Health and Psychology

Health and psychology


Accommodations Testing

Posted by Margaret Donohue on August 15, 2013 at 11:45 AM Comments comments (0)

I get asked about accommodations testing fairly routinely.  Many people call in with questions about how much I charge for specific tests.  Accommodations testing isn't about the tests.  Accommodations testing is the data used for a psychological report that will ultimately be reviewed by an administrative law judge or an attorney involved in applications of the American's with Disabilities Act to ensure that the person seeking accommodations under the Act is not being afforded special treatment putting them in an adventageous position over others.  Accommodations testing is about the report.  The documentation goes to support the functional impairments of the person and to show that accommodations help them perform as well as non-disabled individuals.

If you are seeking accommodations for classes or for a specific test, then it helps to have someone that understands the law and can write a report.  The easiest cases are those people with a long history of having been correctly diagnosed and treated, who have benefitted from accommodations in the past.  My job is to document current functioning status and ongoing need for accommodations.  More complex cases are for people that are requesting multiple types of accommodations, have little to no past history of diagnosis of a qualifying condition, have had no treatment documented, and have never had accommodations before.  We can help those cases as well.  It just takes more time and a more carefully reasoned argument.  

We can also tell people if they would not be helped by the accommodations they think they need.  So if someone thinks extra time on a test would help them, we can document if having extra time actually worsens their performance due to anxiety, changing answers to test questions, or lengthening the entire test cycle and introducing fatigue.  We can then look at accommodations that might help them specifically.

If you are interested in being tested to see if you need accommodations, please contact our office.

On supervision and cats

Posted by Margaret Donohue on August 1, 2013 at 11:15 AM Comments comments (0)

Back when I was in college I was the person someone called to get the stray cat from out of the closet, from under the bed, from making life insane when all someone thought they were trying to do was help by taking the stray indoors.  

I speak cat.  Cats have about 100+ different vocalizations mainly to express how they feel or to connect with what is in their environment.  I wasn't allow cats as a child; my mother hated them.  But as soon as I left home I had cats.  I had training as a behavior specialist and I worked with cats.  Over a period of time I learned how to speak cat.  I mentioned this talent one afternoon years ago when I was watching my supervisor with his young son.  I told him the child was spending so much time with the cat he was starting to speak cat rather than human.  Stuart, my supervisor, asked me what I was talking about, and how could anyone speak cat? So I made a noise, a series of eek eek sounds coupled with clicks and his son ran over to the picture window.  Stuart was amazed.  What did you say? He asked.  Bird.  I replied.  That's the simple translation of cat into English.  But it's more complicated than that.  There's so much more nuance to it.  The eek eek sounds indicate anything flying.  The clicking noises indicate something I want to eat or recognize as potential food. There's an intonation that it needs to be closer for me to get at it.  There's a tone that indicates that I can't get to it because there is a barrier of some sort.  It's so much more than just "Bird."  So much is lost in translation.

Yesterday my cat, Tatum, was visited by her cat friend, a large female white cat with some subtle orange points.  They have communicated through the patio door for some time.  Tatum has made overtures to inviting the cat inside to share toys, food, scratching places, and has shown a great deal of friendliness towards the cat.  The other cat has been attentive but not demanding.  So I decided to invite her in yesterday because I'm the keeper of the door.

So I asked her in cat to come inside using about 35 different vocalizations to do so.  And she responded in kind.  My husband watched from the kitchen window as I spoke with the cat and reassured Tatum.  Eventually she entered.

She explored around the breakfast/work table.  Eventually Tatum hissed at her.  She continued to come in from outside and retreat to the patio over the course of an hour with Tatum staying at a distance, being vary wary.  

