To learn more about Psychological Assessments, click here.
To request an appointment for a psychological evaluation with our practice, click here.
An Interview with Psychologist Priyanka Shokeen
Dr. Priyanka Shokeen is the Clinical Director of the Psychology and Psychotherapy Department at Seattle Anxiety Specialists. She manages the diagnostic evaluations and assessments sector of our practice and has extensive experience in working with trauma and personality disorders.
Jennifer Ghahari: Hey, thanks for joining us today for this installment of “The Seattle Psychiatrist” Interview Series. I'm Dr. Jennifer Ghahari, Research Director at Seattle Anxiety Specialists. I'd like to welcome with us, psychologist, Priyanka Shokeen. Priyanka is the Clinical Director of the Psychology and Psychotherapy Department at Seattle Anxiety Specialists.
Her clinical work is focused on providing comprehensive psychological evaluations, primarily for diagnostic clarification. Before joining our practice, Priyanka was the clinical fellow at Columbia University. Can you tell our listeners a bit about yourself?
Priyanka Shokeen: Oh, yeah. It's always difficult to think about where to start on a question like that, especially after the introduction you gave me. So, thank you for that.
Jennifer Ghahari: Sure.
Priyanka Shokeen: Well, let's see, I've been studying Psychology since the age of 16, and it never fails to amaze me each year as to how little I know, for the fact that I'm still interested in learning more. I'm originally from India, and for the better part of the last decade I was working in New York City.
I'm somebody who's always been interested in advocacy, and throughout my life that's looked different depending on where I am personally and geographically. Then, I'm an avid reader. I don't get as much time to read anymore, but that's a lifelong habit I plan on keep trying to be better at. So, that's a bit about me.
Jennifer Ghahari: What types of books do you read?
Priyanka Shokeen: Oh, mostly fiction. I used to read a lot more theoretical texts, old texts, based in Psychology, back in grad school, even starting as early as undergrad, but right now I think fiction is a good way to detach from work.
Jennifer Ghahari: Yeah. Nice. So, what is it that got you interested in becoming a therapist?
Priyanka Shokeen: Funny enough, fiction.
Jennifer Ghahari: Really?
Priyanka Shokeen: Yeah. This is why I like fiction, the ability to engage with it is so transformative in that it allows you to really flex your imagination. It teaches you to how to imagine the mind of a character, how to experience strong emotions in a safe enough manner.
So, I initially thought this interest would translate into a career in literature and writing. And that was a quick lesson in the fact that hobbies are not necessarily things you're good at, and they probably shouldn't be. It's a good thing that hobbies are not things you're good at.
So, I kept following my interest, not just in the experience of emotions, but also with regards to my curiosity in terms of the confidence that make people behave in the way they do. And those include race and gender and class and culture, apart from, say, biology and family environments. So, I followed a story.
Jennifer Ghahari: Great. I'm going to put you on the spot. Who is your favorite fictional character?
Priyanka Shokeen: Ooh. You know what, I'm not sure if this is a popular book, but it is definitely my most quoted book. It's this book called Shantaram. It's about this convict who escapes from Australia and reaches Mumbai, I think back in the '80s. And it's him getting involved with the underworld there. So, the main character for that is my favorite fictional character.
Jennifer Ghahari: Awesome. Great.
Priyanka Shokeen: Yeah.
Jennifer Ghahari: Thanks for sharing. So, in clinical practice, are there any areas or disorders that you specialize in treating?
Priyanka Shokeen: Well, let's put it this way, my professional areas of interests are the areas I continue to build specialization in. So, with that in mind, I have a lot of experience with personality disorders and trauma, and that's where my primary interest and work lies. I, in the past, enjoyed doing group work a lot. I've run inpatient groups, I've run outpatient groups, I've run groups in counseling centers. I think they have a lot more power than we give group therapy credit for.
Then, like you mentioned in my introduction, I do specialize in differential diagnosis, which again, the personality disorders or the trauma work, for me, remains an area of knowledge that I keep growing in.
Jennifer Ghahari: Great. For our listeners, can you explain a bit about personality disorders, maybe which are the most common, just a bit about them?
Priyanka Shokeen: Yeah, I think if we were to look at personalities as somebody's unique signature in that it is their way of relating to themselves, to other people and to the world around them, that's what we call personality, ideally. Personality disorder is when your characteristic ways of being either with yourself or with people or with the world, they become problematic, they start causing you harm or they start causing people around you harm.
Jennifer Ghahari: Okay.
Priyanka Shokeen: So, in the past, personality disorders have been, according to diagnosis, certain axes. So, the kinds that we see a lot, or that gets talked about a lot, even though it's not that common, is "borderline personality disorder", because that is one of the hardest to deal with. It comes with a lot of emotional dysregulation, a lot of identity instability, risk factors.
