By Jolynn-Marie Wagner, Ph.D.

The role of the psychologist in any type of psychological testing is to be an objective and unbiased evaluator. For this reason, an evaluating psychologist cannot be that client’s therapist nor have any other type of relationship with the client that may impair his or her objectivity. While a treating psychologist may do some testing in order to gain more knowledge about a client to better design a treatment plan, treating psychologists generally do not undertake full evaluations of their therapy clients.

The purpose of the testing and evaluation is dependent on the referral questions. Most frequently, evaluations are conducted to determine a client’s overall level of psychological functioning or to make or rule out a specific diagnosis. The types of diagnoses that are evaluated may include: learning or developmental disorders, attentional disorders, cognitive impairments, mental disorders such as depression, anxiety, post traumatic stress disorder, personality disorders, etc. Use of normed tests, such as an IQ test or a normed personality test, give the evaluator information about how the client performs on a particular test compared to age, and sometimes gender peers. However, an evaluator also gathers information from other sources who know the client, from the client herself, and evaluates based on clinical experience.

There are numerous types of tests and measures that psychologists use to conduct evaluations. However, the different tests can be broken down into general categories by types of skill or ability the tests are meant to measure. These categories would include: tests that measure broad, cognitive abilities (intelligence tests and similar cognitive test batteries), tests of academic achievement, tests of specific language skill, tests of motor skill, tests of visual-perceptual skill, tests of social-emotional skill and personality testing, tests of adaptive behavior, and tests of specific brain functioning, or neuropsychological functioning. Most evaluation with include an IQ and academic achievement test, and other tests used depend on the referral question. With adolescents and adults, personality tests are often also used.

Another type of measure that is typically used with children are checklists. Parents, teachers, and/or daycare providers are often asked to complete behavioral checklists in order to provide information about the child to the psychologist. Children 11 years old and older often complete their own checklist as well.

Psychological assessment is not limited to use of formal tests by the psychologist, and a client’s scores on psychological tests must be interpreted within the context of the client’s history and current situation. For this reason, evaluations also include interviews with the client and parent (if the client is a child), structured and unstructured observations of the client, observation of parent-child interaction, and questionnaires and rating scales completed by the client and/or parent, teachers, and caregivers.

Common Names and Frames: As in any area, there are common names and "lingo" used in the testing field. Most commonly used IQ tests are the Wechsler series, which includes the WPPSI (Wechsler Preschool and Primary Scale of Intelligence), WISC (Wechsler Intelligence Scale for Children), and the WAIS (Wechsler Adult Intelligence Scale). Used less often, you may hear of the Stanford-Binet or the Bayler Scales. If you or your child takes an academic achievement test, you may hear about the WIAT (Wechsler Individual Achievement Test), the WRAT (Wide range Achievement test), or the Woodcock-Johnson. All three are commonly used to measure academic achievement.

When talking about testing, you may hear a psychologist mention norms, the mean, standard deviation, or significant differences between scores. When a test is normed, it means that a large study sample took the test and the test developer calculated the norms for the test, including the mean, or average, and the standard deviation, or how much variability in scores occurred within the test sample. For example, on the Wechsler series IQ test, the mean is 100 and the standard deviation is 15. That means that while most people tend to score about 100 on the test, scores from 85 to 115 are within one standard deviation, or within normal limits. When a psychologist talks about a test scores being "statistically different," they mean that the difference in scores are more likely caused by true differences in the individual’s abilities than by chance.

The specific scores that a client receives are only a sample of the client’s skill or behavior that is part of a wider range of skills and behaviors that the client actually possesses. Test scores are also dependent on the client’s motivation and cooperation. Further, a client may score differently on a different test or with a different examiner due to differences in tests and/or examiners, or fluctuations in conditions such as environment, fatigue, or stress. Finally, specific diagnosis cannot be guaranteed and sometimes no diagnosis is made. Often, the client is being evaluated to rule out a specific problem or diagnosis.

Feedback is given to the client and/or parents verbally after the evaluation is completed. Feedback sessions should include the evaluator’s impressions, how he/she reached that impression, and the evaluator’s recommendations for the client, such as certain treatments or referrals. Feedback can also be provided in a written report if desired by the client. Depending on the purpose of the report, the length of the report will vary and specific test scores may or may not be included in the test.

