Beyond the Diagnosis

The Prospect Hill Model
Dr. Lindsy WagnerCo-Founder · Prospect Hill Wellness

One symptom.
Many possible causes.

Clients often arrive with overlapping diagnoses and failed treatments, with no clear answer for what is actually driving their difficulties.

“What diagnosis does this client have?”
“Why is this client struggling, and what does their brain-behavior profile tell us about how to treat them?”

Not a test score. A map.

Cognitive, Emotional & Behavioral Profile

The same symptom.
Different roots.

“Memory complaints”may actually be caused by poor attention
“Impulsivity”may reflect executive dysfunction, not lack of motivation
“Emotional instability”may interfere with cognitive performance

Better diagnostic clarity leads to more precise treatment.

The whole person.
Not just the diagnosis.

Psychiatric

Diagnosis, medications, symptoms & treatment history

Medical

Physical health, laboratory findings, sleep & medical contributors

Substance-Use

Use patterns, withdrawal, relapse history & consequences

Psychological

Personality, trauma, mood & behavioral functioning

Nutrition & Wellness

Nutrition, exercise, sleep & lifestyle

Family & Social

Relationships, developmental history & support system

The assessment shapes
how treatment is delivered.

Executive dysfunctionIncreased structure & organization
Working-memory weaknessWritten instructions & repetition
Attention difficultiesShorter, focused interventions
Slow processing speedAdjusted therapeutic pacing
Poor impulse controlDBT & behavioral interventions
Emotional dysregulationRegulation skills & psychiatric intervention

The treatment adapts to the client, not the client to the program.

Two clients.
Two very different plans.

Assessment determines not only what to treat, but how a client is likely to benefit from therapy.

Profile A

Strong verbal reasoning. Weak executive functioning.

Insight-driven talk therapy, paired with external structure, checklists, and cueing to turn insight into follow-through.

Profile B

Slowed processing. Memory difficulties.

Shorter sessions, repetition, written takeaways, and pacing that gives the client time to process before responding.

Neuropsychological findings personalize the therapeutic strategy.

Cognitive symptoms
don’t occur in isolation.

The multidisciplinary team considers how cognition may be affected by:

Psychiatric Illness·Medications·Substance Use·Withdrawal·Sleep·Nutrition·Hormonal & Metabolic Factors·Medical Conditions·Chronic Stress·Trauma

Brain health, mental health, and physical health are interconnected.

Where testing
meets real life.

Memory in Everyday Situations
Organization
Impulse Control
Emotional Regulation
Social Interaction
Frustration Tolerance
Decision-Making
Cravings & Triggers

Prospect Hill uses an ongoing clinical cycle.

AssessNeuropsych, psych, psychiatric & medical
UnderstandIntegrated clinical formulation
TreatTherapy, psychiatry, medical & wellness
ObserveFunctioning in the residential setting
MeasureSymptoms, behavior & functional change
AdjustModify treatment based on response

Treating the brain beyond the therapy room.

Neurofeedback & Biofeedback

Attention, physiological regulation & stress management

Nutrition

Supporting overall brain & physical health

Exercise & Fitness

Routine, physical health & behavioral activation

Yoga & Mindfulness

Attention, awareness & emotional regulation

Sleep & Structure

Restoring routines essential to functioning

Experiential Activities

Practicing skills outside traditional therapy

Substance use is the visible behavior, not the underlying problem.

Trauma Emotional Dysregulation Executive Dysfunction Impulsivity Maladaptive Coping Substance Use
“How do we stop the substance use?”
“What is driving the need to use, and what needs to change for recovery to last?”

What looks like “won’t”
is sometimes “can’t.”

Family therapy translates assessment findings into:

Better Communication
Appropriate Expectations
Healthy Boundaries
Accountability
Support Strategies
Relapse Prevention

A blueprint for
long-term functioning.

Clinical Care

Ongoing Psychotherapy
Psychiatric Follow-Up
Medication Management
Continued Trauma Treatment

Daily Structure

Executive-Function Supports
Neurofeedback
Lifestyle & Nutrition

Support System

Family Involvement
Recovery Community
Relapse Prevention

Neuropsychology provides the roadmap.
Residential treatment gives us the opportunity to use it.

Assessment Diagnostic Clarity Clinical Formulation Integrated Care Wellness Observation & Adjustment Continuing Care
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