ABCs of Mental Health Care
print What is Psychological Testing?
Psychological tests offer a formal way to measure traits, feelings, beliefs and abilities that can lead to people's problems. Some tests assess the presence of certain conditions, such as depression, anxiety, anger control or susceptibility to stress. Other tests measure general well being and provide an overall picture of a person's personality. A typical psychological assessment includes an interview with a mental health practitioner and one or more formal psychological tests. The person may be able to complete some tests on his own; others may be completed with an examiner.
Upon a referral for psychological testing, one should recognize that the intent is to gain a deeper, more complete understanding of the problem than can be gained from a brief office visit. Such a referral does not mean that the problem is particularly serious, difficult to understand or complex. It just means that additional information is needed before designing the best approach to address the problem.
If a referral for testing is made, knowing why such a referral is being made is important to know. Becoming generally familiar with what to expect is also important. Often, an appointment for psychological testing requires several hours of time to complete questionnaires or engage in face-to-face paper and pencil testing.
Be an active consumer before, during and after psychological testing. To get started, ask any professional referring someone for a psychological assessment the following questions:
These are examples of only a few questions. It is important to ask any question that will increase comfort level with the test or testing procedure
FAQs About Psychological Testing
Who is qualified to perform psychological testing?
Licensed clinical psychologists, counseling psychologists and school psychologists are typically qualified to perform psychological assessments. The activity of these professionals is regulated by appropriate state statutes and licensing boards. It is wise to check to make sure the assessing professional is licensed. If in doubt, ask the professional to describe her qualifications to perform the evaluation.
How are the results of a psychological evaluation shared with the referring doctor or the patient?
After an evaluation, the results are scored and interpreted and a formal report is usually written. This report is then sent to the referring professional. Some psychologists may also have a discussion with the referring doctor to facilitate understanding of results. The referring doctor usually decides if, and how, the results will be communicated to the patient. In some cases, the referring doctor will ask the psychologist who performed the evaluation to discuss the results with the patient in a feedback session. In all cases, the patient is entitled to an explanation of results in language that he can understand.
Should the latest versions of psychological tests always be used in assessment?
Because the practice of psychological assessment has a long history, many of the tests in current use have gone through several revisions. In general, appropriate practice dictates that the most current versions of these tests should be used. In some cases, however, earlier versions may be used if the professional wants to compare current results with those obtained on an evaluation conducted much earlier in the person's life.
Is the patient allowed to see the results of her psychological assessment?
Every patient is entitled to a clear explanation of the results of psychological testing. Depending on the individual situation, it may be better simply to discuss the results rather than give the report. The doctor or mental health professional should be consulted about the results and about the best ways a patient can learn about them.
Who has access to assessment results?
In most cases, the results are sent to the referring doctor or agency requesting the evaluation. If an insurance company pays for the assessment cost, a review doctor or nurse working for the company also has a right to see the report. Otherwise, the report will be released to third parties only with the patient's written permission, and there are strict rules of confidentiality that are followed. Be aware that there may be some circumstances (e.g., court-ordered psychological evaluation) where the rules of confidentiality do not apply. It is wise to clarify who will have access to the results of the evaluation before beginning.
Psychological tests may be able to describe my current situation, but how good are they at predicting behavior?
Psychological and neuropsychological tests can predict general trends and behaviors, but are not designed to predict future actions, thoughts, feelings or behaviors. For example, the ability of psychological tests to predict violence or suicide is limited, though suspicion might be raised by specific test findings. Such predictions are improved by establishing an ongoing relationship with a professional over a longer period of time.
How accurate are the results of my assessment?
Most psychological and neuropsychological tests are reasonably accurate within a specified range. Each test is subject to measurement error, and the size of such errors is known through test development research. Thus, though a specific IQ or depression score is obtained, a "true" score should be thought of as falling close to the measured score. Many psychological assessments contain more than one measure of the same ability or personality trait. If the measures agree, more confidence can be placed in the results. A discussion of the issue of accuracy and stability of the test results with the professional who conducts the assessment is important.
How much do psychological assessments cost?
Psychologists and other mental health professionals usually charge on a per-hour basis for psychological and neuropsychological testing. Tests that do not require a lot of face-to-face effort on the part of the professional (e.g., questionnaires that a patient completes by herself) are less expensive than those the psychologist must administer. The per-hour fee varies widely depending upon the setting. It makes sense to determine beforehand what the estimated total cost of the evaluation (including report and whether feedback session is included) will be.
