Neuropsychology Training Standards: Houston Guidelines

[Therapist4Chnge]

I thought this warranted its own thread.

Houston Guidelines.

The devil is in the details. Coursework, didactics, practica, etc. are all needed. People often skimp on neuroanatomy, neurophysiology, and related classes, but they are just as important. Many psychologists want to "dabble" in neuropsychology, which is asking for trouble.

Anything short of the Houston Guidelines really isn't sufficient. If a school psychology program (or joint clinical/school) can provide all of the requisite training and mentorship, and the person completes a formal neuropsychology fellowship that conforms to the Houston Guidelines....then (in my eyes) that person has demonstrated their competency to practice neuropsychology.

I agree with most of the above, but my frustrations go both ways. The Houston gudelines are not at all helpful when it comes to pediatric neuropsych. The Guidelines even say so in one section and basically place the burden on somebody else to make peds neuro a specialty...hence the peds neuro board, which from my understanding includes some folks from a school psych background who have gone through the appropriate neuro education and fellowship (which is what I think you were saying, T4C).

I know the HGs aren't perfect, but they are the best attempt at providing some clear competencies and the minimum level of training needed to practice ethically. Similar to issues we are seeing in internship (Non-APA & Non-APPIC sites saying "in line with APA standards", though without any kind of oversight), it is an issue of quality control. It seems that many hold the HG guidelines up as the "ideal", and then aim lower and claim competency. I'm not saying any one group does this, but it is a constant issue within the field.

As for the clinical sub-specialities...you definitely have a point. I had a hard time finding neuro sites that offered sufficient training in rehabilitation, and an even harder time finding rehabilitation sites that offered enough neuro. I know there are only a handful of formal ped. fellowships, and even fewer programs that cover both ped. and adults. With that being said, it'd be nice if there were more quality sites in these areas, but we can't just throw the standards out the window.

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[IT514]

I'm ok with having the HC guidelines as a starting point. However, it would be nice if they expanded the section where peds neuro is mentioned as a subspecialty. It wouldnt be too difficult for them to say something like, hey, we (the houston conference) havent sufficiently outlined the competencies for practice in this area, but these people have:http://www.theaapn.org/exams.php

 

[Therapist4Chnge]

I understand how and why school psychology has attempted to tie themselves into neuropsychology, but I think it is severely inappropriate. School psychologists do use many of our tests, but they are taught to use them very differently than we do. They generally do not have the bio, neuroanatomy, behavioral neuro background to function properly as a neuropsychologist. There is now a school neuropsychology board, in which masters level practitioners are allowed to be members. I've seen this credential attempted as an "expert" validation in the courts (shredded, but still attempted).

This is what I was getting at in my previous posts. Psych-Techs can learn to administer various assessments too, but the knowledge required to properly interpret the data is missing. Can the person take into account significant imaging findings? Do they understand the impact of various medications on the patient's cognition? What does the data say when concurrent medical conditions are considered?

I have a much great appreciation for the knowledge differences since I moved into academic medicine. Pretty much every case that comes through the door is complex. There are many more "zebras" than "horses", and often they come from other psychologists and neuropsychologists who are stumped. How can a case like that be addressed if someone doesn't have the proper background in neuroanatomy, neurophysiology, etc?

We need for the ABPP-Cn to be THE final word for neuropsychology, much as medical boards are the final word for their specialties. This ties directly into enforcement of the Houston guidelines and I think would go a long way in ensuring quality in those that profess to practice neuropsychology.

That is what should happen, though I'm curious to see if the sub-speciality angle gains any momentum. I know Division 22 and Division 40 both are eying the crossover market in rehabliation/neuropsychology services....and I'm not really sure who will win.

 

[erg923]

I disagree with existence of the peds neuro board. ABPP-Cn addresses pediatric neuropsychology. If it needs to be addressed more thoroughly, it can be done so through ABPP-Cn. On orals, pediatric neuro people are tested by pediatric neuropsychologists.



I think the houston guidelines are important. I think board certification (a unified board) is important.

