Trends in Psychological Assessment Training
Psychological assessment is a foundational skill and a central component of the identity of clinical psychologists. As such, the American Psychological Association (APA) requires all clinical psychologists to demonstrate competence in psychological assessment at the graduate level (Piotrowski & Zalewski, 1993; Evans & Finn, 2017; Mihura et al., 2017). Some have even argued that psychological testing is the highest technical achievement of psychology (Swenson, 1997). Indeed, graduate programs have been steadily increasing psychological assessment training at the graduate level (e.g., Ready & Veague, 2014). Assessment training also is shifting away from personality measures, toward an increased concentration on neuropsychological measures (Ready & Veague, 2014; Evans & Finn, 2017).
Neuropsychology as a Distinct Subspecialty of Psychology
Neuropsychology has enjoyed incredible growth and solidification as a distinct subspecialty within the broader realm of clinical psychology. Many luminaries worked tirelessly to create models of training, outline minimum competencies, and facilitate the rigorous process of board certification. Newly boarded early career neuropsychologists enjoy the immediate distinction of diplomate status, some without fully appreciating the work that was put in over the past decades to facilitate the attainment of such a distinction.
This first section is a brisk walk through some key moments in the history of psychological testing and the broader field of neuropsychology, up through the Houston Conference. It ends with a lengthier discussion of our current minimum standards of competence that have been outlined over the past couple of years. It is always important to tip our hat to the notable events in the history of our profession as a reminder of where we came from and where we aspire to go next.
To that end, there are many wonderful works extensively detailing the history of neuropsychology from as early as the 1700s (see Barr, 2008; Bieliauskas, 2008; Barr & Bieliauskas, 2016; Barr, 2018; Bieliauskas & Mark, 2018; Stucky et al., 2020, among others), and it is fair to say that the history of neuropsychology could easily be a multipart volume in and of itself. Nonetheless, it is amazing to think about what Alexander Luria learned in his lab while studying Russian war soldiers (discussed later) and how these and many other studies conducted would shape testing practices and the field of neuropsychology thereafter. Today, there are daily advancements in neuroimaging, neuroscience, and our understanding of the neuroanatomical correlates of behavior. In tandem, there are advancements in the methods we use to measure these behaviors.
As a starting point, here are a few notable occasions in the early evolution of psychological testing practices and the broader field of neuropsychology:
- 1875: The term “neuropsychology” was first found written or printed in 1875 (Merriam-Webster, 2021).
- 1888: Conrad Rieger, a Würzburg neuropsychiatrist, published the first systematic neuropsychological battery (Benton, 2000).
- In the late 1800s, James McKeen Cattell first used the term “mental tests” and was the first to create a standardized test battery that could be used to compare performance across individuals (Cattell, 1890).
- Early in the 1900s, intelligence and psychological testing was used for educational placement, immigration, and military classification but notably lacked the ability to quantify behavioral changes observed in individuals with psychopathology (Barr, 2018).
- Because early psychological testing was so limited, and one test would not capture all brain damage, psychological test batteries in the early 1900s arose out of a desire to characterize the behavioral effects of psychopathology (Barr, 2018).
- Kurt Goldstein studied World War I (1914–1918) soldiers who sustained traumatic brain injuries in battle (Kent, 2020).
- 1919: Shepard Ivory Franz used the first extended psychological battery in a clinical setting at McLean Hospital of Boston (Franz, 1919).
- 1920s: Alexander Luria studied cognition, particularly aphasia, and treated Russian soldiers who sustained traumatic brain injuries in World War II (Greiffenstein & Morgan, 2020). Luria used a case-study approach to treating patients in a highly nuanced, patient-centered, and qualitative neuropsychological assessment method (Kent, 2020). The 1920s were described by E.G. Boring, famous psychological historian, as the “age of mental testing” (Boring, 1950).
- 1921: Hermann Rorschach introduced his inkblot test to diagnose psychological conditions.
- 1930s: Luria’s studies of Russian soldiers with brain injuries enabled him to systematically record the modular geography of the brain.
- 1940: The Minnesota Multiphasic Personality Inventory (MMPI) was first published to objectively measure symptoms in psychiatric patients (Hathaway & McKinley, 1943).
- 1940–1950s: Frontal lobotomies and leukotomies were practiced to demonstrate personality changes.
- 1947: Halstead Neuropsychological Battery was created (Halstead, 1947).
- First half of 1900s: David Wechsler and Alfred Binet advocated for the results of intelligence testing to be considered in the context of the examinee’s personality, social status, work, and medical histories, which highlighted the importance of both qualitative and quantitative data in assessing intelligence (Kent, 2020).
- 1953: Henry Gustav Molaison, or “H.M.,” underwent a bilateral medial temporal lobectomy in an attempt to treat refractory epilepsy. The surgery resulted in dense amnesia due to bilateral hippocampal damage and H.M. became the focus of many neuropsychological studies.
