Dr. Mike Question
Potential clients often ask me whether they need therapy. This is a simple and very important question to ask. My general response is that I think that just about everyone could benefit from therapy at one time or another. Sometimes it is helpful to pursue therapy for personal growth or to address low-level but nagging issues that don’t seem to go away. However, pursuing therapy is important to consider when someone is unhappy for much of the day for most days. Unhappiness can take on many forms, not just depression. We are not happy when we are sad, anxious, angry, detached, disinterested, or stressed. Now, it is normal to feel these emotions, but if a person is feeling them to an extent that his or her overall happiness is compromised, then I believe therapy should be considered.
In short, the answer is “yes – therapy is beneficial.” Numerous studies have been conducted over the decades to demonstrate the effectiveness of therapy. Meta-analyses (i.e., comprehensive studies in which research findings from many studies are statistically analyzed and summarized) indicate that people treated through therapy are better off than 80% of people with similar levels of problems who do not receive therapy. An October 2004 edition of Consumer Reports reviewed the effectiveness of therapy by analyzing surveys from 2,125 respondents who visited a mental health professional for depression or anxiety. Respondents reported a 70% improvement in emotional functioning after 1-6 sessions and almost an 80% improvement after 13 or more sessions. It is a myth that therapy must last several months or years to be effective. Therapy works, and often a substantial level of improvement occurs within the first few sessions.
Yes! It matters a great deal. Just like in any other profession, some therapists tend to be more effective than others. That being said, there is a large body of research that shows that the main factor related to the therapeutic outcome is the therapeutic alliance. That is, the likelihood of a positive outcome from therapy is significantly enhanced when a therapist and his/her client form a strong, trusting working relationship. The therapeutic alliance matters more to the outcome of therapy than the diagnosis or the particular therapeutic approach used. Some therapists are better than others at connecting with their clients. Therapists develop these relationship skills through years of training, and some therapists have an innate ability for this. However, a client’s personal preferences are also critical. Just like in any relationship, we connect better with some people than others. A person is much more likely to find therapy beneficial when he/she trusts the therapist, feels comfortable around the therapist, likes the therapist’s interaction style, and believes the therapeutic approach is a good “fit” for his/her needs. All the therapeutic techniques are out the window unless the therapist and the client form a good connection. So, a person will probably get the most out of therapy when a strong alliance is formed with the therapist. It is imperative to know that just because an individual had a past experience with a therapist that was not helpful; it doesn’t mean that therapy is not helpful. Remember the old saying about not throwing out the baby with the bathwater. Maybe that therapist or that therapeutic approach was not helpful for that person with a particular problem at a certain time in his/her life. So, it is best to remain open to the possibility that, even if a past therapy experience was not helpful, therapy with a different therapist can still be quite beneficial.
This question relates to the previous one. Although all of the marketing and PR from purveyors of particular therapeutic models would have you believe otherwise, the therapeutic alliance contributes much more to the outcome of therapy than the particular model or approach used. Cognitive-behavioral therapy (CBT) and cognitive therapy (CT) are very effective forms of therapy, but so are many other forms of therapy (e.g., interpersonal, psychodynamic, reality therapy, solution-oriented). Well-designed studies that pit different therapeutic models against one another fail to find meaningful differences among them. It does matter that the person finds a therapist who uses an approach that suites him/her.
Yes, I do psychological evaluations through the Austin Psychological Assessment Center (or ApaCenter). You can visit our website at www.ApaCenter.com. The ApaCenter is comprised of Licensed Psychologists who possess different but overlapping areas of expertise.The ApaCenter focuses solely on assessments of children, adolescents, and adults. Several of us are also Licensed Specialists in School Psychology and are experienced at working within schools and with special education staff. So, we are able to tailor evaluations to meet the specific needs of schools when eligibility for special education and/or 504 services is in question. Thus, no matter what your concerns are (e.g., dyslexia, ADD / ADHD, learning disabilities, Bipolar Disorder, chemical abuse/dependency, Asperger’s Disorder, clients interested in 504 services at the college level), there is an ApaCenter psychologist with the right knowledge and skills to conduct a top-notch evaluation. Although all ApaCenter psychologists do therapy as well, our therapy is conducted completely independent of the ApaCenter. The ApaCenter is located at the same physical office as my therapy practice.