Play therapy is a form of expressive therapy designed to help a therapist gain insight into a child’s thoughts and feelings through children’s primary means of communication, which is play. Play is a powerful way that children express their feelings. Play therapy facilitates social, emotional, and behavioral growth and change in children with a wide range of emotional or developmental challenges.

A skilled play therapist is aware of developmental stages and provides a variety of materials that appeal to children of different ages. In general, children ages 2 to 5 years engage in symbolic play. For example, they may make a cookies out of clay, pretend to be a knight who rescues people, set up a scene in the sand with miniature figures, or act out family scenes in the dollhouse. A special type of play seen in abused and neglected children is posttraumatic play, where the traumatic scene is often played out again and again until the child gains mastery over the event with intervention by the play therapist. Children older than 5 years use symbolic play, but also engage in cooperative play, such as board games. Different expressive activities in play therapy include symbolic play, art, sandplay, role playing, and storytelling. Movement, music, animal companions, and other specialty therapy modalities may also be part of play therapy.

Types of Play Therapy: Two types of play therapy are used at Redwood Psychological. Non-directive therapy involves allowing the child to explore the play therapy room and gravitate to an activity, toy, or game that interests him or her. The therapist’s role is to listen, observe, and note the symbolic actions of the play and use factual commenting, such as, "I see you have chosen to feed the doll baby today," or to ask questions. The therapist remains supportive, but non-intrusive, allowing the child to lead. Directive therapy involves the therapist taking an active role in the play and structuring the session for assessment, diagnostic, and treatment purposes. The therapist may ask the child to draw themselves or their family or suggest an interactive game with a child who has difficulty getting along with others. Directive activities may also be used to lend closure to a particularly challenging session where a lot of emotional work has occurred.

There are many types of therapeutic techniques that might be part of play therapy. Expressive Arts play therapy involves use of materials and activities such as sand tray therapy, various types of art therapy, or story telling. Attachment-based play therapy and techniques such as "Theraplay" emphasize the relationship between the child and parent and works with specific techniques to enhance that relationship. Cognitive behavioral play therapy works to change thoughts and behaviors directly. With young children, this may be as simple as identifying and verbalizing emotions or as sophisticated as using a behavioral program to change a child’s behavior.

Therapy Room: Play therapy rooms are specially set up to be safe, nurturing, and therapeutic. Toys, activities and materials are carefully chosen to encourage expression of feelings and to facilitate the symbolic enactment of difficulty children may be experiencing. Some things you will find in our therapy rooms include sand, toy figures, art and craft materials, dolls and "house" materials, dress-up materials, building toys, and games. At Redwood Psychological, we believe a natural model is most therapeutic, so that our materials are natural wood, wool, cotton, etc.  Also, toys are picked specifically for thier therapeutic value.

How are Parents Involved in Play Therapy? Parent involvement in play therapy varies from family to family, depending on the child and family needs. Parents spend part of the session with the child and therapist, and then the therapist spends the remainder of the session alone with the child. Some children spend most of their sessions alone with the therapist. In any case, your child’s therapist will discuss your child’s goals and progress in treatment with you regularly. You are also asked to provide input to the therapist as to how your child is doing at home and school. Usually, you will meet alone with the therapist from time to time to discuss ways that you can support your child’s therapy at home.

Modern American Society – It is not a new concept that the unfolding of modern American society has brought with it many ills. When once the family unit was primary in our social structure and support, families are now often fragmented by divorce, physical distance or multigenerational mental health issues. Our pace of life has become extremely fast, we are often overscheduled, and we have little time for rest, sleep, recreation, and quiet family time. Our jobs have moved indoors to small desks in front of computer screens. The urbanization of our country has taken away our country sides and wild areas. Shopping and consuming have replaced many social interactions. Television, computers and video games have replaced much of children's natural play.
All of these factors cause stress and in turn can cause physical ailments, depression, anxiety, and social, behavioral and school problems.
My approach is to address not only symptoms and their causes but to address the holistic aspect of the child in her environment, including helping families to strengthen bonds and create a healthy family and community environment.

Some of the ways this is accomplished is to help the family prioritize, slow down, simplify their lifestyle have reasonable expectations for both parent and child, and to best match the home and work/school environment to the child and family.  Therapy with the child can involve play, expressive therapies, relaxation and integrative movement.  What is learned in therapy is applied at home, community and school/work.