But just as common is, more common than BPD, is "avoidant personality disorder" (AVPD) or OCPD, which is different from OCD. So, OCPD is "obsessive compulsive personality disorder", different from "obsessive compulsive disorder".
Jennifer Ghahari: Great. So, if anybody thinks that they may have one of these, reaching out to someone you would be good, to talk about and possibly get an evaluation-
Priyanka Shokeen: Absolutely.
Jennifer Ghahari: ... as an example. Great.
Priyanka Shokeen: I think one of the first points of entry into getting help is if you have started noticing that your characteristic ways of acting are not bringing you what you want or that people around you have started noticing something before you have. So, they're giving you consistent feedback about certain ways in which you act, say, for people who have really explosive anger.
Jennifer Ghahari: Okay.
Priyanka Shokeen: People around them are the first to notice that, "Hey, I think you need to get help." So, yeah, absolutely, I would be very happy to help. And if I feel that I'm not the most competent person to help, I would absolutely provide a good referral.
Jennifer Ghahari: Great. So, aside from something like explosive anger that people are telling you may have a problem with, what are some other signs or symptoms that people should be on the lookout for?
Priyanka Shokeen: Well, it depends on different things. It depends on your priorities. So, let's say if you have avoidant personality disorder, the characteristics of life where we measure functionality, where you're functioning well, is what is generally agreed upon as health. Different degrees is, self-care, it is your relationships, it is occupation, student, whatever job you're doing.
So, if you start noticing something going wrong in either of these areas, that's important for you to know. So, if you, as I was mentioning with avoiding personality disorder, you do want to form relationships, but just the task of it, the fear of it is so much you avoid them to the extent that it starts affecting you, that you end up being self-isolated. And again, the last three years have taught us, self-isolation is especially punishing.
So, that can be one of the signs to look out for. For "narcissistic personality disorder", it's very hard. Self-reflection is not the first criteria for it. So, people around can start saying, "Hey, you take a front to seemingly small things." They feel very personal to you. And as somebody who's going through it, you may think, initially, that they're saying it to hurt you or they don't value you, but depending on the number of contexts you're getting that feedback in, it becomes harder and harder to deny.
So, people may come in for complaints of depression or anxiety, which, once resolved, you might realize, once those symptoms are done, there are still lingering symptoms in these areas of occupational functioning, your relationships, your self-care. And that's generally when personality disorders initially start getting addressed, unless there's something as dramatic or as explosive as, say, BPD.
Jennifer Ghahari: Wow. Great. Thank you. That's really helpful. So, let's say someone contacts you and makes an appointment and goes to see you for X, Y, or Z, how can you explain your treatment approach? What can someone expect to experience if they're going to therapy with you?
Priyanka Shokeen: Okay. So, I'm going to try and break it down into my overall clinical approach, and then say what an initial couple of sessions with me can look like and what the purpose of asking certain questions is. My approach to clinical work is largely integrative. Most therapists out there, you'll ask, that's what they end up following, because we've been taught so many things and we know how to draw on different things, depending on what the client is presenting with.
With regards to case conceptualization, which is an overarching view of what I think the nature of someone's presenting problem is, I have a psychodynamic approach. So, I use my training in, say, diagnostic tools in psychological tests, and I put a focus on developmental history. I keep an eye out for differential diagnosis. I try and understand, what is the larger family context or the cultural context in which someone's presenting complaints operate?
So, the psychodynamic framework, it allows me to start building a coherent narrative of someone's life with the data that I've gathered from different perspectives. That said, I also use a lot of CBT and DBT techniques in session, depending upon, again, what the presenting problem is and what the client needs. So, that's more my approach, overall, throughout the course of treatment.
With initial sessions, intake with me can take anywhere from two to three sessions. Those three sessions are a good place for me to decide if I have the clinical competence to provide you the best care with what you're coming to me with, and that's a good way for you to assess if you would want to, keep coming to me, if you like my style, if you feel comfortable talking to me, even if not about everything, just initially.
So, the goal of that initial exploration is to get an understanding of what the client is coming to therapy for, they're presenting complaints, the history of that complaint, and then the circumstances in which the client is, as well as their own personal characteristic that keep those situations that they have a problem with or those symptoms operational.
I say this often enough to most all my clients that you're not reacting in a vacuum. There's two parts to this. There's the internal and there's the external. So, as part of this initial exploration, there's a lot of attention that I pay to developmental history, so trying to gather data about someone's attachment patterns.
