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Prospective clients, either adults or parents seeking help for their children, usually have
a good idea of the kind of problem(s) they or their children are facing, but often have
questions about how these problems will be addressed in the context of a psychology
clinic. This document discusses some initial considerations for clients who must decide
on assessment and intervention for themselves or their children.
An important consideration for clients is that psychological services are not covered under the Ontario
Health Insurance Plan (OHIP). Most psychological services are private, and so need to be paid for out of
pocket or with the help of an extended health insurance policy. Sometimes psychological services are
provided by psychologists in hospitals or other agencies that are independently funded, typically by the
government. Normally these services are available only through admission as a patient to a special hospital
clinic or department of psychiatry.
Mental-health services covered by OHIP are typically provided by psychiatrists, who are mental-health
practitioners with medical degrees. Although there are exceptions, psychiatry is a discipline with a specific
model of mental-health problems and treatments, often called the medical model. In this model,
psychological problems are often viewed as “illnesses” or disorders like illnesses, and are thus often
considered best treated using some form of medication.
Psychologists, on the other hand, are trained in a different academic and clinical tradition than
psychiatrists, and thus view human behaviour and experience in somewhat different terms. They usually
subscribe to a behavioural or cognitive-behavioural model of mental health, which give a major role to
learning, training, beliefs, and experience in the causes and treatments of psychological problems. An
important advantage of teaching, training, and behavioural approaches is that change is related to
increased inner competence and skill. Thus, a person is more likely to retain those changes when
treatment is stopped.
It is important for people to realize that, in choosing a mental-health practitioner—psychologist or
psychiatrist—it is not just OHIP coverage that defines the difference. There are also critical differences in
assessment and treatment philosophy and intervention techniques.
After an initial consultation with the psychologist, the first step in any program of intervention is
assessment. Psychologists are strong believers in assessment, and the discipline of psychology is at the
forefront of the field of scientific inquiry called “tests and measurement.” Psychologists use psychological
tests, called psychometrics, to measure skills, traits, tendencies, interests, and preferences, which provide
objective data on which to base diagnoses and interventions. Psychometrics measure many factors,
including developmental levels, intelligence, language, brain function, social skills, personality, behavioural
tendencies, and emotions. The results of these tests are combined by the clinician with the client’s
history—familial, developmental, educational, and vocational—to formulate an understanding of the
client’s difficulties, to make diagnoses, and to offer recommendations for intervention.
Psychometrics have two purposes. First, they help a clinician understand what strengths and weaknesses a
person has—to develop a profile of that person, which might include diagnosis or other types of
categorization. Second, psychometrics are used to evaluate progress in treatment—how far someone has
progressed in treatment or training since their first or previous assessment, and how far someone has
progressed relative to the long-term goals of treatment.
How much assessment is necessary? This depends on a number of factors, including how serious and
widespread a person’s problems are; how likely is it that some specialized intervention will be needed to
help the person; how critical is it to have a “diagnosis” for purposes of schooling or other medical or
educational programs; how much the client can afford; or, how much information a client or guardian
would like to have about the nature of their own, or their child’s, psychological difficulties.
We define two levels of assessment: one driven by considerations of breadth and economy of coverage, and
the other by considerations of depth and thoroughness. At one end of the continuum is the screening,
which seeks to evaluate a broad range of issues in a cost-effective way.
A screening includes a review of
the client’s background—family, school, behavioural, and social history—as well as the administration of
behavioural and personality questionnaires and inventories, and a number of short performance tests.
Screening is typically used in conjunction with on-going intervention, and also allows clients with limited
financial resources to put most of those resources into intervention rather than assessment per se.
At the other end of the continuum is the full psychological assessment. The full assessment includes indepth
evaluation of performance, cognition, attention, memory, achievement, or other specialized areas of
functioning. This assessment gives an enormous amount of psychological information about a person’s
make-up. Such an assessment may be required for certain conditions and purposes, like learning
disabilities, severe or pervasive behavioural problems, long-standing adjustment issues, drug or alcohol
abuse, or injury due to motor vehicle accident.
