What is a Psychologist?

Until we go through a tough time, most of us only see psychologists on television dramas. So it is only natural that many people are not exactly sure what a psychologist is and what they have to offer. People are often confused about how a psychologist is different from a psychiatrist or counselor. Here’s a short article to help you figure out if a psychologist is the health care provider who can help you. At the end is a list of ways to find a psychologist in your area.

A psychologist is a licensed health care provider who is an expert in human behavior, emotion, learning, and development. Psychologists are generally trained as ‘scientist practitioners’—meaning that they learn to conduct and interpret research. This means that a psychologist applies scientific findings to provide effective treatments. Psychologists diagnose and treat psychiatric disorders (like depression or anxiety).  Psychologists are trained to diagnose psychiatric disorders using assessment tools called psychological tests. These tests measure how well a person is thinking, learning, and processing information as compared to other people his age. Psychologists also provide psychotherapy. Psychotherapy and behavior modification are treatments that help people become healthier by changing their behavior. Psychotherapy can be used to treat mental and physical health conditions.

Education and Training
A Licensed Psychologist has earned a doctoral degree in Psychology, Education, or Human Development. No one without a doctoral degree and license can call himself a Psychologist. Most psychologists have earned master’s degrees as well as their doctorates. In most states, psychologists complete a year or two of post doctoral residency training. Finally, the psychologist takes the national psychology exam, a state exam, and then applies for the professional license. By the time he gets his license, a psychologist has completed five to seven years of graduate training before being able to finally call himself a psychologist.

Diagnosis
Psychologists diagnose psychiatric disorders through testing. Testing is a systematic process of data collection and formal observation. Testing can be done for many reasons. Common ones include: to determine if a child has learning disabilities, if an older adult is just depressed or has dementia, and to help with court decisions. Testing is often needed after a head injury or stroke. Psychologists also do testing to determine if a student qualifies for special education services. Every student who is eligible for special education services must be assessed through psychological testing. Testing results are used to plan treatment and interventions for the patient.  

Psychotherapy
Though psychologists are not the only professionals who use psychotherapy, psychologists generally have more extensive training in this area than other mental health care providers. Psychiatrists, Licensed Professional Counselors, Clinical Social Workers, and Psychiatric Nurses are among the other licensed professionals trained in psychotherapy techniques. Effective psychotherapy is based on the science of human development and behavior change. It is not just talking to a person and being a good listener! It is very important to seek psychotherapy only from a licensed professional (just ask if the person holds a professional license before scheduling an appointment). A license guarantees you that the person has the proper credentials and has to follow a code of ethics.

There are a lot of myths about psychotherapy. Most people still think of laying on a couch with the distant doctor scribbling on a notepad. Modern therapy is an active process-it takes work! At its core, psychotherapy is about learning to change your behavior, thoughts, and feelings. Good psychotherapy depends heavily on the quality of the relationship between the patient and therapist. It also depends on the therapist being well trained to assess the needs of the patient and to select evidence based treatment approaches. Psychotherapy has been shown to be as effective as psychiatric drugs for many disorders. It comes with no health risks or nasty side-effects. Unlike medication based treatments alone, the effects of well done therapy can last forever. Psychotherapy and medication together is often the best supported treatment course for conditions such as anxiety or depression.

Psychologists can help with :
* Needing to change unhealthy behavior (smoking, overeating, drinking, cutting)
* Healing interpersonal relationships (couples, parent-child, families)
* Improving quality of life (changing destructive behavior patterns, improving self-esteem, assisting with life transitions)
* Helping you through painful times (grief, loss, trauma, anxiety, depression, stress, divorce)
* Needing to learn new skills (managing children’s behavior, teaching social skills, anger management, improving a manager’s ability to motivate his workers)
* Treating psychiatric disorders (schizophrenia, eating disorders, anxiety/panic disorders)

How do I find a psychologist?
If you are not sure a psychologist is the provider you need, just call one and ask. The psychologist should be happy to have a brief phone call or consultation session. The doctor will be able to tell you if he can help you, or if another professional would be the best choice. Though you should consult your primary care doctor first, not all physicians have had much opportunity to learn about psychology or work with a psychologist, so they may not be sure how to advise you. I always recommend you ask your friends—you would be surprised how many people have needed a psychologist but won’t tell you unless you bring it up! It can be hard to find a psychologist, especially in small towns or rural areas. You may need to be persistent in your search.

