Mary V. Cunningham, Ph.D.

Licensed Psychologist
Assessment, Therapy
marry cunningham
 

My practice is divided between therapy and assessment. I enjoy each and feel privileged to be able to do both – each enriches the other. (See Therapy Practice and Psychological Assessment Practice sections below.) I am a licensed psychologist.

Professional Background
I have a B.S. in Biology from the University of Santa Clara, an M.P.A. from George Washington University. My Ph.D. is from the University of Texas.

Prior professional history includes teaching as adjunct faculty at the University of Texas in the Department of Educational Psychology. Before moving to Austin in 1983, I lived in Washington, D.C. where I was an LBJ Congressional intern, worked on several political campaigns, and for the Overseas Private Investment Corporation — putting together developmentally-appropriate joint ventures between U.S. businesses and counterparts in developing countries. I’ve done lots of event planning, was a resident counselor at a girls’ boarding school, and wrote a “Neighborhood” column for the Austin American Statesman for two years. I like to write. I was awarded an Evaluation Research Fellowship from the Hogg Foundation for Mental Health. I founded The National Organization to Treat A-T, a public charity that funds treatment research for a rare childhood disease that my son had. My greatest privilege has been to be Mom to my three children and grandparent to their children.

Published research includes a study on the cost-effectiveness of residential placement of emotionally disturbed youth by Texas school districts. This research ultimately changed policy employed by many Texas local school districts to essentially rid their districts of students with severe emotional disturbance — these districts placed students with severe emotional disturbance in very expensive private resident placements which had no efficacy (they didn’t work and cost hundreds of thousands of dollars). I was principal researcher on a number of other outcome studies, including the Family Preservation Program (funded by the Hogg Foundation); Austin-Travis County MHMR (funded by the ARC of Texas), and the Austin Children’s Museum Junior Volunteer Program, which addressed the feasibility of designing museum programs as interventions for at-risk youth. My dissertation research was interdisciplinary in psychology and pharmacology – investigating the clinical effects of trace alcohols (present, but not labeled, in many processed foods,) on children’s attentional abilities.

My practice is different from many others, in that I do not file insurance for clients. I do provide statements, which clients can file on their own. Running my practice this way reduces the amount of paperwork, helps me keep my rates down, and allows more time for keeping up with the psychological literature, as well as books relevant to my practice and to individual clients.

Therapy Practice
Most of my therapy clients are adults or adolescents, although I also see school-aged children and their families.

I specialize in treating relationship issues, anxiety, depression, certain personality disorders and traits, families, parents, adult child issues, adjustment to loss, divorce, parenthood and crisis, adjustment to medical issues and bad experiences in hospitals, and trauma – including assault, abuse, rape, and loss by death, drowning, fire and abandonment.

I draw from a number of therapeutic approaches including cognitive-behavioral, psychodynamic, interpersonal, family systems and structural family therapy. I often make recommendations to clients for relevant outside reading.

I may use EMDR (Eye Movement Desensitization and Reprocessing) to address “stuck” cognitive beliefs or the effects of trauma. EMDR is one of two therapies approved by the World Health Organization for treatment of PTSD. EMDR is effective in treating PTSD for both “big T” trauma (such as assault, loss, abuse, neglect, etc.) and “little t” trauma (such as lifelong criticism from a parent, late diagnosis of learning differences and all the ramifications that occurred in school, being raised by parents who wanted a blue ribbon child, etc.). These aren’t actually “little” but this distinction helps make the different applications of EMDR understandable.

In both “big T” and “little t” trauma, we tend to develop core cognitive beliefs that, when triggered, may result in reactive internal and/or external responses. “Big T” trauma is more obvious – a veteran of the Iraqi war is walking down 6th Street with his girlfriend on a Saturday night and a car backfires very near to them. He knocks his girlfriend out of the way and drops to the ground. His heart is pounding and his life is in danger. He is having the same response he had 8 years ago when the jeep ahead of him in the desert hit a buried IED and blew up.

As just one example of “little t” trauma………

Back in the summer of 1997 ………..….. nine year-old Eric is scheduled to go to Dad’s on Friday night because it is the 5th weekend of the month and Dad has 1st, 3rd as well as 5th weekends, when a 5th weekend occurs. Eric waits on the front porch, as the sun sets and it is getting dark. It is getting cold, as fall is setting in. Mom and step-Dad left earlier because it’s ‘date night’ and they are going to a movie. It’s better this way because Mom and Dad usually argue in front of their son and this is very upsetting to Eric. Dad forgets – this is not the first time. Eric has a phone. He digs through his backpack and finds it. Mom doesn’t answer; Dad doesn’t answer. Eric calls Mom 20x. He texts a pal, just to talk to someone. His friend texts back, and it becomes clear that his friend is at a birthday party of one of their mutual friends. Eric feels sad and alone and not a part of anything, and he is getting scared. Eric develops the belief “I don’t matter” – a belief that gets stuck in his brain, and is associated with feelings of sadness and anxiety, with getting cold, and with the weather change.