I understand how and why school psychology has attempted to tie themselves into neuropsychology, but I think it is severely inappropriate. School psychologists do use many of our tests, but they are taught to use them very differently than we do. They generally do not have the bio, neuroanatomy, behavioral neuro background to function properly as a neuropsychologist. There is now a school neuropsychology board, in which masters level practitioners are allowed to be members. I've seen this credential attempted as an "expert" validation in the courts (shredded, but still attempted).

We need for the ABPP-Cn to be THE final word for neuropsychology, much as medical boards are the final word for their specialties. This ties directly into enforcement of the Houston guidelines and I think would go a long way in ensuring quality in those that profess to practice neuropsychology.

As a student (like myself), one is not very well educated on what exactly differentiates the two adult boards-and I'm talking objective stuff that actually matters here, not petty nonsense. So, what makes ABPP-CN better than ABPN? At the moment, If I were to join a board, I think I would join ABPN, for the simple reason that ABPP-CN's subtle superiority complex is off-putting and I like cheering for and supporting the underdog... For example, my wife and I are KC royals fans...haha. Seriously though, since nobody knows about or cares about boarding other than neuropsychologists themselves, does it really matter which one a person chooses. If so, why?

PS: I do not plan on doing much forensic work, so a judge's opinion about board reputation means little to me.

 

[AcronymAllergy]

I, like many others I'm sure, am all for standardized and formalized training and competency criteria such as that put forth by the HC guidelines. I also am all for some type of boarding in specialty areas of training, whether they be in psychology, medicine, or wherever else. Ideally, neuropsychology boarding would all occur via a single organization. Subspecialty boarding, such as peds, could be evaluated by subcommittees of said organization.

With respect to ABPP-CN and ABPN, my knee-jerk reaction would be the opposite of erg's--I'd tend to initially side with the more-populated board (assuming commensurate levels of member training and expertise between the two), as simply based on logistics, it would seem to make more sense.

 

[erg923]

Thanks JS, but I suppose my question is, at the present time, why should one pick abcn over Abpn? It's obvious your choice comes from a historical fact, but my question is a little more focused on pragmatics. I could really care less about all the past, and who did what first, and would prefer to focus on what the tangible benefits of boarding are for it's practitioners at the current time. As of now, I don't see much, hence why (probably because of my personality) if I were forced to choose, I think I would rather be associated with board that is viewed as less "upity." and superioristic.

 

[Therapist4Chnge]

ABPP-cn has been arounf longer, is recognized as the gold standard, and it is more selective. I know some people don't like the "elitism" sometimes associated with them, but it isn't a bad thing to have high standards. I would like to see this as a requirement for neuropsychology...but that is a hard sell.

 

[IT514]

I disagree with existence of the peds neuro board. ABPP-Cn addresses pediatric neuropsychology. If it needs to be addressed more thoroughly, it can be done so through ABPP-Cn. On orals, pediatric neuro people are tested by pediatric neuropsychologists.



I think the houston guidelines are important. I think board certification (a unified board) is important.

I understand how and why school psychology has attempted to tie themselves into neuropsychology, but I think it is severely inappropriate. School psychologists do use many of our tests, but they are taught to use them very differently than we do. They generally do not have the bio, neuroanatomy, behavioral neuro background to function properly as a neuropsychologist. There is now a school neuropsychology board, in which masters level practitioners are allowed to be members. I've seen this credential attempted as an "expert" validation in the courts (shredded, but still attempted).

We need for the ABPP-Cn to be THE final word for neuropsychology, much as medical boards are the final word for their specialties. This ties directly into enforcement of the Houston guidelines and I think would go a long way in ensuring quality in those that profess to practice neuropsychology.

Peds neuro does need to be addressed more by ABPP-CN. Collaboration with the peds board?? Steve Hughes (current pres of the peds board) is a really reasonable guy, and they seem to be more willing to work with those who have a school psych background AND THE APPROPRIATE TRAINING that is no different from yours (I'm assuming) and mine, which goes off of the HC guidelines.

I'm not talking about weekend warriors who take a few courses. I'm talking about people in the field who have had great training, are making huge contributions to the field and are without a doubt qualified by any standard. If they want to go through the peds board and not ABPP-CN, its obviously saying ABPP-CN doesnt represent peds well enough.

I'm not saying that school psychologists should be able to call themselves neuropsychologists! I will, however, if they go through the coursework and fellowship. MA level school psychologists are without a doubt not able to do so.

