure. Well, I wonder you use this term, now I’m curious, the term modern accounting, I don’t know if that’s something you have actually fleshed out and defined or branded if that’s the word. But if so, I would love to hear what you even mean by modern accounting. And if not, that’s okay. We can go to something else.

    Eddie: Modern accounting, I think is big [00:10:00] on the relationship piece. You’re a classic accountant who is either focused on just doing your monthly bookkeeping, organizing numbers, and then sending your report. You’re a tax accountant/tax preparer, once a year, you talk to them, send them information, they organize it, send it back to you and to the IRS.

    And so there’s no real relationship except for this transactional relationship and the classic accountant. And those are the beef I had in my career. It was all transactional. I never really met the clients or talked to them.

    And so this modern accountant is taking a look at the numbers on a regular basis and able to assist the client with advising. That’s really what the relationship is. It is based on some level of advising. A lot of ours is just [00:11:00] tax-driven, tax fundamental advising. We also just serve as a resource for a lot of financial nuts and bolts, just little things that come up, we’re here to help and talk through it, educate. And so, what makes it interesting is just having conversations like this, educating others, and maybe even talking shop with my clients. It’s super valuable. It saves them a lot of time. And I think it makes it that much more enjoyable for each party.

    Dr. Sharp: Yeah. I think that’s true. At least in my experience, I think I’ve had a little bit of both approaches, sort of the hands-off once-a-year kind of thing, and then working with someone who is a little more proactive or engaged. And it definitely makes a difference. Because if we’re talking about just running with these [00:12:00] avoidance themes, the once-a-year transactional approach doesn’t work super well. I mean, that’s almost enabling our avoidance of something that we need to be really familiar with.

    Eddie: Yeah, absolutely. And there’s this whole proactive approach that we do that you just can’t handle at tax time. You have to do it throughout the year. You’ve got to plan for it and take advantage of it during the year. And it results in dollars saved and reduced taxes.

    Dr. Sharp: Yeah. That’s important. So let’s get into that. When you say you, I think you described yourself that way, when we were chatting before the podcast. What does that even mean when you say proactive approach or proactive tax planning? How does that operationalize our contact throughout the year, the work that you do?

    Eddie: Yeah, sure. So [00:13:00] it comes in with this whole avoidance piece. If you’re not looking at your numbers during the year, you’re getting paid, money’s coming in and after you pay your expenses, you have money left over, that’s good and all. Hopefully, it’s paying for your personal expenses.

    And you get through the year and at tax time, at some point, you’re going to be faced with a large tax bill. That might not be your first year, maybe your second year or third. Oftentimes, you could have done something about that big tax bill. And it’s that proactive piece. You can’t really do anything about that tax bill when you’re filing your taxes, but during the year you have plenty of opportunities to take advantage of the tax code. Take advantage of certain things that reduce your taxes so that you can [00:14:00] whittle away that number before you get to filing your tax return.

    And so that’s just on the tax side. If you’re regularly looking at your numbers, you can make adjustments. You can make managerial decisions for your practice to account for certain things. If your profits are too low, if you’ve recognized your profitability, you can make the decision to either reduce your expenses or increase your revenue somehow. But just getting familiar on a regular basis allows you to make choices during the year.

    Dr. Sharp: Yeah. How often would you say it’s recommended to look at the “numbers” and then what does that even really mean when you say, look at the numbers?

    Eddie: Yeah, look at the numbers. Well, ideally you’re sitting [00:15:00] down once a month and just comparing it to the years or assuming the months prior. What those numbers are is just a categorized list. It typically takes the form of a profit and loss statement or income statement. They’re the same thing. It’s a list of your revenue at the top and then followed by each of the expense categories and then your profit at the bottom. 

    If you look at those and compare them to prior months, you can see these trends. Maybe your profits are growing or maybe your profits are shrinking. And then you can look at those different categories and say, okay, it looks like for some reason, my energy bill is going up or my advertising is going up. So, you can just start creating these opinions [00:16:00] and see trends or maybe some bad habits forming and take action on it before it becomes the norm, I guess you could say.

    Dr. Sharp: Yeah, that totally makes sense to me. I’ve had people in the past talk through profit and loss and everything and what that entails. And I think it’s overwhelming for a lot of us to know what to look at and how to make sense of all those numbers and figures, and even how to navigate QuickBooks. I mean, I’m pretty tech-savvy and I use QuickBooks and I do this every month, but I’m still like, “This doesn’t seem super intuitive.” So maybe there’s like a software component to it with how to create graphs and comparisons and so forth. I think that just reinforces the importance of having someone who helps [00:17:00] us do that.

    Eddie: Yeah, and there are just definitely do-it-yourself options like QuickBooks or using a spreadsheet. There’s a learning curve. All you’ve been studying is psychology.

    Dr. Sharp: Yeah, we did not have a QuickBooks class.

    Eddie: Right. Even for us accountants, there’s a learning curve to learning QuickBooks. But yeah there is a gap and I’ve seen plenty of therapists, psychologists that have learned how to use QuickBooks and learned how to use a spreadsheet to track their stuff. And it gets the job done. Absolutely.

    Dr. Sharp: Yeah. You look like you maybe were going to say something.

    Eddie: Yeah. But I guess at a certain point what I’ve [00:18:00] seen is a lot of the clients that do that, it gets the job done, but they leave a lot on the table. There’s the whole tax code piece. And there’s a lot to be taken advantage of there. So missing deductions is often one that comes up and certain entity arrangements. These are all things that your accountant can steer you toward that will result in significant tax savings.

    Dr. Sharp: Definitely. Maybe we could get into that. I’m guessing people listening are like, let’s talk about how to save money or make more money. So when you say deductions, I think we all have a good idea of deductions. We can deduct things for our taxes. But what are some of the major ones that you find mental health folks leaving on the table like you said?

    Eddie: The major one is the home [00:19:00] office. So home office can result in maybe $1000 worth of tax savings if not more depending on where you live. 

    Dr. Sharp: So, this is an example that’s very relevant for me. And I think it is probably going to be relevant for a lot of folks this year, specifically as we all transitioned to doing Telehealth from home. So I have two questions there that we could maybe dig into. One, I’ve been told by accountants that it’s maybe risky to try to write off a home office if you have a physical business office that you could go to. So that’s one statement/question I’d love to hear your thoughts on. And then maybe the bigger issue that’s more relevant right now is, how do we take advantage of a home office this year as many [00:20:00] of us have transitioned? And what does that even look like when you say, writing off a home office? So a lot of stuff wrapped up in those two questions.

    Eddie: Yeah. So let’s first talk about that advice. And whenever you talk to accountants, you’re going to probably hear varying things. We have our own spectrum of a conservative approach to aggressiveness. And one thing with the accountants is they may push that on you. You take a more client-driven approach in terms of our aggressiveness and conservatism with using the tax code.

    Another thing is just how they interpret the tax code. I don’t know about that account you talked to but they may be missing an exception for you guys. [00:21:00] There’s this thing called the administrative exception when it comes to the home office deduction. And so clearly right now, you guys have a lot of hours being put in at the home office. They forced that in many states to work from home. And so clearly, you can take the home office, but in prior years you were just as equally able to take home office deduction despite the fact that you guys have an office say downtown or in your neighborhood. All you have to do is just do administrative work from home and do it in an office area of the home. And that’s the qualification. That’s the bare minimum you have to do.

    A lot of clients think they can’t take it. And so they leave $1000 or so [00:22:00] up for grabs.

    Dr. Sharp: That’s unfortunate.

    Eddie: It’s unfortunate. Yeah. And this home office this year, it’s got to be just like a designated area of the house. It can’t be a master bedroom. It can’t be that area between your couch and the TV. It can be a portion of the living room or maybe a portion of the kitchen perhaps. But it’s typically a room or part of the room that is your home office. And you get to take a lot of deduction from that.

    Dr. Sharp: I see. So in your mind, it’s totally legit to take the home office deduction even if you do have a physical office that you could go to?

    Eddie: Yeah, without a doubt.

    Dr. Sharp: So how does that work? And we might be getting in the weeds a little bit. Hopefully, there are folks who are interested in this. I know I am. So, [00:23:00] how do you determine how to take that deduction? I mean, is it just like a blanket based on the square footage of your home or do you have to spend a certain amount of time in that office versus your physical office or your business office or anything like that?

    Eddie: Yeah, sure. So there’s no time requirement for it. That area of the room does. That room has to be primarily used for business.

    Dr. Sharp: Yeah. Sorry to interrupt you. Can I throw a curveball example at you? And this is just blatantly self-serving. Again, hopefully, other people are in this situation, but with the transition home over the past 7 or 8 months, this is what’s come up in our house. So, we have a large master bedroom with a, what would I call it? a nook or an area that is like a sitting area that we put a desk, two chairs, a lamp, and a [00:24:00] computer and all of those things. So that’s what we’ve got going on. Where does that fall here this whole time?

    Eddie: Same as me. I’ve been kicked out of the office. My wife uses that. And now I am sectioned off into this little area of the master. Jeremy, welcome to my master bedroom.

    Dr. Sharp: Great to be here.

    Eddie: I will use square footage.  So, I’ll have to take measurements of this little area and compare that to the total size of our house. So you take this deduction at tax time whenever you’re filing your taxes. There’s a home office area and you’re going to need the square footage of your home office, square footage of your house, and then all your expenses for your house.

    Dr. Sharp: That’s right. And when you say expenses, you [00:25:00] mean like the mortgage, the gas, the utilities, the internet?

    Eddie: Yeah. Everything but the mortgage principal. If you’re renting, you’re good too. You can include that. You can probably come off better as renters. Even if you have pest control or if you have a cleaning service that comes through, but not your pool service. That doesn’t even indirectly impact your home office.

    Dr. Sharp: Fair enough. Yep. In most of our practices that lose getting, let me see. Maybe two more nuanced questions with that. So again, in our family, both of us are self-employed or are working from home. Can we both take that deduction I suppose or does it just happen once [00:26:00] like on our joint return?

    Eddie: Yeah, you guys can both take it. As long as you guys have separate businesses, then sure you guys can each take one and it would be based on your home office and hers would be based on her home office. If you guys are sharing the same home office, I think it would be best to split that between you guys, the square footage.

    Dr. Sharp: Got you. Well, that anticipated my second question. What if we have two home offices or what if you only have one that you’re sharing? Okay. That’s great. So went down a little bit of a detour there, but I think hopefully relevant for a lot of folks right now. What are some other deductions that people are not catching?

    Eddie: The cost of therapy. And this goes beyond supervision which is required [00:27:00] therapy session but the cost of therapy…

    Dr. Sharp: Can you give me the rationale for that? I mean, you’re hitting on all the hot topics. So this is another one that there’s a lot of debate. I’ve heard a lot on both sides. Like we can, we can’t. So hit me with your rationale for writing off therapy in our business?