If your son or daughter is struggling academically, behaviorally, or developmentally to a significant degree in elementary, middle, or high school, you should consider requesting that the school conduct an evaluation to determine whether he/she meets eligibility criteria for special education services for having a disability (e.g., a learning disabled, speech impaired, emotionally disturbed). To be eligible for special education services, there must be: (1) an educational need (usually evident in academic performance, but the educational need can be social, behavioral, or developmental needs as well), (2) a disability present. Schools will typically not conduct an evaluation for special education services unless there is sufficient evidence of an educational need (e.g., repeated failing grades, ongoing discipline problems, repeatedly failing the Texas Assessment of Knowledge and Skills test), and the student has not made sufficient progress with other documented intervention efforts. If you choose to have an assessment of your son or daughter through the ApaCenter, a Ph.D. with a license in psychology with specialized training in the area of concern would conduct it. Many of the Licensed Psychologists at the ApaCenter are also Licensed Specialists in School Psychology (LSSPs). So, we are able to conduct comprehensive evaluations that meet the criteria of schools. A private evaluation through the ApaCenter also allows you to have control over how the results are used. Regarding school-based evaluations for special education services, on the positive side, this evaluation would be of no charge to you. On the negative side, school-based evaluations can take up to 60 days for the report after parental consent for the evaluation has been formally given and another 30 days to review the results at the Admission, Review, and Dismissal (ARD) meeting. In addition, several weeks often pass between when the parent first inquires about testing and the first committee meeting during which consent to conduct the evaluation is officially agreed upon. A private assessment can be helpful in significantly speeding up the process. I can usually complete the evaluation and provide feedback within 2-3 weeks. Also, the comprehensiveness and quality of school-based evaluations vary considerably depending on the particular district, school, and evaluator. If the school declines to conduct an assessment of your son or daughter because they perceive only mild struggles, he/she still might be eligible for some accommodations through the 504 program. Schools rarely conduct evaluations to determine eligibility for 504 services, but you could try requesting one.
Yes, I conduct evaluations through the ApaCenter to help determine whether a student is eligible for Section 504 services at the college level. Colleges usually require a recent, comprehensive evaluation to determine whether a student is eligible for services. Colleges often require comprehensive evaluations to be within the past 3 years for learning disabilities and ADD/ADHD and within the past 12 months for emotional disabilities such as depression, anxiety, and bipolar disorder.
Yes, I conduct evaluations through the ApaCenter that can help determine whether a student is eligible for special education or Section 504 services. Since, in addition to being a Licensed Psychologist, I am an LSSP (Licensed Specialists in School Psychology), I am able to conduct assessments and write reports in a way that meets the needs of schools. Also, I am knowledgeable about the laws and rules governing special education and Section 504 services, and this enables me to serve as an advocate for parents and students. Although my assessments are designed to establish whether a disability exists and whether there is an educational need for services, at the primary and secondary school levels, a team consisting of school staff and a parent must decide whether a student is eligible for special education services. Regarding Section 504 services, schools and colleges are ultimately in charge of deciding whether a student is eligible for services. Although I cannot guarantee that a school district or college will accept my findings and recommendations, I have had a great deal of success with schools and colleges accepting our results since I am knowledgeable about how to conduct assessments that meet their criteria.
Yes, I can conduct an evaluation through the ApaCenter to determine whether you meet the criteria for ADD (or ADHD). When trying to determine whether a person meets diagnostic criteria for ADD/ADHD, it is important to keep in mind that this is a clinical diagnosis, and there is no definitive test that can determine whether a person has ADD/ADHD. Also, many different problems and conditions can have a negative impact on attention, and these need to be ruled out in evaluations of ADD/ADHD. For example, depression, anxiety, stress, sleep deprivation, memory problems, and slow processing speed can all have a negative impact on attention and might look like ADD/ADHD. So, a determination of whether ADD/ADHD is the appropriate diagnosis is actually rather tricky. A more comprehensive assessment can help ensure that an accurate diagnosis is made. A proper diagnosis leads to more effective treatment recommendations.
If your son or daughter receives an evaluation by his/her school to determine eligibility for special education services, and you disagree with the results, you can ask for an independent evaluation for which the school district will pay. You can choose who does the evaluation. This independent evaluation must be requested in writing and documented at the Admission, Review and Dismissal (ARD) meeting when the results of the school district’s evaluation are reviewed. As I mentioned previously, in addition to being a Licensed Psychologist, I am also a Licensed Specialists in School Psychology (LSSP). So, I am able to conduct evaluations that will meet your needs as well as the school’s standards for acceptability. I know how to advocate for parent and student rights and interests and can communicate with schools in an effective manner.