Maybe I'm letting personal experience bias my opinion -I've benefitted from supervision from folks from all three boards. However, theres definitely an attitude from the ABPP-CN ppl I've worked under that they can do it all. Then they write a report to a school and it means nothing to school personnel! Personally I'm benefitting a lot more from ABPdN when it comes to kids. Not saying there arent great ABPP-CN people out there, but I think that ABPdN does a better job of it as of 2011.

 

[erg923]

Think about who is making the accusation of "uppity" or "superioristic" traits of ABCN. It's the same people that utter the words "ivory tower" with derision. Think about when "arrogant" and "elitist" get thrown around on this board. It's when people are upset about someone questioning the standards of professional schools. Get the picture?

Well actually, no, thats not who I envisioned having this perception at all. I was reffering to other (often very senior) neuropsychologists/rehab psychologists who view ABPP-CN's multiple attempts at power grabs as quite shaddy and their attitude of "our way is the only way" (regarding training) to be unnecessarily exclusionary and off-putting (eg., the recent incident in Minnesota, which, in my mind, seems exclusionary to both non-boarded neuropsychologists and those who are certified by other boards.) Thereby, contribututing to the continued divided status of the profession by attempting to create a two-tier system of boards. The "your not good enough" attitude doesn't bring neuropsychologists together, it continues to reinforce the need for another board (ie., the two board system). From talking to other psychs, its seems the perception is that ABPP-CN doesn't so much want one board as much as they only want their board. Lastly, I can actually appreciate that ABPN has somewhat broader defintions of what constitutes acceptable post-doc training. As you know, unlike generalists, there are actually to few formally trained neuropsycholgists in this country. I dont understand the mentality of trying to keep us small and exclusionary. Who does that benefit?

 

[AcronymAllergy]

Well actually, no, thats not who I envisioned having this perception at all. I was reffering to other (often very senior) neuropsychologists/rehab psychologists who view ABPP-CN's multiple attempts at power grabs as quite shaddy and their attitude of "our way is the only way" (regarding training) to be unnecessarily exclusionary and off-putting (eg., the recent incident in Minnesota, which, in my mind, seems exclusionary to both non-boarded neuropsychologists and those who are certified by other boards.) Thereby, contribututing to the continued divided status of the profession by attempting to create a two-tier system of boards. The "your not good enough" attitude doesn't bring neuropsychologists together, it continues to reinforce the need for another board (ie., the two board system). From talking to other psychs, its seems the perception is that ABPP-CN doesn't so much want one board as much as they only want their board. Lastly, I can actually appreciate that ABPN has somewhat broader defintions of what constitutes acceptable post-doc training. As you know, unlike generalists, there are actually to few formally trained neuropsycholgists in this country. I dont understand the mentality of trying to keep us small and exclusionary. Who does that benefit?

If there is ever going to be "one board (or standard) to rule them all," then in all honesty, some amount of power grabbing and inclusionary/exclusionary criteria are going to be necessary. The only approach that would work would essentially dictate "if you can't meet our agreed-upon criteria, then you aren't qualified to be boarded as a neuropsychologist."

The difficult part in all of this is determining what these agreed-upon, necessary-and-sufficient criteria should be. Looking over the ABCN process, although I'm only a student myself, I at the least don't see anything that seems particuluarly unreasonable or unwarranted.

 

[erg923]

Well, instead of painting them as that (rather derogatory) color, maybe they could be conceptualized as professionals who simply dont want to be deprived of their financial earning potential because they dont belong to an optional tree house club of other neuropsychologists? Thats really how it appears to folks on the outside anyway. Boarding should be a challenge and an opportunity, not motivated by threat reduction.

 

[erg923]

The only approach that would work would essentially dictate "if you can't meet our agreed-upon criteria, then you aren't qualified to be boarded as a neuropsychologist."

