10 commonly used psychological assessments

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Sometimes, meeting with a client in therapy isn’t enough for a therapist to know what is going on. You are seeing someone out of her regular context, moved into a intrusive (though supportive) environment. You aren’t the same self in therapy as you are the rest of the time, so it can be good to get a closer look at traits and symptoms. If your therapist needs more insight into your situation, he might request that you take one or a series of assessments. Following are some of the most widely used ones.

1. Clinical interviews

Clinical interviews are a series of set questions that focus on any symptoms you may have, helping the clinician better assess if you have a diagnosable disorder. During the interview, you will be asked open-ended questions. The interviews generally last between 30 minutes and two hours. Sometimes, the clinician that is administering the test will assess 

attitudes, appearances and behaviors in order to 

supplement the verbal answers given.

2. Screening inventories 

A screening inventory is an assessment that is looking at client symptoms and distress. They can be used both to diagnose mental illnesses and to look at therapy progress and outcomes, depending on the test and context you are taking it in. For instance, the Outcome Questionnaire-45 (OQ-45) can be used before each session to check in on where the client is at. The Beck Depression Inventory (BDI) might be used to get a better handle on a client’s depression symptoms. The Symptom Checklist-90-R (SCL-90-R) might be used to look at a number of symptom clusters while conducting a psychological study. There are a wide variety of tests to suit many purposes.

3. Rorschach test

The Rorschach test (also known as the inkblot test) is perhaps the most famous psychological test of all time. It is a projective assessment wherein the subject is shown a series of symmetrical images created by ink on paper. The subject says what she sees in the images and the test administrator will write down everything, no matter how trivial it may seem. These statements are later interpreted in regards to personality, emotional functioning and to detect thought disorders. 

4. Thematic Apperception Test (TAT)

The TAT is another projective assessment. In this one, the subject is shown ambiguous images of people. The client will tell the proctor stories about the individuals the pictures, which can be interpreted in a multitude of ways. This test is considered a glimpse into the subconscious and the way people see the world. It has been used to study a variety of items, such as motives, concerns, personality and emotional stability. 

5. Rotter Incomplete Sentence Blank (RISB)

A third commonly used projective test is the RISB. In this assessment, the subject is given a list of 40 sentence stems, or incomplete sentences. These are deliberately vague and encompass such phrases as, “I need…,” “Other people…” and “My greatest fear…”. The subject simply completes the sentences however he wants. There is not much in terms of standardized scoring, but themes will emerge, such as a preoccupation with ones appearance or social anxiety. These can help the therapist better tailor treatment to areas of concern. 

                                                                                                                   6. Wechsler Adult Intelligence Scale (WAIS)

   

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The WAIS, currently in its fourth edition, is an intelligence test. It measures raw intelligence and gives you an IQ score. The average IQ is 100. It focuses on a variety of areas, including working memory, processing speed, arithmetic and vocabulary. It has questions ranging from picture completion to finding similarities between words. This test measures your aptitude, not how well you are actually doing in the areas tested.

7. Woodcock-Johnson Tests of Cognitive Abilities

The Woodcock-Johnson, in contrast to the WAIS, is made to measure cognitive performance. It shows how well you actually do in the areas of math, reading and writing. You may score higher or lower than your actual IQ would indicate; for this reason, it can be useful in identifying learning disorders. 

8. Minnesota Multiphasic Personality Inventory (MMPI)

The MMPI is the most commonly used psychological test. It is used to assess personality and psychopathology. Depending on the version of the test you take, you answer either 338 or 567 true or false questions about yourself. This is used to gauge your level of pathology in areas such as depression, hysteria and paranoia. Based on the areas you have the highest scores in, a portrait of your personality and psychological issues can be made. There is also an adolescent version of this assessment, the MMPI-A, which is 478 items long.

9. Millon Clinical Multiaxial Inventory (MCMI)

Used strictly to assess psychopathology, the MCMI does not tell you about personality in the same way the MMPI does. It has a clear focus on psychological symptoms, as it identifies personality disorders and clinical syndromes. It is, however, much shorter than the MMPI, only having 175 true or false questions that can generally be answered in 25-30 minutes. The adolescent version of this assessment is called the Millon Adolescent Clinical Inventory (MACI) and is 160 items long.