A psychological assessment, which is performed by a Licensed Psychologist, is a process of gathering information and integrating this information to meet the needs of the client. It typically involves gathering information from various sources such as a review of history, interviews, observations, standardized tests, and projective tests. Information is obtained about the client’s strengths and weaknesses and often a determination is made as to whether a disability is present (e.g., dyslexia, depression, ADD/ADHD). Oftentimes, a psychological assessment is conducted to answer a specific referral question (e.g., “Why do I have so much difficulty concentrating?” or “Is Sarah eligible for any accommodations in school?”). In essence, a psychological assessment is used to better understand a client so that recommendations can be made to help that client reach his/her goals. The ApaCenter views recommendations as the heart of psychological assessments. Diagnoses are important insofar as they point to certain treatment recommendations.
You might find some professionals who distinguish “psychological evaluations” from “psychological assessments,” but for the most part, the terms are used interchangeably. The ApaCenter usually uses the term “psychological assessments” but we are not differentiating them from “psychological evaluations.”
A psychoeducational assessment is a term that is sometimes used to describe an evaluation that primarily focuses on examining a person’s intellectual abilities and academic skills. Often, these types of assessments are used to determine whether a person has a learning disability, such as dyslexia. Psychoeducational assessments typically do not explore how emotional, psychological, and behavioral factors might be influencing a person’s academic functioning.
According to the Education of All Handicapped Children Individuals with Disabilities of 1975 (later renamed the Individuals with Disabilities Education Act or IDEA), all children are entitled to a Free and Appropriate Education (FAPE). Thus, children who are identified as having a disability and an educational need for services are entitled to accommodations to ensure FAPE. The law provides funding for state and local education agencies to guarantee the provision of special education and related services for students who meet eligibility criteria. Special education services are offered to children who demonstrate an educational need for services and possess one or more of the following disabilities: specific learning disabilities, speech or language impairments, mental retardation, emotional disturbance, multiple disabilities, hearing impairments, orthopedic impairments, visual impairments, autism, combined deafness and blindness, traumatic brain injury, and other health impairments.
Some students with special needs do not receive special education services under IDEA, but can receive services under Section 504 of the Rehabilitation Act of 1973 instead. Section 504 is a civil rights law similar to the Americans with Disabilities Act, and it prohibits discrimination on the basis of disabling conditions by programs and activities receiving or benefiting from federal financial assistance. Although schools are required to offer services and accommodations under Section 504, this statute does not require the federal government to provide additional funding for students identified with special needs. Under the rulings of Section 504, schools must provide students identified as eligible for Section 504 services with reasonable accommodations in order to “level the playing field” with their non-disabled peers. For example, a student with dyslexia may need extended time on tests.
The differences between special education and Section 504 services are many and a bit confusing. Both special education and Section 504 services require students to meet eligibility criteria based on: (1) an educational need for services, and (2) the presence of a disability. In general, students with mild disabilities and/or mild educational needs are more often served under Section 504 while students with more severe disabilities and/or greater educational needs are served through special education. Special education provides a greater number and more comprehensive services than Section 504. Here is a table comparing some of the differences between Section 504 and special education:
|Area||Section 504||Special Education|
|Ages served||Throughout the lifespan - college included.||Ages 3-21. No special education services at the college level|
|Identification & Eligibility||Evaluations for determination of eligibility draw upon a number of sources. Schools do not typically do any standardized testing.||Requires that the student be fully and comprehensively evaluated by a multidisciplinary team. Standardized testing is provided by trained school staff.|
|__||Student is re-evaluated periodically to determine continued eligibility, but school typically does not do any standardized testing.||Student is re-evaluated every 3 years by the school, which can include standardized testing. However, standardized testing is not required for every re-evaluation.|
|__||No provisions made for independent evaluation at the expense of the school district or college.||Provides for an independent evaluation at the district's expense if parents disagree with first evaluation|
|Responsibility to provide FAPE (free appropriate education)||Requires a plan for accommodations, but guidelines for service delivery are more loosely defined, followed, and enforced.||Requires a comprehensive individualized educational plan (IEP) that describes goals, measurable objectives, timelines, and accommodations|
|__||Usually all services are provided in a regular classroom.||Services can be a combination of regular education and special education classrooms.|
|Parental Rights||Fewer rules and laws to protect parents' rights.||Extensive rules and laws designed to protect parents' rights.|
A psychologist is a person who specializes in the study of the human mind and behavior. Psychologists have earned a doctoral degree, usually in the form of a Ph.D. or a Psy.D. Psychologists typically receive extensive training in employing research methodologies and scientific approaches to better understand human behavior. In addition to the 4-6 years of graduate work required to obtain a doctoral degree, which includes writing and defending a dissertation, prospective psychologists who wish to deliver mental health services must then complete a one year supervised internship in their field of study, pass comprehensive written and oral exams from a state licensing board, and complete one year of supervised post-doctoral training. Within the field of mental health, psychologists are able to provide therapy, consultation, and psychological evaluations. By nature of their profession, psychologists are knowledgeable about how biological, social, cultural, and environmental factors impact behavior, relationships, and mental health functioning. Psychologists receive comprehensive scientific and clinical training so that they are able to choose effective, ethical, and safe psychotherapy approaches to help the unique needs of each client. Psychologists are not trained or licensed to prescribe medications except in certain areas of the country (not including Texas) after receiving specialized training.