This reminds me a lot of what happens with new supervisees in therapy with new clients.  It parallels the process of therapy. The cat speaks her own language.  I need to learn it.  The cat has a life outside of the house that currently works more or less adequately.  I need to understand that.  The cat will come and go as they choose and I get to leave the door open.  My husband asks if the cat will stay.  I reply that I have no idea. But I suspect the cat has another home and is just visiting.  She's not scrawny and not dirty enough to be a stray.  She visits for an hour or so and leaves.  She'll likely be back.  One of my supervisees told me a therapy client returned after a year of being gone from treatment.  They do that, I told her.  Just take them where they are at and find out what they might need now.  One of my supervisees found a cat.  Can I keep it?  She asked. Cats that are not strays usually have homes.  I replied.  They having roaming territories of 1 to 3 miles.  If you want to take it home for the night feel free but it may not choose to stay with you.  If you keep it overnight take it to see if it's microchipped and return it to it's owner.  The cat took off after it reached her house walking distance from the office.  She found out it lives by the office and reunited with it's owner a day or two later.  It might return to the office or even to her house at some point in the future.  They do that.

After an hour or so the white cat left only to return at night.  Tatum sat by the door, but made no move to invite her cat friend into the house so I didn't open the door.  Eventually the cat left.  She'll likely return again.  Maybe Tatum will invite her inside.  My husband doesn't speak cat.  He understands a couple of vocalizations at best. But he can ask the cat "show me" and she will take him to what she wants.  She's learned some English as well. 

Who are you? What's important? What do you value?

Posted by Margaret Donohue on May 5, 2013 at 11:00 AM Comments comments (1)

I received an email from a psychological assistant of mine forwarded from an insurance company.  It talked about dual relationships being created by allowing clients to run up enormous debt and then having to collect that debt.  It's the wrong focus.

The focus should be on understanding your purpose and what you value.  If the purpose in providing mental health care is to help clients get better then allowing them to amass enormous debt doesn't serve that purpose.  All too often insurance companies and risk management assessments focus on avoiding harm and not what's in the best interest of the client.  Those things are often different.  But the risk avoidance method misplaces the focus on what may be safest for the therapist and not what is in the best interest of a client.

The same should be true at an organizational level.  This is the idea behind mission statements, Total Quality Management, and 360 degree evaluations and feedback.  But for some organizations these tools are just new gizmos that are expected to be used by an organization, but don't really get used to produce value, quality and customer focus.  The organization really doesn't trust their workers.  The organization ends up moving into micromanaging, withholding information and limiting feedback.  While the organization may make a profit, the costs to creativity, innovation, and employee morale is staggering.

As I get ready to teach students about job crafting, the exercise in which you redesign your job to better fit what's important, what is valued, and what's essential, and to take ownership, I'm struck by how often companies and organizations whittle away at what brought their employees to the job in the first place, making them easily frustrated and readily willing to adopt the same self-serving attitude.  In short, as one employee of a large firm recently said, "Why do I need to work there?  I can get treated like crap anywhere." And it's true you can.  But why should you?  Why in the world would a company want to treat employees badly?

I've run several companies and have had multiple employees and supervisees over the years.  If I, as owner or supervisor, don't help my employees or supervisees feel better about themselves, have ownership over their work, and feel like they contribute to the organization, then I don't feel like I'm doing my job.  I've worked for several companies where that position takes a back seat to the day-to-day operations and work production.  But for some organizations, the idea of employees having ownership is frightening.  

I can teach the process of job ownership to students and provide for the experience in small group format--create something, own it, evaluate it, test it, work with a team, have it reflect positively on you, your group and your organization, have it inspire you and give back to the community as a whole, present it and your information back to the class.  It works.  It's a great format.  It works in job settings.  It works in my company.  It works in lots of companies and there''s a ton of research to show that the process not only works, but beats any other model of management.  I've been doing this for years.

As I listen to employees tell me about wanting to leave their jobs, go out on stress leave, or just feel they are unappreciated, I wonder about what the companies that have these employees are thinking.  What a waste of human capital, of training, and of value to the organization.


Posted by Margaret Donohue on December 3, 2012 at 10:55 AM Comments comments (1)

The DIagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM V) is published by the American Psychiatric Association.  It is due out next year.  Already the complaints are coming in about it not having an adequate research basis for many diagnostic categories.  The is another diagnostic system: The International Classification of Disease 10th Edition (ICD 10).  As a result of problems with the DSM system many psychologists will be switching over to the ICD 10 system of diagnosis.