Well thats exactly the problem. What are the implications that come/follow from that? It's already obvious that many (presumably in ABPP-CN?) are pushing to exclude non-boarded and other boarded neuropsychologists from being able to legally bill for their services-this has already happened in Minnesota. Thus...does this result in?:

That people who already exist out there are now (suddenly) excluded from practioning the specialty area they trained in? Essentially pulling their livelihood (ability to bill) away from under them because they didnt have a ABPP-CN supervsior at their post doc? Get real! With absolutley no evidence to show the those criteria result in a better neuropsychologists or better patient outcomes (or whatever), I would have to side with the senior "arrogant bastards" on this one and say...Who they hell are you to tell me I'm competent or not....and potentially take away my earning potential?"

 

[AcronymAllergy]

Well thats exactly the problem. What are the implications that come/follow from that? It's already obvious that many (presumably in ABPP-CN) are pushing to exclude non-boarded and other boarded neuropsychologists from being able to legally bill for their services-this has already happened in Minnesota). Thus...does this result in:

That people who already exist out there are now (suddenly) excluded from practioning the specialty area they trained in? Essentially pulling their livelihood (ability to bill) away from under them because they didnt have a ABPP-CN supervsior at their post doc? Get real! With absolutley no evidence to show the those criteria result in a better neuropsychologists or better patient outcomes (or whatever), I would have to side with the senior "arrogant bastards" on this one and say...Who they hell are you to tell me I'm competent or not....and potentially take away my earning potential?"

I definitely agree that should the standards become a requisite for training and practice (and, by extension, billing), a phasing-in process would almost be a necessity. I can see the argument that you'd want to immediately eliminate unqualified individuals from practicing in the guise of neuropsychologists, but at the same time, individuals who had previously been practicing and who would not immediately be disqualified per certain criteria (e.g., not holding a doctoral degree) should be given the benefit of the doubt and allotted appropriate time to obtain boarding.

Per Jon Snow's post, speaking of the ABPP-CN specifically, it seems as though they'd apply only those criteria that were relevant at the time of training (and also, I don't believe they require that even current trainees be supervised by boarded neuropsychologists).

 

[Therapist4Chnge]

Lastly, I can actually appreciate that ABPN has somewhat broader defintions of what constitutes acceptable post-doc training. As you know, unlike generalists, there are actually to few formally trained neuropsycholgists in this country. I dont understand the mentality of trying to keep us small and exclusionary. Who does that benefit?

It isn't that they want it small and exclusionary (right from the mouths of multiple ABPP Board Members I've spoken with about this issue), but instead they want to ensure a level of competency to protect the public and also the profession. If you look at their requirements, they really are not that strict.

-APA-acred program & internship....that is the majority of people.
-Multiple years of experience practicing neuropsychology....that should be a given.
-Written exam, case examples, and oral defense....all good ways to evaluate a clinician.
-Completed coursework and didactic trainings outlined by the HGs....very important and not very hard to accomplish.
-etc.

Nothing listed is "elitist". They aren't requiring you graduate from a specific program or even that you practice under a select handful of clinicians. Boarding is a normal expectation in many other fields, and yet psychology has been resistant.

Some places of employment are starting to come around with boarding. The VA system is offering more money for boarded people. More academic medical centers are requiring it, including my current employer. Places like The Mayo Clinic have required it for years. Many senior-level positions out there have shown a strong preference for ABPP people. I admittedly don't know much about college counseling and other non-medical settings, but I suspect that is where a lot more of the push-back is originating.

 

[erg923]

Our work within medical settings and the continued integration of psychological services within multidisciplinary medical settings is important, yet, I do not understand this incessant focus on modeling ourselves and our training after the medical model. Who decided that this was the "golden model" that psychology should automatically emulate? This simply speaks to psychologist insecurity, if you ask me...

In summary, not only do I have doubt about the overall real world value of boarding, I frankly resent the fact that I am expected to subject myself to such an arduous, time intensive, and financially draining process in order to have any chance of differentiating myself from incompetent practitioners of neuropsychology in my community (and that I should be damn grateful for the opportunity!) Hello, shouldn't that weeding out process have happened before that?? It just shouldn't be like that. I don't think the professional costs/sacrifices of boarding in ones chosen medical specialty is this big a pain the ass, is it? And we are trying to emulate medicine, right? If you really wanna sell this idea, I would suggest that they make the process less expensive and less-time consuming, and an overall smoother process. The never ending hoop jumping in this profession is getting quite tiresome. I am much more inclined to spend my post-doc years attending my kid's soccer games, hanging with the fam, with any extra work I choose to engage in having some significant financial benefit for myself and my family. Unless I am working in VA, I really don't see boarding doing that. Call me selfish I guess, but I am very jaded an cynical about investing my precious time and (limited) finances on a process that has some abstract "greater good of the profession" quality...but no real benefit to myself and my practice (unless I am in a VA).