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

    Eddie: A business expense has to be ordinary and necessary. So if we can accomplish those two things, then we’re good to write it off. What’s nice about working with a niche accounting firm is that we have insight into your career. And one of the big things with your industry, I’m not sure how it is for Testing Psychologists, but to burnout for many therapists. They’re listening to pretty rough stories, traumas on a daily basis and that can really wear on someone. So the therapist is almost necessary for the longevity of your business.

    [00:29:00] Similar thinking, my mom, she’s a dance professor. She has to dance with her students, choreography, and whatnot. And so maintaining that old body of hers is important. So the cost of yoga is really important to maintain her back and those joints.

    Dr. Sharp: Yeah, that opens Pandora’s box of self-care in general then. So I’m curious, is it just therapy that we can write off or could we write off massage or yoga? Where do you draw the line? Gym membership? I’m curious about this?

    Eddie: We got to go back to the ordinary and necessary for a dance professor. A dancer or [00:30:00] performer just working on their body, that kind of stuff is important. It’s ordinary and necessary for her to keep going. Massages for you guys might be ordinary but it’s not necessary.

    Dr. Sharp: Fair enough.

    Eddie: Yeah, if you’re buying these things and you’re a group practice of some sort, you want to give these things you need to maybe work with your accountant to determine whether or not it’s a gift or a reimbursable business expense.

    Dr. Sharp: Sure. Great. What else are we leaving on the table that you can think of?

    Eddie: Health insurance. If you’re self-employed, that’s a big one. Your business can pay for your health insurance. And again, this is actually something [00:31:00] that would be deducted whenever you put together your tax return. There’s a little spot for that to drop it in there. And that can tip them a few hundred dollars in tax savings if not maybe a thousand.

    Dr. Sharp: Oh, sure. Yeah, health insurance can be expensive.

    Eddie: So bam, I saved you guys $2000.

    Dr. Sharp: We’re already up to $2000. This is great. So you mentioned, and maybe we’ll circle back to deductions if that comes up later in the conversation or if you think of other things, I am curious, you mentioned the entity of our practices. Could you say more about what you mean by that and then, of course, flow into how that relates to our taxes?

    Eddie: Yeah, sure. One of the biggest tax savings is the S-corp. And I’ll get into exactly what that is and how to get that in [00:32:00] just a moment. Legal entities and tax entities are something that is often getting confused with. And so just taking a moment to talk about that, I think would be really helpful.

    So each state has these legal entities. Texas, we’ve got a lot of therapists that are PLLCs- Professional Limited Liability Companies. And I think most of the United States is like that. California, you guys form P-Corps, professional corporations. And oftentimes it’s the licensing boards that say what corporation or company you can be, what kind of legal entity you can be. And so these just provide you a little bit of legal protection. Not much, it’s really just from creditors and people that you owe money to. It protects your personal money from those people snatching that up if you owe them.

    If[00:33:00] you’re committing fraud with your clients, misleading them, if they sue you, that legal entity won’t protect you. So don’t look at those legal entities as something that is necessary for your practice from the get-go to feel protected and more like that insurance that, what is it?

    Dr. Sharp: The liability or malpractice.

    Eddie: Yeah, liability malpractice insurance, those things. That’s going to provide you a lot more protection. And just being honest helps too. So that’s a brief overview of what an illegal entity is. And then there are the tax entities which are… you guys automatically become one when you start a business. Once you put that sign above your door saying that you’re in business, you are a sole proprietor [00:34:00] and whatever you are as a legal entity, doesn’t change that.

    The other tax entity is the S-corp and there is supposed to be a business reason for becoming an S-corp. But the real reason is just simply reducing your taxes. That’s the only reason that I see of becoming an S-Corp. And again, this is just a tax treatment. It tells the IRS to treat your income differently. It simply allows you to get taxed at a smaller rate. Most of my clients are like a PLLC legal entity as well as [00:35:00] being an S-corp. So you can be these two different entities simultaneously. So they don’t really interact with each other.

    Dr. Sharp: So where does the general LLC fit into the tax entity? Because I know that that is on like in the W9, I might fill out, it has the options like an LLC or you are a sole proprietor or you an S-Corp, but then there’s another option which is what I check, which is LLC filing as an S-Corp. Can you talk through that a little bit?

    Eddie: Yeah. That makes sense. So it’s going back to being simultaneously two things. If you become an LLC, that won’t change anything tax-wise. That doesn’t set off a chain of events. [00:36:00] If anything, the IRS might send you a new tax ID but there’s no tax impact until you tell the IRS that you would like to be treated as an S-corp. So the reason it’s on the W9 is just so the virus doesn’t assume that you are an LLC sole proprietor. It’s just the caveat. You’re an LLC as an S-corp.

    Dr. Sharp: So tell me and the listeners, how an S-corp actually saves on taxes compared to a sole proprietor or maybe a single-member LLC?

    Eddie: It all begins with employment taxes. This is an often-overlooked tax. It’s around 14%. [00:37:00] You’ve been paying this ever since you were an employee. You and your employer would have split it when you were working for someone, then paying 7.5% and you paying 7.5%, around those numbers. Whenever you become your own boss, you get to pay both sides of that. And yeah, it often gets overlooked and you end up owing a chunk of change all resulting in this employer tax.

    And so, what the S-corp allows you to do is treat your income differently, pretty much as a royalty which gets taxed differently. It doesn’t get hit with the employment taxes. Now, this doesn’t apply to all of your income, but it is safe to say around 60% of your [00:38:00] income doesn’t have to pay this additional 40% tax. So if you’re making, I don’t know, $100,000 in profits, then I think you’d be able to save when the math is done around $10,000 of taxes or something. So it’s significant. And that’s on an annual basis, the kind of tax savings that being an S-corp can be. It comes with a price though but it’s worth it typically.

    Dr. Sharp: Okay. I want to talk about the process of becoming an S-corp and when we might consider that. I’ve heard certain income quotas before we would consider it. I wonder if we could walk through an example just to make this super concrete for people. I mean, you said if we’re, let’s just keep it at  $100,000 to keep it easy. If you have $100,000 in [00:39:00] profit and you are not an S-corp, you’re just a sole proprietor. Then you’re going to pay that 14% self-employment plus whatever income tax bracket. Is that right?

    Eddie: Correct.

    Dr. Sharp: So that’s going to end up being whatever it is. I mean, let’s just say $14,000 plus your income tax which might be $25,000 or $30,000 or whatever it might be?

    Eddie: Right.

    Dr. Sharp: So then… I keep interrupting you. Go ahead.

    Eddie: No, you’re fine. So one thing that needs to happen is you have to be a legal entity first before you can go down the S-corp path. You can only become an S-corp as early as the year you became a legal entity. So if you’re making over $100,000 in revenue, I would definitely go become an LLC PLLC or whatever, a legal entity of some sort because I might be leaving money on the table.

    [00:40:00] And so it’s as simple as really filing a form with the IRS to elect that you would like to be treated as an S-corp. You want to run through the numbers first with an accountant to see if it’s even worth becoming an S-corp because there’s a cost involved? You really should have an accountant for it because accounting can get a little complicated.

    You also have to do an S-Corp tax return. So you’re going to want the accountant to do that. You need to be on the payroll. The big thing is that you actually have to run a salary, you got to pay yourself via salary with a payroll provider. These costs add up. Typically, it’s depending on where your accountant is. It’s going to be around $1500 a year.[00:41:00] So you want to make sure that the tax savings exceeds the financial cost as well as the effort of being in an S-corp.

    Dr. Sharp: Right. Can I ask a dumb question?

    Eddie: Yeah.

    Dr. Sharp: So if you’re saving that 7.5% right off the bat, why wouldn’t someone just do that as soon as they start?

    Eddie: I think it really comes down to the cost. You’re signing up for a lot at the beginning of your practice. If you don’t already have enough costs, you’re going to be adding a minimum of $1500 more if you don’t already have an accountant, and then you’re sending yourself up for payroll which can be a slight hassle to deal with. [00:42:00] And so you’re setting yourself up for a lot and it may not be worth it. 

    Dr. Sharp: So, if that 7.5% you save is not more, it’s if that doesn’t cover the expenses then…

    Eddie: Yeah. And it’s more like 14% to correct you. Yeah. So, if your profits are $100,0000 for the year, you’re going to be saving around $14,000.

    If you add in the cost of, I don’t know, $1,500, then it’s clearly worth it. Right? You’re coming out $12,500 ahead. So clear that’s worth it, but if you’re making around $30,000, the tax savings is going to be so much less and at that [00:43:00] rate, you’re probably not paying that much taxes anyways.

    What gets people is between just starting out at like $30,000 and that second-year maybe where they’re making $60,000- $80,000 in profits, so after expenses, that’s when the taxes really reveal themselves and become a pain.

    Dr. Sharp: Yes, that makes sense. I know. I’ve heard that story so many times. Getting hit with big tax bills.

    Eddie: Yeah. And at around $40,000 to $60,000 is when you want to start thinking about whether or not to become an S-Corp. That’s when you want to start running the numbers, maybe with an accountant. But the rule of thumb is around 10% tax savings by becoming an [00:44:00] S-Corp.

    So if you’re making just $50,000, then you might save around $5000 in taxes. And if you’re going to pay 1500 to maybe $3,000 in taxes, you could very well come out $1000 to $3000 ahead after taking into account costs. And so all that hassle may not be worth going down the S-corp route but I don’t know, $3,000 I’d take that.

    Dr. Sharp: Absolutely. Sure. It’s all-important. So again, another maybe dumb question. I feel like I know just enough about this stuff to be completely dangerous. I’ve heard from both accountants and practice owners that something changed over the last year or maybe two with the tax code or something where being an S-Corp was not as [00:45:00] advantageous. Is that totally off base? I’m not sure where that came from. I never really looked into it.

    Eddie: No, it’s still clearly advantageous. We’re on the up and up with the tax code and changes to it. If anything, one of the big changes that happened in the past four years was the standard deductions, which is not really a business issue. It kind of made buying a home and donating to charity sometimes major things for certain households, it made those two things negligible. As far as tax savings go, it doesn’t really play. [00:46:00] It is not a tax saving anymore.

    Dr. Sharp: I see. Fair enough. Like I said, just enough to be dangerous.

    Eddie: Yeah.

    Dr. Sharp: Great. Is there anything else to say about becoming an S-Corp or considerations with that side of things?

    Eddie: Yeah, I think the biggest thing is if you’re not already a legal entity and you’re making money, like just rough numbers upwards of like $70,000 plus in revenue, it might be a good time to just go ahead and become an LLC. That way, you will have the ability to become an S-corp say this year or next year, whatever year it makes sense to become one. [00:47:00] You don’t have to elect to become an S-Corp ASAP. It’s the one thing you can do retroactively as long as you’re an LLC or PLLC, whatever the preferred legal entity is in your state. That has to be there in order for you to be an S-corp.