- 1954: Paul Meehl characterized two diverging methods of testing used by psychologists: “statistical” (quantitative) versus “clinical” (qualitative, projective/Rorschach) (Meehl, 1954; Barr, 2018).
- 1963: Neuropsychologia, the first journal dedicated to neuropsychology, was published. The second, Cortex, was first published in 1964 (Boake, 2008).
- 1965: Normand Geschwind published “Disconnection Syndromes in Animals and Men,” a catalog of disconnection syndromes that result from severing the corpus callosum.
- 1967: The International Neuropsychological Society (INS) was formed as the first open-membership organization dedicated to the study of brain–behavior relationships, with its first meeting held in New Orleans in 1973 (Boake, 2008).
- 1974: Luria’s patient-centered methods were standardized by Anne-Lise Christensen, resulting in the Luria Neuropsychological Battery.
- 1975: The National Academy of Neuropsychology (NAN) was founded.
- 1976: Muriel Lezak published Neuropsychological Assessment, and it was advertised as the first sourcebook on adult neuropsychology (Kent, 2020). He also introduced the concept of a flexible battery approach (Lezak, 1976).
- 1977: INS forms a task force, led by Manfred Meier, on the Education, Accreditation, and Credentialing in Clinical Neuropsychology (Meier, 1981, 1992) focused on the development of educational and training guidelines in professional psychology.
- 1980: Division 40 of the APA (now called the Society for Clinical Neuropsychology) was established; it is now the largest division of APA.
- 1982: ABPP recognized the American Board of Clinical Neuropsychology (ABCN) as a specialty board (Lucas et al., 2014).
- 1988: Edith Kaplan published on the process approach, identifying and discussing multiple processes that could underlie a particular behavior and focusing on the “why” or “how” a failure occurred or score was obtained (Kaplan, 1988).
- 1994: The Association of Postdoctoral Programs in Clinical Neuropsychology (APPCN) was formed.
- By 1995, the Association for Doctoral Education in Clinical Neuropsychology (ADECN) and the Association of Internship Training in Clinical Neuropsychology (AITCN) were formed.
- 1995: The Clinical Neuropsychology Synarchy (CNS) was formed as a consensus voice of the specialty.
- 1996: Clinical neuropsychology was recognized as a psychological specialty, along with clinical, school, and counseling psychology specialties by the Commission for the Recognition of Specialties and Proficiencies in Professional Psychology (CRSPPP; Boake, 2008).
- 1997: The Houston Conference was held on the University of Houston’s campus, from which a policy statement was issued outlining recommendations for training beginning at the undergraduate level for those interested in becoming a clinical neuropsychologist (Hannay et al., 1998; Bodin et al., 2016).
The Quest for Competence
Key efforts to detail and measure competence in the field of neuropsychology were undertaken in the late 1990s. In 1998, the Houston Conference Guidelines (HCG) were published, providing the first structured guidance on how to train neuropsychologists, with a focus on the process of specialty training in neuropsychology (Hannay et al., 1998). While this document has served us well for greater than 20 years, efforts are currently underway to update those guidelines given the ways our field has evolved over the past two decades. In addition, the Taxonomy for Education and Training in Clinical Neuropsychology was published in 2017, refining expectations for training at all levels: from graduate coursework through postdoctoral fellowship and ongoing maintenance of certification (MOC; Sperling et al., 2017). It provides a guide to training directors as to the expectations of coursework, didactics, and experiences, and delineates levels of training in neuropsychology from “exposure” to “major area of study.”
In the broader field of clinical psychology, the 2002 Competencies Conference: Future Directions in Education and Credentialing is now considered a foundational event for the “competency movement” in professional psychology (Kaslow et al., 2004). A push was made to standardize both foundational and functional competencies across all areas of psychology. Foundational competencies included areas such as knowledge, ethics, individual/cultural diversity, self-reflection/attitudes, and values that are required aspects of all psychologists’ training. Functional competencies were defined as specific aspects of professional practice, or what different types of psychologists “actually do” (Rey-Casserly et al., 2012). Within the context of a “cube model” developed by Rodolfa and colleagues, a three-dimensional cube illustrates foundational competencies along the x-axis, functional competencies along the y-axis, and stages of professional development along the z-axis (Rodolfa et al., 2005). In this model, foundational and functional skills are learned and refined over the developmental sequence of training (e.g., graduate, internship, postdoctoral, and continuing education experiences).
Following an initial application of the competence-based cube model of training to the field of neuropsychology in 2012 (Rey-Casserly et al., 2012), the CNS reviewed and updated the model, publishing “Entry Level Competencies in Neuropsychology” (Smith & CNS, 2019). The updated competency model further identifies those training benchmarks that should be achie...
