Do we believe in assesment more than the therapy?

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psych84

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I just get this sense from reading the forums that Psychologists have a lot more faith, and frankly a lot more fun, assessing people/diagnosing them. That seems like the "cool" part.

People, for most part though, seem to not only care less about the therapy part, but I'm not sure if they have much faith in it. I'm not sure if those two things are connected...less faith in therapy working = not that interested in doing it. I know there is also more frustration doing therapy, and it may not be as lucrative, but I can't help but feel that many Psychologists just don't have faith in let's say "CBT".

Thoughts?

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I have not had that experience. I feel like most of my colleagues are quite happy with CBT and the outcome data. It's been this way across multiple settings where I have worked. Also, I haven't seen the "less faith in therapy working" part either. Maybe you work with pessimistic individuals?
 
I have not had that experience. I feel like most of my colleagues are quite happy with CBT and the outcome data. It's been this way across multiple settings where I have worked. Also, I haven't seen the "less faith in therapy working" part either. Maybe you work with pessimistic individuals?
I'm just finished my undergrad, so I haven't worked with anyone. But when you read forums people just don't seem to like the therapy part. I'm just asking if maybe part of the reason is that people don't believe in it, don't think it works for most people, despite the data?
 
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SDN has an over representation of assessment focused clinicians (at least amongst the more frequent posters). In day to day practice i'm guessing most psychologists do more therapy than assessment work.

I very much value and trust talk therapy (EBT supported), though it is not how I want to spend my time so I refer out for that work.
 
I have a secondary specialization in PE for trauma. I enjoyed it quite a bit and had a lot of successful terminations with patients. I just like npsych more. I still take the occasional therapy client to keep up with it. When you use EBT's, they work quite well, in line with the data, in my experience.
 
I am not an "assessment focused clinician." I probably don't do traditional therapy because the primary care environment doesn't lend itself well to that, but my job IS intervention, primarily(70%). Other is administration and research.

I'm not sure what you dont "believe" in it? As in we think its ineffective? If that's what you meant, I have never heard anyone say such a thing.
 
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I am not an "assessment focused clinician." I probably don't do traditional therapy because the primary care environment doesn't lend itself well to that, but my job IS intervention, primarily (70%). Other IS administration and research.

I'm not sure what you dont "believe" in it? As in we think its ineffective? If that's what you meant, I have never heard anyone say such a thing.
Yes, ineffective. I just wonder if a lot of psychologists actually trust the data?
I know that the general public certaintly doesn't believe in it. I know a lot of people that say "why would you waste $200 going to someone just to talk to you..i'll do it for free?". I'm just wondering if actual Psychologists feel like that way sometimes as well.
 
Yes, ineffective. I just wonder if a lot of psychologists actually trust the data?
I know that the general public certaintly doesn't believe in it. I know a lot of people that say "why would you waste $200 going to someone just to talk to you..i'll do it for free?". I'm just wondering if actual Psychologists feel like that way sometimes as well.

No, because that not really a good understanding of what psychotherapy actually is.
 
Yes, ineffective. I just wonder if a lot of psychologists actually trust the data?
I know that the general public certaintly doesn't believe in it. I know a lot of people that say "why would you waste $200 going to someone just to talk to you..i'll do it for free?". I'm just wondering if actual Psychologists feel like that way sometimes as well.
I don't think the general public as a whole "certainly doesn't believe in it." In fact, the data would suggest that they are overwhelmingly in support of it.

http://www.apa.org/monitor/2009/03/public.aspx
http://www.ncbi.nlm.nih.gov/pubmed/9124079
 
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Many clinicians I know personally and even clinicians on this forum have really emphasized that assessments typically yield a higher payout, therapy is not AS profitable, vs. assessments, especially in a private setting. In the neuropsych. office I work in, the going rate for a TBI battery could range between $3-5K for example whereas a 45-50min. CBT session could range from the double to lower triple digits.
 
I am a postdoc, so I'm not in private practice but I am in a university clinic setting. People differ in whether they like assessments or therapy better, but it's a good mix of folks in my experience. I, for one, LOVE therapy and do not particularly like assessment all that much. I like building the relationship and helping people get better. I focus on CBT for mood and anxiety disorders and am very familiar (and believe in) the treatment literature supporting the use of CBT for those disorders. I think your sample must be skewed for you to think most clinicians strongly fall one way (i.e., assessment, as you indicated).
 