    And just to give you an example, a new client just started with me maybe two months ago. She is making like $140,000 profit. She made that much that the past two years and she’s not an S-Corp though. So she’s been paying a pretty good amount of taxes. And so there’s a chance that we will be able to retroactively turn her into an S-Corp all the way [00:48:00] back to 2018 because that is when she became an LLC in her state. And that could result in a windfall of more than $30,000.

    Dr. Sharp: That would be great. Good luck to her. Well, and I’m thinking of… I was just talking with a practice owner, literally yesterday who’s been in practice for maybe 10 years and is not an S-corp and they are doing quite well. And it’s surprising and mindblowing, but it’s like, where is this information? Why didn’t anybody tell you? Why hasn’t your accountant told you this? She has an accountant. I’m like, “What’s going on here?”

    Eddie: She might have a good accountant who is great to work with, but he’s on that spectrum of playing it conservative and they just have a [00:49:00] flawed interpretation of the tax code. This is the way that we do it. My prior employers did it. It’s been blessed with our Ex-IRS auditor employer.

    Dr. Sharp: Oh, wow! There we go. Great. People have questions often about what is an accountant versus a bookkeeper? Can that be the same person? Should it be different people? Can you talk about that relationship at all?

    Eddie: Sure. The profession is accounting. It’s the umbrella term for all of these different roles. You have the bookkeeper, and that is someone who is organizing your expenses and your revenue, the [00:50:00] ins and outs of money. Typically, they’re organizing it around like QuickBooks or some other bookkeeping software. We use Wave primarily. And so they’ll typically turn it into…

    And when they’re done organizing it, they’ll spit out some sort of financial statement and share it with a client. And that clients can use those financial statements as information to make decisions for their business.

    Another organizer is the tax preparer. And they take information directly from you, from your household or your business, and organize it into some tax software.

    Then you have, let’s say, tax advisors. And so that’s a role that we have baked into our monthly bookkeeping. A tax advisor has knowledge of the tax code. [00:51:00] And they become familiar with your current financials and they can help you to make tax decisions, come up with tax strategies to have you pay as little as legally possible towards taxes towards the IRS, towards your State.

    And then beyond that, you might hear about the CFO, advising services. That’s another cool emerging service where they’re partners, coaches perhaps, and their goal is to help you increase the bottom line, grow your business be it financially, or increase the number of therapists psychologists you have on your team. Whatever your goals are financially typically business-wise, [00:52:00] a CFO can help with that.

    Dr. Sharp: Yeah, that’s fascinating. I know I had an external CFO on the podcast, I don’t know, six months or a year ago. It’s fascinating to see the different delineations of this whole area. And I like that you highlighted all of those because I think again, for a lot of us with this avoidance thing, it’s just like numbers. And to know that there are different people to help them with different aspects, whether its goal setting or like a vision for your practice finances versus saving on taxes, these are all important jobs. It just depends on what we need.

    Eddie: Yeah, absolutely.

    Dr. Sharp: Well, let me see, I wanted to maybe touch a little bit, and I know this is not exactly your area of expertise, but just retirement planning and [00:53:00] things that we need to consider or can consider especially for those of us who are self-employed, which technically I think is all of us in private practice. What does retirement planning look like? What should we be thinking about with that?

    Dr. Sharp: Yeah. I believe they say the best time to start saving for retirement was like 20 years ago. The second best is now. And so I think that’s one of the big things there is just to start throwing something towards a retirement fund. It might be as little as $20 a month or something like that. Certainly, you can afford that. And that’s just like the domino to just get things going because fortunately we probably need to save a lot more than we typically can afford [00:54:00] for retirement. And so we just need to work towards increasing that number.

    Your savings rate is the biggest factor in how big your retirement fund can become. Something that I look towards is always trying to increase my savings rate. And it started out by just going little by little. The easiest place to start with a retirement fund is an IRA account. There are two types, traditional, and there’s Roth. Either is fine. If you don’t want to overthink it, just go with Roth. Either or flip a coin, something. They both have their benefits. Traditional allows you to take a tax break now, a Roth [00:55:00] gives you the tax break when you retire. Either is fine.

    And that is good for anyone that can contribute up to $500 because it maxes out at $6,000. If you can contribute more than that, then you’re looking at something like a 401k. And so those are the two options. There’s absolutely more than that, but just to keep it simple, you can’t lose with those two options.

    Dr. Sharp: That’s great. Yeah, we’ll keep it simple. And even just emphasizing for folks that you are responsible for saving for retirement once you’re self-employed. That’s not a thing that just happens. Some people overlook it. I’ve definitely worked with practices in coaching who don’t know that. So simply knowing.

    Eddie: Yeah. It’s also [00:56:00] a source of reducing your taxes. If you want to get into the tax reduction game, a great place to start is to throw money towards retirement.

    Dr. Sharp: There you go. I like that. Yeah, it’s like we’re ending up where we started with deductions for taxes. What else? I know you’ve worked with a lot of practice. You’ve talked with a lot of practice owners. What else is out there that I maybe haven’t asked about in terms of major areas, topics, things that we get tripped up on, or could use some help within the financial world?

    Eddie: This is even outside of accounting, but just personal finance, just like literacy around that, knowledge of that is a big area of improvement. Most Americans need a lot of help in that area. And you [00:57:00] can either start with reading or maybe a financial planner- someone who can hold your hand, tell you what to do. But I think just getting the knowledge yourself is a great place to start. How to manage your personal money. That also carries over to your business. How to budget or how to approach purchases?

    One of my favorite books is Your money or your life. I can’t try to think of her name, but it’s your emotional attachment to money. That’s just a book that causes you to look at that and how you approach things. And what that means for your happiness. And that could [00:58:00] create a lot of a fundamental change for you and how you handle your personal and business finances. The money we spend we’ve got to earn that money back.

    And so, if you’re spending a lot of money, that’s just so many more hours got to work. So just being real conscientious about that, not beating yourself up about your spending or shaming yourself which is something I’ve experienced, but just being more mindful and what it’s doing for you because we’ve worked so hard for that dollar. It’s just tough when you’re struggling for it.

    Dr. Sharp: Yeah, absolutely. I mean, I think a lot of us probably agree that mindfulness is [00:59:00] an attractive option to deal with almost anything. So just if nothing else, if we just highlight doing some reading and some self-study to help you be more mindful of your spending and where that is at, that’s going to be helpful.

    Eddie: Yeah, absolutely. I’ve got two more book recommendations for certain people. If you have debt issues, credit card issues, Dave Ramsey’s Total Money Makeover, that’s kind of the go-to that can give you a systematic plan for tackling your finances. There’s often a financial numbers approach to tackling your finances. And then there’s a behavioral approach and he’s got a behavioral approach that gains it. [01:00:00] It just seems to be a lot more successful than the ideal scenario.

    Dr. Sharp: Yeah,  I’ll second that, that was one of the first money books I got however many years ago. I know a lot of families that have done that system and had a lot of success. We did it for a long time and have a lot of success. So, I totally agree. That’s a good one.

    Eddie: Yeah. And then there’s this kind of… on the opposite end of mindfulness to money or a good behavioral approach is this guy, I will teach you how to be rich. I don’t have his name, but he can be kind of polarizing/attitude, but he’s got some really good suggestions on just handling your money, creating some systems so you don’t have to spend much time handling your money. Take a look at the [01:01:00] summary and see if it works for you.

    Dr. Sharp: Yeah. I can totally second that one too. I’ve read that one as well. I take a lot from that. You’re right. He does have a vibe for sure. I don’t know how to describe it exactly. He’s very direct and a little bit sarcastic and flips it around, but super smart. I mean, the principles I think are right there on point. 

    Eddie: Yeah. I’d like to see him and the lady who wrote Your money or your life in the same room, it’d be interesting.

    Dr. Sharp: Yeah. This is great. And I know you put together a bit of a landing page for listeners as well. Can you talk about what that’s all about?

    Eddie: Yeah. I’m inviting you over to have a conversation with us. If you’re interested in accounting services, we offer a 15-20-minute consultation free to get to know [01:02:00] each other. Oftentimes we sprinkle in a little bit of free advice and so it’s worth the discussion alone for that. But yeah, we’re offering to do bookkeeping catch-up for the year. If you don’t have any bookkeeping in place we’d be happy to do it at half the cost from January through October. So that’s quite a bit of saving, maybe around $600 or so. That’ll get you caught up to today and we can continue your bookkeeping going forward.

    Dr. Sharp: That’s awesome. Yeah. I’ll definitely have a link to that and all the resources and books that we’ve mentioned in the show notes so that people can check those out. And I’m guessing people can get a hold of you through that landing page. Are there any other ways [01:03:00] that you prefer to be contacted if people want to just reach out and learn more about your services and Wellness Fi so forth?

    Eddie: Yeah, that’s absolutely a good place to start. Otherwise, if you want to reach out to me directly look me up on LinkedIn. Eddie Valls.

    Dr. Sharp: Okay. Awesome. Well, thank you. Thank you for the time and the knowledge, and hopefully demystifying the numbers a little bit and helping people at least get comfortable with the idea of working with their numbers.

    Eddie: Yeah, I appreciate the opportunity.

    Dr. Sharp: Okay. Y’all thank you so much for tuning into this episode. I hope that you learned a little bit about finances and some things that you might be doing differently with your taxes and your practice. I definitely did. That home office deduction was a big one for me. I’m going to have to go back to my accountant and really think about that, trying to sort through that. So I hope that you took away some [01:04:00] items that will be helpful.

    Like I said at the beginning, if you are an advanced practice owner and you want some support and accountability in reaching those goals that you may have set but not reached in your practice, I would love to talk with you about that. We have one cohort of the Advanced Practice Mastermind going now, and it is just amazing. These group members are crushing it and keeping each other on track and helping each other reach their goals. So, starting in another section, we have a spot or two left. You can schedule a pre-group call at thetestingpsychologists.com/advanced.

    All right, take care. Hope you’re all doing well. Enjoy your Thanksgiving. And I will be back with you on Monday. Bye, bye.

    [01:05:00] The information contained in this podcast and on The Testing Psychologist website are intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric, or medical advice, diagnosis, or treatment.

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

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  • 163: Using Artificial Intelligence in Suicide Risk Assessment w/ Dr. April Foreman and Dr. Tony Wood

    163: Using Artificial Intelligence in Suicide Risk Assessment w/ Dr. April Foreman and Dr. Tony Wood

    Would you rather read the transcript? Click here.