 

[IT514]

I think who you're trained by has a lot to do with it. Personally, when I apply to internship and post-doc, the most important factor will be location. I, like erg, have a wife and getting closer to our families is our priority. Many of the sites close to my hometown are good APA sites with boarded and non boarded people. It just so happens that most of the boarded people are ABPN, not ABPP-CN. I'm ok with that.

Frankly I dont care, because I've seen variations in quality from both boards and theres nothing for me to objectively hang my hat on. Jon mentioned something about the HR and cut offs for brain injury...well I've seen some crazy stuff from ABPP-CN (think QEEGs and neurofeedback to save the world...crazy!).

 

[PETRAN]

Man, why do they need so many many years to practice neuropsychology (or applied psychology in general) in the states. I mean come on, 5-year PhD and internship and fellowship...are you kidding me? Why can't they just implement some bloody full-time 3-4 year sponsored-by-some-organization Psy-D for each psychological specialty like in the UK, some European countries or Australia? Is it such a big deal to do so? It would be immensely more practical and easier (not academic/clinical-level-easier but making-everyone’s-life easier) no matter what way you look at it.


Here is an example of a 4-year Doctorate in Clinical Neuropsychology from monash univesity-Australia

http://www.monash.edu.au/pubs/handbooks/courses/2932.html


Simple, nice, beautiful, practical, combined with doctoral-level research and has 5 directions (adult, child, rehab., psychiatric and forensic).

Oh yeah right, this is not right, you need a separate academic PhD (like it will make a difference in applied clinical settings, i think it would be much better to combine the modules with the clinical work and the research side by side) and then the internship, and the fellowship and the post-fellow-fellowship, and the post-fellow-fellow-senior-internship leading to post-sub-sub-specialty and a second PhD followed by 4 internships (of which 2 and a half could be accomplished before the second PhD and 1 and a quarter before the first PhD, leaving no more than a quarter of the time spend after the second-post-doctoral qualification. Alternatively, a third PhD and a semi-clinical-post-intern-fellowship before any two PhDs can lead to the requirement or perhaps you can go and get an engineering degree and get a job after that ). After all this stuff you can get approval after you give one written and two orals (no naughty pun intended) by the senior-assessment royal body of ABPP-ABCN-ABTD-ADHD-OCDPureO something which will grant the three-times-certified lordship and knighthood of the royal academy of neuropsychological mastership in the holy arts of sacrificial neuro-assessment and then you die

 

[Occlumentia]

Hi Petran, thanks for the , epsecially the last past of your post - I needed that today.

I'm Australian and just need to point out that while, yes, our psych postgrad stuff is pretty well-structured and organised, the following is also true, as far as I know:

1. If you do a Master or Clinical Doctorate in Neuropsych, then you are a "Neuropsychologist", but not a "Clinical Psychologist". This is important, as many positions and Medicare rebates are restricted to "Clinical Psychologists" (i.e. members of the Australian Psychological Society College of Clinical Psychologists). If you want to be both a clinical psych and a neuropsych, then you would need to do two Masters or two Clinical Doctorates. In Australia, Neuropsych is not a specialisation of Clinical - they are two separate fields.

2. If you do want to work primarily in academia/research, then a DPsych or an MPsych (although they both have hefty research components, especially DPsych) won't cut it, in most cases. To be competitive for grants you pretty much do need a PhD and a postdoc.

3. The clincal component of our Clinical Masters/Clinical Doctorates is not funded. You can obtain a scholarship for the research component, however. If you do a PhD you can get a scholarship (although it's not a huge amount) for the whole period, and the course fees are waived. In the UK, however, clinical training comes under the NHS and clinical psychologists in training get a salary, as far as I know - lucky them!

One of the advantages of our system is that it does separate those who want to be primarily clinicians and those who want to be primarily researchers, in terms of postgraduate (or in the US, "graduate") education - although it is worth noting that even the primarily clinical path does always have a considerable research component, as we too use the scientist-practitioner model.