10. Child Behavior Checklist (CBCL)

This test is designed to be used with minors, starting as young as 18 months of age. A parent or caregiver takes the test and reports social, behavioral and emotional observations of the subject. There are also versions of the test that can be filled out by teachers or the youth themselves. The assessment asks how true certain statements are, such as “talks or walks in sleep” or “acts too young for his/her age.” Because parents and teachers have higher access to the youth than the therapist does, it can be helpful to get input from someone used to seeing the child in other settings. 

Have you taken any psychological assessments? Did you learn anything interesting about yourself? Talk about it in the comments. 

Supporting the Role of Psychotherapy in Modern Life

Psychotherapy has proven over and over to be effective. In some cases its has proven superior to other interventions, including medication. And yet, over the last 20-30 years there has also been a variety of factors which has limited access to these services.  From the time of the rise of accountable care or health maintenance organizations, many of which have limited its approval and duration, psychotherapy has been struggling to stay alive much less to thrive.

Numerous other societal influences have contributed to this problem.  These include:

• The reduction of time in psychological services provided in medical settings, which have claimed to integrate such services but have only cursorily done so.
• Shifting emphases away from psychotherapy in training programs.  It is now not uncommon to meet trainees with only a handful of therapy contacts under their belts. This is partly due to the sources of grant funding, an orientation toward other health care activities and settings, and the development of manualized treatment programs which place less value on the relationship dyad.
• Burdensome issues relating to overhead costs and below market-pricing for those in private practice, a disincentive to engage in this work.
• Clear valuing of medication delivery in the medico-pharma-insurance conglomerate, to the exclusion of other approaches.  (This may change as pharmaceutical development for mental health slows down due its reaching a ceiling in benefit to humans.)
• A public which has been encouraged to seek quick, effortless relief from life's ordinary challenges.
• A parallel trend in which the public has been convinced that ordinary challenges, such as bereavement, are mental illnesses requiring a biological intervention.
• A reduction in mental health funding at the state level, which actually releases the hospitalized back into the community where they will face long waits just to talk to someone.
• The erosion of privacy in healthcare settings.
• The digital age, which has directed the attention of individuals to devices and away from the support of each other.
• A lack of humanizing development in psychotherapy itself.  All recent "innovations" I can think of actually reduce human contact, as in the cases of online therapy and telemental health services.

In an era in which humans crave and need human contact and community, psychotherapy has a role which is more relevant than ever.  But on top of that, IT WORKS!  There is an ample base of evidence for this.  When you or yours need assistance with one of life's many challenges, seek out a competently trained therapist first.  Look for those trained in accredited, residential programs, who are fully licensed in their jurisdiction, and who will meet you face to face for no less than a full 50-minute session per week, just to start. Insist on a high degree of privacy such that only you and your therapist know your concerns, so that you may experience trust.  (As stated in a previous post, confidentiality is the magic behind therapy.)  When dozens have access to your record, this is lost.

Life-changing therapy relationships are possible.  Don't settle for inferior or illusory "interventions".  Seek out the best psychotherapy possible.  College counseling services are one of the last true preserves of psychotherapy; encourage your student to take advantage of this opportunity which may never be as cost-effective or convenient during their lifetimes.

The importance of self-care

   

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Therapy is hard work. It takes a lot out of you to spend extended periods of time focusing on the most difficult aspects of your life on a regular basis. It’s not hard to burn out while working on particularly intense issues. This is why self-care is essential to recovery. You need to make sure you are in the best place possible in order to move forward in your treatment. 

Self-care is maintaining your health and general well-being. It can take many forms and will be specific to each individual. What matters is that the activity promotes your welfare. If taking a walk in nature makes you feel better, do it. If self-care means the occasional binge-marathon on Netflix, that’s okay, too. There is no right or wrong way to engage in self-care; the only thing that matters is that it works for you.

While you might think that self-care for mental health is only about taking care of your mind, that is not true at all. Taking care of your body is essential, too. Physical health and mental health are very interconnected, so what’s good for one is good for the other. Make sure to exercise, eat healthy foods and get plenty of sleep. Follow your treatment regimens for any physical illnesses you have. 