    Are y’all ready for a barn burner of an episode? I hope so. Dr. April Foreman and Dr. Tony Wood are here talking all about their pioneering work in suicidology, particularly how they’re using artificial intelligence and algorithms to gather information from social media and predict suicide risk. The two of them have an infectious energy and a clear passion for this incredibly important topic, and both of these qualities are on full display during this episode. Here are just a few things that we discuss:

    • Artificial intelligence in this context of suicide research
    • The true impact of risk factors in suicide assessment
    • Ethics of AI research
    • Cultural differences in language that predicts
    • The possibility of uploading our consciousness at some point in the future

    Cool Things Mentioned

    Featured Resource

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

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

    About Dr. April Foreman

    April C. Foreman, Ph.D., is a Licensed Psychologist serving Veterans as the Deputy Director of the Veterans Crisis Line’s Innovations Hub. She is an Executive Committee member for the Board of the American Association of Suicidology, and has served VA as the 2017 Acting Director of Technology and Innovation for the Office of Suicide Prevention. She is a member of the team that launched OurDataHelps.org, a recognized innovation in data donation for ground breaking suicide research.

    She is passionate about helping people with severe (sometimes lethal) emotional pain, and in particular advocates for people with Borderline Personality Disorder, which has one of the highest mortality rates of all mental illnesses. She is known for her work at the intersection of technology, social media, and mental health, with nationally recognized implementations of innovations in the use of technology and mood tracking. She is the 2015 recipient of the Roger J. Tierney Award for her work as a founder and moderator of the first sponsored regular mental health chat on Twitter, the weekly Suicide Prevention Social Media chat (#SPSM, sponsored by the American Association of Suicidology, AAS). Her dream is to use her unique skills and vision to build a mental health system effectively and elegantly designed to serve the people who need it.

    About Dr. Tony Wood 

    Anthony D. Wood, COO Qntfy, is Founder of #SPSM (Suicide Prevention and Social Media spsmchat.com) the largest and most engaged social media community dedicated to connecting Suicidologists, Crisis Preventionists, Researchers, Social Workers, Psychologists, Psychiatrists, MDs, People with Lived Experience of suicide, Data Scientists, Law Enforcement Officers, Teachers, and Students with the best and latest research related to Suicide and Crisis Prevention worldwide. His work with the social media aspects of Suicide Prevention as a founder of the Social Media Team at the American Association of Suicidology’s Annual Conference earned him the 2015 Roger J Tierney award for Innovation from AAS. His research on the intersection of social media and mental health has been published in AAS, ACM CHI, JSM and CLpsych. As a result of this work, he has become a sought after resource for mental health professionals, private companies and organizations interested in the intersection of new media, mobile data and Mental Health.

    About Dr. Jeremy Sharp

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

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

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  • 163 Transcript

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

    This episode is brought to you by PAR. The TSCC and TSCYC screening forms allow you to quickly screen children for symptoms of trauma. Both forms are now available through PARiConnect-PAR’s online assessment platform. You can learn more at parinc.com.

    All right y’all, welcome back to another episode. Hey, today’s episode is pretty incredible. I know that I say that a lot, but I think they’re all incredible, and this one is particularly incredible. Today I’m talking with Dr. April Foreman and Dr. Tony Wood all about their use of artificial intelligence in suicide risk assessment. [00:01:00] So if you find yourself thinking, I have no idea what that even means, that’s totally okay. That’s a big part of what we cover in the episode.

    So we talk about what artificial intelligence is in this context. We talk about how we as clinicians have basically been getting suicide risk assessment wrong for all these years. We talk about the ethics of using artificial intelligence in this research, touch on some cultural differences in language that predict suicide risk. And at the end, we get into a little bonus discussion on the possibility of uploading our consciousness to some sort of AI system in the future.

    So this is action-packed. I have a ton of resources in the show notes. And I think you’ll see very quickly that April and Tony are so knowledgeable and so passionate and excited about this work that they’re doing. It is truly inspirational. So [00:02:00] stick around and check this one out.

    Let me tell you a little bit more about them just so you have an idea of the guests today.

    April is a licensed psychologist. She serves Veterans as the deputy director of the Veteran’s Crisis Lines Innovations Hub. She’s an Executive Committee member for the board of the American Association of Suicidology. She served VA as the 2017 Acting Director of Technology and Innovation for the Office of Suicide Prevention. She’s a member of the team that launched OurDataHelps.org, which is a recognized innovation in data donation for groundbreaking suicide research. We talk about that a lot today.

    She works with people with severe emotional pain, advocates for folks with Borderline Personality Disorder. She is known for her work at the intersection of technology, social media, and mental health with nationally recognized implementations of innovations in [00:03:00] the use of technology and mood tracking. She’s also a recipient of the Roger J. Tierney Award for her work as a founder and moderator of the first sponsored regular mental health chat on Twitter, the weekly Suicide Prevention Social Media chat. Got a link to that in the show notes.

    So April’s dream is to use her unique skills and vision to build a mental health system effectively and elegantly designed to serve the people who need it.

    Now, Tony Wood is the COO of Qntfy. He’s also so a founder of the Suicide Prevention and Social Media Chat on Twitter, which was the largest and most engaged social media community dedicated to connecting a variety of professionals including those with the lived experience of suicide, with the best and latest research related to suicide and crisis prevention. He has worked with the social media aspects of suicide prevention as a founder of the social media team at the American Association of Suicidology annual conference [00:04:00] earned him 2015, Roger J Tierney award for innovation.

    His research intersection of social media and mental health has been published in a number of professional journals around the world. And as a result of this work, he has become a sought-after resource for mental health professionals, private companies, and organizations interested in the intersection of new media, mobile data, and mental health.

    So like I said, as you can tell from their bios, these folks they’ve just been doing it. Doing the work for many years and they’re doing it so well. And again, the energy that they bring to this conversation is completely infectious. So tune in and enjoy my conversation with Dr. April Foreman and Dr. Tony Wood.

    [00:05:00] April,Tony. Welcome.

    Dr. Tony: Hey Jeremy, how are you?

    Dr. April: Thanks for having us.

    Dr. Sharp: Yes. Thanks for coming on. I was thinking this morning, I don’t know that I have been… I think I’m more nervous for this podcast interview than I have been for any other in a long time. Not because I see your face. Nothing because of y’all, aside from the fact that you’re just like…

    Dr. April: Who knows what can happen today?

    Dr. Sharp: This is true. It is Friday the 13th. We’re recording on Friday the 13th. Things are a little wild. But yeah, y’all are clearly experts and rock stars in this area. I am just so excited. I’ve been thinking about this for a long time and what this interview might be like. And I’m afraid I’m not going to ask the right questions or [00:06:00] get the information that I am excited about. There’s just so much. I feel like I need to put that out there.

    Dr. April: I feel like we’ll make it fun. And if we aren’t fun enough. Folks at home who are listening, if you wanted to hear more, if we didn’t get to something really crazy or cool, maybe we’ll ask for a follow-up episode and we’re down for it.

    Dr. Sharp: I love it. All right. You heard it here.

    Let’s just dive in. I know from the introduction that people are probably already just like, what are we even talking about here when we say AI, research, social media, and assessing suicidality through those means? Let’s just start with a big-picture overview. What do all those words even mean? And how are y’all doing this in your lives?

    Dr. April: Our mutual friend, Dr. Rebecca Resnick, often has broken it down so well talking about how [00:07:00] fancy people like her husband, Dr. Phil Resnick, who are linguists can take our language, and also there are wonderful data scientists and then other people that we worked with who can take a lot of digital data points and some of that may be language and they can turn those into very large data sets of a lot of people. And using big data processes and data science processes, they can predict people’s suicide attempts in many ways months before it happens.

    And there have actually already been several successful attempts at this. So we know that we can assess suicide risk and we can predict attempts and deaths months ahead of time now in some cases using these very complicated big math procedures. And so [00:08:00] it is not just theoretically possible. It is possible for people to then leave digital or language samples, and for us to know something about their suicide risk and their mental health. And did I say that okay, Tony?

    Dr. Tony: It’s not magic. It’s statistics.

    Dr. Sharp: I love how simple you make it sound. I think for a lot of people though, this is like the next level, the year 3000 kind of stuff as far as what we’re doing on a day-to-day basis, right?

    Dr. April: Conan O’Brien moment, right? I didn’t sing the songs. It’s probably copyrighted. So here’s the deal. In suicidology, we have not made a lot of progress until very recently in data science, suicidology didn’t really do this, about understanding suicide and predicting it. And so when you Jeremy or I went to graduate school, they told us you can’t predict suicide. You can assess ambient risks. And it’s then Craig Brian has Fluid Vulnerability Theory guided that a person’s suicide risk [00:09:00] is really ebbing and flowing. And whatever you say in the office is pretty much good for that 30 minutes in the office.

    And so we’ve all developed a system of care and a system of understanding the science of psychology around some fundamental assumptions about suicidality that this is really challenging. Of course, this feels really like the year 3000, but Amazon already knew what kind of laundry hamper I wanted to buy this morning. They were amazed by the $29.99 prime delivery.

    And so we know that there are some people who have a real financial interest in predicting low base rate human behavior and making money off of it. And the issue is then when we apply it to suicide, we have a conundrum where people in our field often make one of two really dumb mistakes. And I’ll tell you what they are so you don’t make them because if you make it at a party, I’ll secretly judge you. And you don’t like that.

    You’ll do one of two things, you’ll [00:10:00] think, this is Harry Potter magic. It’ll be like a Sims Game. Everybody’s suicidal. Have a little blue light happen above their head and we’ll just go find them and save them. Not true. Or this is total hogwash. It’s like how people felt about email in the early 1990s when we all just got it. And they’ll be like, this is just a trend. Nobody’s going to be using this. I’m just not going to bother with it.

    Dr. Tony: We call it the sorry grandfather response.

    Dr. April: Sorry, grandpa. And don’t do either of those things. The issue is, this is happening but there are some real realities about it. What’s likely to happen that I think is important for people to understand. But when you make one of those sorts of polarized reactions, I don’t have a lot of respect for you. And as a psychologist, we should be better than that.

    Dr. Sharp: Right. So, the happy medium there is maybe just curious, right?

    Dr. April: Yes, I like it.The middle path. So curiosity, ask some questions, become educated, like healthy Copers, right?

    Dr. Sharp: Yeah, for sure.

    Dr. Tony: The bandwagon. Just [00:11:00] pay attention.

    Dr. Sharp: There you go. We’re good at that. We should be anyway? 

    Dr. April: Right. These are skills to help us cope with AI.

    Dr. Sharp: Right. Well, and I think putting it in a real-world context probably helps folks. And the Amazon context is a really good example. Like we’ve been, we, not me, other people have been using online data and human behavior to predict future behavior for a long time. It happens every time Amazon suggests something for you or Facebook suggests something for you. It’s just calling all of the data that’s out there and then making predictions from it. And like you said, Tony, it’s just math. It’s just complicated math that none of us can probably do, but people do it and it’s out there.

    Dr. Tony: Yes.

    Dr. Sharp: I love that.

    Dr. April: And we can probably… I think I really liked your idea of discussing some real-world examples and what it’s going to look like. So we are now at the part where we [00:12:00] can tell people what it’s going to look like, how you might use it in your clinic, what some of the limitations are, what it will mean and not mean, I think we’re at that part, right Tony?