 

[AcronymAllergy]

Hi Petran, thanks for the , epsecially the last past of your post - I needed that today.

I'm Australian and just need to point out that while, yes, our psych postgrad stuff is pretty well-structured and organised, the following is also true, as far as I know:

1. If you do a Master or Clinical Doctorate in Neuropsych, then you are a "Neuropsychologist", but not a "Clinical Psychologist". This is important, as many positions and Medicare rebates are restricted to "Clinical Psychologists" (i.e. members of the Australian Psychological Society College of Clinical Psychologists). If you want to be both a clinical psych and a neuropsych, then you would need to do two Masters or two Clinical Doctorates. In Australia, Neuropsych is not a specialisation of Clinical - they are two separate fields.

2. If you do want to work primarily in academia/research, then a DPsych or an MPsych (although they both have hefty research components, especially DPsych) won't cut it, in most cases. To be competitive for grants you pretty much do need a PhD and a postdoc.

3. The clincal component of our Clinical Masters/Clinical Doctorates is not funded. You can obtain a scholarship for the research component, however. If you do a PhD you can get a scholarship (although it's not a huge amount) for the whole period, and the course fees are waived. In the UK, however, clinical training comes under the NHS and clinical psychologists in training get a salary, as far as I know - lucky them!

One of the advantages of our system is that it does separate those who want to be primarily clinicians and those who want to be primarily researchers, in terms of postgraduate (or in the US, "graduate") education - although it is worth noting that even the primarily clinical path does always have a considerable research component, as we too use the scientist-practitioner model.

Occlumentia makes an excellent point. In the U.S., clinical neuropsychologists are first awarded degrees in clinical psychology, and THEN afforded specialization in neuropsychology. Thus, in the minds of many training committees, the ~5 years of graduate school should be devoted almost entirely to training you as a clinical psychologist more generally, while concomitantly providing some exposure to the specialized practice of clinical neuropsychology. Internships continue with this generalist training (possibly exposing some heavily neuropsych-specific trainees to their first real dose of general clinical psych work) while also often fostering further specialization in clinical neuropsych. The post-doc is where the true full-on neuropsych focus (at the expense of any further general clinical psych training) often occurs.

 

[PETRAN]

Hi Petran, thanks for the , epsecially the last past of your post - I needed that today.

I'm Australian and just need to point out that while, yes, our psych postgrad stuff is pretty well-structured and organised, the following is also true, as far as I know:

1. If you do a Master or Clinical Doctorate in Neuropsych, then you are a "Neuropsychologist", but not a "Clinical Psychologist". This is important, as many positions and Medicare rebates are restricted to "Clinical Psychologists" (i.e. members of the Australian Psychological Society College of Clinical Psychologists). If you want to be both a clinical psych and a neuropsych, then you would need to do two Masters or two Clinical Doctorates. In Australia, Neuropsych is not a specialisation of Clinical - they are two separate fields.

2. If you do want to work primarily in academia/research, then a DPsych or an MPsych (although they both have hefty research components, especially DPsych) won't cut it, in most cases. To be competitive for grants you pretty much do need a PhD and a postdoc.

3. The clincal component of our Clinical Masters/Clinical Doctorates is not funded. You can obtain a scholarship for the research component, however. If you do a PhD you can get a scholarship (although it's not a huge amount) for the whole period, and the course fees are waived. In the UK, however, clinical training comes under the NHS and clinical psychologists in training get a salary, as far as I know - lucky them!

One of the advantages of our system is that it does separate those who want to be primarily clinicians and those who want to be primarily researchers, in terms of postgraduate (or in the US, "graduate") education - although it is worth noting that even the primarily clinical path does always have a considerable research component, as we too use the scientist-practitioner model.

Thanks for the info occlumentia!

I personally like the idea of clinical neuropsychology being seperate from clinical psychology. I believe it has matured enough to be a seperate sub-field. What is the case of clinical neuropsychologists in Australia? Are there any good job opportunities/prospects etc.?

Plus, is it completely impossible to go into Academia with the DPsych? Aren't you allowed any post-doc research positions after the DPsych in clinical neuropsychology?