Here are some other places to look:
* Your state psychological association (google your state + psychological association), either call or check their website for a ‘find a psychologist’ link
* The American Psychological Association maintains a searchable database at
http://locator.apa.org/
* Hospitals (look for the Behavioral Health or Psychiatry departments on the website)
* Community Mental Health Centers (look up your county’s website, they are listed there)
* Psychology Today’s website has a searchable database of local psychologists
* Your child’s school guidance counselor
* Your college campus Counseling or Mental Health Center
* Your insurance company (though many of the providers listed may not be accepting new patients, you may be able to get on the wait list)

Final thoughts
Don’t suffer in silence, and don’t wait for your problems to go away. If you are hurting, please seek care. Just as you would not ignore a broken bone or chest pain, it’s a bad idea to ignore emotional pain. The spirit is no less worthy of treatment than the body! It is ok to take good care of your self, even if the problem is not a physical ailment, and there are people out there trained to help you do just that.

Good luck and best wishes
Dr. Rebecca Resnik

<img src="http://www.yourmindyourbody.org/wp-content/uploads/2011/05/APA_BlogDayBADGE_2011.jpg"

Its mental health awareness month everyone! Check out the American Psychological Associations 'Blogging for Mental Health" event at http://www.yourmindyourbody.org/mental-health-month-blog-day-may-18/
Bloggers from all over the world are posting about psychology, psychotherapy and the experience of coping with mental health problems. The goal is to help get the word out that we need to seek treatment for our mental health problems the same as we do for our physical ones--without shame or stigma!

Did you know that mental health problems are among the most expensive problems the world faces? Depression alone costs more in terms of diminished worker productivity than most diseases like heart problems or diabetes. Mental health related problems like substance abuse, juvenile behavior problems, and non-adherence to medical treatment plans (like not changing your diet if you have diabetes!) not only cause a lot suffering, they have a significant economic impact.

The good news is that the fields of psychology and psychiatry have developed effective treatments for these and other mental health problems. These problems are treatable, but so many people out there are afraid to get psychological or psychiatric care. So take a moment today to think about if someone you love needs a little encouragement to go get some help.

Best Wishes
Dr. Rebecca Resnik

Accommodations for Standardized Tests--What You Need to Know about Psychological Testing to Document a Disability

There is such confusion and stress about applying for accommodations during “high stakes” tests such as the SAT, ACT, GRE, LSAT, and MCAT. For some students, accommodations such as extended time or frequent breaks during testing gives them a better chance of showing their true potential. As a clinical psychologist, I frequently receive calls from parents or young adults asking what they need to do to arrange for accommodations when they take standardized tests. Unfortunately, most parents, students and even some psychologists are not familiar with the process. Common mistakes can jeopardize the student's chances of being granted accommodations. It is critical to do your research well in advance. This blog was written to help you plan ahead to document a disability and request accommodations.

The right to reasonable accommodations is granted to people who have disabilities that impair their ability to perform major life task (such as learning, reading, speaking, working). The law that guides who gets accommodations under what circumstances is the Americans with Disabilities Act (ADA), Section 504. This section of the law protects individuals with disabilities from discrimination. Students with disabilities may receive special education services during the K-12 years as delineated in a “504 Plan.” A student with a documented disability has the right to reasonable accommodations. The key word here is 'reasonable.' The word 'reasonable' does not mean that the testing situation has to be perfect, only that testing companies take reasonable steps to 'level the playing field' so that students with disabilities can compete with their peers. Accommodations may include special privileges to help minimize the impact of a person's disability. For example, a person with diabetes may take breaks to check blood sugar or eat. A person who can not write well with a pencil may dictate responses or use an alternative interface. A person with dyslexia may take his test untimed or with 50% extra time.

There have been recent changes to ADA that will make it easier to document a disability. The changes also broaden how many people may qualify for accommodations. Under the revised ADA, people may have accommodations even when their disability is managed with a “mitigating measure”. A “mitigating measure” refers to medication or other helpful device that the person uses to cope with his disability.  For example, a student with diabetes can still have accommodations, even though insulin regulates her blood sugar. It can also mean that a student with ADHD is still entitled to accommodations when taking their stimulant medication. The new changes in the law also protect people with disabilities that are do not impact their lives all the time. For example, a person with epilepsy could be entitled to accommodations even if he is not actually have a seizure during the testing.

Finally, the law has been changed to recognize people's difficulties across a broader range of 'life activities.' These activities may include learning, self-care, writing, or working. The student's performance can now to be compared to what would be expected for a person as compared to their peers, not only the general population. This means that the student's need for accommodations can be compared to the other people in their same situation, such as other students applying to graduate school. All of these changes mean that more people with disabilities could be eligible for accommodations. Companies who produce and administer standardized tests must comply with the provisions of ADA.

Though the changes in the ADA law are good news for people with disabilities, it is very important to understand the process to avoid being denied. There is a natural tension between students and the publishers of standardized tests. Parents and students want to get the best scores possible.  Testing companies want to make sure the scores they produce continue to be useful predictors of how a student will perform in the higher education setting. Testing companies naturally want to maintain standard procedures as much as possible. Standard procedures ensure fairness as well as the validity of the scores they produce. As a result, they carefully study all applications for accommodations. Its not that testing companies are 'bad guys' who want to deny students at all costs; they provide a service and must protect their ability to do so as well as they can.