    Dr. Tony: I think so. I mean, I think the things that we will say here will likely be laughed at by our future colleagues because we’re in that sort of 19th-century telephone area where people thought telephones were going to be really exciting and all these things were going to happen and they got flying cars and all this stuff. We got a lot of those things but it wasn’t really shaped the way that it looked to the people in the 19th century. So that’s what we’re talking about now. 

    How is this really going to be integrated into the system of care? How are people going to ethically determine the people’s given state, especially in emergency cases? But the beauty of this technology is that we get way ahead of crises. A very large number of people come to [00:13:00] this pre-crime idea where you’re looking forward to somebody’s future.

    Dr. April: Yeah, like minority report but for suicide.

    Dr. Tony: That’s what they all think of, but it’s not the worst analogy ever, but it has some issues in that really you’re not trying to arrest a for sure outcome. You’re trying to influence future behavior. So very similar to the regular work that psychologists do. You’re not policing someone, you’re really trying to help them help themselves make a decision that gives them a better outcome.

    Dr. April: Yeah, I think that’s really good. And so what we’re also talking about is, many of us, like me, have a home blood pressure cuff, but that doesn’t make me a cardiologist. I still need to go to a doctor even though I can take my blood pressure. A blood pressure problem can still mean a lot of things. And so you’re still going to need clinicians. You’re just going to need clinicians who are, I think a little bit more sophisticated about how to use tools.

    So when we talk about some of these algorithms for [00:14:00] predicting suicidality, the thing that people are incredulous about is that there are several published by well-respected suicidologist and data scientists methods for predicting suicide risk, six months, one month, one week, one day before they happen or suicide attempts and deaths, like not even risk. So predicting that. And that’s pretty amazing.

    What people don’t probably understand, what I think brings us down to earth is that the best algorithms for these things and some of the work we’ve done have led to one of the better algorithms. It’s still going to have a false positive rate. You’re going to have three false positives for everyone that you predict accurately. Now, that’s way better than the human error in our clinics which is really high. Not because clinicians are bad, although we’re bad when it comes to suicide and we’re pretty untrained like ground truth before technology, [00:15:00] 90% of clinicians couldn’t pass a basic competency exam on assessing suicide risk and doing an evidence-based intervention. 90% of licensed clinicians going to do that. That’s just us with licenses.

    But what we know is that with assistance from these algorithms, you could get much better. And for the folks who are false positive, even if it’s all you’re false positive for a suicide attempt in six months or in one week, that doesn’t mean it will happen. But those odds of 1 out of 4 times are much better than what we have now. And folks that we’re finding with false positives are still in a tremendous amount of pain and not doing well. So, if I go to my doctor’s office and I have high blood pressure could mean I’m going to have a heart attack. It might mean a lot of other things, but it means something’s probably not good and my doctor should follow up. And that’s what this stuff is capable of.

    Dr. Tony: And the blood pressure cuff [00:16:00] lowers your risk of a major cardiac event. That’s really what it does ultimately. It’s way upstream of that. But that’s precisely what we’re trying to do with these algorithms. Give the clinicians the tools that they need to make a better decision faster so that the patient and the individual and the client and their families and their friends can all participate in having them never see another crisis event.

    Dr. Sharp: Of course. So I think we’re laying some really nice groundwork for this. And hopefully, folks are with us through this discussion so far. So the idea that we are or y’all, I keep saying we, I do not want to include myself in this amazing work, but y’all are…

    Dr. April: You’re here now.

    Dr. Sharp: Thank you, April. You’re so welcoming. But y’all are doing this work where you can somehow pull that out from social media posts and other online sources maybe, but primarily social media and [00:17:00] run it through this complex math and predictive software algorithms kind of thing to figure out someone’s risk for suicide at a certain period of time in the future. Is that a fair summary?

    Dr. April: So we want to add one piece to this, which is ethics, right? Is that what we want to add?

    Dr. Tony: First, I want to add about the data source…

    Dr. April: Okay, and then we’ll talk about ethics.

    Dr. Tony: And the reason why I want to focus on data sources a little bit is that people become very focused on this pretty fast. So they say, well, what data are you bringing in because that’s the basis of all measures, like how you do it, how’s that applied? And where does that information come from?

    Social media data is of course a primary source because it’s a very rich source of language. However, there are a bunch more data that I would call exhaust from your cell phone, but we call it digital life data. So everything that you do that’s digitally mediated can be input into an algorithm and taken into [00:18:00] consideration by these machine learning models because you don’t have to have a human being that’s deterministically building a set of rules. You’re using statistical tools to build those models dynamically as you roll along for an individual person down to the individual actual Sally Jones.

    Dr. Sharp: Tony, can you give me examples? When you say exhaust from your cell phone, what does that mean exactly?

    Dr. Tony: All the things you do on your cell phone. Everything that everybody does on their cell phone. What games do you play? What time do you get up? How many calls a day do you make? When do you send emails? When do you not send emails? When do you turn your phone on? When do you have your phone off?

    Dr. April: When are you shopping? How much are you shopping for?

    Dr. Tony: Yeah. All five of those W’s

    Dr. Sharp: Of course.

    Dr. April: Yeah. And that’s really interesting. […]and he’s like a brilliant data scientist, he just got inducted to the [00:19:00] European academy of science. You have to be a really good drinker when you go out with peers to keep up for the night. And so I just have to really check my memory on these conversations, but he’s like, I only need to know two things about you to know who you are. He’s like, if I know on Saturday night you’re on the street where there happens to be a synagogue, I almost certainly know that you’re Jewish and I also know a few things about you. And if I know one more thing I can tell you, probably what region of the country you live in, like your name or whatever. So, he was like, I really only need very limited actual data points to know a lot about people. People are generating a lot of data points and there were people who were incredibly clever about knowing which data points say what.

    And so there are some that it’s like very reductionist. And then when it comes to predicting suicidality, [00:20:00] what happens when we talk about this, is it someone says, okay, so which three data points tell us someone’s going to kill themselves? What is it that really causes it? And what we say is, well, the algorithms are more complicated than these three risk factors that you’ve heard on the public service announcement model. And so we really don’t know that. We might be able to figure that out someday, but we don’t know that yet.

    Dr. Tony: This enters me onto a soapbox, which is, please let go of risk factors as soon as possible.

    Dr. April: It is not a thing.

    Dr. Tony: It is not true.

    Dr. April: It was a PR thing.

    Dr. Tony: Yeah, mostly.

    Dr. April: There was no agreed-upon set of suicide risk factors that every literature agrees on. And there is no one thing that’s suicidology back. Like this was a thing that, and I’m on the actual lines where we communicate about this, but it’s just really a PR thing.

    Dr. Tony: And if you want the paper, I believe it’s Franklin et al 2016, maybe. Joe Franklin, now he’s at the University of Florida. He came out of Harvard. He was at Harvard. [00:21:00] So point of the story is that he did a multi-study review and none of the risk factors have a predictive factor more than chance.

    Dr. April: So what happens when psychologists go to do these assessments clinically, they tell you to pay attention to risk factors. They give different psychologists different risk factor templates. All of these templates, including the Columbia, which is one of our better ones, shout out to Kelly Posner, who is the Angelica Houston of suicidology, gorgeous, wonderful thing. But it’s even our best ones. Like the Columbia is like as good as, or worse, slightly worse than chance.

    Dr. Tony: As a quiet moment in time and it’s the best thing that a lot of people don’t understand.

    Dr. April: she seemed to let go… So what happens is I’ll talk to a psychologist or licensed clinicians, and they’ll be like, oh, they told me this. So I knew they weren’t going to get. And I’m like, these clinical narratives about suicide, first of all, if you’ve got that kind of like they said this, I knew that they weren’t [00:22:00] evidence-based, you should not do those ever anyway. And I mean, if you’re going to do a crystal ball and join a sideshow, because really what we’re talking about is the fact that we just didn’t ever understand suicide well enough to behave like that. we just haven’t.

    But we’ve held licensed providers very accountable without having science to back it up. And this is the idea that now let’s give us some science to back it up. So we know that these algorithms have been developed that assess risk, which is different than predicting an attempt, right? Assessing risk versus predicting an attempt. Your audience knows that. What we know is that the algorithms that assess risk are probably operating 40% better than well-trained clinicians, some of the best suicidologists, as a matter of fact.

    We’ve participated in some data science efforts to get data to take language data from suicide watch on Reddit and have clinicians assign risk. And then see if you can get the [00:23:00] algorithm to find the risky posts. And what we know is that compared to an average clinician, these algorithms outperform them. And may even outperform excellent clinicians.

    So right now in psychology, we’re practically reading the vapors, we’re tasting people’s urine to tell what kind of metal. Well, I mean, people did that, right? Even a hundred years ago. But we’re operating at this level, but data science will allow us to do some better things with things like you need to know the false positive rate. You need to know how to ethically do this research, things like that.

    Dr. Sharp: Of course.

    Dr. Tony: Stethoscope is much better than an ear horn.

    Dr. Sharp: Say that again.

    Dr. Tony: A stethoscope is much better than an ear horn. And that’s really what this is. It’s another tool. It’s not magic.

    Dr. Sharp: Right. It’s an evolution in a way.

    Dr. Tony: It’s a direct descendant of [00:24:00] evidence-based measures.

    Dr. Sharp: Right. I feel like I need to ask because I’m guessing that people are listening and asking, well then what do we do? I mean, if the risk factors don’t work, if we’re bad at assessing suicidality but we don’t have access to these algorithms, what do we do?

    Dr. April: I’ll give you three things to do.

    Dr. Tony: And one of my favorites, just be kind. Try that. Try not to be afraid of your suicidal patients because you can’t predict their suicidal behavior any more than they can.

    Dr. April: And maybe less. He’s not wrong. So number one, we’ve all got to operate in the land of liability. If you don’t have the training, get it. And get and renew training about assessing and intervening with people who are suicidal every licensure cycle that you have. The training i`s pretty easy to get. There’s very expensive training. Get CAMS or DVT [00:25:00] training which by the way is excellent. It was shown to reduce suicidal thoughts and behaviors. So it has evidence-based. Harder therapy to do, have. It works great. I’ve seen it work with folks who have really profound chronic risk and watching them recover. But whatever training you can get that’s evidence-based, get it.

    Have policies in your clinic or in your practice. Then follow your training and follow your policies. Do them consistently. And don’t be a jerk to your patients. And I’m a person who works with high-risk folks. And I would tell you that there’s a certain amount of bravery and continuing to practice knowing that there are tools being developed and you don’t have them yet.

    And then I would say, instead of being afraid of what’s coming or maybe saying it or treating it like it’s going to be magic, just stay really educated because these are the tools. AI will be like electricity was in the industry a hundred years ago. You already have AI if you’re using like your Google or your Outlook, there’s already [00:26:00] AI features that are making things like your email work better.