Thirty-plus years later, it is going to be the first Thanksgiving since Eric’s divorce and his ex-wife picks up their kids for Thanksgiving break. His kids are totally OK going to Mom’s. He thought he would feel relief at having a few days to himself because he has the kids most of the time – more than she does. But on Thursday morning, with no plans for Thanksgiving dinner and no one to take care of, Eric feels exponential sadness and totally alone. His feelings and associated sensations trigger an all-body “I don’t matter” and his heart literally hurts. He can barely move.

The holiday season is everywhere and through December, Eric acts like he doesn’t matter. This is not intentional and does not feel controllable. Logic doesn’t help – Eric knows he matters intellectually. But he is irritable with his kids and at work, and can’t muster up the where-with-all to get ready for the holidays, which is somewhat unusual for him. He finds himself snapping at the kids, sometimes yelling, and can’t stand it when the kids say anything positive about their Mom. When his daughter asks him for wrapping paper to wrap the parent-gift she made at school – for Mom — he snaps “Why does your Mom get the gift? Don’t you think that might hurt my feelings?” His daughter bursts into tears and throws the gift in the trash. Eric knows he needs some help.

I also hold in mind, and incorporate, as needed, applications from attachment theory, the Myers-Briggs, assertiveness training, systems theory and theories of identity development including Erikson. I also focus on strengths — on what works. I do not provide treatment for alcohol or drug abuse, or for eating disorders.

While we do not wallow in the adult client’s childhood history, I do believe it is important to identify early/old patterns of relating and problem solving that may be getting in the way as an adult. Presumably, as children and adolescents, we developed patterns of responding (to conflict, to others, to disappointment, to stress) that made sense at that time. But for many of us, some of these patterns and associated cognitive beliefs may not make sense in our current relationships, and in fact, may underlie our anxiety, depression, avoidance, irritability, etc.

Neuropsychological/Psychological Assessment
What is the difference between testing and assessment?
Testing (e.g., an intelligence test, personality test, or mental health test) occurs as part of the process of assessment. Assessment is a complex process whereby a broad range of information, including the results of neuropsychological and psychological tests, as well as the individual’s approach to problem solving, is integrated into a meaningful understanding of a particular person.

In addition to standardized tests, assessment usually includes interview, record review, demographic information, medical information, personal history, and where appropriate and feasible, gathering information from others (with permission) about the client via interview or checklists. Almost without exception, children are observed by me in one or more natural envionments (this is before a child meets me, so they don’t feel observed.)

What is the difference between neuropsychological and psychological assessment?
There is a large degree of overlap between neuropsychological and psychological assessment, particularly in private practice settings.

In Texas as in most states, there is only one licensure for the practice of psychology – Licensed Psychologist. There is no specific licensure for neuropsychologist, child psychologist, counseling psychologist, etc. The Ethics code requires that psychologists represent themselves in a straight-forward and transparent way – essential to trust and enhancing our clients’ autonomy by promoting more fully informed and autonomous choices. The practicing psychologist is to represent him or herself as a “licensed psychologist with a practice in forensics”, for example. Accordingly, I am a licensed psychologist with a practice in neuropsychological and psychological assessment.

Neuropsychology is the study of brain-behavior relationships. By testing a range of cognitive abilities and examining patterns of strengths and weakness, neuropsychological assessment can make inferences about underlying brain function. Psychologists providing neuropsychological assessment work in a range of settings, from rehab hospitals to Veterans’ facilities to private practice settings Neuropsychological testing is also an important tool for examining the effects of toxic substances and medical conditions on brain functioning. Psychological assessment is often indistinguishable from neuropsychological testing, but may also include, as warranted by the referral question, assessment of other equally important areas — including emotional, social, family, and educational functioning.

The Scientist-Practitioner Model
By definition, all Ph.D. psychologists are trained according to the scientist-practitioner model. One of psychology’s most unique and important characteristics is its coupling of research and practice, which stimulates continual advancement of both. Some psychologists work in both fields. Others choose science or practice, but the training is entrenched.

Those who specialize in research address a wide range of psychological phenomena, including cognitive processes (e.g. thinking, perception, memory), learning, personality formation, family dynamics, and biological bases of behavior, as well as fundamental things about human and animal behavior. Good research addresses these phenomena through well-designed studies.

Specialists in practice are trained to evaluate and apply research findings in helping solve problems and promoting healthy development. Psychologists are trained to critically evaluate research findings, and to keep abreast of current research through reading, peer consultation, and continuing education.