So how do parents and students go about getting accommodations? The first thing to do is to PLAN AHEAD. Make sure that the student has a DOCUMENTED record of receiving, using, and benefiting from accommodations in the educational setting well before the test. Any accommodations that the student will request from the testing service should already be a documented aspect of that student's educational program (e.g. 504 plan or IEP). Many parents make the mistake of letting their high school students 'get by' with informal accommodations granted by helpful teachers. For example, Ms. Smith may let Jay turn in his work late, and finish tests during lunch because she knows he will do well if given more time. Some students beg their parents to let them avoid a 504 plan or IEP so they will not have to feel different from their peers. Of course, many parents give in and do things like spend hours helping with homework or hiring tutors to help the student along. This will hurt the student when she then applies for accommodations from a testing company, because there is no documentation of what the student had to do differently from her peers in order to succeed.  Without a formal 504 plan, IEP, Disability Support Services record from a college, or private school education plan, there is no documented history of a need for accommodations. If the student has been successful without accommodations for all of his educational, why should the testing company believe that he suddenly needs them a month or two prior to a 'high stakes' test?

Parents and students also make the mistake of calling to schedule a psychological evaluation a few weeks before the test date. Waiting until the last minute can be a disaster. Companies like the Educational Testing Service review thousands of applications for disability accommodations. They specify on their websites how much time they need in advance to review each student's case. Do not miss their deadlines. Also consider that during peak times of year, particularly January through April, a psychologist may be booked out for months. After the testing, some psychologists and doctors may take at least four weeks or more to produce your report. Families must make their testing appointment months in advance of the application deadline to ensure having results on time.

Parents and students also make the mistake of selecting the wrong person to do the testing. Some clinicians who do psychological testing are not familiar with the law or with the guidelines of the testing companies. As an active member of my state psychological association, I often see listserv questions come up between psychologists who are confused about how to test to document disabilities for high stakes testing. Additionally, not all professionals who conduct evaluations know much about the provisions of ADA and IDEA (the laws that protect students with disabilities). They may have excellent clinical skills, but no training in how to advocate for a student's rights in a letter or report. Last but not least, before you schedule your testing, make sure that the psychologist or educational diagnostician has the credentials the testing company requires.This information is on the testing services websites.

Aside from credentials, it is critical to ask if the evaluator has the experience, the very latest versions of all tests, and up-to-date training to make sure the testing is done properly. The last thing anyone wants is to pay for an expensive psychological evaluation only to learn that the evaluator was not well prepared to document a disability for 'high stakes testing.' Before calling the psychologist, parents and students must visit the websites of each testing company to learn exactly what to ask for in an evaluation. For example, each test publisher has specific requirements about what tests they accept as documentation and whether they require the student to take his medication as usual ( some testing companies require testing be done with the student taking his medication as he does on school day, even though doing so may make it harder for the psychologist to understand the nature of the student's impairments).

Finally, there are research data to indicate that quite a few students who request testing for accommodations exaggerate or even fake problems. So aside from giving a sermon about why this is wrong (if you can read this, you already know), its a mistake to try it. If a student tries to exaggerate a disability, he may end up skewing the results to look like he is of low intelligence or severely impaired. Not a great idea if the student plans to use the report to advocate for herself in college or graduate school. The student may also happen to be tested by a psychologist who uses tools designed to detect malingering or detect unusual response patterns. Remember, psychologists are behavior specialists, and will be very skeptical if a very smart, successful student comes in and earns unexpectedly low scores (most would probably refer that student for a serious neurological work-up). I certainly don't claim that we can't be fooled, but if a student corrupts the data of a psychological evaluation, then that very expensive document becomes pretty worthless.

To learn more about ADA and IDEA, please check these websites:
The National Dissemination Center for Children with Disabilities  www.nichy.org  
The Council for Exceptional Children   www.cec.sped.org
and of course, check the website of the publisher of any standardized test you plan to take

I am greatful to JoAnn Simon Esq and Robert Mapou PhD, as well as Jim Hardcastle Esq for their excellent training in understanding the changes to ADA

Good luck on your tests!
Dr. Rebecca Resnik
Licensed Clinical Psychologist

New Screening Measure for Doctors Detects Signs of Autism at 12 Month Well Baby Visit--Good News!

There is some wonderful news for all of us parents of young children! The Journal of Pediatrics has published a new tool for screening one-year-olds for early signs of developmental delays--including symptoms and behaviors consistent with Autism. Autism is a developmental delay that impacts children's language, social functioning, play, learning, and behaviors. Since Autism varies so much in severity, clinicians refer to it as a 'spectrum disorder' (you may hear the term Autism and Autistic Spectrum Disorder used interchangeably in news stories). This is excellent news for parents and children, because early identification is crucial.