I am a postdoc, so I'm not in private practice but I am in a university clinic setting. People differ in whether they like assessments or therapy better, but it's a good mix of folks in my experience. I, for one, LOVE therapy and do not particularly like assessment all that much. I like building the relationship and helping people get better. I focus on CBT for mood and anxiety disorders and am very familiar (and believe in) the treatment literature supporting the use of CBT for those disorders. I think your sample must be skewed for you to think most clinicians strongly fall one way (i.e., assessment, as you indicated).

I wouldn't say skewed, it is none-the-less an opinion much like yours. I am personally a fan of providing more therapy vs. assessment, but from my experience thus far, I am seeing more clinicians take the the argument I had stated. I am sure you and your colleagues may lean more towards therapy, etc. Mathematically, it makes more sense that a psychologist is utilizing (especially in private practice) assessments over therapy.

As a caveat, the OP didn't mention whether his assertion/ experience is revolving around those in clinics, hospitals, universities or private practice. I would say the outcome largely will depend on the setting one is practicing within.
 
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I wouldn't say skewed, it is none-the-less an opinion much like yours. I am personally a fan of providing more therapy vs. assessment, but from my experience thus far, I am seeing more clinicians take the the argument I had stated. I am sure you and your colleagues may lean more towards therapy, etc. Mathematically, it makes more sense that a psychologist is utilizing (especially in private practice) assessments over therapy.

As a caveat, the OP didn't mention whether his assertion/ experience is revolving around those in clinics, hospitals, universities or private practice. I would say the outcome largely will depend on the setting one is practicing within.

I don't think we disagree, perhaps it was my wording. I meant that I think there is a range to what people prefer, enough so across settings that I have never thought "clinicians like X over Y" as a broad statement. Some of my colleagues absolutely prefer assessment and testing, some strongly prefer therapy, and some enjoy all aspects equally. So, that's why I wondered whether their sample was skewed (probably based on setting, as you mentioned) and thus led to forming such a strong impression of what clinicians prefer.
 
I currently do about 70% traditional talk-therapy (45 minute office setting), 10% assessment, 20% consult work with hospital. That is pretty close to the balance I want. Would also like to get back to teaching a few classes again and add that to the mix. Several posters on the board identify as neuropsychologists. Neuropsych, based on my experience, is much more focused on assessment. Forensics is also more assessment based. I considered pursuing neuropsych during my neuropsych practicum, but just felt that it was more test administration than I would personally like to perform.

Final note, we could have just as good a debate about the use and misuse of assessments as we could about psychotherapy. It becomes especially problematic in the realm of personality assessment, and there are also problems with IQ testing. I know that I am on much more solid ground diagnosing and treating PTSD than I am when trying to "test for ADHD".
 
To be clear, DX for ADHD should only be made after a medical work up, review of collateral info (parent & teacher rating, in depth interview, review of school records, etc) and neuropsych testing. I usually get the person last, which is my preference.
 
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To be honest, the npsych testing is mostly unnecessary. Our tests are not very specific for that diagnosis. We serve that eval better by looking for secondary gain and malingering rather than using attention tests diagnostically for ADHD.
 
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Yeah, as WisNeuro mentioned, neuropsych isn't really all that great for diagnosing ADHD (and in actuality, it can't diagnose ADHD, as all the diagnostic criteria are behaviorally- rather than explicitly cognitively-anchored). But what it can be great as is helping to rule out and/or identifying other factors.

As for how a neuropsychologist would answer that? I'd say probably similarly to what I've mentioned above--any psychologist should be able to diagnose ADHD, don't need a neuropsychologist for that; but if you'd like me to potentially assist in ruling out other factors, I can help with that.

I understand wanting to have some type of hard-and-fast, objective evidence before sticking someone on stimulants, but it's just the reality that simply because someone performs poorly on some of our attention-laden tasks doesn't mean they have ADHD, and just because they perform within normal limits on said tasks doesn't meant they don't have ADHD.

Tangent aside, to get back to the OP's question--as others have said, it's been my experience "in the real world" (i.e., outside of these forums) that most clinicians are primarily interested in therapy, and that the number who enjoy spending most of their time in other areas like assessment, program evaluation, and administrative duties are in the minority.
 