Make a list of self-care activities so that when you are feeling exhausted, you don’t have to try to come up with something. Keep it on your phone, in your purse, on your refrigerator – wherever you have easy access to it. Make an effort to do something on the list every day. Try new activities, too. You never know when you’ll discover something helpful. 

By regularly practicing self-care, you can avoid future mental health crises. Taking care of yourself as stressors come up means that you won’t have a reservoir of unresolved emotions that flood you all at once when the buildup is too strong. If you are having trouble coming up with self-care ideas, you can talk to your therapist. Together you can come up with a plan for how to take care of you both daily and when a stressor comes up.

Do you practice self-care? How has it helped you? Tell us in the comments.

10 journal prompts to improve relationships

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In the past, we have looked at journal prompts to increase self-reflection. It is a very powerful way to explore yourself and come to a better understanding of who you are. Because this is currently my most popular post of all time, I thought we’d look at some other ideas to write about. This time, we’ll take a look at questions that can help you improve your relationships.

Remember, journaling can also be done visually through drawing, painting, collage and so on. For some examples of art therapy exercises, check this out. You can modify them to fit these prompts.

1. Make a list of the most important people in your life. What do you admire about each of them? 
2. What are nice things that others have done for you? Can you do any of these things for someone else?
3. Pick a relationship you cherish. Write a letter to this person explaining why this relationship is especially important to you. (Sending it is optional.)
4. Think about couple you feel have a loving relationship. What have you observed them doing that you’d like to see in your own relationships?
5. Write about childhood friendships. What positive things did you do as a child that you have lost over the years? 
6. Make a list of traits you have. Next to each of them, list who else in your life has those traits. You might find some new common ground.
7. Who has had the greatest influence on you? Why have these people mattered so much?
8. How can the examples of others help you improve yourself?
9. Have you had a special relationship with a pet? What have you learned from this that can help you be better in your human relationships?
10. What kind of person do you want to be in the context of your relationships (sister, boyfriend, student, etc.)?

What did you discover using these prompts? Do you have any other ones you’d like to share? The comments are open!

Diagnosis spotlight: anorexia nervosa

   

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When most people hear the word “anorexia,” they think of really skinny people. There is, however, a lot more to this disorder than ones weight. Anorexia nervosa is a disorder of both the body and the mind. It can have adverse effects in many areas of one’s life and should always be taken seriously.

First of all, it’s important to acknowledge that anorexia can happen to anyone, regardless of gender, age or race. A college boy could develop anorexia in response to athletic pressures, or transitioning out of independent living could instigate it for a senior citizen. The stressors that can lead to eating disorders are in all our lives and while young females are more at risk, it is important to acknowledge that that isn’t the whole population.

A hallmark trait of anorexia is the restriction of food intake. Someone with anorexia might create unhealthy diet plans, not giving the body the calories and nutrients it needs. Certain foods are avoided completely, leading to a very restricted diet of what has been called “safe foods.” 

For anorexia to be diagnosed, as opposed to another eating disorder, this restriction should lead to a low body weight. The DSM-V diagnostic criteria used by mental health professionals defines this as “less than minimally normal” for adults and “less than that minimally expected” for children and adolescents. 

Another criteria for anorexia is an intense fear of gaining weight or interfering with weight gain despite being at a low weight. This is often related to the final criteria. One of the following needs to be present: disturbance in how you perceive your body (thinking you’re fat when you’re not, for instance), your self-esteem being excessively influenced by the way you see your body or a failure to acknowledge the seriousness of the low body weight. 

Furthermore, there are two types of anorexia: binge-eating/purging type and restricting type. The former involves episodes of binge eating and/or purging behavior. Purging refers to expelling food from your body, like self-induced vomiting or misuse of laxatives or diuretics. The restricting type does not binge and/or purge, but loses weight through dieting, fasting and/or excessive exercise.

Anorexia also often accompanies other psychiatric illnesses. Depression, bipolar disorder, obsessive-compulsive disorder, personality disorders and self-injury are some of the more common comorbid conditions. This can make the anorexia even worse, as there is more internal turmoil. Getting treatment for other mental health – and physical – disorders can help in the recovery from anorexia.

