The Psychodynamic Assessment Process


My assessment process is a comprehensive one. It includes taking a history of gifted development—exceptional achievements as well as underachievements and failures—and a complete personal, social, educational, family, and medical history. The assessment process also involves a review of all previous therapies, testing results, and psychological work-ups. All parts of a gifted individual’s present and past personal experience are separately explored in depth. Understanding how these experiences interact with each other helps establish a preliminary psychodynamic formulation. This formulation is a brief statement that describes how a patient’s circumstances as well as unresolved developmental conflicts may be responsible for their symptoms, complaints, and problems.

In the case of a gifted individual, the formulation can be used as a psychological framework for understanding how normal and gifted growth have complemented or conflicted with one another. It establishes each patient’s vulnerabilities and strengths, and it clarifies how unresolved feelings about early childhood experiences may have caused persistent conscious or unconscious conflicts that can influence current thinking, feeling, and behavior. In doing so, the formulation helps in understanding the patient’s central dynamic conflicts (Perry, Cooper, & Michels, 1987). In my patients, the majority of these conflicts were about the inner experience of giftedness, not about family, peers, or school and work.

The elements of a formulation become the building blocks for a comprehensive treatment plan. As the psychotherapy is set in motion, the formulation provides a consistent focus for the treatment, but it remains flexible—expanding and contracting as the patient and therapist get to know each other. Most importantly, the formulation does not simply reduce the meaning of a gifted person’s life to a few psychological conflicts. Moreover, the formulation can be an important diagnostic tool when used to understand gifted/learning-disabled individuals and gifted polymaths with Attention Deficit/Hyperactivity Disorder (ADHD).


Gifted/Learning-Disabled Individuals

Distinguishing between a twice-exceptional individual—a gifted person with a true neurologically based learning disability—from a gifted person with a “pseudo learning disability” can be difficult. Some gifted children, especially those who are exceptionally or profoundly gifted, may believe that because of their quirky intelligence their peculiar style of learning is actually a disability rather than an asset. Others may impose restrictions on their ability to learn as a way of resolving internal or interpersonal conflicts about their extreme giftedness (Grobman, 2006). These self-imposed deficits may mimic a true neurologically based learning disability.


The Gifted Polymath

A careful assessment and formulation can distinguish a gifted polymath in crisis from a gifted person with ADHD. A true polymath—an individual exceptionally gifted in many different domains—can be highly accomplished in many areas simultaneously. Under normal circumstances, gifted polymaths are natural and successful multitaskers. Under extreme stress, their ability to concentrate may break down. The resultant loss of focus, distractibility, and eccentric behavior may mimic ADHD.