Tangent aside, to get back to the OP's question--as others have said, it's been my experience "in the real world" (i.e., outside of these forums) that most clinicians are primarily interested in therapy, and that the number who enjoy spending most of their time in other areas like assessment, program evaluation, and administrative duties are in the minority.

Interesting. Is that mostly because we might have more Counselling psychologists as opposed to Clinical? At least in Canada, Counselling programs, much more often, graduate a ton more people, and you earn less.
 
Interesting. Is that mostly because we might have more Counselling psychologists as opposed to Clinical? At least in Canada, Counselling programs, much more often, graduate a ton more people, and you earn less.

The one professional school in Canada is counseling psych, I believe. The other couns programs, of which there are very few, are normal small-cohort programs (UBC, McGill). There are definitely NOT more counseling psych than clinical psych people in general; large programs almost all grant clinical degrees, and even only counting the smaller-cohort programs clinical outnumbers counseling by a fair bit. (see appic match statistics to get estimates of degree type #s)
 
The one professional school in Canada is counseling psych, I believe. The other couns programs, of which there are very few, are normal small-cohort programs (UBC, McGill). There are definitely NOT more counseling psych than clinical psych people in general; large programs almost all grant clinical degrees, and even only counting the smaller-cohort programs clinical outnumbers counseling by a fair bit. (see appic match statistics to get estimates of degree type #s)

There is actually another professional school in Canada now, that is a clinical psych program. It is a PsyD from Adler in BC. I think the first year it opened was last year. :S
 
I think it would depend upon your interests and purpose for entering into psychology. I entered a clinical psychology doctoral program because I wanted to work with a clinical population doing mostly if not all assessment/evals. Although this was my primary focus when I initially entered the program and opted to be in the forensic concentration. However, never did my interest in diagnostic assessment undermine my belief of therapy as a crucial and necessary component of clinical interventions... after all, assessments help to inform and guide therapeutic recommendations. I think you would also be hard pressed to find clinicians in training who favor medication over therapy.

Thinking about my cohort, many students absolutely enjoy conducting therapy and are passionate about their theoretical orientations. On the other hand, I know several colleagues who have absolutely NO interest in diagnostic assessment and complain about this area of focus within our clinical program because they only want to do therapy; and not with a clinical population. To which I wonder... why pursue training in clinical psychology rather than counseling psychology. But that may be my own naivete.

After my therapy practicum I too found that I enjoy therapy and would like to conduct therapy as part of my private practice albeit assessment will be my bread/butter. Diagnostic assessment is a large area of focus for our clinical training but we also receive in depth/breadth of training in 5 therapeutic interventions. We're expected to demonstrate competency in these five theoretical interventions by the time we go on internship in addition to sitting for our comprehensive exams on two theoretical orientations of our choice.
 
There is actually another professional school in Canada now, that is a clinical psych program. It is a PsyD from Adler in BC. I think the first year it opened was last year. :S
Oh, I thought that was the counseling program. The one I'm thinking of is older (existed last time I was at CPA, in 2009). Maybe there is another Adler or they added a clinical program.
 
Had a couple questions.. In neuropsychology, is intervention synonymous with therapy? Or does it really depend on the type of patient population you are seeing. Also, sorry to sound ignorant, but what usually happens after a neuropsychologist is trained to do assessments but not interventions, and finds all these specific types of cognitive impairments (in attention for example) in the patient? Since he/she doesn't prescribe, do they just relay that info to the neurologist? Thanks.
 
Had a couple questions.. In neuropsychology, is intervention synonymous with therapy? Or does it really depend on the type of patient population you are seeing. Also, sorry to sound ignorant, but what usually happens after a neuropsychologist is trained to do assessments but not interventions, and finds all these specific types of cognitive impairments (in attention for example) in the patient? Since he/she doesn't prescribe, do they just relay that info to the neurologist? Thanks.

If a neuropsychologist isn't trained in typical psychological interventions, then their training program quite simply didn't do its job.

To answer your first question, I suppose it depends on how you define "therapy." You may help implement behavior plans to address disruptive, self-injurious, or disinhibited behavior plans for an individual struggling with the effects of dementia or severe TBI, so if you consider that to be therapy, for example, then yes, most of what a neuropsychologist would do intervention-wise is therapy. And in all honesty, much of what you're doing with the various types of patients you see in neuropsychology is going to be symptom management-based. Some exceptions would be neurosurgical and pharmacological interventions for movement disorders and seizures, although those folks often also have comorbid emotional and/or behavioral difficulties as well.