    You’re going to increasingly see these in the ways you manage much of your life or if you bought something on Amazon. When it goes wrong, like when Facebook always keeps recommending that I rent plus size clothing, like get a box, wear the clothes and then give them back, and not my right size. And I’m not really a clothing renter but Facebook really thinks I am. So AI will get some things right and some things wrong. Just keep yourself a little educated. Don’t be resistant. And don’t overly buy-in. I think those are really good coping skills.

    Dr. Tony: The security industry was an early adopter and then second-most to the finance industry. And so if you make purchases with electronic money, then AI monitors all of those for fraud. It monitors all of those patterns and determines what human behaviors are appropriate and which ones are not, which ones should be flagged for human review, and which ones are just definitely wrong and [00:27:00] they need to be shut down.

    Dr. April: The financial industry has a lot more money than we have and a lot more liability than we have. And they’re amazing at what they do. And if you have fraud settings like I do, they have a wonderful human-AI hybrid so that when I have my fraud settings, China got my data and federal employees in China got my data, and so now I really monitor things. And it’s caught several things. I’ve never lost a dollar then knock on wood, but sometimes it’s flagged some of my purchasing behavior very occasionally, but a few times a year. And then you call in and you have a system for doing that.

    So just think about that in our clinical practice. What we’re going to be doing is using the tools that are developed in a human-AI hybrid where you’re going to get information and then you’re still going to use your clinical judgment and develop processes to keep people even safer and make sure to take care of.

    Dr. Sharp: I love this.

    Dr. Tony: Multichannel, always on. [00:28:00]

    Dr. Sharp: Yeah. Well, I think a lot of people are… this is an unfamiliar concept. It’s a little bit scary. And we hear about big data and tech companies taking over the world and that kind of stuff. There’s just a negative association. That’s true.

    Dr. April: I just talked about that today. I was like, I don’t know if it’s going to be good, but anyway, keep calm.

    Dr. Sharp: I think for a lot of us, there’s some cognitive dissonance to resolve with this too. Okay, well now, how do we use a tool like this that has a negative association with something that is very important in our field?

    Dr. April: I would say, first of all, just advocate for better science. I think that our field should start to say, you’re holding me responsible without the science to support me. And that’s not okay. We don’t fund very much of the science, but we hold therapists very accountable. So I think we should be joining with our friends who are advocating for leading-edge science saying this needs to be funded and we need good evidence-based.

    We were talking about [00:29:00] ethically. So the ways that we’ve been able to do these projects because I think people are very worried about your data being used without your permission or whatever. But we actually are part of a small group of people that came up with the concept of data donation for this kind of thing. The reason we’ve been able to do these projects was without very many resources actually. It was coming up with a way for people to donate their social media and digital data to then give to scientists who pass IRB and get all the appropriate approvals. And we’ve now done this with two data sets.

    And so we’ve now got a model to very quickly get data to data scientists to work on, but it’s data that’s donated. It’s data that’s ethical. Because one of the big challenges with this, the big barrier with this science, is getting it to the hands of clinicians so they can be using this and we can do what we all care about, which is helping people recover and live good lives.

    Dr. Tony: And advertisers haven’t and creditors haven’t.

    Dr. April: But we want to use [00:30:00] it and not always ethically. Donation is one way that you can do that ethically. And we can talk about some really crazy stuff if your viewers wanna hear some crazy stuff. We know some crazy scenarios that we think are interesting and ethical. But this data can be donated ethically. It can be released when people come to apply to use it who previously obtained IRB approval. We’ll make them read ethics articles and agree to secure handling of the data and a bunch of other things.

    So if we can get datasets into data scientists’ hands, and if we can get things like let’s just fund suicide research at the level of the other top 10 healthcare concerns in the country, just the level and we’re not asking for extra, just at that level of impact, there will be plenty of money to do this research if we get people’s data. So can we get people’s data? And then can we fund that research so that clinicians have the tools and the science to support what we are already holding you accountable for?

    Dr. Sharp: Such a good point. Yeah. The idea that we’re [00:31:00] already being held accountable for those is crucial, but yet it’s not backed by science. I just want to highlight that. I don’t know that a lot of us are probably thinking about that fact.

    So let’s operationalize this a little bit. What does this actually look like? I mean, how are you getting this data? I think ethics is a part of that, of course. How are you gathering all of this and what are you actually doing with it to create some usable information? I’m curious in the nuts and bolts and I think other people might be as well.

    Dr. April: So if you want to go see an example online, dear listener, please go to ourdatahelps.org and veterans can go to warriorsconnect.org. There are various ways. Tony is the CEO at Qntify who has just [00:32:00] generously donated hosting of this data. And it’s the same real way that you collect data say for coupons where you say, oh, to connect to your Facebook account and you get a 10% off coupon. There are applications that have been used to make your user experience pretty seamless. And there’s an informed consent that we wrote with people with lived experience of suicide attempt survivors and people who had survived a suicide death together.

    So they helped put it in plain language and they proved it. So we really worked collaboratively on this. And then you can donate your data and it works retroactively to donate your data in the past and you control what you donate. If you want your Facebook data, your Twitter, your Fitbit, and then you can donate going forward and [..] I don’t even know if I’m using language but you can donate going forward and you can stop at any time. And that’s one way that you can donate data.

    You can also [00:33:00] donate the data if you are the account holder for someone who’s died by suicide. So we can then get the data of someone who’s died by suicide. And we can look at that and compare that to folks who had attempts and survived or folks that have never been suicidal.

    Dr. Tony: And then for veterans and military, it’s  warriorsconnect.ourdatahelps.org. And that’s a project for the George W. Bush Institute and their Center for Veterans Health.

    Dr. April: So it’s like real people, fancy people.

    Dr. Sharp: Right. Real fancy people. I have to ask. Is there a selection bias at work here if people are donating their data?

    Dr. April: For sure. Right now. But…

    Dr. Tony: The beauty of this is you’re looking for a sample of conditions that are either self-stated or diagnosed. And once [00:34:00] you have a significant sample of self or diagnosed conditions, then you can go out and validate that against the general population using data that’s openly available. So you can do a much better job than you could do when a traditional research setting without the ability to do those comparisons.

    There’s just so much data flowing out around there. Suicide data is really interesting. And so, trying to predict suicidal behavior is a funny problem because it’s not really a big data problem. Not really. It’s a small data problem. So, we’re talking about very precise models versus ones that are much more general models like determining somebody’s age or somebody’s gender or somebody’s race or their ethnicity. Those are big data problems. This is a very small data problem because the number of people who attempt suicide is relatively small. It’s big, but it’s relatively small. And the people who go on to die by suicide which we want to actually predict is very small in the United States.

    The ratio is [00:35:00] something like 1.2 million-plus attempts annually versus 6,000 deaths. So your true positives get very small very fast. So that’s how you deal with that is that you get as good of a sample as you can from people who have experienced suicidal behavior and of course your decedent data.

    Dr. April: And they can get timestamps. They can say, this is when that happened and here’s all my data. So then you know. When you think about a number of clinical trials or research on this, could it be a better sample? Yeah, but there are so few data sets and this research is so hard to do. That’s a step forward.

    Dr. Tony: And for psychologists, these numbers are huge.

    Dr. April: Oh yeah. It’s not 200 people. We’ve got like 6000 or 8000.

    Dr. Tony: It’s not 75 people on our campus, we’re talking about 3000, 6000, 9000 individuals. It breaks down when we get into individual conditions. We have a really great [00:36:00] data set in a partnership with the University of Maryland on a long-term schizophrenia study. So we have a great model for schizophrenia. We have a great model for anxiety disorder. We have great stuff for major depressive disorder. When you combine these, you end up with a whole picture of a person that is much more accurate than an individual clinician could do in the space of time that they have to provide care. So this is the way that you could… like I said, you could use an ear horn to figure out people’s hearts but it’s much easier to use a stethoscope.

    Dr. April: Or like strap them to something, right? And I think what’s really interesting is that these can really lead to the development of monitoring tools. Craig Brian, one of the best suicidologists in the world who uses this kind of analysis says, suicide risk is very fluid. So maybe what you’re doing is you’re having a high-risk patient who says, I’m going to put this app on my phone, it’s going to [00:37:00] monitor my digital activity and it’s going to alert me and other people if there’s a change much like you might wear a harness. If you have a heart condition, they might have you wear a harness to be measuring what’s happening with your heart even when you’re not in the doctor’s office because most of the things related to your fluid suicide risk don’t happen in doctor’s offices. And in doctor’s offices and psychologist offices as most of your listeners know, we do a lot to make that environment very standardized, very stabilizing.

    So we do a lot of things in our office that might mitigate risk or reduce expression of risk. And so we might have clients that look pretty together in our office. The minute they go out in a different environment are not going to be doing as well. So these tools could possibly be collecting digital signals and alerting people like a pacemaker, like my father-in-law’s pacemaker, right? Like those things could happen.

    Dr. Sharp: Right. I’m glad you brought this up. I was going to ask those questions, but here we are. So just to put a fine point on it, are [00:38:00] we at a place where there is an app that our patients could put on their phones that would do this, yet?

    Dr. April: Those things are regulated by the FDA. CSo could that happen technologically? Absolutely. But I would say, in our field, what we would really need to do is have better funding to do this at a bigger scale so you can have FDA trials because if you’re monitoring a lethal health condition with an application, not only does the algorithm need to work, but a bunch of other aspects of the technology design needs to be pretty reliable and work, and then they need to be extensively reviewed for safety. That can totally be done. I mean, we’re developing a vaccine for COVID in like a few months, right? It feels like forever when it’s only been a few months. And I hope someone listens to this podcast in10 years and goes, “Oh yeah, there was a pandemic.” This can be done with enough resources, but it really does take the same level of attention and development that other things in healthcare take.

    [00:39:00] Dr. Sharp: Of course.

    Dr. Tony: Regulations on medical devices is one track that this burgeoning industry of AI and behavioral health has headed down. There’s a whole collection of folks that are head down the medical device route, which is FDA. And then there’s a whole bunch of other people that are headed down the other direction, which is more open tech stuff. They could download the app store. We’re on the brick. My little company Qntify, we’re on the bridge of between. We’re doing pilot projects with healthcare systems that are closed pilots that are available to select patient populations. And so soon enough, we think that this technology will be widely available, whether it’s us or somebody else.

    Dr. April: And when you want to road test this thing safely. And I have done things like using moods 2, 4, 7 and using it in a clinic with high-risk patients. Go look that up I think I did an article about this called just text me like 10 years ago in the journal of Collaborative Patient Care. But the issue is, if you’re going to use things like this [00:40:00] or applications that work similarly, there are just some real fundamental things, like these never take the place of good clinical care. You still need a standard safety plan. You can use them as an adjunct, but not in place. A good monitoring, good safety planning, responsive clinical care access to emergency and crisis services, et cetera.