So what are the problems?  There has been a tendency in the DSM-IV to lessen the clinical criteria for diagnosis.  This has led to more people being prescribed psychiatric medications for conditions that would have been questionable in previous years.  It's also allowed for children down to preschool age children to get diagnosed with psychiatric conditions that would have been considered a normal part of childhood adjustment.  This includes attention deficit disorder and childhood bipolar disorder.  It also includes neurological conditions being misclassified as childhood schizophrenia.  These problems are continued into DSM V and additional problems have been created.  There is a new diagnosis called Dysruptive Mood Dysregulation Disorder, which will make temper tantrums into a diagnosis.  It has eliminated Asperger's Disorder and combined Asperger's Disorder with Autistic Spectrum Disorder.  There are other changes as well that may impact education and the need for educational accommodations.

Psychology and psychiatry have had difficulties with diagnosis and the need for research to back up diagnoses being used.  The new DSM V is likely to do more harm than good in this regard.


Posted by Margaret Donohue on January 8, 2012 at 8:10 AM Comments comments (0)

Ethics is often presented in psychology as a form of risk management, but that does ethics an injustice.  Ethics is about making a determination about the correct course of action after looking at a variety of options.  It's not about religion, or feelings, or laws.  Although hopefully religions proscribe rightness of actions, and feelings guide you to correct choices, and laws uphold the correct course of actions.  But that's not always the case.  Risk management involves actions to take to prevent lawsuits.  It doesn't guide you toward correct and ethical decision making.

The first step in becoming ethical is to understand the ethical issues in a situation.  You do this by talking or consulting with other people.  In some cases this is supervision.  In some cases this is a simple consultation.  You have to start by asking questions:

  • What is the right thing to do in a situation?
  • What obligations are there? 
  • What are the benefits to society?  
  • What is fair?
  • What produces the most help to others?
  • What produces the least harm to others?
  • What protects those that have the least ability to stand up for themselves?
  • Is the action I'm thinking of virtuous?
  • Is it honest?
  • Does this course of action make me a better person?
  • If others learned of this action would I feel ashamed?

To behave ethically as a psychologist is to stand up for the best of the profession.  The American Psychological Association produces a code of ethics.  You can access a copy here:

Personal mission

Posted by Margaret Donohue on September 15, 2011 at 11:45 AM Comments comments (0)

I have a sign up at my office at the Westwood Counseling Center.  There's a flying pig over the sign that suggests both the aspirational nature of the saying and the impossibility of living up to it.  It says that "My mission is to inspire people to be their best self and to inspire others to bring out the best in the people they come in contact with and to inspire them as well.  Nothing can stand in my way.  There is always a way.  There is always time."

Having that idea changes me.  It changes how I see my job.  It changes how I interact with my life as it unfolds.  It changes my students and my supervisees.  The idea produces drive, ambition, and purpose.  It produces those in the face of any and all obsticles.  It forms resilience.  The idea battles ambiguity, doubt and tyranny.  it makes me, as an individual, both responsible and goal oriented.  It forces ethical consideration in the aspirational sense rather than in the risk management sense.  It forces me to be clear, direct, and purposeful.

Those things are all hard.  There are lots of forces that would make it easy to avoid confrontation, avoid introspection, avoid honesty, and just get things done rather than do them right.  But that's not the mission. 

The mission is to use inspiration as aspiration and to use that to inspire others.  There are always things that get in the way.  I get tired.  I run out of time.  I run out of resources.  I fall short.  I'm human.  But the purpose is to go on despite all that.

It's something you may want to try.  Being your best self and inspiring that happening in others.

