WHY A GOOD EVALUATION MATTERS

You go see a doctor and complain “I have these pains in my stomach.  And they’re getting worse all the time.”  The doctor grabs a bottle of pills off his desk, thrusts them at you and says, “Here, take these.  These are really good for pain!”  Only a fool would say that. And yet, everyday that is what happens when a clinician sees the patient for 30 minutes and says “Your daughter needs therapy” or “Your son has ADD.  He needs Ritalin.” We cannot possible know the right treatment before we really understand the nature of the problem.  10 different people can have the exact same symptoms for 10 different reasons. At our practice, especially with children and teenagers, we usually recommend a thorough psychological evaluation before proposing treatment options.  Children and teenagers rarely know what is troubling them; and if they did, they would not tell us anyway. Psychological evaluations may vary in length and complexity, depending upon individual needs, presenting problems and history.  Evaluations, which consist of valid and reliable psychological tests, explore several different aspects including thinking skills, emotional life, attention and memory and academic achievement.  Other specialized tests investigate motor skills, daily living/self-care abilities and career interests.  We will prepare a detailed comprehensive written report for the parents and referring physician and then discuss the findings and recommendations in detail in person with you.  We will spend as much time as needed in order to be sure that you are clear about what we did, what we found, what we concluded, what are your options, what we recommend, why we recommend it, and where you can get the best kind of affordable help when you need services that our practice does not offer, such as occupational therapy, medication evaluation/management, special education services, tutoring, etc. Most insurance companies will cover at least a portion of the testing; some will pay 100%.  Insurance plans often require preauthorization and we are glad to complete and submit any required paperwork at no charge. Our practice is affiliated with every insurance company we are aware of (except Medicaid)), including Blue Cross, AETNA, CIGNA, United Health Care, Medicare, etc. Feel free to discuss the details of your particular situation and insurance plan with us, either by phone (no charge) or in...

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DIVORCE ALWAYS HARMS CHILDREN

Rarely is there anything in a child’s life that causes more harm than divorce.  “Harm,” like “cripple” involves permanent injury from which one can never completely recover.  “Hurt” is temporary.  We say “He hurt himself on the playground” and we don’t worry much because we know that soon he’ll be okay.  Divorce can actually kill you.  A recent book discussing an 80-year study of human development (The Longevity Project) noted the single strongest predictor of early death in adulthood is a history of divorce.  Grown children of divorced parents die five years sooner than those from intact families. It’s not hard to understand why divorce is so harmful.  When parents divorce, children lose their family.  And to kids, their family is virtually their entire world.  The family is the incubator in which cognitive and emotional development are nurtured.  The experience of being a child who wakes up to discover his parents are divorcing is not unlike, in its devastating anxiety, an adult’s terrifying experience of beholding an earthquake having obliterated one’s home.  We adults minimize children’s suffering, because we “grown-up-ize” children.  We assume that kids perceive and experience the world the same way we do.  We imagine children can recover from trauma as quickly and with as little damage as we can.  One divorced father told me his goal was to put his former wife into prison.  When I pointed out the obvious – how harmful losing his mother would be to his preschooler, he blithely replied, “No, I have a girlfriend.”  Divorce is permanently devastating also because children are still developing.  We accept the fact that the younger the child, the less toxicity it takes to produce physical damage.  Small amounts of alcohol can harm a fetus.  Merely witnessing sexual or violent activities can cause youngsters serious trauma.  A miniscule amount of radiation is all it takes to develop cancer in a child when an adult would escape unscathed.  Further, most children of divorce never entirely abandon their “reconciliation fantasies” that their divorced parents will one day reunite.  A teenage patient’s parents divorced when she was little.  Mother and father both remarried and each had more children with their new mates.  Well over a decade later, my patient still believed that her mother and father would one day remarry and everybody would be as happily together again.  Divorce actually can be tougher for children to recover from than the death of a parent.  Kids comprehend there is really no possibility they will be reunited in this life with a deceased parent.  But children understand that the only thing preventing their family from reconnecting is the parents’ refusal to get back together.  Kids deeply resent their parents choosing to...

