Tough Conversations: Discussing Capacity Assessment with a Loved One

As a psychologist, I have worked with many families struggling with the delicate issue of when and how to seek a capacity assessment. Most often, an adult child and/or caregiver of an older adult has observed concerning changes in their parent’s ability to manage finances, make medical decisions, or live independently, because of cognitive decline.

Approaching a parent or partner with this concern can feel heavy with emotion, fear, and the potential for conflict. Yet, when done thoughtfully and with empathy, it can be a catalyst for understanding, support, and ultimately, better care for our loved ones.

So, how do you navigate this challenging terrain? Here are some steps to guide you:

1. Choose the Right Time and Place

This isn't a quick elevator-ride chat. Pick a calm, private moment when distractions are minimal. Allow ample time for open discussion. Consider a familiar setting like your home or a favorite park, where your loved one feels most comfortable and safe. I always recommend against having complicated conversations in the car, because you can’t make eye contact and at least one person is distracted by, you know, driving. It’s ideal to sit face-to-face and see all of the nonverbal communication between you.

2. Start with Empathy, Not Accusations

Frame the conversation as coming from a place of concern and love (hopefully, this is actually true!). Start by reassuring your loved one that you care about their wellbeing, and recognize they are an adult and value their independence, just like anyone else. Use "I" statements like, "I'm worried about your forgetfulness lately, and I want to check in about some things I’ve noticed.” 

3. Focus on Functioning, Not Diagnosis

Avoid labeling your loved one's capabilities or jumping to conclusions about their mental health. Instead, focus on specific areas where you've observed challenges, like managing finances, remembering medication, or making safe decisions about daily living. “I’ve noticed that some of your bills seem to be piling up because they’re going unpaid,” is likely to get you further than “I think you have dementia.”

4. Listen Actively, Without Judgment

Give your loved one the space to express their perspective, fears, and frustrations. Remember that their feelings are valid, even if you disagree with their views of the situation. Use open-ended questions like, "Can you tell me what's been happening lately?" or "How have you been feeling about managing your finances?

5. Education is Key

Explain the purpose of a capacity assessment – to understand their strengths and weaknesses in specific areas, not to take away their independence. A capacity assessment is about protecting an older adult, but also, about preserving their autonomy. Any psychologist doing capacity assessments is trained in balancing the right to independence and autonomy with the need for safety and support in certain situations. You might find it helpful to share resources like informative websites or brochures to foster understanding.

6. Address Fears to the Best of Your Ability

Many people fear losing control or being labeled "incompetent" when faced with the potential need for a capacity evaluation. Acknowledge these anxieties and emphasize that the assessment is collaborative, not punitive. Reassure them that the goal is to find the best support if they need it, not remove their autonomy.

7. Offer Choices and Control

Present different options for the assessment process. Suggest involving their doctor, choosing a familiar evaluator, or even having them initiate the conversation with their lawyer. Empower them to feel involved and in control.

8. Be Patient and Prepare for Resistance

This conversation might not go smoothly. Denial, anger, limited insight into safety issues, and resistance are common, and it’s important to know that if your loved one is indeed experiencing cognitive decline, they may not be aware of the changes in their capacity. Be patient, stay calm, and avoid getting defensive. Acknowledge their emotions and revisit the topic when they're ready, with the understanding that in certain situations, safety has to be the priority. For example, if your loved one has left the gas range on all night for the second time, or has suffered a fall because their home has become cluttered as a result of their cognitive change, or they have been the victim of a financial scam, those may be more urgent situations. You may need to balance giving them time to process your concerns, and also moving forward to schedule a capacity assessment in order to support their safety.

9. Remember, You're Not Alone

Seek support from other family members, friends, or healthcare professionals. Join online communities or support groups for caregivers if appropriate. Sharing your journey with others who understand can be immensely helpful, and you may learn strategies for navigating the situation that have worked for others.

10. Celebrate Small Victories

Acknowledge progress, no matter how small. A willingness to talk to their doctor, research resources, or even just acknowledging that a financial decision may have been off, or a situation may not have been safe – all these are steps forward.

