From Diagnosis to Treatment: The Importance of Psychological Testing – Podcast

Dr. Monica Durham, a psychologist from LifeStance Health’s Dallas office joins us to discuss the nuances of psychological testing. Dr. Durham shares her unique journey from a business career to psychology, emphasizing her passion for psychological and neuropsychological assessments. 

We cover the purposes and types of psychological tests, such as IQ and ADHD assessments, personality tests, and cognitive evaluations following brain injuries. Dr. Durham explains the differences between general psychological testing and neuropsychological testing, identifying when each is most appropriate. She highlights how psychological testing can aid in diagnostic clarity and treatment planning, ultimately offering the best possible care for various mental health conditions.

Learn more about Psychological Testing

Nicholette Leanza:

Welcome to Convos from the Couch, by Life Stands Health, where leading mental health professionals help guide you on your journey to a healthier, more fulfilling life. Hello everyone, and welcome to Convos from the Couch. I’m Nicky Leanza, and on today’s episode, I’m excited to be talking with Dr. Monica Durham, psychologist from our Dallas, Texas office, and she’s going to be helping us understand more about psychological testing. So great to have you back on Dr. Durham.

Monica Durham:

Thank you. Thank you so much for having me.

Nicholette Leanza:

I think there’s a lot of misunderstanding about what psychological testing is and what’s it used for, so I’m really looking forward to our conversation today for you to help us understand it more. So why don’t we begin by having you tell us a little bit about yourself and what got you interested in psychological testing?

Monica Durham:

Yeah, actually, fun fact, I started out in business, in my career. I got an MBA, I worked in San Francisco, [inaudible 00:01:07] industry. Yeah, yeah. I worked for a startup there, I moved back to Dallas and was in the nonprofit world. And when I was turning 30, I was like, “Is this really what I want to be doing?” Psychology had always been pulling at me. And so I decided to go back to school and I got my doctorate. I went to school, I went back to school to become a therapist. I didn’t even know that psychological testing was a thing. And I took my first assessment class and I was like, “Oh my gosh, I love this. I have to do this.” And so I studied as much of it. I took as many classes as I could, and I did practicums in it, and I just fell in love with it.

Nicholette Leanza:

It’s great. Yeah, I was going to say, it sounds like you definitely fell in love with it for sure. And you’re also the director of psychological, and is it neuro testing? Neuropsychological-

Monica Durham:

Yeah. Yeah, so at Fife Stands we have what’s called the PNT program, and it’s the Psychological and neuropsychological testing program. So I’m the regional testing director for the central region, which is Texas and Colorado and Oklahoma.

Nicholette Leanza:

Oh, great. Oh, awesome. So can you define for us what is psychological testing and what’s its purpose?

Monica Durham:

Sure. It’s tricky because it’s a lot of things, right? So in general, it’s the assessment of cognitive functioning, learning and memory, behavior, mood, and personality. And it’s for diagnosing things like ADHD, intellectual disabilities, personality disorders, learning disorders, developmental disorders like autism. And we also do a lot of assessment of a person’s brain functioning after things like a traumatic brain injury, or if the person is starting to show signs of dementia, or let’s say that they had a stroke. So we do a lot of cognitive assessment after there has been an injury to the brain.

Nicholette Leanza:

Sounds like it does a lot of stuff, that’s for sure. It definitely assesses for a lot of different things. So what are some of the most common psychological tests given, and why?

Monica Durham:

Some of the most common tests are IQ tests, just looking at intellectual functioning and strengths and weaknesses in the different domains of what we consider to be intelligence. We do a lot of ADHD assessment, which is looking at particularly how the frontal lobe is functioning. So we’re looking at things like working memory, ability to shift between tasks and activities, ability to be planful and organized. We do academic testing, specifically looking at reading, learning disabilities, dyslexia, math learning disabilities, writing learning disabilities. We do personality assessments. People oftentimes people will have borderline personality disorder is the most common one. But we’re trying to figure out is this a no disorder or is this a characteristic of this person’s personality, because they have different treatment implications

Nicholette Leanza:

Distinguish between the two, then.

Monica Durham:

Yeah, yeah. We have assessments that sort of tease out the differences. I guess when we’re looking at that, if the person’s symptoms are situational or appear to be driven more by brain chemistry, then they have episodes of depression or they have these symptoms of anxiety. Then those are symptomology, associated with a mood or life experiences or whatever. But if it’s a core characteristic of their personality that is stable across time and is not something that fluctuates as much but is a core part of who they are, then that’s more of a personality disorder. And then we look at dementia, we look at cognitive functioning, dementia type assessments, traumatic brain injury, strokes, and then behavioral things as well, which is getting more into autism or kids. A lot of the assessment with children looks at behaviors, what diagnoses do they have, what can we do to try to help them?

Nicholette Leanza:

Great. So what’s the difference between neuropsychological testing and other forms of psychological assessment?

Monica Durham:

So psych testing, there’s a lot of questionnaires, a lot of just, do you have this symptom or not.

Nicholette Leanza:

Okay.

Monica Durham:

And there are cognitive assessments too, like IQ testing and learning disabilities. And certainly there is cognitive assessment in psychological testing. Neuropsych testing is just very brain-based. So it’s not looking very much at mood or personality. It is looking at memory and learning and executive functioning. Frontal lobe functioning. It’s looking at language skills, visual spatial skills, abstract thinking. So neuropsych is much more technical and much more, I would say performance driven. We’re not just asking, “Does this person have a symptom?” We’re saying, you have to perform on this test, and we’re going to measure how you do.” If that makes any sense.

