In place of my usual physiology Phriday post, I give you this…
“I think I need a psychiatric evaluation? Can you test me?” These are some of the questions I get from time to time. And they reveal an ongoing confusion about testings, assessment, evaluations, the world of psychiatry, psychology, and neurology. Interestingly, if you type in “psychiatric evaluation” into wikipedia, you actually get redirected to an entry on psychological evaluations and testing. So, let me try to differentiate a bit here:
What is a psychiatric evaluation? It is done by a psychiatrist who is a physician with special psychiatry training (courses and residencies). This evaluation is comprehensive but medical in nature. Expect the person to ask for your physical, behavioral, and cognitive histories, order blood tests or other medical exams, evaluate (by observation and interview) your mood, your reality testing, and mental status etc. Ultimately, after an extensive (and usually expensive) interview, the doctor will arrive at a psychiatric diagnosis (if appropriate) and may also recommend medicines to help with the problem–which they can prescribe. A few also provide ongoing talk therapy but most do not. Rather, they recommend you find a therapist for that part. They will follow up with med checks as needed to titrate or refine your medicines. When a person has a very difficult, complex, or lengthy history of mental health, or, when the person is needing a diagnosis for legal reasons, a psychiatrist is a good choice. They are usually gifted at extracting subtle physical and behavioral matters that may help correctly pinpoint the problem. While a person might well get anti-depressants from their regular doctor, a good psychiatrist is better able to deal with complex matters and follow you more closely to get the right compound and dosage.
Neurological Evaluation. Stating the obvious, a physician with neurological specialties and qualifications does a neurological evaluation. Neurologists specialize in…wait for it…the nervous system (brain, spinal cord, and 12 cranial nerves). A neurological evaluation includes many of the things evaluated by psychiatrists but with special attention to your motor and sensory systems, your reflexes, and similar kinds of things. You might more likely see a neurologist when you obviously have a neurological issue. Neurologists are more likely to specialize in ADHD, brain injuries, and psychiatric problems that result from dementias or other known physical problems. They are often better able to give and interpret MRIs and other imaging that might be appropriate. They will also prescribe and follow medications.
Psychological Evaluation, AKA testing, psych assessment. These are offered, mostly, by doctoral level psychologists. These evaluations will cover much of the same history, mental status, and provide diagnoses when appropriate. Interviews, just like the previous two options, are essential. However, what sets psychological evaluation apart is its use of standardized tests. These may be paper and pencil or electronic. They may be filled out by the client or by family members. The results provide a snapshot of behavior, or cognitive functioning, or mood by contrasting the individual results against a peer group. For example, a child may complete a computerized test to assess attention span. The results are compared to thousands of children taking this test who either are “non ADHD” and or ADHD. A good psychologist collects data from multiple data points (test data, interviews by client and maybe family, observations, etc.) and uses that data to make interpretations and recommendations for ongoing care. Usually, the best psychological evaluations begin with a very objective, specific question. Just throwing a bunch of tests at a person to “see what comes up” isn’t all that helpful. Just because something pops up doesn’t mean it is meaningful.
It is true that masters level therapists (licensed or not) give and interpret some tests. But most of the best tests can only be given and interpreted by doctoral level, licensed psychologists.
There are other types of evaluations. Neuropsychologists are doctoral psychologists with specialized training and help pinpoint brain injury, unravel more complex learning disabilities, etc. Neuropsychiatric evaluations are done by another similar but slightly different professional. You can check out their interesting history on this wikipedia page.
So, how do you choose what is best for you? Answer a few questions.
1. What do I really want to know when it is all said and done? What might help me decide how to proceed? The more specific you are, the more likely you can get the answer you want.
2. Do I think I need to focus more on physical options or behavioral options?
3. Do I think I’m likely to need medications? The physician types are better. Psychologists cannot prescribe meds (unless you live in Hawaii or are in the military).
4. If I am given a diagnosis, what do I need it for? Both doctoral level psychologists and psychiatrists are capable of giving you diagnoses. However, some people or systems value one opinion over another. Figure out if it matters for your purposes.
5. Am I looking for specific behavioral/relational suggestions? Then psychological evaluations are more appropriate.
6. Am I looking to form an ongoing therapeutic talk based relationship? See the psychologist.
Musings on Faith and Psychology 
Re: “But most of the best tests can only be given and interpreted by doctoral level, licensed psychologists.”
I think this statement is biased and inaccurate.
The two issues are: a) does my license allow me to do testing and b) will the publisher sell me the test.
A licensed mental health professional (in most states) – even those without a Ph.D. – can give any test for which they have received the proper training. When I apply to a publisher to purchase a test, I have to demonstrate that I have a license and that I have the necessary academic courses and/or workshop training. Granted, some – perhaps many – masters level therapists don’t have the proper courses in their background, but I’m not aware of any publisher who would look at my training and experience and turn me down solely because I didn’t have a Ph.D.