Receive Support with a Mental Capacity Assessment in Los Angeles, CA

Talking about the need for a capacity assessment with an older adult or a vulnerable adult is never easy, but it can be crucial. If you are in need of consultation related to capacity assessment, or a capacity evaluation, please don’t hesitate to reach out. Dr. Reger is happy to offer support. Follow these simple steps to start the assessment process:

1. Contact (424) 262-1925 to schedule your appointment

2. Meet with a Los Angeles Psychologist for an evaluation

3. Start receiving the support your loved ones deserve!

OTHER SERVICES OFFERED BY DR. REGER IN LOS ANGELES, CA

Capacity assessments aren’t the only service I offer. I know that you may encounter more than one mental health concern at a time. This is why I’m happy to offer multiple neuropsychological and psychological assessments. Other assessments include cognitive and dementia testing, pre-surgical assessments, and med-legal evaluations. In addition to evaluations, I also provide individual therapy, counseling for older adults, and mental health consultations and presentations. Visit my blog for more helpful support today!

Before You Begin: Demystifying Psychological Testing

As a psychologist, I've tested many people for many reasons: psychodiagnostic testing, psychoeducational testing, neuropsychological testing, and capacity testing for older adults or people with disabilities.

I’ve observed that many people approach any type of psychological or neuropsychological testing with a mix of anxiety and intrigue. The word "test" conjures images of school exams and graded papers, leaving many wondering: "Will I be judged? Will I be labeled? What if I don't do well?"

But there is no need to be afraid of testing! Psychological and neuropsychological testing is not about judgment, but rather, about understanding. Think of it as a collaborative process to get answers and clarity, not a test you will either pass or fail. I’m not here to grade you; I’m here to gather data about what might be going on for you, rule out what’s not going on, and give you personalized recommendations about what to do after learning your test results.

Before you embark on the adventure that is psych testing, here is some essential knowledge:

1. Ditch the Pass/Fail Mindset:

There is no such thing as “failing” neuropsychological or psychological testing. Your responses aren't graded, they're interpreted in the context of your life, and in comparison to sound statistical data that helps us understand what your responses mean. This will inform us about your strengths, vulnerabilities, and what type of support might benefit you.

2. Tailor-Made, Not One-Size-Fits-All:

You won't be subjected to a monotonous battery of generic tests. Just like a chef wouldn't serve the same dish to every diner, your assessment will be personalized to your specific concerns and goals. This ensures we're not just ticking boxes, but gathering relevant information that speaks directly to your unique needs, and your testing will be worth the investment of your time, energy, and money.

3. Test Results Can Be a Powerful Compass:

You don’t exist in a vacuum. Your life experiences, your environment, and the choices you've made all play a crucial role in shaping who you are. We'll consider these factors alongside your test results, creating a comprehensive understanding that goes beyond a mere numerical score. 

4. Honesty is Your Superpower:

Remember, the more open and authentic you are throughout the interview and testing, the more accurate and helpful the results will be. It is so important to give your full, best effort on tests, and to be totally honest about your life, your opinion about yourself, and what you experience. This will give you results that you can truly use to move forward in the most effective way from testing.

5. You Hold the Reins:

You're not just a passive participant in this process. You have the right to know why you're being tested, what assessments will be used, and how the results will be interpreted. Feel free to ask questions, voice your concerns, and clarify any doubts. Your understanding and active participation are crucial for a successful journey.

6. Results are the Launchpad, Not the Finish Line:

The real magic happens when we move beyond the numbers and delve deeper. I will translate your test results into actionable steps, transforming them from abstract concepts (like executive functioning or processing speed) into concrete strategies for growth and well-being (like recommendations for developing an organization strategy, areas of focus for potential psychotherapy, or practical solutions for keeping track of daily tasks). Whether you're navigating life's challenges or aiming to achieve specific goals, your results become the springboard for your next steps.

Psychological testing isn't about labeling you or limiting your potential. It's about empowering you with self-awareness, equipping you with the tools to navigate life's complexities, and helping you thrive. So, approach it with curiosity and a willingness to learn. Embrace the opportunity to understand yourself better and be open to the results and recommendations you worked hard for!

Remember, you're not alone on this expedition. Psychological testing in Los Angeles, CA

I'm here to guide you every step of the way, answer your questions, and explain anything confusing or difficult to take in. Psych testing is an investment in yourself, and you deserve the answers and clarity that come from professional assessment, diagnosis, and recommendations. You can start the process and receive the support you deserve with Dr. Reger by following these simple steps:

1. Contact (424) 262-1925 to schedule your appointment

2. Meet with a Los Angeles Psychologist for an evaluation

3. Start investing in mental health!

Other Services Offered By Dr. Reger in Los Angeles, CA

I know that you may encounter more than one mental health concern at a time. This is why I’m happy to offer multiple neuropsychological and psychological assessments. Other assessments include cognitive and dementia testing, pre-surgical assessments, and med-legal evaluations. In addition to evaluations, I also provide individual therapy, counseling for older adults, and mental health consultations and presentations. Visit my blog for more helpful support today!