My Philosophy of Assessment
My philosophy of assessment considers the whole person, from sensory-motor to cognitive functioning, to interpersonal and emotional functioning, as needed; to gather data from multiple measures across multiple environments before reaching conclusions; and to provide comprehensive feedback including a written report, face-to-face feedback, assessment of strengths, opportunity for discussion, and recommendations.

The assessment process, itself, is an intervention. The client begins to understand how s/he is “wired”, how to use this information for success. Often, assessment results help the client achieve a more accurate understanding of prior behavior and performance.

In addition to the above, my assessment practice is different in two ways that are especially important for people who are seeking an assessment:

  1. Rather than scheduling full-day or multi-hour assessment sessions, I schedule assessments across 3-4 separate appointments, from 2 to 4 hours each. While assessments are interesting and can be fun, I believe the most valid results are obtained by limiting sessions to a half-day at a time, at the most. Scheduling over several sessions also allows for a sense of trust to develop, which impacts disclosure. For younger children, I may use 1-2 hour sessions, depending on attention span.
  2.  Also different from many others, I personally conduct all interviews, observations and administer and interpret all tests. Beware that a psychologist can use their letterhead and sign a report without actually conducting the assessment — instead using “supervised” students, interns, paraprofessionals or Masters-level diagnosticians. There are no standards for these individuals.

Reports and feedback focus on diagnostics and real-world interventions. Recommendations may include treatment, legal rights to salient academic accommodations (e.g., as appropriate, extended time, copies of instructor notes, reduced load, testing in distraction-free environment, etc.) and/or assistive technologies including use of a computer, texts on MP3, voice-to-text apps, accessible PDF apps, etc.

I have a sizeable referral network of schools, tutors, occupational, physical & speech therapists; psychotherapists; psychiatrists. I often provide two reports – a comprehensive one for the individual, and an edited version to be used in educational or work settings. (The edited version in no way compromises findings but may not include personal information not relevant to the school or work.)

Areas of Assessment:
I conduct assessments in the areas below as well as for Autism (including high functioning), Bipolar and depressive disorders, Anxiety disorders including PTSD and dissociative disorders. I also conduct assessments for children and adults who have been difficult-to-diagnose under a medical model; for FAA review of a disciplined pilot; to determine the best rehab placement for a parolee with learning disabilities; of older children adopted from other countries; and of neuro-diverse individuals including children with epilepsy and history of prematurity.

Academic problems: cognitive processing, reading issues, dyslexia, calculation, math calculation, math reasoning, written expression, handwriting, learning but not testing well.

Dyslexia: there are subtypes of dyslexia – dysphonetic, orthographic and mixed. Knowing subtype is extremely helpful for choosing treatment.
Dysgraphia: handwriting problems can be due to hand weakness, but they can also be due to problems with trunk weakness, weakness in the shoulder girdle, etc. I screen for these potential problem areas and refer to appropriate professionals.

Cognitive processing: executive functioning, fluid reasoning, verbal and nonverbal conceptual ability, auditory and visual processing, working/short-term/long-term memory, processing speed.

Intelligence: There are many intelligence batteries. Choosing the right one is critical. For example, if one’s handwriting is poor, reflecting visual-motor problems, nonverbal intelligence assessment should not require visual-motor abilities. Or, if one has expressive language problems, verbal IQ should not be measured with tests that require extensive verbal expression. There are verbal IQ tests that are equally reliable and valid measures that require less verbal output. Or, if one has ADHD, intelligence tests with a focus on speeded performance will likely underestimate an individual’s IQ.

ADHD: ADHD must be differentiated from situational stressors, anxiety, other executive functioning problems, auditory processing disorder, sensory processing, language &/or learning disabilities.

Executive functioning: neuropsychological subtypes of attention, working memory, use of feedback, auditory and visual selective attention, cognitive flexibility, complex E.F.

Attachment and relationship issues: relational functioning – adults, international/domestic adoptions, reunifications, family functioning (step, blended), aging parent-adult child relationships.

Assessment methods
While certain aspects are fairly standard, each assessment is individually designed. As assessment progresses, I remain flexible to new information that emerges. Methods include standardized tests, a complete history, interviews, self-report measures, projective tests, and record review (e.g. previous testing, medical).

Emotional assessment includes clinical interviews, standardized self-reports, and projective measures as well as a cognitive battery. Interestingly, it is not uncommon for cognitive processing problems or differences to contribute heavily to interpersonal issues, relationship and workplace distress, and communication problems.

All selected tests or aggregate measures have reliability above .80 and usually above .90.

Where do assessment referrals come from?
Clients are referred from several sources — relatives, friends and colleagues of former clients; neurologists, psychiatrists, family practitioners, internists, pediatricians; psychotherapists, speech/ language therapists; public and private schools and universities; the internet. Many adults self-refer.