Psychological Diagnostic Consultation

I consider diagnostic consultation to be one of the most important clinical services I provide — so important that I never shut up about it even though it’s not expensive or glamorous. Why?

  • Psychological diagnosis is difficult and requires specialized training.
  • And yet… the average therapist or case manager — through no fault of their own — gets very little training in differential diagnosis.
  • As a result:
    • Conditions like ADHD and Bipolar Disorder are massively over-diagnosed. This leads to the improper use of medications that aren’t helpful, since the disorder they are supposed to treat is not really present.
    • Meanwhile, other conditions are highly under-diagnosed
      • Trauma-related conditions like Borderline Personality Disorder and Dissociative Disorders are massively underdiagnosed. Community screening studies have found 75% of dissociation cases to be undiagnosed even though severe dissociative disorders are as common as schizophrenia (about 1% of the population)
      • High-Functioning Autism Spectrum Disorder (also called Aspergers Syndrome) is rarely diagnosed correctly. It’s easy to spot a severely autistic kid who can’t talk to people, but people on the high-functioning end of the spectrum usually end up diagnosed with some form of anxiety or obsessive-compulsive disorder.
      • Schizophrenia is rarely recognized in its early phases, and so in most cases it doesn’t get fully addressed until a person winds up in a major psychotic break.

Psychological testing is very helpful, but can be costly

I do provide full psychodiagnostic evaluations — which usually consist of 4-6 hours of face-to-face psychological tests and hours of data analysis — in order to provide clear diagnoses in cases where the patient or the treatment team recognize that they really can’t figure out what’s on. But it’s labor intensive, and kind of expensive, so it’s not something that therapists jump to unless they’re really feeling stumped. But what about all the cases where there’s more going on than they recognize? What if they don’t know that they don’t know?

In that case, people end up going through a series of treatments, for various diagnoses, to no good effect. Until someone finally sees what’s happening and gives them what they need. And that can take years! For example — the average time that a case of Dissociative Identity Disorder goes misdiagnosed (as any number of different psychiatric conditions) is 6.8 years. The better part of a decade. And it is a treatable condition, once it’s finally recognized.

Brief, inexpensive psychological assessment

So, over a period of 3 or 4 years, I developed a system for brief diagnostic assessment that manages to provide a pretty good picture of what’s going on. In just an hour or two I can determine what diagnoses are likely or unlikely, what to be on the lookout for, and whether the therapist seems to be on the right track in matching their therapeutic approach to the patient’s needs.

I can also get a pretty good idea of whether the extra expense of testing would be worthwhile… if a $3,000 assessment could potentially save $40,000-$60,000 in going-nowhere therapy and 7 years of lost time, then it’s a very sound investment. But in other cases, a full round of testing might not be necessary. So a quick diagnostic consultation can really deliver a lot of bang for the buck.

The brief assessment is quick to administer, and I can usually turn around the results within a day or two — at a fraction of the cost of a full assessment.

If you’ve been in treatment but don’t feel like the diagnosis you’ve been given really fits your experience — or if you’re a therapist working with someone who might benefit from a little more clarity — get in touch with me via Psych Lab Psychology Center to set up a diagnostic consult.