 

[Therapist4Chnge]

I personally like the idea of clinical neuropsychology being seperate from clinical psychology. I believe it has matured enough to be a seperate sub-field.

I could not disagree more. Clinical neuropsychology requires solid generalist training as a foundation, or the neuropsychologist is practicing with at least one hand tied behind his/her back. Neuropsychology is far more than a bunch of assessments and report writing. Understanding the etiology of a disease state is needed, as is what it looks like "in real life".

Case and point, at our pathology rounds a few weeks ago, the head pathologist started asking me questions about clinical presentation and associated behaviors of a typical AD case. We saw the commonly associated neurological changes in our brain (both gross and later on slides), but that only told half the story. He wanted to know what it looked like, and then tied that in with the various effected areas.

Thank God it was an AD case and not some random neurological disease I've only seen a few times. The pathology fellows get the brunt of questioning, but I've been around enough that I'm fair game.

 

[IT514]

I'm 100% with T4C here. Dementia of any kind is a good example of why a good generalist background is required for competent practice in clinical neuropsych.

At my VA externship I went on an inpatient eval to see a older guy with a leg injury due to questionable competency to return home, drive, etc. One of the attendings on his case was SURE the guy had dementia. Post neuropsych eval, it turns out that there were no cognitive issues at all, but serious axis II-type issues that made the staff think he'd lost it. So, we addressed those issues, talked to the staff about how to deal with him, and all was well, well sort of.

Without a good generalist background, we would have been able to say that he didnt have dementia, but would not have been able to address the personality issues cogently and talk to staff about behavioral interventions.

 

[PETRAN]

I could not disagree more. Clinical neuropsychology requires solid generalist training as a foundation, or the neuropsychologist is practicing with at least one hand tied behind his/her back. Neuropsychology is far more than a bunch of assessments and report writing. Understanding the etiology of a disease state is needed, as is what it looks like "in real life".

Case and point, at our pathology rounds a few weeks ago, the head pathologist started asking me questions about clinical presentation and associated behaviors of a typical AD case. We saw the commonly associated neurological changes in our brain (both gross and later on slides), but that only told half the story. He wanted to know what it looked like, and then tied that in with the various effected areas.

Thank God it was an AD case and not some random neurological disease I've only seen a few times. The pathology fellows get the brunt of questioning, but I've been around enough that I'm fair game.

haha good for you that you are able to stand on your feet with all these pathology fellows. You make the psychologists proud



Yeah, i see what you mean, but it is not hard to see a clinical neuropsychology doctorate with all the appropriate generalist training. If you look at the Australia degree it provides general clinical courses (like ethics, CBT and psychopathology) and at the same time it is more "neuro". I believe it is no different than those American clinical doctorate courses which have a "neuropsychology concentration" (like the Houston degree or the Gainesville one in Florida). Well, i guess it already happens in the states

 

[PETRAN]

In my experience, at the graduate school level, neuropsychology tends to differ as a concentration at the elective level and often requires a bit of extra work. The core training is the same (i.e., abnormal psych child and adult, personality, intellectual and behavioral assessment, stats, research methods, etc. . .). Practica still require therapy and internships require therapy training. Postdocs could go either way (all neuro and no therapy training or some therapy included). There are some phd neuropsychology programs in the US, but they are generally not viewed favorably. I would see it as a problem.

Not viewed favorably? Why is that? Isn't the Houston program any good? I can't see why you can't get more neuropsych focus at the graduate level of study. I mean, yes you need to have basic clinical training in psychotherapy, personality etc. but for neuropsychology you also need a lot of extra training in the neurosciences and cognitive psychology. Some clinical neuropsychologists are basic/cognitive neuropsychologists as well and i see this combination (in "clinical" as well as in "basic/cognitive" aspects of neuropsychology) as an excellent means to be a "complete brain-behaviour" expert. Even for the purely "applied" clinician it is more valuable to understand various neurocognitive theories of attention, executive functions and memory (and how could they apply in neurological conditions) than some kleinian psychodynamic theory of personality.

 

[Therapist4Chnge]

What I'm talking about is a thought process. We are clinical psychologists. Neuropsychology is a specialty. But, that doesn't mean it's like an undergraduate minor. To make a medicine analogy, though imperfect, it's like we are neurologists versus psychiatrists.

