Introduction to Sample Feedback
Background: Below this intro is a sample feedback for a 17 year-old adolescent male with psychosis (as discussed in this podcast).
Parents had these questions for the evaluation:
He wants to be a famous musician, but doesn’t want to put in the work – why? How can we support him in reaching his dreams?
He's always had the “artistic temperament” but now his anxiety is getting worse, and he’s lying and stealing. This could put important people off and they won’t want to help him. How can we interrupt this cycle?
He’s failing school, so should he drop out so he can just focus on his music?
He’s not making social connections, and therapist is worried about autism. That doesn’t seem right to us, so is this the right therapist for him?
(Answers below highlighted in light yellow)
My best guess is that the parents' secret questions are:
Is there something really wrong with our child?
We are really invested in our dreams for him. Do we have to give those dreams up or redefine them?
Mom: Did I cause this?
Dad: Is he going to end up like my aunt [who is institutionalized]?
(Answers below highlighted in light blue)
This family seems very overwhelmed and the parents are making some unusual decisions because they are so lost. I want to emphasize their need for support as an essential part of the plan for supporting their son.
(Answer below highlighted in light pink)
For an explanation of the bolded 2-word prompts, please see: this post about my feedback format.
[Let's pick this up after I've welcomed the parents into my office, offered cup of tea, and settled them in. I've also heard how their experience with the assessment process has been so far, and asked for their perspective on how Sasha reacted to the testing. We agreed that the testing seemed stressful for him, and that one of our reasons for conducting the evaluation is that he seems to be struggling with a lowered resilience to stress.]
You were right about "something seeming off with Sasha’s thinking." Now we know what it is and what to do about it. May I tell you what we found in a little more detail?
Sasha has a condition called psychosis. Psychosis is when a person’s thinking and their actions become more confused or illogical.
What that means for Sasha is that his mind is playing tricks on him. He is hearing voices that aren’t there. These voices tell him what to do, or comment on what he is doing. These voices upset and distress him. These symptoms are called auditory “hallucinations.” Sasha is also feeling sensations on his skin even though nothing is touching him. Another symptom of psychosis that Sasha has is called “delusions.” These are beliefs Sasha holds that you know are not true, like that people are spying on him and want to fight him.
You gave me a helpful example during our first conversation about another delusion Sasha has. You told me he thinks it is his destiny to become famous, and sometimes he thinks he already is famous. I saw a similar example during our time together. He told me that he has been chosen by the universe to be the most famous musician ever, and that his music will stop all wars. These beliefs are symptom of the psychosis he is experiencing.
Sasha doesn’t always believe the unusual sensations or ideas he has, but sometimes he does. He can’t control when he believes them and when he doesn’t. I want to be clear that Sasha is not making these things up, and he is not saying them for attention. He is not trying to lie. These strange sensations and ideas are confusing and scary for him and he is doing the best he can to understand them.
Sometimes Sasha tries to avoid things that evoke these confusing ideas and sensations, like the color red. Sometimes he tries to get you to help him keep these ideas and sensations away through routines or superstitious behavior, like spraying his room or collecting objects and carrying them around. These are ways he is trying to manage scary thoughts and ideas he is having.
People with psychosis also experience other thinking problems. Sasha told me he is having trouble thinking as sharply as he used to. That’s also what my test results show. Sasha is having a hard time paying attention, remembering things, and making good decisions. He also can’t understand what others are saying as well as he used to. Let me show you an example of Sasha’s test results so you can see how hard it is for him to think clearly right now. [Example – adjust as family needs]
Psychosis also affects Sasha’s mood. This is why you feel like his anxiety is getting worse, and why he seems to overreact to stress. Psychosis also affects how Sasha relates to others. He does not have autism. But his symptoms will affect how well he can connect with peers and adults. You’ve noticed that sometimes he acts in ways that do not make sense, or confuse others. Sometimes he may even act in ways that are uncomfortable, or that don’t help him reach his goals. We are going to need to help support him in managing this symptom of psychosis.
I want to pause for a moment and be clear right now that there was nothing Sasha did, and nothing you did, caused this to happen to him. This is an illness he has. It could not have been prevented.
Sasha can do a lot of things that will help him manage his symptoms, like following the treatment plan we are going to lay out. He can also do things that build his resilience so he can better manage stress and better cope with any setbacks. These will be things like keeping up with the hobbies he enjoys, spending time with family and friends, and taking good care of himself.
