Health and Psychology

I'm in the process of completing a paper on phenomenological testing and neuropsychology with my colleague, Maria Martin, Ph.D.  We're hoping to present at the Los Angeles County Psychological Association in the Fall.

Phenomenological assessment is so much different than standard psychological or neuropsychological assessment. I thought I'd explain the difference here. I do standard psychological evaluations a couple of days a week. These are relatively quick evaluations. I see people to confirm or reject a diagnostic hypothesis. A person comes in saying "I have schizophrenia. I see people that aren't there, and they talk to me. I can't sleep for days at a time. I'm confused. I do bad things." So in this case the person has a label for a psychiatric condition. There are a lot of things I expect to note in someone with that label and some things I do not expect. So I do testing to confirm or reject the label the person provides. Visual hallucinations are more likely to be the result of drug use or sleep deprivation or both than schizophrenia. So I'm going to ask about that. I'm going to have the person draw things because the organizational component in the brain of a schizophrenic causes some specifiic kinds of impaired drawings. I'll look for those. I'll then write up the little snapshot I've gotten from the person and confirm or reject the diagnostic label they came in with.

In my private practice I often see clients for an entire day of testing. I change the environment in the office. I do tests in different orders and sequences. I look for subtle changes in functioning. I keep asking questions about how the person thinks they are doing. That allows me to gage their experience and compare it with the objective data I have on the tests. I look for effects of fatigue, lighting, noise, temperature, requests to go faster or to be more precise, distractions, etc. How does the person do right after breakfast or lunch? What about 2 hours later?

These kinds of evaluations allow me to see issues that might be missed in a standard 3 or 4 hour psychological evaluation or an evaluation that takes place over 3 or 4 days and misses the impact of fatigue. These evaluations allow me to see potential medical issues such as changes in oxygen flow in a cardiac or diabetic patient, the impact of changes in circadian rhythm in a neurological patient, or changes in attentiveness over time in a child with ADD or ADHD.

The ability to perform complex phenomenological evaluations simply allows me to assess functional impairments better than someone just reporting test scores compared to a normative base. This is often required in situations like assessments to document the need for accommodations for disability such as for the SAT or GRE or other formal examination. But it's also required in complex cases where someone hasn't responded to treatment, or has complex medical, neurological or psychological issues. Often testing someone over the course of an entire day or seeing them in different environments allows for a much better and more nuanced understanding of what's going on.

If you're interested in getting a psychological or neuropsychological evaluation find out if the person is going to be able to provide you with a snapshot of how you or your child is functioning or is able to do a much more in-depth process of evaluation.