Will insurance pay for psychological assessment?
It depends. Some insurance policies have mental health benefits that will pay for a limited amount of psychological testing. Medical insurance policies may cover all or part of psychological testing if it can be shown to be "medically necessary." This is most commonly true for neuropsychological assessment of a patient who has cognitive problems related to a documented medical condition. Insurance reimbursement is generally better for physician-referred assessments. It is standard practice for the professional to obtain pre-authorization from the insurance company before the assessment begins. Prior to making an appointment for testing, call the insurance company and verify benefits for psychological or neuropsychological testing.
Russell Bauer, PhD. All rights reserved.
Just as the heart and lungs are critical in bringing oxygen to other internal organs, the brain is the key player in the nervous system. When disease affects the heart and lungs, the complex mechanisms that affect oxygen delivery break down, leading to damage in other organ systems. Similarly, when disease affects the brain, the functions normally controlled by the central nervous system, including thinking, emotions and behavior, begin to break down. Recent research has shown that many mental disorders, including anxiety, depression, schizophrenia, obsessive-compulsive disorder and certain personality disorders, as well as cognitive and behavioral impairments, may result from disturbances in brain functioning. As a result, techniques for evaluating brain function as it relates to these problems have gained wide use in the mental health field.
There are a number of ways to measure brain functioning. Imaging techniques like computed tomography (CT) or magnetic resonance imaging (MRI) scans look for structural abnormalities in the brain. Tests like an electroencephalogram (EEG) are designed to look for abnormalities in the electrical activity of the brain. Neuropsychological tests offer another alternative: in these tests, the brain is evaluated by putting it to work and measuring specific abilities like memory, language, perceptual ability, problem-solving and motor and sensory functions.
Neuropsychological tests involve paper/pencil and mechanical procedures, are painless, are not invasive and carry little if any risk to the patient. They normally involve direct, face-to-face work with a psychologist or her staff member. A comprehensive neuropsychological examination may take 6-8 hours and involves a broad range of tests and activities. A briefer, more selective evaluation may be performed, depending upon the individual case.
Neuropsychological tests are performed by psychologists and other mental health professionals who have specific educational and practical training. Not all psychologists are trained to perform neuropsychological tests, and it may be worthwhile to ensure that the assessing professional is properly trained to give and interpret neuropsychological tests. The clearest indication of proper training is board certification in clinical neuropsychology. When a referral is made, the professional or her staff should be contacted for specific instructions. Typically, the individual is encouraged to take customary medications, get a good night's rest the night before, and to bring glasses or contacts if vision correction is needed.
Unlike MRI or EEG procedures, which follow relatively standardized protocols, there are a variety of approaches to neuropsychological assessment. The neuropsychological examination usually begins with a clinical interview to enable the psychologist to become more familiar with the client's problems and to elicit any signs and symptoms of psychiatric or neurological illnesses. After the interview is completed, formal testing begins. Some neuropsychologists perform this testing themselves, while others use trained neuropsychological technicians. Both approaches are appropriate, since it is the psychologist who will ultimately be responsible for interpreting these test results. Some professionals use a standard battery approach in which the same group of tests is given to all patients regardless of the presenting problem. The clearest example of this approach is the Halstead-Reitan Neuropsychological Battery. This battery consists of a number of validated tests of brain function. Other professionals use a flexible battery of tests that are selected based on the patient's specific problem. For example, an elderly patient with suspected Alzheimer's disease might get a slightly different group of tests than a young patient after a closed head injury. While the Halstead-Reitan is the most widely used fixed battery of tests, most neuropsychologists use some version of the flexible battery approach. In general, it is a good idea to inquire about the psychologist's general approach and how the tests will be used in making diagnostic decisions.
Although the content of individual neuropsychological evaluations may differ, the evaluation typically includes measures of intellectual functioning and some assessment of emotional/personality functioning. In addition, several domains of cognitive (thinking) ability are assessed:
Neuropsychological tests can be quite useful in defining cognitive and behavioral strengths and weaknesses as well as in diagnosis of specific medical conditions. If the results are abnormal, this does not necessarily mean that the person is cognitively impaired. Various emotional conditions (depression, anxiety, confusion and mental dullness) can impair neuropsychological test performance. Because of this, the neuropsychologist takes into account all reasonable explanations of the profile in interpreting the results. In most cases, the results will also lead to specific recommendations for treatment or management of the patient's problems.
Russell Bauer, PhD. All rights reserved.