You told me – and Sasha showed me – a lot of unique and special qualities. He’s so musically talented, and he can be very creative. We can help make sure Sasha continues to participate in activities where he can nurture these strengths. We might need to re-evaluate what Sasha’s future looks like, but for right now, let’s make sure he has a lot of opportunities to pursue activities that are meaningful to him so that he can keep developing his gifts.
Sasha will need help managing his symptoms, though. He will need a team that involves you, his school staff, a therapist, and a psychiatrist who are all working together to help him understand what is happening to him and that help treat his symptoms. This team can also help monitor his symptoms and see how they develop over time.
Psychosis can be part of other problems, like a mood disorder, and they can improve as the mood disorder improves. Or, they can be a temporary. They can also be symptoms that come and go. Or, psychosis can be part of a lifelong disorder like schizophrenia.
We want to plan for the best case and worst case scenarios for Sasha, so he feels safe and supported no matter how his symptoms progress. The worst thing would be for him to feel scared no one will know what to do if his symptoms get worse.
To make sure we’re supporting him, Sasha needs us to do 3 things. First, we need to make sure Sasha is medically healthy. Let’s talk to his pediatrician about his results and see if his doctor thinks he needs any medical work-up to support his health.
We also need to talk to Sasha’s psychiatrist about these test results so together you can find the right medication for Sasha. With the right medication, we can make sure Sasha gets the best treatment available, which will lead to the best possible outcomes. While the medications we have are not perfect, they are a lot better than they used to be. Finding the right medication means we can avoid the kinds of outcomes that people with psychosis used to experience. We also want to make sure Sasha is sleeping and eating well and getting good exercise several times a week.
Second, we need to set up Sasha’s support team. That’s going to be you, the school, the therapist, the psychiatrist, and other adults. After we call the psychiatrist, the next step is to find the right therapist for Sasha. When I talked with your current therapist, he agreed it’s a good idea to find a therapist who specializes in psychosis. There are a few names you can call written down here.
We also need to figure out how to best support him at school. Sasha can’t quit school to focus on his music, because he needs the support and structure of school to keep him as healthy as possible. He can keep focusing on music if he wants, though he may not always have the motivation to focus on that right now. But he has to go to school and he’ll need support there. Let’s give the school a copy of the report and ask them to walk you through the next steps of getting support. If they don’t give you the answers you need, give me a call and we’ll figure it out.
We also need to make sure Sasha’s support team has support. That means support for you, since you are the most important member of Sasha’s support team. I have a couple of options for you here: a parent support group, a therapist who helps parents navigate changes in their teen’s health status, and more informal ways to get self-care. You don’t have to decide which of those sounds good right now. But I wanted to stress that it’s just as important for you to get support as it is for Sasha to get support, because he is counting on you.
The third thing we want to do is make sure Sasha understands what is happening. If you and Sasha are okay with it, I’d like to meet with him and have a conversation with him about what psychosis is and how we want to help him. I also want to develop a safety plan with Sasha during our conversation, so he knows that no matter what happens, all the adults in his life are going to help keep him safe. Let’s set that up for later this week.
Here is a list of those three things we need to do and the numbers to call. (1) Keep Sasha medically healthy, which means setting up appointments with the pediatrician and psychiatrist. (2) Set up the support team, which means calling a therapist, and making a plan for taking care of yourself. And (3) Talking with Sasha, which we’ll do on Friday at 3:00.
This is all really hard news. How are you feeling about what you're hearing? A lot of parents are worried about what the future will look like for their teen with psychosis. Is that something you’re wondering about? Some parents wonder where this came from. What are you worried about?
Psychosis is more common than most families think, and we have some good medications that will help Sasha manage some of the symptoms of his psychosis. You told me that your aunt experienced psychosis and had a really bad experience with the treatment she received, and we won’t let Sasha’s experience be like that. We want to find the medication or combination of medications that leads to positive outcomes for him.
Some of Sasha’s other symptoms will be harder to manage with medication, so our hope is that we can put supports in place that will help Sasha reduce the impact of those symptoms on his life. We also want to nurture Sasha’s coping skills and his resilience to stress. This will also help reduce the impact of the symptoms. The more strengths and supports Sasha has to draw on, the better he will be able to cope with these symptoms.
Now, I want to hear what questions you have for me. Ask me anything that you're wondering about.
You may also have questions later, after you've had more time to process all this. I want you to know this doesn't have to be our only conversation. Take a few days to sit with this news. After we have our appointment where we talk with Sasha, I’d like to meet with you again to hear how you’re doing, and to answer the new questions you have.
[For examples of an evaluation summary for an adolescent with psychosis, or a letter to an adolescent explaining his test results to him, send an email to email@example.com & ask to see my 'sample reports' page]