Biased? Yes. Innacurate? Well, now that is up to interpretation. To be eligible to purchase, use, and interpret certain tests one needs to show doctoral level psychological asessment training and experience. Even doctoral level, licensed psychologists (with transcripts that show such courses) require a reference letter for some tests from another psychologist stating that the person requesting the test has experience. I would have trouble getting approved to buy the Halstead Reitan (neuropsych) test since I only have a course on neuropsych but no actual experience using it. Now to the “best” question. By best, I meant those tests that have the greatest research, the highest reliability and validity. Finally, it is true that someone without the graduate level training may be certified in an individual test use. So, I have seen some lacking grad training able to use one test that they have been approved on. But, they do not get blanket approvals.
This is helpful. I am planning on pursuing a Psy.D, and being aware of what type of doctor does what will help me define my goals more concretely. Great post.
Thank you for emphasizing that one not practice outside of their competancy. When it comes to testing and the interpretive uses of the data provided by testing, one not trained in being competant and careful could at least potentially cause harm. It’s hard to view ourselves as potential harm-doers, but I think at times we need to so that we maintain the appropriate levels of training and supervision necessary to provide the services we say we can.
We appear to be in agreement that one should only practice within the scope of their training and competency. And we likely agree on what constitutes the best tests.
It’s your statement that some tests”can only be given and interpreted by doctoral level, licensed psychologists” that I take exception to.
The Halstead-Reitan, to use your example, can in fact be sold to and administered by masters level clinicians. To quote the Reitan Neurospychology Labs web site, the qualification guidelines include licensed psychologists, members of qualified professional organizations, or “(3) persons who are qualified on the basis of professional licensure or certification to use neuropsychological tests.”
Granted, a masters level clinician would have to jump through an inordinate number of hoops, both academic and experiential, to demonstrate competency, but it could be done. (Why they would want to, I have no idea.)
The issue, as you noted, is training and experience, not highest degree completed. A LPC with 10, 20 or 30 years experience, a great deal of post-grad continuing education, and time spent being mentored by an expert in the field, may be perfectly qualified to administer many of the “best tests”.
Bowden, I stand corrected, in part. You are technically correct and my memory wasn’t as good as I thought about the qualifications. However, in practice, I am probably still correct in that many tests require training and coursework that most masters level people do not have. Some Master level folk get training (in my program we have a psych assessment course) on testing/assessment but many do not. Later, they may go to get certified (say in the 16PF) on a particular test but this will not enable them to use other similar tests. So, the psychologist, with coursework and training, has a wider variety of tests and measures available to him or her. Do we agree on that? I think so based on your previous comment. Thanks for correcting my post.
Pingback: Psychiatry, Psychology and Criminal Systems – Part 2 | Hunter Emkay
I think we need to be careful of reductionism by focusing so much on the medical aspect and the testing area. I am a Registered Social Worker and Registered MFT and find myself picking up on clients/patients who fall through the cracks of the two establishments. Better to emphasize the importance of interdisciplinary and collaborative approaches where the client/patient is a potential “expert”.
Excellent information for both the practitioner and the client. This commentary really puts into perspective the differences between psychiatry and psychology, as well as the advantages and limitations of the different levels of post-graduate degree or certification. Further, it is important that clients be particularly aware that there are safeguards in place by the assessment developers to insure that any practitioner administering the measure is competent to do so. Thank you very much for sharing this information.
I find both the explanation and responses so far quite useful. This should help in my preparation to go into consulting as one with a PhD in psychology
My sense is your statements attempt to discredit the licensed professional counselors who receive the same training to perform evaluations.
Shad, As a professor of LPC oriented Assessment class, I can tell you this is not true. I am not discrediting LPCs neither am I suggesting the training counselors receive in their degree programs are the same as what doctoral level psychologists receive. There are differences.
That’s really interesting that the main difference between psychiatric and psychological evaluation is that psychological testing uses standardized tests. We have a son who has been having a hard time focusing at school and we want to take him to a psychologist to see if he has some kind of attention disorder. It’s really helpful to know that there is a difference between these two kinds of testing and that it could help us find a solution for our son.
Pingback: Should I Get a Psych Evaluation? - The Gray Matthews Project
After visiting several doctors after a recent traumatic event, one suggested that I participate in a psychological evaluation. I never knew that psychological exams stand apart from psychiatric evaluation in their use of standardized testing that provide an overview of cognitive functioning. Thank you for the information regarding psychiatric care and psychological evaluation!
In the UK Psychiatrists are medically trained,use the medical model and diagnose. Psychologists don’t use the medical model, they use the biopsychosocial model and they formulate. That’s the main difference over here.
I really liked what you said about how a psychological evaluation will cover history, mental status, and provide diagnoses when appropriate. My cousin is looking to immigrate to the US since she was born and raised in Spain, so we’re looking into what she’ll have to do to make it through immigration. Thank you for the information about how there may also be standardized tests that will be done with pencil and paper or electronically.