A psychiatrist is a physician (M.D.) who also specializes in the treatment of mental illness or emotional distress. Psychiatrists are trained to understand the relationship between physical and emotional problems, and they are able to prescribe medication for the treatment of mental health problems. Training to become a psychiatrist is similar to the length of time after college required to become a psychologist (7 to 8 years after college). Psychiatrists complete medical school and a 4-year residency in psychiatry. Although psychiatrists are trained to deliver therapy/counseling services as well as pharmacotherapy (i.e., medication), most people choose to see psychiatrists if they want to have their mental health problems addressed through medication. Often psychiatrists and psychologists (or other mental health practitioners) work together, with consent from the client, to alleviate the distress of that client. In these situations, the psychiatrist addresses the mental health issues of the client through pharmacological treatments, and the mental health practitioner addresses the behavioral/emotional problems of the client through therapy.
A psychotherapist refers to a type of therapist who focuses on improving a person’s mental health (as opposed to a massage therapist or a physical therapist). Psychotherapy typically involves some form of “talk” therapy.
For the most part, the terms “therapist,” “psychotherapist,” and “counselor” are generic terms used interchangeably within the mental health field. Typically, a mental health practitioner using one of these titles is trained and licensed, although no licensing or credentialing agency regulates the use of these generic titles. So, whenever seeking mental health services it is important to ensure that the services are being delivered by a qualified professional.
A Licensed Specialist in School Psychology is a master’s level mental health professional who specializes in the delivery of psychological services within school settings to improve the education, adjustment, and behavior of students. Typical skills include assessments of students to determine whether disabilities are having a negative impact on educational functioning, recommendations for school-based interventions for students, teacher consultation, parent consultation, and individual/group therapy. LSSPs are also knowledgeable about laws that affect the education of students such as the Individuals with Disabilities Education Act (IDEA) and 504 services (from the Rehabilitation Act 1973). This enables LSSPs to better advocate for the rights of students and families. A Licensed Specialist in School Psychology cannot use the title of “school psychologist” unless they are also a Licensed Psychologist. Although LSSPs have a strong background in assessment, they are not allowed to conduct private evaluations outside of a school setting unless they are also a Licensed Psychologist.
A Licensed Clinical Social Worker is a master’s level mental health professional who is trained to use psychotherapy to assist clients with a variety of mental health and living problems. They are also skilled at interfacing with government and social agencies to support the physical and mental well-being of their clients. Licensed Clinical Social Workers do not conduct psychological evaluations or prescribe medication.
A Licensed Professional Counselor is a designation for master’s level mental health professionals who are able to provide psychotherapy to improve the functioning of their clients. They are trained to employ a combination of mental health and human development principles to alleviate the distress of their clients. They are able to provide some evaluation/assessment services, but are more limited in their scope than psychologists. For instance, they are not permitted to use standardized projective testing methods or to diagnose physical conditions or disorders unless they are under the supervision of a licensed psychologist. Licensed Professional Counselors do not prescribe medication.
A Licensed Marriage and Family Therapist (LMFT) is…you guessed it…a designation for master’s level mental health professionals who specialize in understanding and treating clients with marital and family difficulties. They are trained in various psychotherapeutic approaches that are designed to improve marital and family functioning. Licensed Marriage and Family Therapists do not conduct psychological evaluations or prescribe medication.