Mind Set

Posted by Margaret Donohue on May 13, 2011 at 9:30 AM Comments comments (3)

I did something different.  I decided to write a psychological assessment report directly to a child.  Not about a child.  To them directly.  I'm not sure why I never thought about doing that before or why I thought about it with this specific child.  But it just seems respectful of the child.  After all the child was the one that went through all that evaluation.  In her case it was about three hours on a Sunday.  And it's what I'm going to do from now on when I test a child.  It makes everything clear and treats them as if they have the ability to understand.  The report is shorter, written in kid-friendly language, and tells them what they themselves can do for improving things.  It's just the right thing to do.

It's a mindset.  Last semester I decided to put exams for students on my website.  They can take them as many times as needed until they pass at 100%.  I realized that some students were learning more from taking the tests than they were from the lectures or the readings.  So I decided to change the purpose of the test.  It's to help them clarify the essentials of what they need to learn.  So there are more tests than in most classes and the information is esssential.  I used to get horrific test anxiety.  I threw up before my licensing exams in two states, and the SAT/PSAT exams.  And yes I did well in all of them but it's not an experience I like.  So why not change it?  So I talk to my students as if they are to be my future colleagues, because they are.  I talk to them about what they should expect of themselves as professionals, and what they should expect of their peers as professionals.  It changes how they start to think of themselves.

The same mindset happens when I work with clients.  I have a picture of who they are in the future.  Who they have told me they wish to be. Their best self.  And my interventions are then geared to assist them in reaching that picture.  My job is then to help them remain on tract or notice when they seem to be moving away from what it is they have said they want.

For me it's about ethics.  It's about doing the right thing by someone.  I don't have an ethical perspective that's about law and order and not getting caught doing the wrong thing.  It's not a risk management perspective.  It's about finding out what the right thing is and doing that.  It's a mindset about believing people are willing and able and motivated and wanting to do better.  My professional role then become how to facilitate that.

Ehlers-Danlos Syndrome

Posted by Margaret Donohue on Comments comments (0)

Jessica Jacobs died in August. She had Ehlers-Danlos Syndrome. She is also described as having Postural Orthostatic Tachycardia Syndrome. I say described because I’m not sure I believe that. I think she had Ehlers-Danlos Syndrome with Autonomic Dysregulation and postural orthostatic tachycardia syndrome is just a part of that. She lived most of her adult life in Washington, DC but moved back to Twain Harte, California when she became too disabled to continue working. She wanted to be closer to her family.

Ehlers-Danlos Syndrome has several variants. The symptoms can consist of a variety of any of the following: hypermobility of the joints, thoracic outlet syndrome, early onset of osteoarthritis, degenerative joint disease, long slender fingers with swan-neck deformity, boutonniere deformity of the fingers, tearing of tendons or muscles, scoliosis, kyphosis, a tethered spinal cord, muscle pain, joint pain, trendelenberg’s sign (balance instability), Osgood-Schlatter disease, fragile skin, atrophic scarring, easy bruising, multiple skin folds, subcutaneous spheroids, molluscoid pseudo tumors, valvular heart disease, postural orthostatic tachycardia syndrome, arterial rupture, aneurysm of the ascending aorta, Raynaud’s phenomena, heart murmur, heart conduction abnormalities, hiatal hernia, gastrointestinal dysmotility, dysautonomia, the ability to hyperextend the tongue to touch the nose, anal prolapse, collapsed lung, Arnold-Chiari malformation, platelet aggregation, pregnancy complications, sleep apnea, chronic pain and insensitivity to local anesthetics., drooping eyelids.

Jessica Jacobs was an advocate for the disabled and a blogger that wrote about her poor medical care and lack of coordination of her medical treatment. The types with dysregulation of the autonomic nervous system, and bleeding disorders are at risk for sudden death. Jessica noted all the places that were not accessible to her in a wheelchair, including her hospital room bathroom. She attempted to ensure that all her doctors could share medical records but carried around a binder of them because they couldn’t. She found her primary care physician dumping her onto uncoordinated specialist care abhorrent. Unfortunately, this is a common practice with any rare medical condition. It’s a bit more common with Ehlers-Danlos Syndrome.

She’ll be missed.