When a neuropsychologist is able to work in-step with a neurologist, physiatrist, psychiatrist, and/or primary care doc, then great things can certainly happen, as everyone is able to provide unique expertise and interventions while also sharing enough of a common language to be able to (usually) communicate effectively and precisely.
 
If a neuropsychologist isn't trained in typical psychological interventions, then their training program quite simply didn't do its job.

To answer your first question, I suppose it depends on how you define "therapy." You may help implement behavior plans to address disruptive, self-injurious, or disinhibited behavior plans for an individual struggling with the effects of dementia or severe TBI, so if you consider that to be therapy, for example, then yes, most of what a neuropsychologist would do intervention-wise is therapy. And in all honesty, much of what you're doing with the various types of patients you see in neuropsychology is going to be symptom management-based. Some exceptions would be neurosurgical and pharmacological interventions for movement disorders and seizures, although those folks often also have comorbid emotional and/or behavioral difficulties as well.

When a neuropsychologist is able to work in-step with a neurologist, physiatrist, psychiatrist, and/or primary care doc, then great things can certainly happen, as everyone is able to provide unique expertise and interventions while also sharing enough of a common language to be able to (usually) communicate effectively and precisely.

Thanks AcronymAllergy, that helps put things into perspective. Although I have talked to a couple neuropsychologists, and at least one of them said they're not trained to do interventions. Some are solely trained to do assessments and diagnoses, but not implementing rehabilitation, depending on their program? I'm hoping to join a program that will train me to implement internventions/rehabilitation plans for patients, so I was a little worried when I heard that some neuropsychologists aren't trained for instilling treatment.
I guess the concept I have of therapy is "talking therapy", where the patient just pours out their troubles, and the psychologist listens and offers some sort of structured feed-back. On the other hand, I see interventions that would involve the neuropsychologist suggesting cognitive strategies (although this could also go under CBT), and other rehabilitative programs that could be cutting-edge. I agree with that last part that when these professionals work as a team, it can be quite miraculous for the patient.
 
Again I'd say that if a neuropsychologist isn't at all trained in intervention, then either their training program did a bad job or the student didn't engage properly. Now, this doesn't mean that all neuropsychologists are trained to explicitly provide full rehabilitation services, mind you; there's a reason ABPP boards rehab psych separately from neuropsych. But any neuropsychologist should know the basics of cognitive and behavioral therapies, and should have gotten experience treating at least some of the conditions they're likely to come across (e.g., insomnia, pain, adjustment difficulties and/or mood disorders, etc.).

This doesn't mean that all or even most neuropsychologists regularly provide therapy as a part of their job. But if your polytrauma team physiatrist comes and says, "hey Dr. AA, I've got a patient here who I think would really benefit from a brief intervention to address his sleep problems/her lack of engagement in speech therapy/his chronic pain," there should be at least a handful of such requests you'd be qualified to meet. And if it's something that's going to require either a skill/set of skills in which you aren't trained, or a resource investment you can't provide, then having a basic knowledge of those interventions will still allow you to make an informed referral.
 
I guess the concept I have of therapy is "talking therapy", where the patient just pours out their troubles, and the psychologist listens and offers some sort of structured feed-back. On the other hand, I see interventions that would involve the neuropsychologist suggesting cognitive strategies (although this could also go under CBT), and other rehabilitative programs that could be cutting-edge. I agree with that last part that when these professionals work as a team, it can be quite miraculous for the patient.

You are correct about a lot of this falling under CBT. I do some cognitive rehab with a few different manuals, but rely a lot on my essential, basic, perhaps boring and totally un-sexy "talk therapy" skills with the severe TBI folks. Have you ever had a conversation with someone with a severe TBI who is disinhibited? You need a very solid therapeutic background to just get a word in, not to mention getting them to buy into rehab when they have little to no insight into their problems. I'm less impressed with what has been called "cutting edge" cognitive rehab the more I work with the very severe folks. For different populations and conditions, maybe, but not the majority of severe injuries in my setting. Look up anything by Prigatano at Barrow.