If you are wondering whether to request a screening or a full psychological assessment, normally Dr.
Maxwell will make a recommendation based on the first consultation and other information about severity
of the condition, need for diagnostic clarity, etc.
For the most part, assessments define a program of intervention for change, renewal, and growth: they
determine the need and focus of change and evaluate the magnitude of change. Some assessments, on the
other hand, focus solely on determining if someone qualifies for a particular program or benefit from an
institution, like a gifted student assessment or a learning disability assessment.
It is the purpose of the assessment to identify possible and preferable
interventions that are compatible with a person’s strengths and weaknesses. This is especially true for
specialized profiles and their corresponding interventions—for example, educational strategies are partly
determined by the nature of a learning disability. There may also be targeted interventions for
psychological problems like anxiety, phobias, depression, or behavioural difficulties, which may include
behaviour modification, cognitive-behavioural therapy, desensitization, counselling, etc.
While many psychological interventions can be thought of as “specific” to certain
problems a person might have, some issues that people face are virtually universal—and the corresponding
solutions are also universal. All people experience stress, and the inability to successfully cope with stress
is at the core of many mental-health problems. A general form of psychological intervention to address this
universal need is self-regulation training. Self-regulation training typically uses biofeedback to develop a
person’s capacity to adapt there psychological responses to the varied demands of the environment.
Physical exercise is another example of a universal form of intervention, which is helpful for mental health
no matter who does it.
Good stress coping and adaptive skills are part of a general set of competences called self-regulation skills.
Self-regulation is the capacity to maintain mental and physical systems in balance for optimal adaptive
functioning. Many problems that people face represent failures of self-regulation, including general
motivational problems, depression, anxiety, attentional deficits, and performance and behavioural
problems. A common, well-known “formal” disorder of self-regulation is attention deficit/hyperactivity
disorder (AD/HD or ADD), which includes difficulty regulating attention, emotion, motivation, planning,
and organization.
In the past 30 years, there have been enormous advances in the practice and technology of self-regulation
training. Many advances have emerged from an area of psychology called applied psychophysiology and
biofeedback. In biofeedback, a person learns to control and modulate a physiological variable that
underlies poor performance or adjustment.
The current pinnacle of biofeedback training is neurofeedback
or brain-wave biofeedback.
Neurofeedback is a unique conjunction of learning theory, neuroscience, and
computer and physiological technology that focuses on training optimal brain-wave patterns. We invite
you to enquire about this important area of intervention. Virtually all problems we see in the clinic are
profoundly improved by training of self-regulation skills. Training in these skills provides a child or adult
with the inner skills to manage stress and be self-directed, and is a core intervention that we recommend to
all clients—children and adults alike.
A high proportion of our clients come to us on psychiatric medications, and in our extensive work with
these clients on self-regulation skills, we find that in general they progressively require less medication as
their intrinsic capacity to self-regulate increases. Virtually all of these clients find this a satisfying outcome
of their therapeutic experience.
From a general social and medical point of view, there is a surprisingly
widespread and unquestioned view that psychoactive medications—those used to treat psychological
problems—are necessary for successful clinical outcome and benign in their impact on the neurological
system. It is perhaps worth emphasizing that this general social consensus is in part conditioned by the
enormous power and influence of the pharmaceutical industry—one of the most financially successful
industries in history. Bear in mind as well that psychoactive medications have an enormous appeal in their
ease of administration, apparently powerful impact on certain “stubborn” psychological problems (like
depression or psychotic conditions), and the fact that their use is often seen to eliminate the need for active
and time-consuming participation in a life-changing therapeutic program.
In summary, if you have any questions about our services, financial policies, assessment or intervention
options, or overall emphasis in our work, please ask. We look forward to working with you.