The Top 3 Mental Health Presentation Topics in Los Angeles, CA

One of the most enjoyable aspects of my work as a clinical psychologist is presenting.

I enjoy teaching about complex mental health topics in a way that non-psychologists understand and can use in everyday life.  Mental health stigma remains a major barrier for folks who might otherwise need or seek out support from a therapist.  Education about mental health can help reduce stigma and empower people to seek help and understand themselves or others.  Here are my most requested mental health presentation topics.

ADULT ADHD

ADHD has become a widely recognized issue only within the past couple of decades, so there are many adults with lifelong ADHD symptoms who have never been diagnosed. Unfortunately, these folks may have had very negative experiences as kids, being viewed as disruptive, bad, stupid, or spacey. This happens when parents and teachers either don’t know or don’t recognize the signs and symptoms of ADHD, and kids suffer as a result. For some, ADHD symptoms get better with age, and for others, they don’t. Menopause and other life changes can also worsen ADHD symptoms.  Many people don’t understand what ADHD looks like in adults, for example:

• Always running late

• Forgetting appointments or events

• Difficulty following through on tasks

• Disorganized spaces at work and home

I have given many presentations to various organizations about adult ADHD signs, symptoms, and ways to manage because there is a lot of interest now in understanding and coping with ADHD.  

TRAUMA AND PTSD

We live in a world where trauma is part of life. On a large scale, such as wars and natural disasters, and on an individual level, such as interpersonal violence or sudden losses, trauma is common. As a psychologist with a decade of experience working with veterans with PTSD, I am often asked to speak about trauma for different groups. Learning about the effects of trauma and ways to build resilience and coping skills is valuable for many different audiences, including:

• First responder organizations and leadership

• Workers’ compensation adjusters

• Attorneys working in personal injury, disability, or workers’ compensation

• Court and other legal staff exposed to details of crime regularly

• Parents and teachers who need to support kids exposed to trauma

• Nurses, physicians, and allied health staff working in emergency departments or other settings where trauma is common

STRESS MANAGEMENT

Most of us operate with some level of stress from day to day.  Los Angeles is a fast-paced city, the cost of living is rising everywhere, and many of us are worried about things happening in the world, locally and around the globe.  Although a little stress can be good for us because it motivates us, a lot of stress can cause a ripple effect of problems, such as:

• Sleep problems

• Difficulty concentrating

• Forgetfulness

• Low mood (which can lead to depression)

• Excess worry (which can become anxiety)

• Difficulty being present

• Not enjoying activities and people

• Physical ailments (stomachaches, headaches, muscle tension)

It’s clear that stress can have a far-reaching impact. Presenting on stress gives me the opportunity to educate about:

• How to recognize stress

• Self-care and life balance

• Seeking support when needed

Techniques to manage stress can include mindfulness, building gratitude and resilience, and setting healthy boundaries.  These are topics that I really enjoy teaching about, and that most people, especially in LA, can benefit from.

Begin Working With A Psychologist Speaker in Los Angeles, CA

There are many topics of interest to organizations in Los Angeles; these are just a few examples of great topics that can benefit a lot of people. If you are interested in having Dr. Reger speak to your group in person in Los Angeles County, Orange County, or anywhere virtually, please follow these simple steps:

1. Contact (424) 262-1925 to schedule your appointment

2. Meet with a Los Angeles psychologist speaker

3. Start learning & benefiting from mental health presentations!

Other Services Offered By Dr. Reger in Los Angeles, CA

Speaking arrangements aren’t the only service I offer. As a therapist, I know that you may encounter more than one mental health concern at a time. This is why I’m happy to offer multiple neuropsychological and psychological assessments in addition to the ADHD assessment. Other assessments include cognitive and dementia testing, pre-surgical assessments, and med-legal evaluations. In addition to evaluations, I also provide individual therapy and counseling for older adults.

The Impact of Culture on Psych Evaluations in Los Angeles, CA

Los Angeles is one of the most diverse cities in the world, with people from over 140 countries speaking over 200 languages. This diversity makes it especially important that psychologists conducting psych evals are culturally competent.  

CULTURE INFLUENCES THE WAY YOU PRESENT YOURSELF IN A PSYCH EVALUATION

Culture can have a significant impact on a psych evaluation in a number of ways. First, it can influence the way that people present their symptoms to the psychologist conducting their eval. For example:

• Some cultures place a high value on self-reliance and shame, which can lead people to minimize or deny their symptoms. 