I try to attend to the mention of key figures or key moments in somebody's life, specifically in early development, but also crucial details or crucial figures clients either forget to talk about or avoid talking about, because for me, that's the beginning of trying to understand somebody's presentation.
So, in this manner, guided by this dynamic framework, the goal is to start bringing what feels nonintegrated parts of the client self in order to provide them with greater access to their own internal world.
Jennifer Ghahari: Great. So, talking about all these different diagnoses that people may have, and you run our practice’s psychological evaluation program. Can you explain what that is that you're running and what people can expect to experience if they reach out for an evaluation?
Priyanka Shokeen: So, generally speaking, psychological evaluation or assessment, it's an evidence-based approach which makes use of information from a number of different sources to arrive at a holistic picture of how a person's mind functions and the ways in which they experience the world.
So, psychological evaluation or assessment, it makes use of clinical interviews, it makes use of behavioral observations, and then standardized psychological tests to understand a more comprehensive profile of what your strengths and weaknesses are, and what are the next steps for your mental health journey. I think you asked me another question as part of this, but I seem to have forgotten.
Jennifer Ghahari: No, that's okay. So, if I'm going for a test, what can I expect to do? Am I going to fill out one of those old-time Scantron sheets where you pick A, B, C or D? Is it going to be, do people actually take the Rorschach tests, things like that? What do you do?
Priyanka Shokeen: So, yes to the Rorschach, absolutely yes to the Rorschach. It's one of my favorite instruments to use. When used well and in a standardized setting, it can be one of the biggest sources of information about somebody's personality. But let's, again, start from the beginning.
So, an assessment would involve either question coming from the client, their loved one, their psychiatrist, their therapist. They don't need to be in therapy with me for us to go through evaluation. So, the process begins with, what is the referral question? What are you looking to get assessed? Once we've had a referral question, we'll set you up.
The first point of contact is a clinical interview. And the purpose of this interview is to gather detailed information about what is your current functioning and how you were functioning at a previous time. After the clinical interview is done, comes the process of the assessment. So, yes, there are forms to fill out, there are Rorschachs to do, but these are all different standardized tests.
And they can be part of a whole battery of tests. So, it might just be you end up doing one big test, like the Rorschach or the MMPI, which is also a personality measure, or you end up doing a bunch of different tests, like we do with our ADHD assessment, to understand different aspects of the functioning and how best to answer the referring question.
Once testing is done, we score it, we explain the results to you, we compile everything into a detailed report. And the final part of the assessment is a debriefing session where we go over with the client about what we found, what test was meant to do what… And it carries actionable recommendations on what to do with this information that we've learned, where to go next.
So, a lot of the times, this assessment in and off itself is enough to answer the referral questions. Sometimes we might feel we haven't gathered enough information or you need some other kind of assessment that we're not yet providing. And in that case, we make those referrals in addition to the recommendations that we're providing.
Jennifer Ghahari: Great. So, I think we're in a society where people want instant gratification, so I'm presuming that this whole process is not an instant thing. Like you said, there's a debriefing and a full report. In general, let's say I came to you for some tests and we did the test today, when could I expect to get my results and the debriefing and all that? How long does it usually take?
Priyanka Shokeen: Yeah, again, I wish I had more of a straightforward answer to that, but it really does depend on the referral question. On average, you can think of budgeting anywhere between five to 10 hours for the entire assessment process. That includes the clinical interview and the debriefing session. So, the hours-
Jennifer Ghahari: Is that at one time?
Priyanka Shokeen: I'm sorry?
Jennifer Ghahari: It all happens...
Priyanka Shokeen: Oh, my God, I would never. I think it would defeat the purpose because exhaustion and fatigue are a thing that affect performance. No, it definitely happens over, again, depending on the test battery. So, let's say a particular test is supposed to take anywhere between two to three hours. For a particular client it ends up taking to four hours. So, that would be one. But that's all we're doing that day.
Then, the rest of the things that we need to get done, we'll do it over 2-3 hour sessions over the next couple of days. So, definitely not putting anyone through that in one go.
Jennifer Ghahari: They don't have to bring pajamas or a pillow or anything?
Priyanka Shokeen: If it comes to that, we will provide the sleeping bags. (laughing) But you also mentioned when you can get the results? So, oftentimes it takes a lot of hours to score the tests in a particular way, to consult norms, to make sure you're doing the right thing, and then compiling them into a report. So, if you think assessment is time-taking on the administration, and believe me, it's double that on the report end.
So, I generally give anywhere between three to four weeks from the last testing session for me to compile reports because I don't want to do it in a way that misses out on any detail or skims on any part of the report. So, 3-4 weeks for you to get the report, and that's when we'll have the debriefing session and we'll go over the report together.
