Rory Fleming Richardson, Ph.D., ABMP, TEP
Psychological & Neuropsychological Services:
Assessment, Treatment & Consultation
Everything that we call a disorder is made up of something that we absolutely need but the levels are too high or too low. The focus is to help biochemistry, neural plasticity, thought processes and behaviors to move into a range where the individual can function best and achieve the best quality of life possible. Obviously, to achieve this, a comprehensive assessment is needed. Unfortunately, many services that are provided focus on the symptoms rather than attempting to achieve a balanced gestalt (whole picture) of the causes of the imbalances. When the etiology can be found, treatment can be honed to match individual needs.
Therapeutic Psychological and Neuropsychological Assessments are for purposes which include:
(1) to identify current neurological and/or psychological conditions which the patient is suffering from,
(2) to determine possible dynamics and their interplay which could affect treatment,
(3) to determine possible treatment and accommodation needs,
(4) to provide recommendations for further treatment and assessment, and
(5) provide a prognosis given the information available.
This type of assessment is solely for these purposes and is not designed nor should be considered an assessment for any other purpose. As part of this evaluation, it is likely that treatment contacts will or have been included and that the assessment is to improve the quality and effectiveness of services.
Providing Individualized Services
Evidence-based therapeutics which is based on outcome research may or may not be of value to consider. Many times when outcome research is done, the original information can be less than the best. Many times the identification of the specific diagnoses is left to professionals who lack the most extensive knowledge of psychological, medical and neurophysiological dynamics, thus missing subtle variations which skew the information.
In addition, each individual is unique with subtle differences in genetic response to different chemicals (pharmacological) and drawing on different, varied cultural backgrounds. To assume that one technique unmodified will follow the statistical norms is naive. Just as with the physical sciences of neurophysical imaging (i.e., PET and SPECT imaging), additional information and assessment is needed to hypothesize the dynamics impacting the individual. This is needed to identify the subtleties for application of therapeutic methods. Another problem with outcome based research is that it does not take into account the telic (the feeling into or empathetic) relationship discussed by master psychotherapist Jacob Levy Moreno, M.D. This is a very important dynamic which has been identified by research shown in the level of trust or “like” the patient has toward the therapist or health practitioner. The third issues which is of concern in depending on outcome based research is that much of the research is based on identification of “symptom categories” which are found in the DSM-IV-TR. Although these categories do provide a common vocabulary to describe patterns of response, it does not always suggest an etiology. If we understand that there are genetic patterns (or disorder) which are biologically based which are passed on to the next generation, then the possibility of blending and mixing of different tendencies must be considered as a component of diagnostics. For example, a person who comes from a home where one of the parents is bipolar very well may have inherited the condition from that parent and also been exposed to intense emotion within the home. It is likely that this exposure could match the intensity of emotion that another individual from a home with a parent that is Obsessive Compulsive grew up in. The two individuals may be attracted to each other based on like emotional experiences, marry and have children with both predisposition to bipolar disorder and obsessive compulsive disorder. Treatment of these children would need to consider this genetic dynamic to select the safest pharmacological approach to treatment.
Some of the outcome studies draw on community mental health clinics which employ clinicians with very little experience and limited training. This draws question to the quality of research data. Statistics is excellent to present trends but can not be used to address the qualitative nature of each individual’s unique needs.