• Other cultures may have different ways of expressing and experiencing mental distress, which can make it difficult for clinicians to make accurate diagnoses.  

• It is normal in many cultures not to share too much personal information, which may lead to underreporting in a psych eval.

• Many cultures are skeptical of Western medicine, or of mental health providers for reasons like religious beliefs or mental health stigma, which can change the way a person speaks to their psychologist in an evaluation.

It’s so important for a psychologist to consider the way culture may impact a patient’s comfort and willingness during a psychological evaluation.  A psychologist should work to build trust and rapport during an interview for a psych eval, to ensure the most accurate testing results.

CULTURE IMPACTS THE WAY TESTS USED IN PSYCH EVALUATIONS ARE DEVELOPED

Cultural variables can also influence the way that psych evaluation tools are developed and used. Here are a few examples: 

• Many psychological tests were originally normed on white, middle-class populations, which means that they may not be accurate for people from other cultural backgrounds or who did not have similar learning opportunities. 

• Some cultures may have different views on what constitutes mental illness, so the measures used may not line up with the patient’s views.

Thankfully, today there is more awareness in general of the cultural biases that can be built into psychological tests, and test creators are using more diverse normative groups to determine what an “average” score looks like on testing.

BOTH PATIENT AND PSYCHOLOGIST CULTURE COME INTO PLAY IN PSYCH EVALS

Identity variables can also influence the way that psychologists and other mental health professionals treat their patients.  Just as each patient has a cultural background that impacts their responses during testing, the psychologist has a cultural background that influences the work as well. Psychologists are trained in science and research methods as well as cultural competence, so they are often aware of common biases to watch out for, but we are all human.  A psych evaluation is designed to minimize cultural bias as much as possible, so that the results are accurate and answer the question that needs answering. Ideally, your psychologist is also aware of the biases they bring into the psych eval, and does their best to minimize the impact of those on the testing and interpretation of results.

COMMON CULTURAL CONSIDERATIONS FOR A PSYCH EVAL IN LOS ANGELES, CA

Because Los Angeles is large and diverse, there are a few unique cultural challenges that you may have to navigate if you’re seeking a psych evaluation in LA.  Here are some examples:

Language barriers:

Many people in Los Angeles speak a first language other than English, which can create a barrier to communication during psych evaluation, and may impact performance on certain neuropsychological tests. It’s very important to find a culturally competent psychologist who can consider the impact of culture on tests, and ensure that language factors don’t get in the way of accurate testing.

Cultural differences in symptom presentation:

People from different cultures may experience and express mental distress in different ways. For example, some cultures have higher rates of “somatic” symptoms; meaning that emotional distress shows up in physical ways like headaches or stomach problems. A culturally competent neuropsychologist will take these types of variables into consideration.

Cultural differences in attitudes towards mental illness:

Some cultures may have more negative attitudes towards mental illness, which can lead to people delaying or avoiding seeking help. Additionally, some cultures may have different beliefs about the causes of mental illness, which can impact the way that they seek treatment.

In Los Angeles and elsewhere, culture can come from many factors. 

Obviously, country of origin and ethnic identity are cultural variables for many people, but other aspects of identity can affect testing as well.  Other important identity variables include age, sex, gender identity, sexual orientation, disability status, immigrant status, veteran status, and more.  

Ideally, you should seek a psychologist who is culturally competent, which means that they have the knowledge, skills, and awareness to provide effective mental health services to people from different cultural backgrounds. Inclusive and respectful practices will put you at ease in a psych evaluation. This will give you the best odds of getting an accurate and meaningful psych evaluation.

Receive a Psychological Evaluation in Los Angeles, CA

Getting a psychological evaluation from a culturally competent psychologist will ensure you get the most from this experience. Dr. Reger would be happy to offer support with psychological evals and other forms of support from her Los Angeles, CA-based practice. Start testing by following these simple steps:

1. Contact (424) 262-1925 to schedule your appointment

2. Meet with a Los Angeles Psychologist for an evaluation

3. Start receiving the support your loved one deserves

OTHER COUNSELING SERVICES OFFERED BY DR. REGER IN LOS ANGELES, CA

I know that you may encounter more than one mental health concern at a time. This is why I’m happy to offer multiple neuropsychological and psychological assessments in addition to the ADHD assessment. Other assessments include cognitive and dementia testing, pre-surgical assessments, and med-legal evaluations. In addition to evaluations, I also provide individual therapy, counseling for older adults, and mental health consultations and presentations.