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Looking Backward: 30 Years of Experiences I Wish I’d Had When I First Became a Therapist

An invited speech at the UNC Chapel Hill School of Social Work, given April 1, 2006. INDRODUCTION Good morning. I am delighted and honored to be here. It is a special privilege to be speaking at the school where I began my career 34 years ago. I’m looking out at the audience: So many people, so many familiar faces who’ve come out early on a Saturday morning. It’s amazing! I’ve got this thought I’ve never had before – and probably will never have again: Thank goodness they made continuing education compulsory! In my checkered past, I’ve formally studied English Literature, Social Work, Psychology, and Psychoanalysis. I graduated from the UNC School of Social Work in 1974. After a brief stint in public welfare, I worked at a Family Service Agency for six years. In 1981 I entered full-time private practice which I’ve continued ever since. Naturally anyone who’s worked at anything for over 30 years has to have learned a great deal. So in that respect, my experience is no different from anyone else’s. The most distinctive aspect of my talk might be the form I’ve chosen to relate my perspective and point of view. Instead of presenting a typical paper in the usual linear format with a beginning, middle, and conclusion, I am doing something different. My narrative takes the form of a series of brief, distinct episodes: “sound bites,” if you will. We have all listened to lots of presentations and papers over the years. I don’t know about you, but me, I have come to the conclusion that if I had some truly important issue on my mind, something that required my intense, undivided concentration, I’d go to hear an analyst present a paper. It’s that experience I want to spare you. There is nothing new under the sun. I don’t claim much originality. Some of the people who taught me what I know are, in no particular order, John Howie, Don Rosenblitt, John Fowler, I H Paul, Roy Schaefer, Charlie Keith, Hilda Lipman, Ruth Falk, Paul Lerner, Dave Freeman, Pauline Kael, and Sigmund Freud. I especially want to thank my friend Bill Meyer for doing so much for clinical social work and for making this presentation possible. Finally to avoid the awkwardness of using two genders all the time, I’ve opted to refer to the patient as she or her and to the therapist as he or him. I intend no disrespect or hierarchical judgment with this convention. (1) So many therapists: So little skill Given the choice, most people would prefer to be in therapy with someone who can’t help them. This explains why so many lousy therapists are so successful. Never underestimate the...

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DR. BLOOM’S ADD ARTICLE FROM THE NEWS and OBSERVER

This Point of View article appeared in The Raleigh News & Observer in 2001. It explains my philosophy of evaluating patients for ADHD and the critical importance of performing a thorough and complete assessment. As a psychoanalyst, as well as a psychologist, I have a different point of view about attention deficit disorder than many other clinicians. I believe that, in general, professionals of all disciplines are these days enormously and, I think, dangerously glib about diagnosing ADD. I have often heard from a parent this scenario: “I went to see Dr. So-and-So about my son and I told him that Sonny doesn’t stay in his chair at school, he doesn’t finish his work, he can’t keep his mind on what he is supposed to, he has trouble with organization, forgets his assignments. Dr. So-and-So told me, “Your son has ADD.” What’s wrong with this picture? What’s really wrong is that this reply has no explanatory power. In other words, it’s merely a rephrasing of what the parent already said to the doctor about her son. The reply sheds no light on the problem. It explains nothing. It adds nothing to our understanding of the symptoms. And unless everyone involved with the ADD patient–especially the patient himself–comes away from an evaluation with a clear and more comprehensible understanding of the meaning–not necessarily the cause, but the meaning–of this particular patient’s symptom picture, then we’re not doing our best job. And what especially concerns me is that we are likely to miss other conflicts and problems if we base our evaluation essentially on the outward behavioral symptoms of ADD. This risk of misdiagnosing is just as high–maybe even higher–if the clinician adds to his diagnostic inventory the usual–or even unusual, flashy and high-tech–instruments: computer aids, rating scales, I.Q. subtests, teacher checklists, etc. In fact, misdiagnosing, under-diagnosing or over-diagnosing is then even more likely, I think, because, well you know how the omniscient tests can lull and seduce one into a false sense of security; “the tests said it–it must be true,” especially if it’s a computer test! And let’s face it: Most teachers, pediatricians and therapists do, in fact, base their diagnosis of ADD entirely on behavior alone. What’s wrong with this approach is the fact that all ADD symptoms may be part and parcel of other forms of psychopathology or normality! There are few behaviors which are not forced to fit into the procrustean bed of ADD in order to support what is so often, in my experience, a pre-determined diagnosis. I most certainly do believe there is such a thing as “true,” biologically-based ADD. But I think I could probably count on two hands the number of such...

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