Jennifer Ghahari: Perfect. And I think what sounds really nice about this process is, there are surveys online that people could take for this or that, and you hit a button and that's instant gratification, especially put in your email address, for so many websites.
But with this, like you said, it's really customized. You're a trained psychologist who, again, knows what you're doing to be able to look at the nuances of what a specific answer means, especially in conjunction with other tests and other answers.
So, I think the fact that we can provide these detailed reports for people, even though it is slightly more time consuming, the quality of what you walk away with is so much better than more of the quicker, instant gratification type of things that people can do on their own. So, I think this is great what you're doing.
Priyanka Shokeen: I'm glad. I don't begrudge people on what makes them reach out for the instant gratification of doing an online quiz. It is the most accessible thing. Going through an assessment requires a lot of time and resource, commitment as well, but it isn't just about our report being most tailored to your question, it's that it's accurate. The reason why I say that is oftentimes people can get versions of tests online, but they don't know how to read the report.
You can assign a numerical value, but people might not know how to read that numerical value. Does that numerical value mean a different thing for a clinical population versus research subjects? And psychologists are the only profession that are trained to do this kind of testing. Not to give that example, but do you remember when this part of the previous president's cognitive test, some part of it got leaked online and people thought it was very easy.
It was one question in a neuropsych battery, and people were making assumptions about easy or difficult, but that had nothing to do with what that test represents. So, misinformation is vast and very easily accessible also.
Jennifer Ghahari: That's a great point. And I think too, if people walk away with not really having the right diagnoses, they're potentially going to take a wrong path then, which would hinder their mental health recovery even longer. If I am actually presenting with diagnosis B, but I think I have diagnosis A, I might follow the wrong path and, actually, potentially get worse.
So, by going through something this, you're able to get the treatment that you need or at least the guidance that you need in order to have a better recovery and get the outcome that you're looking for, right?
Priyanka Shokeen: Yeah, absolutely. And the thing with diagnosis is also, there's a lot of emotion attached to it. It can be hard to get a particular diagnosis because of how it's perceived. For some people it can be very relieving to get a diagnosis. For most people, the diagnostic categories don't represent a 100% of what they're experiencing. So, even the nuance of why we're saying this is a diagnosis versus that, even that is an important part of treatment.
Jennifer Ghahari: Great. Before our last question, I'm going to change directions a bit here. What's your favorite part of Seattle? It could be anything.
Priyanka Shokeen: Oh, my God. It's the proximity to my niece. She just turned two, and, oh, my God. I used to think it was the summers here, which also, beautiful, but tiny, cute baby learning words…
Jennifer Ghahari: Nice answer. Do you have any final words of advice or is there anything else you'd to share with our listeners?
Priyanka Shokeen: Oh, I hope somebody, whoever's listening, to whatever extent, that they can derive meaning out of it. The idea of comparison is so extremely prevalent, be it you comparing yourselves to coworkers, to family members, to people on social media. It's very easy to think that somehow everybody else can do things that somehow are very difficult for you or they're getting to places that you're not getting to.
They look a certain way, they do a certain thing. And I think the weight of those comparisons can really run you ragged. Or the thing that I find a lot of clients doing and have over the past several years of working has been when people in extremely hard conditions finally seek help, and it is very hard for them to give themselves the space to be tired, to be exhausted, because somehow everybody else is going through it too, how come they get rest?
Or somehow other people have it more difficult than them. And I always tell them, we're not playing the “Misery Olympics”. So, we don't know what goes into making somebody function. We don't know if what we're looking at is the real picture. We don't know the kinds of support they have or the resources they have, the protective factors, or on the flip side, we don't know what they're hiding or how close they are to a break.
So, it's okay to look at those things and think of them as either places you'd want to be or things you'd want to do, but that does not need to be a determinant in how you should feel about yourself when you should seek help, when you should seek rest. So, I hope some somebody listening can find some meaning in it.
Jennifer Ghahari: Well, I've found meaning in it, so thank you.
Priyanka Shokeen: I'm glad.
Jennifer Ghahari: Now, this has been great. Thank you so much, Priyanka, Dr. Shokeen, for joining us today for this installment of “The Seattle Psychiatrist” Interview Series. And if anybody would to reach out to Dr. Shokeen or perhaps schedule an appointment at some time or some type of evaluation, you're welcome to do so by contacting info@seattleanxiety.com, and we'll get back to you shortly. Again, Priyanka, thank you so much, and we wish you all the best.
Priyanka Shokeen: Thank you so much. Have a good one.
Jennifer Ghahari: You too.
Editor: Jennifer (Ghahari) Smith, Ph.D.