Part of neuropsychologists not doing a lot of therapy is pragmatics - huge waiting lists are the norm just to get someone in for an assessment. There is simply not enough time to do therapy for everyone you see, nor is it necessary.

Its been my experience that many neuropsychologists view the assessment as the intervention with feedback to the patient/family/care team playing a crucial role. Having something wrong with your brain and/or your thinking can be really scary. A good assessment with a good feedback session can be very therapeutic.
 
Its been my experience that many neuropsychologists view the assessment as the intervention with feedback to the patient/family/care team playing a crucial role. Having something wrong with your brain and/or your thinking can be really scary. A good assessment with a good feedback session can be very therapeutic.
This is how I view most of my work.

Some clinicians also do follow-up family education, supportive therapy, etc. ...though traditional ongoing psychotherapy can be very hard to find. Very few neuropsychologists I know do any F/U therapy or other non-assessment based intervention; I choose to refer all F/U needs out to other providers.
 
This is how I view most of my work.

Some clinicians also do follow-up family education, supportive therapy, etc. ...though traditional ongoing psychotherapy can be very hard to find. Very few neuropsychologists I know do any F/U therapy or other non-assessment based intervention; I choose to refer all F/U needs out to other providers.

We do a good amount of f/u therapy. But it's usually short-term things, sleep hygiene, adjustment to cognitive change after a stroke or tbi, etc. If it's a longer course of treatment we will refer out. I do like to do an occasional trauma patient to keep those skills sharp though.
 
Do you guys feel that neuropsych's have the most prestige in Psychology?
 
From other psychologists? From psychiatrists? Physicians? From lawyers? The general public?

I I think one thing you need to remember is that most people don't even know what to neuropsychologist is. Most people don't even know the difference between a psychologist and psychiatrist is.
 
From other psychologists? From psychiatrists? Physicians? From lawyers? The general public?

I I think one thing you need to remember is that most people don't even know what to neuropsychologist is. Most people don't even know the difference between a psychologist and psychiatrist is.
I meant within Psychology. (I guess I meant more how much respect Psychologists themselves would attribute to each area of Psychology)

I guess it may be the perception that if you put neuro infront of anything..it sounds cool and something important. lol
 
I really don't know. And who cares.

I associate the perception of "prestige" as a superficial form adoration or respect but generally lacking in critical thought or analysis.
 
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I really don't know. And who cares.

I associate the perception of "prestige" as a superficial form adoration or respect but generally lacking in critical thought or analysis.

I agree, but at the same time "prestige" or "respect" for a profession is one reason we work hard to become that thing. Sure, it should never be the number 1 reason, but people respecting what you do is certainly nice and plays a part in the motivation to become that. And I know that in medicine, they have discussions about which speciality has more prestige, pay, or allows for a better work-life balance. Cardiologists, neurologists, derms, and maybe emergency docs, tend to get the most respect in medicine, it seems.

I wondered if there is a specific hierarchy in psychology, as well.
 
I wondered if there is a specific hierarchy in psychology, as well.

I am sure there is, but it is very subjectively based. I personally think highly of psychologists that work with children while some have said "child psychologists just prefer working with simple minds because they are [relatively] simple themselves."
 
Do you guys feel that neuropsych's have the most prestige in Psychology?

Eh. I think some clinicians and researchers who work in the area of neuropsych have been able to increase the visibility of the field, which helps give us a seat at the crowded healthcare table. I'm no sure if I'd consider that prestige, but it has helped the field as a whole.
 
Eh. I think some clinicians and researchers who work in the area of neuropsych have been able to increase the visibility of the field, which helps give us a seat at the crowded healthcare table. I'm no sure if I'd consider that prestige, but it has helped the field as a whole.
Are you also involved in politics by any chance?
 
I think healthy narcissistic investment is likely a prerequisite for climbing to the top of any field, especially academics. But I think the notion of prestige dissipates quickly in the day to day working of most clinical professions. I always introduce myself professional as Dr. X to patients and colleagues in the clinical setting, but I doubt anyone is running a prestige analysis on me as we converse.
 
If you want prestige and respect, be great at your job. I don't care what specialty you are, if you do a ****ty job, word gets around and it doesn't mean jack ****. Focus more on doing what you love well, rather than chasing empty accolades.
 
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What does F/U therapy stand for? Sorry if this is a dumb question.
 
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