Nicholette Leanza:

Yeah, that makes total sense. So then help us understand in what situations might H be most appropriate? When would you use neuropsych versus regular psychological test battery?

Monica Durham:

So most of us do both. There are some licensed neuropsychologists and they have some specialized training, and there are some people who do more of just the psychological piece, mood and personality. But most of us do some combination of both…

Nicholette Leanza:

Oh, I see.

Monica Durham:

… because the two affect each other.

Nicholette Leanza:

Makes sense.

Monica Durham:

People with a traumatic brain injury or dementia or autism, often there’s a mood component to those things too, and vice versa. So most of us are trained to some degree in both. There’s a lot of overlap, but it would definitely be more appropriate to do neuropsych testing if the question is very medically driven. If there’s some part of the brain that is being affected.

Nicholette Leanza:

So that would be, like you said, a traumatic brain injury. Would that also be if someone’s showing signs of dementia or Alzheimer’s potentially too?

Monica Durham:

Yeah, dementia, Alzheimer’s. We see a lot of patients who have been diagnosed with something like Parkinson’s. We see people who… Like, for people who’ve been children who’ve been exposed to toxic substances like lead, even children or adults who’ve had cancer treatments can affect their cognitive functioning. And so there tends to be probably a much more medical basis for what is happening with the patients and what’s affecting their brain functioning that is more appropriate for neuropsych testing.

Nicholette Leanza:

Makes sense. So are there situations where it would not be appropriate for someone to participate in psychological testing?

Monica Durham:

This is a good question, because it made me really think, “When would we not do that?” The only time that I could think of where we would not do any type of assessment is if the patient was too dysregulated for some reason. So I’ve had kids come in for autism assessments or ADHD too, and they’ve been too dysregulated, they can’t sit still, they can’t focus or concentrate, and I’ve had to end the session early. Like, “We have reached the limit of what we can do today and what would be considered valid results of how this patient can do.” I did my internship in a state hospital in Massachusetts, and there were times where patients were just too psychotic or too manic or too… Anytime where you couldn’t get valid results that are truly indicative of the person’s ability and functioning, is anytime that you would not want to do the assessment.

Nicholette Leanza:

Makes sense, for sure. Any other takeaways you’d like to share?

Monica Durham:

Yeah, but the purpose of… I think what people know that testing is out there, but they don’t really know what it’s for. And the reason that we do testing is for diagnostic clarity and treatment planning. So if medication providers or if therapists or parents or patients, are not sure what’s going on and they want clarity around exactly what’s going on, then that’s a good time for testing. And the cool thing about knowing exactly what’s going on, is we can point you in the direction of what treatments will be most effective. So clarity of diagnosis and treatment planning is the main reason that people would participate in testing. If it’s a kid with, “This kid is having trouble reading, do they have a learning disability?” Yes, they have a learning disability, and here are the things that you can do to help that.” Or “Does this person have dementia or is this in line with what would be considered normal cognitive decline as a result of aging?”

We can tell you, “Yes, you are declining at a rate that is faster than your age would indicate,” or we can say, “Nope, you’re right on schedule for a person who’s 80 years old, you’re doing great.” And if there are memory deficits or if there is a decline, we can point people in the direction of treatment planning for that as well. Most of our recommendations include either therapy or medication management or both. Many include both. And we can also point people in the right direction of other resources they get. “Yes, you should definitely see a neurologist. It looks like this decline is faster than it should be.” Or “Yes, this child has autism and probably you should seek out a speech therapy and an occupational therapy evaluation.” Because they’ll probably qualify for services. So diagnostic clarity and treatment planning are the main reasons why people would want to participate in testing.

Nicholette Leanza:

And so-

Monica Durham:

And another… Oh, sorry. Go ahead.

Nicholette Leanza:

It sounds like it’s just so helpful to determine that. Definitely.

Monica Durham:

Yeah. The other time that I would recommend people do it is if the treatments you’re doing are failing. Right?

Nicholette Leanza:

Oh, okay. Okay.

Monica Durham:

As a clinician, if you think you know what’s going on and what you’re doing is not working, there might be something else going on. The same thing for medication providers. If you’re treating this person for depression and they are just not responding, it might be that they have a personality disorder. And same thing for people who are out there, who are patients who are listening to the podcast. If you have been in therapy for five years and your symptoms are just not budging, and you’ve been taking medication and you don’t understand what’s going on, then we if nothing else, we can say, “Yep, you’ve just got depression that’s really resistant to treatment.” Or we can say, “You’ve got some features of this. Actually, it’s trauma that’s causing your symptoms. And that needs a bigger focus. Here’s what you should focus on in therapy. And it isn’t depression symptoms, it’s what happened to you as a kid,” or those kinds of things.

Nicholette Leanza:

My gosh, Dr. Durham, you’ve been so helpful in helping us understand more about what psychological testing is and what it can be used for, to help clarify. So thank you again for sharing all your knowledge with us.

Monica Durham:

Of course. Thank you so much for having me. It was my pleasure.

Nicholette Leanza:

I’d also like to thank the team behind the podcast, Jason Clayden and Juliana Whidden, with a special thank you to Jason who edits our episodes. Thank you for listening to Convos from the Couch. Take care, everyone.