The new screening questionnaire called the Communication and Symbolic Behavior Scales Developmental Profile for Infants and Toddlers (abbreviated CSBS DP IT) is specifically designed to be used by pediatricians during the 12 month well baby visit. So why is this such a big deal? Most children who have Autism and other developmental delays do not get referred for a proper diagnosis until around 5 and a half years of age. This means that most families lose two or three years that would be the very best time to get their child early intervention services. Research has shown that early intervention services (including speech language therapy, special education, applied behavior analysis and psychotherapy) are the gold standard of care in treating children with Autism. Not only is this the time when the child's brain is the most adaptable, but professionals can intervene early to prevent undesirable behaviors from taking root. Young children with Autism desperately need to learn skills that unfold naturally for most children, and there is no time to be lost in getting them the help they need.

Lets consider a fairly typical course for a child with Autism. I'll ask you to imagine the case of a child named Aiden Doe (not his real name). Aiden was an incredibly easy baby. He was beautiful and healthy. He did not cry much, but liked to be left in his crib to stare at his mobile. Since he was their first baby, his parents did not notice that he babbled and smiled less than most babies. During his doctor's visits, he was growing and gaining weight. The physician did not note anything amiss. Aiden did begin speaking at 18 months, so that was a relief. What his mom did not realize for a while was that he was not speaking like most children, but repeating things other people or TV characters said. Over time, Aiden became more and more different from his peers. He developed sensory hypersensitivities to noise and textures, and started having temper tantrums. His mother took him to the doctor, but during his visit he played happily with the otoscope and sang songs, so the physician did not get to see anything unusual. The next couple of visits he had ear infections and strep throat, so he just clung to his mother like all children do when they are sick. So again,the pediatrician could not see anything of concern.

“He's just a boy,” or “He'll grow out of it” said Aiden's relatives. Aiden's parents tried him in the best preschool they could afford. Preschool was a nightmare for Aiden. He became so stressed he withdrew to the train corner and screamed when anyone touched him. He was soon expelled for hitting other children who tried to touch 'his' trains. Mrs. Doe quit her job to stay home with Aiden. Mr. and Mrs. Doe were facing increasing behavior problems at home. Aiden began banging his head on the wall when they tried to stop him from playing with his trains or watching his favorite video. He would spend hours pacing and talking to himself. When he was upset, he rubbed the skin on his lips until it was raw. They could no longer go out to eat or to visit friends without fearing Aiden's meltdowns. “How on earth is he going to be ready for Kindergarten next year?” they began to ask. “Are we just bad parents?” they worried.

Now lets imagine that Dr. Jones gave Mrs. Doe the CSBS to complete before Aiden's 12 month visit. It would have taken Mrs. Doe about 5 minutes to complete the 24 item questionnaire. The CSBS could have picked up on early signs such as less eye contact, delayed communication skills (both language use and gestures), and unusual motor and social behaviors. All of us parents know that a well baby visit lasts about 15 minutes. This is barely enough time for the physician to conduct a physical exam, never mind learn much about the child's development (and lets face it, doctor's visits are hardly the time when your child presents his best self). Unless your child is demonstrating obvious differences during those precious 15 minutes, even a terrific physician can miss important signs of developmental delays.

In this scenario, Dr. Jones would have had data to indicate that there was something unusual about Aiden's development. Dr. Jones could then have referred the Does to a psychologist, speech language pathologist, developmental pediatrician or the public school system's Infants and Toddler's Program. Any of these professionals could have given Aiden a thorough evaluation to determine if he had a significant developmental delay. Each of those professionals would have been able to create an individualized treatment plan just for Aiden. The Does' could have accessed the services they needed to help their son. Aiden could have spent the next four years learning the skills he would need to cope with the world. His parents could have learned how to manage his behavior and soothe him.  When it was time for Kindergarten, the family would have had a team of professionals in the public school system (or private, as appropriate) who were designated to meet Aiden's needs so that he could make progress. Best of all, the Does could have escaped the misery of not knowing how to help their little one.

Since 2007, the American Academy of Pediatrics has recommended that physicians screen for Autism and other developmental delays at 18 and 24 months. With this new tool, physicians can gather information that may identify up to 75% of children with developmental delays at 12 months. It is not the standard of care anymore for a pediatrician to simply 'eye-ball' a child and ask a few questions--particularly when there are such high quality, easy to use screening tools. I encourage all of the parents who read this to ask your pediatrician to use objective screening devices. Children with disabilities need to be identified as early as possible! The CSBS can be downloaded for free from this website:
http://www.brookespublishing.com/store/books/wetherby-csbsdp/checklist.htm. If your doctor does not already use it, you can bring it in yourself.