    Dr. Sharp: Sure. That’s incredible. I know technologically, it sounds like we could do it. This call for funding is a theme throughout our conversation so far. So I want to highlight that.

    Dr. April: If you fund things, at like $100,000 a year or what? No, it’s a few million a year. I’m sorry. If you fund suicide research at the same rate that you fund smallpox research, PS: No one’s had smallpox died off in the US in like forever. If you do that, guess what you won’t get? You won’t get advances in science. I’m not saying that funding solves every problem, but it’s like literally the one thing [00:41:00] we haven’t tried, which is funding science at the scale of impact.

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

    Well, if there’s anybody out there who happens to be able to fund the science at the scale of impact, please.

    Dr. Tony: All congressmen and senators, please, consider it carefully.

    Dr. April: I’m a federal employee, so I make no statement that would be in violation of the health act.

    Dr. Sharp: Of course, I will say it for you. Well, there’s definitely potential. I mean, the science is incredible. You talked about models for anxiety and depression. One thing I wanted to ask you all about just from reviewing some of the research in this area is, it looks like there is maybe some work into cultural differences in language as well. Particularly around depression, there was an article that I paid attention to. So I wonder, can either of you speak to that in [00:43:00] any detail and what that research is about?

    Dr. April: That’s science for identifying depression anxiety even across populations, because that’s so common, right? That’s like 1 out of every3 or 4 people in the population. And you can actually do models that are pretty specific to a lot of cultural, gender, geographic issues. Tony, what do you say?

    Dr. Tony: Oh, absolutely. As far as I know, our group at Qntfy first makes these algorithms actually and tests them, but we have race and ethnicity classifiers stepped on in our neural nets for anxiety disorder and major depressive disorder, especially, but we also work on the schizophrenia model. So we sure take those racial and ethnic and language differences into account by stacking those algorithms together and hooking them together in a  very technical way. But that’s ultimately what you’re doing.

    Dr. April: And let’s talk about ethics again, because algorithms can be sexist and algorithms can be racist. And they are. So, [00:44:00] the great news is that some of the people that we’ve collaborated with are on those tech industry panels looking at racism and bias sexism abuse in AI. So I think Meg Mitchell is on one of those. I think she’s at Google right now. If you want to know Meg Mitchell, you can see her, if you go on Netflix, she’s on the episode, Bill Nye, the science guy, episode 3, showing how you can use AI to identify pictures. And we have friends like Meg who are familiar with this research and have been around as it has been developed.

    And they’re really thinking about bias racism, being cis-gendered, sexism, things like that in our predictive algorithms, and making sure that when we’re designing things, we aren’t designing things that are replicating our own oppressive biases. And there are people in the AI industry interested in that. And I think folks like us like to talk to those people.

    Dr. Tony: Meg is a pioneer on the [00:45:00] computer vision specifically, which as you can imagine as a hot item for augmented reality and for self-driving cars and for airplanes, for all other things. But ultimately, she has invented technology that allows a set of algorithms to look at a picture and identify the elements in it and tell you things about it. So it can show you a dog in autumn, and it can tell you that it is a dog and it’s a Labrador. And then that’s a pine tree. And this is sometime in the fall.

    Dr. April: And recognizing a dog on the internet and differentiating from a cat or a bear is actually harder than you think. So there are people who are thinking about those ethical things. And so I think if you were one of those like sorry cranky grandpa listeners out there, you’d be like, it’s got all these problems. And it absolutely does just like all technology does, but we as humans are worse and you got no minder to make sure I’m not a racist or that I am not a sexist when I’m with my patients. You just hope I’m a decent person, right? [00:46:00] So I think that you’ve got to look at those things.

    Dr. Tony: Absolutely. It’s a balance. Once again, you wouldn’t use a blood pressure cuff to diagnose hypertension. So don’t. You wouldn’t use these tools to ultimately diagnose a disease. You might use them to help you diagnose one, but it wouldn’t do it for you. It doesn’t do it for you in that specific way. It gives you a great score on what’s probable. I’ll tell you that. And it’s very accurate, but you wouldn’t want to use it to diagnose diseases at this point because we’re just not at that level, but maybe someday.

    Dr. Sharp: Sure. I think that’s the important thing to keep in mind. Like it’s easy like you’re saying to take that cranky grandpa approach and naysay, and this is not perfect and whatever, but it’s getting better and it seems like in a lot of cases, better than what we can do just as clinicians on our own.

    Dr. April: If your primary care doctor [00:47:00] tests your diabetes risk by testing your urine, you need to get a better doctor. And if they’re grumpy because there is bias in the lab test and the lab tests have error so that’s what they choose to do instead, you would go, “Oh, you should not have a license.” Similarly, we should be looking at that. It is not, is the AI perfect? It is, how is this better or more accurate? What direction are we moving towards in terms of accuracy and help? And ultimately, it should be a contribution to people getting well. And it does this move us forward. Don’t get cranky unless you think it’s harming people and not moving this forward.

    Dr. Sharp: Yeah, that makes sense. Well, I think that with a lot of this stuff, it’s just fear. Fear is driving a lot of these reactions

    Dr. April: We’re experts in modulating irrational fears to help be good copers and problem solvers. So I expect more from us, Jeremy.

    Dr. Sharp: Fair enough. [00:48:00] Okay. No, this is good. I think it’s true. I have to ask the question that I’m sure y’all have been asked before. It comes up in every discussion about AI in any sort of medical context, but is this going to take our jobs?

    Dr. Tony: No.

    Dr. April: Maybe

    Dr. Sharp: Let’s dig into that. Okay.

    Dr. Tony: The problem is so big that it’s hard for us to imagine in the current system. So there are so many people that do not receive any care in the world right now that the capacity issue as we perceive it today is not the same. Now, could these psychologist jobs be very different in 25 years? Sure. But it’s not going to take their jobs away. Not at all. There’s just too much.

    The beauty of logarithms and the beauty of this [00:49:00] orders of magnitude growth is possible to make big changes in short periods of time. And that’s what most people are afraid of, but it’s not going to take away psychologists. The reality is in the short to medium term. You need more of it, not less.

    Now, we need more of a specific kind. We need people who understand the technology to a level they can contribute. That’s a thing that’s very likely to happen. The requirement of these future jobs, everybody is now expected to be able to use a word processor. There’s no exception. There’s no pretty much no job that I can think of. Even the most average electrician’s assistant has to be able to tick boxes on their tablet to keep track of their work. So there’s that kind of change, it is going to happen. Definitely, the EMR, EHR systems are going to continue to be more aware and the clinicians will be expected to navigate that, [00:50:00] but it’s not like displacement. Not like we’re thinking in the short term.

    Dr. April: I see it differently, but that’s okay, right?

    Dr. Tony: Maybe. It depends on what you’re seeing.

    Dr April: We have a good time. If you’re listening to call us up, we’ll go out, right? So here’s the deal. If you want to keep doing your therapy practice like they did, and walk-in talk therapy on a couch because you want to see 6 clients a day and do handwritten notes when someone lays on the couch and talks to you and you do the talking therapy from the Victorian era, yes, this is going to replace that. And if you think that that is what’s best, you need to double down. I don’t think that. I think that was a very good advancement for the 1800s, but it is the 2000 kids.

    So I don’t go to my cobblers to make shoes. There are some [00:51:00] artisanal cobblers still making shoes. I’ll make them for my individual feet, but I wear shoes that were probably manufactured by people in a probably third-world country and probably not really proud of that. And then they were shipped over here and I might’ve bought them from Zappos. Like how we all get shoes that are cheaper, better, and faster in some ways, and other ways it’s bad for the environment and human rights, let’s not get into that just for a minute. Let’s just talk about changes. We get to choose differently. We don’t go to cobblers, but people are still making shoes and we’re still wearing them.

    The issue quite simply is that helping people get well, we’re not doing it scale. So when we looked at the number of people who were at high risk for suicidal, our best estimates, then I applied slim models for it. What we know is evidence-based like what someone should get when they walk into a clinic, for us to just manage as we have been doing, the suicidal patient…. So imagine it’s the Sims and that blue light comes over the head of everyone and is suicidal. So we don’t even have to find them and assess them. You [00:52:00] just see them. We would have to take every year a licensed mental health provider from clinical social worker to a psychiatrist and everyone in between who’s independently licensed. And they would need to have 50-60 people on their caseload. And we would have to employ them full-time working at the top of their license, doing nothing else but suicide care.

    So if you needed substance abuse care, sorry. If you were autistic, too bad. And only that and doing 50-60 folks at high risk. And so with our current clinical models, the standard recommended caseload is two people. So we aren’t set up to do what we have been doing at scale. We do have effective treatments. They do work, I practice those. They do not work at scale. And so the way we have been doing things was great for the 1800s if you only needed to treat six people, but it’s not going to work for 8-9 million people or the 800,000 people in the world that are going to die this year.

    So we’re going to have to do something else, which means your job is [00:53:00] going to be different and it may change. And if you were later in your career, maybe… I remember a guy who told me we were watching Marshall Linehan present at a conference and there was a guy telling me that he would retire before social media would affect him in his job. And I remember tweeting about him and mentioning his name. Like people being assholes. Pardon my French bleep this out. If this is a G-rated podcast. But being like that, like that my desire to not change is more important than the need of the people who are sick.

    It is just so off mission. And so beyond me. And that level of resistance is so not acceptable to me in our profession. So, I’m just going to be like that antagonist. I’m not going to end up on your bad list, hopefully. Hopefully, you’ll think that’s like a force for good. But I think our jobs are going to change. I think that they’re going to have to, and if you are really married to the way you do your job and not [00:54:00] the outcome of your job, you may be very unhappy.

    Dr. Tony: And it’s likely to become more obvious what your outcomes are. I will say that. I will add that, I think that everyone would agree that the golden age of psychoanalysis in the United States was the 1960s, And then it really didn’t go anywhere. That all kind of went away for various reasons, mostly related to insurance, but then some other things related to the outcomes.

    It’s a boutique therapy. It works for some people. It’s nothing against psychoanalysis. However, that age isn’t coming back. It does not appear any time in the future. And this technology is not going to help bring that back. So we’re in the same boat here that outcomes we’re going to be more and more focused on outcomes and better outcomes faster than we ever were in the past. The brilliant part of that is that right now you’re held accountable for outcomes [00:55:00] and you don’t really have the tools to produce them. That will change.

    Dr. Sharp: There’s so much to sort through here. So much to think about, but the point of we’re moving forward and not backward. Technology, I use that term very broadly, but that’s where we’re going. People attest specific to assessment, right? Neuropsychology testing and personality assessments and so forth. That’s what we’re doing. I mean, the tests now are being developed and normed and standardized on digital means of administration. And that’s it. We’re headed in that direction.

    Dr. April: And I don’t mean to speak at your audience like they are the cranky grandpa. There are a whole lot of people carrying the waters for innovation and progress. I think there are a whole lot of people out there who recognize the need and just needed somebody to put some words on the frustration of being held accountable for something that no one’s invested in the technology to support. And I want you to hear that level [00:56:00] of frustration and anxiety, that’s pretty reasonable. And the way forward to solving the problem.