If you or someone you love is experiencing these symptoms, it’s imperative that you seek out help from a qualified professional. Anorexia nervosa is the most deadly mental health disorder. It will wreak havoc on your body until it literally eats itself. You cannot survive without nutrition. But it’s not just your body. Suicide causes one in five anorexia deaths. It is so important to get help.

Find someone who specializes in eating disorders. They have their own specific challenges and your best shot at recovery is with someone experienced. There might also be local support groups you could join in addition to therapy. If the anorexia is severe or treatment-resistant, consider finding a treatment center. If serious physical symptoms develop, call 911 or get to an emergency room. Look out for fainting, seizures, irregular pulse and other symptoms that could be considered serious. Recovery from anorexia is essential, so don’t hesitate to get whatever help you need.

To learn more about supporting loved ones with eating disorders, read this.

What has been your experience with anorexia? What helped you or a loved one get better? Share your thoughts in the comments.

7 reasons to enter individual therapy

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Therapy can be helpful for lots of different concerns. While we have discussed when it is appropriate to enter treatment, we haven’t had a good look at the reasons for doing so. If you or someone you love is having problems in any of these areas, you should consider contacting a therapist to commence treatment.

1. Relationship problems

Relationships are, perhaps, the most important aspect of life. While there are a few hermits out there, people aren’t generally meant to go it on their own. We need others, whether that means a farmer who grows your food or a friend that offers a shoulder to cry on. Relationship impairment is, therefore, very significant. If you are having a hard time with your relationships in general or are struggling with an important relationship, a therapist might be able to help you figure
out your part in it and how you can improve those bonds.

2. Support during transitions

Change can be hard. Change is even harder if you go it alone. As well-meaning as friends and family may be, they are not always enough to guide you through major adjustments. For instance, if you have been diagnosed with a major illness, are going through a divorce or can’t quite get in the groove with a new job, it might be a good idea to talk to a therapist. He is removed from the situation and doesn’t have anything but your best interest in mind, whereas others – while wanting to help – might have their own agendas. 

3. Impulsive behaviors 

Everyone does something on impulse from time to time. Whether it’s as simple as trying a new place for lunch or as complex as quitting school to travel the world, sometimes we just want to do something. At times, however, impulses can get the best of us. Doing things without thinking can damage the lives of us and the people around us. It is especially important to get professional support if you are having problems with addiction or sudden aggression. If you wake up the next day regretting your decisions, consider contacting a therapist.

4. Difficulties in school

Education is a very important part of life. Struggling with it is definitely a cause for concern. You could have a learning disability, or something might just be in the way of you completing your work efficiently. Therapists are trained to identify what is causing your problems and can even offer assessments to see where your challenges lie in order to help you get through them. They can also make recommendations to your school about accommodations for any conditions you might have.

5. Vocational issues

What you do for work is one of the most important life decisions you will make. Whether you are struggling to find out what you want to do or not doing well in your current occupation, therapists are a great resource for working through work issues. Because employment is essential to supporting oneself and one’s family, entering therapy when you are struggling is a good investment. As with school, therapists can sometimes make recommendations for accommodations in your workplace to help you succeed in your job.

6. Sexual concerns

Sex is a significant part of intimacy; therefore, difficulties in that area of life can be particularly distressing. Luckily, therapists are not there to judge you and can help you work through any concerns you have in this area. Whether you are struggling with people accepting your sexual orientation, learning to be intimate after sexual assault or curious whether your sexual quirks and kinks are healthy, a therapist is a good sounding board to help you work through such personal and important questions.

7. Self-improvement

Therapy isn’t only for those who are unhealthy. Sometimes, people go to therapy just to become better people. You might have some meaning-of-life questions, or you might just want to be a better friend or more comfortable in your own skin. Therapy is a great setting to explore your strengths and weaknesses and find out how to make the most of your life. Therapists can teach you useful skills and techniques, help you work through “the big questions” and explore how you can add more meaning to your life. 

Why did you decide to enter therapy? Tell us in the comments.