    Dr. Sharp: Right. I think you were giving people a lot to think about here, which is good.

    Dr. April: If you take me drinking, I’ll just say three things.

    Dr. Tony: If they don’t scream us off the podcast, we’re happy to come back.

    Dr. Sharp: I love it. Well, could we talk a little bit more, just if there’s anything else to add in terms of the real-world application here just from like normal clinician going through their practice day to day. What could we do tomorrow if we want it to, or what do we get involved in? How does this come into play?

    Dr. April: Technology things tomorrow. For clients who have survived a suicide death, consider having them donate data. For clients who would like to see an advance in science, letting them know that they can advocate and donate data. These are things that they can do. Let them know that. Let them see. I think people are [00:57:00] curious. I think of my cousin who eventually died of cancer and she was incredibly interested in all the latest treatments coming out and what’s happening. So I think like, let people know what’s coming because I think that gives people some hope that feeling suicidal could have a way of tracking, measuring and responding more reliably. And wouldn’t that be great letting folks advocate for research that would benefit them? I think those are things we can do.

    There are apps that I think are great. And I wouldn’t recommend. People often say, give me the names of three apps that you would recommend. I think they just took mood 247 offline after a decade, but apps that will track your mood on a scale of 1-10 and let you enter a journal article or like a journal entry and talk about what’s happening and share with your clinician and graph. Those are great. And those are surprisingly good for folks that diary cards don’t work. Doing that, you go from like an [00:58:00] adherence of about 11%. And if your therapist always looks at it and hearing some of that 91% charting mood and diary generation.

    My clients at high risk for suicide were incredibly responsive to several different applications that are DBT diary cards. And they were more adherent with keeping their DBT diary cards using applications, and those included suicide measures. I think that’s super cool. There are free ones and ones that are for pay. And probably, my last two years, when I was doing clients full time, I had most of my members of my group using, by their choice, they could use the paper diary card or pick an application. And I had almost everybody using applications, not because I told them to but because they work really well and their adherence for all their sessions was really high. So have folks start to do that. Other thoughts?

    Dr. Tony: Do what you can to [00:59:00] collect data from your patients in a reasonable and ethical manner. Have a policy ready to deal with managing that data. There’s a lot of choices. You’ve got a lot of choices to make as a clinician. Sometimes you work at a clinic that dictates all that to you, but if you’re an individual clinician, you’ve got a lot of leeway as to how you’d like to provide care. Take a look at the current app infrastructure. There’s a lot of mood and diary apps, and there may be ones that you prefer as a clinician to others. And there may be ones that your patients prefer. You can be pretty flexible. You get the same output pretty much no matter which way you slice it. That’s stuff you can do tomorrow.

    Dr. April: And if you work in healthcare systems and they start to say like, which clinics would like to participate with this volunteer. So Qntify works with healthcare systems where they’re collecting information to reduce suicide deaths or to engage in improving mental health care some other way.

    [01:00:00] Virna Little, who is also a very well-respected suicidologist use data in the mental health record to reduce overall suicide deaths across 75 or so federally qualified healthcare homes in the Manhattan area largely because they were able to identify data sets within their clinical data sets of folks that were more likely to die. And they weren’t what people thought. And that was usually folks who had a blood sugar regulation disorder, like diabetes and the anti bipolar diagnosis, and they got different primary care.

    So, if there’s an opportunity to do that and you belong to one of those systems, or you as a clinician might want to hook up with folks who are, just get involved. I feel like there are so many little steps that you can do that I think the more that we chip away at it, they’ll just be a tipping point. I think this will change.

    Dr. Sharp: That’s great. So before we wrap up, two things, I would love to close just [01:01:00] with resources and things that people can look at. But before we do that, I want to come back to what you said before we started recording, which is this conference about uploading intelligence or consciousness?

    Dr. April: Oh my gosh.

    Dr. Sharp: What’s going on there?

    Dr. April: I don’t know how you edit your podcast, but this is where you would go whoo! It’s like spooky music. This is real stuff. Real science that’s happening. Tony would tell you when I started this, I’m a very technology averse person. I was the last person to get a cell phone to text or whatever. And so I’ve used my coping skills in the service of helping patients because I came to believe things had to change. And so I started with myself. I was maybe the worst client you’ve ever worked with. Awful crying if you change my email. I wasn’t good at coping. So now I go to AI conferences because I want to learn what the trends are in artificial intelligence and [01:02:00] machine learning and data science so that I can start to think about how they apply to my field because we just weren’t going. Those things are free or cheap to go to like, a few hundred. I can afford that.

    And for us to know what’s coming in the big world, and there were speakers from like Pfizer or from Optum, like for major healthcare systems and big pharmacies. And they’re looking at that. And so if we don’t want to be the poor cousins in mental health, we could just go to the same events in technology that everyone else does. So I went virtually because it’s a pandemic for posterity if you’re listening to this 10 years from now, and I hope you are, and they were showing a project that someone in the tech industry founded. So there’s a foundation and then there’s a nonprofit that supports it where they encourage people to start to upload their consciousness.

    And I’m not saying we installed like a little output in your head and we plugged you into the machine. But what they did was they had them create a ton of data [01:03:00] about themselves and tell they could put it into a little like an uncanny valley robotic AI head. And you could talk to it as if it, and it would respond with the personality of the person that uploaded it. And they’ve gotten pretty good at it. So they did some demonstrations of it. And I think they were talking to a woman who was a social worker because it was very fun.

    And it occurred to me one of the really hard things to do in suicidology is do research on people who died by suicide that’s ethical because once somebody has died, it’s a little bit too late to do experimental research where you try things and try to get different outcomes, right? Because one outcome is death and there are some real ethics. And so I’m like, oh, this would be about the best way I know. You had a ton of artificial intelligence of people who died by suicide and folks who didn’t and you could try different therapies or experiments to see what worked and what didn’t.

    So I’ve talked with some folks. That’s actually possible. Now, is that going to happen today? No, I would have to really [01:04:00] deal and form a lot of relationships and get a lot of willing people to do it. And some of those might die by suicide. But there really could come a day, and that’s what this foundation is working towards, where people put a lot of their digital data about themselves in such a way that we have a good idea about how their personality would respond. And those data sets could be used for doing research on suicide without actually impacting a real human being’s life. And maybe then we could do some more experimental things in our field. And I think that’s cool. Also creepy.

    Dr. Sharp: Okay. It can be both, right? We can live in that gray area. Cool and creepy.

    Dr. Tony: And imagine being able to merge data from high-resolution MRI and blood work and a full medical record and digital life data, and anything else that you could think of to be able to build better models and better techniques and better tools to fight this problem.

    Dr. Sharp: [01:05:00] Right. It’s so exciting. I know that it’s also terrifying and this whole big data, what are people doing with it? It is terrifying. And to talk with them all, it’s nice to hear that there are folks out there who are trying to do it consciously, ethically, and mindfully to truly help people. That’s pretty amazing.

    Dr. April: Well, thank you. I think that there are a lot of people in our profession who really do care about changing the world. And this is a transformative period in history. So that there’s never been a better time in history to care about it. And during periods of change, you can pick where you want to be in the change. And I think that there are hopefully, a lot of your audience. And I hope that you’ll join us because this can help the problem suicide, but it can do so much for mental health beyond that, I think.

    Dr. Sharp: Of course. Well, if people want [01:06:00] to dig into this, want to learn more, want to learn more about you, want to learn more about the tech, I mean, I’ve been taking copious notes. We’ll have pretty lengthy show notes. B`ut are there any big resources, websites, places people can go?

    Dr. April: What do you think about the Qntify peer-reviewed? Like there’s some really good papers on Qntify,

    Dr. Tony: Qntify research. You’ll see our published research from our team. There’s a bunch of papers up there. I think some of those will be quite exciting to serve your listeners.

    Dr. April: And if you want to go to the journal of suicide and life-threatening behavior, Tony is the board chair of the American Association of Suicidology. I’m on the executive committee and Thomas Joiner is the editor of that journal. And Dr. Phil Breznik was the first author. I was the second author of an article published about this topic. I think some fundamentals just like last month. So October 2020. So if you want to get Resnick et al, in suicide and life-threatening behavior, I think you can read it. I think it is a pretty good [01:07:00] article targeted for our field.

    Dr. Sharp: Awesome. Thank you all. Thank you all so much. I’m guessing that there will be some discussion around this. I hope that people are responding and we’ll share some thoughts around here, but maybe this is just round one. I would love to talk with y’all again if the opportunity presents itself. But for now, thank you so much. It was great to chat with you.

    Dr. April: Thank you for having us. Folks if you’re listening and you had a good time, Jeremy is incredibly conscientious and fabulous to work with. So hit likes, leave good reviews, stars, whatever platform that’s on to support this because I think this is a great way for cool information about our field to get out there in a timely way.

    Dr. Sharp: Okay. Y’all thank you so much for listening to this episode. If you have not checked out the show notes, I would definitely do that. There are a ton of links there with all of the information, people, resources that April and Tony mentioned. And like they said, [01:08:00] I definitely want to call your attention to the page on the Qntify website that has all of the relevant research that we talked through today. There’s a lot to sort through there and it’s so compelling. So I hope that if nothing else, you took away some hope that we have tools out there that are getting better and better by the day to help folks who really need it.

    Now, if you’re an advanced practice owner and you would like to get some support of your own and building your practice and taking it to that next level, I’d love to help you with that. My Advanced Practice Mastermind Group is a group coaching experience where about 5 or 6 psychologists get together and keep each other accountable to set and reach goals in their practices around hiring, streamlining, making things more efficient, increasing your income of course and your [01:09:00] impact with your clients. If that sounds interesting, I think we do have two spots left at least at this point. You can find out more at thetestingpsychologist.com/advanced.

    Okay, I will catch you all next time with another business episode coming up this Thursday. Take care in the meantime. Bye, y’all.

    The information contained in this podcast and on The Testing Psychologists website is intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric, or medical advice, diagnosis, or treatment. [01:10:00] 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 pro 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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  • 162: Healthy Schedule, Healthy Boundaries

    162: Healthy Schedule, Healthy Boundaries

    Would you rather read the transcript? Click here.

    How many of you are feeling overwhelmed with reports or other aspects of your practice? Are you working at night or on the weekends? You’re not alone! Why is this happening to so many of us intelligent, competent psychologists?? I spent years working nights and weekends, taking time from my family and self-care. As a recovering weekend worker, I’ve done a lot of reflecting over the last few years about what that was all about. Today I’m sharing some of those thoughts, as well as how to restructure your schedule to work FOR you instead of against you.

    Cool Things Mentioned

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    The Testing Psychologist podcast is approved for CEU’s!

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

    About Dr. Jeremy Sharp

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

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

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