One concern I have about the "neuropsychology" Ph.D. is that they do not build enough of a foundation is straight clinical psychologist to truly understand the pathology that is completely absent of neuropsychological issues. If everything is taught through a neuropsychological lens, I think the trainee will have a hard time seeing things unrelated to a neuropsychological diagnosis. If all you were given was a hammer, everything looks like a nail.

 

[PETRAN]

One concern I have about the "neuropsychology" Ph.D. is that they do not build enough of a foundation is straight clinical psychologist to truly understand the pathology that is completely absent of neuropsychological issues. If everything is taught through a neuropsychological lens, I think the trainee will have a hard time seeing things unrelated to a neuropsychological diagnosis. If all you were given was a hammer, everything looks like a nail.

If you have the general modules on psychopathological processes, CBT and stuff why should there be a problem? A neuropsychology PhD programs (or PsyD for that matter-if it ever exists) containing modules and practica on mental health should be just fine. Its not like you do only neuroscience and cognition, you'll also do the mental health stuff. Just not to the extend that an adult clinical psychologist would (and should do), like options in different psychotherapeutic modalities and advanced personality theories etc.


I can personally understand mental health better through the "neuropsychology lens" like understanding what the basal ganglia and cortical-subcortical circuits (possibly) do and how do they contribute to OCD and some other major psych disorders. Not in a sterile one-factor biological way, but in a more dynamic way in which by understanding the functions of various areas and circuits and how do they get modified and possibly change in response to the environment and one's behaviour (leaving windows and opportunities for science-based psychotherapy), one can build a very strong neuropsychopathological model (and maybe a neuropsychotherapeutic intervention!). I believe that one day all psychology will be a kind of neuropsychology but this is wild speculation

 

[Therapist4Chnge]

If you have the general modules on psychopathological processes, CBT and stuff why should there be a problem? A neuropsychology PhD programs (or PsyD for that matter-if it ever exists) containing modules and practica on mental health should be just fine. Its not like you do only neuroscience and cognition, you'll also do the mental health stuff. Just not to the extend that an adult clinical psychologist would (and should do), like options in different psychotherapeutic modalities and advanced personality theories etc.

The program you described exists already....it's a clinical psychology program with neuropsych training (classes, mentorship, practica, and research).

 

[Existenz]

We need for the ABPP-Cn to be THE final word for neuropsychology, much as medical boards are the final word for their specialties. This ties directly into enforcement of the Houston guidelines and I think would go a long way in ensuring quality in those that profess to practice neuropsychology.

Now that I'm done with postdoc and stuff I'm starting to move towards boards. I never gave much thought to doing ABN. Most of my mentors are ABPP. I wonder how the ABN vs ABCN debate is going these days?

 

[WisNeuro]

ABPP numbers are incresing quite substantially, I don't know about ABN. I honestly have 0 colleagues who are ABN boarded vs dozens who are ABPP. I'm betting on the horse that I'm sure is going to be around in 20 years, personally.

 

[AcronymAllergy]

ABPP numbers are incresing quite substantially, I don't know about ABN. I honestly have 0 colleagues who are ABN boarded vs dozens who are ABPP. I'm betting on the horse that I'm sure is going to be around in 20 years, personally.

Same here, although it's probably been a bit of a self-selecting sample. All of the non-neuro folks I know who're boarded are also ABPP (are there even other boards for other specialties..?), so there's a bit of a common understanding and parlance there, which is helpful.

 

[IT514]

My fellowship has both boards represented, and I've probably worked with an equal number of ABPP and ABN folks throughout my training. I know that ABN just recieved some kind of certification and some are working to develop ABN fellowship guidelines, so I guess that means its still active, but I dont know much about it.

I will go ABPP. My reasoning is not that ABN is an inferior board. ABPP aligns with my training a bit more, as the criteria are perhaps more stringent, mention the Houston conference guidelines, etc.

 

[WisNeuro]

I believe that the ABN board was officially recognized by CRSPP as a credentialing organization, so, not a huge change. I don't know how that has translated to some state reqs.

 

[notfullyfathomd]

This has been an interesting thread to read, now that it's a few years old -- doesn't seem like much has changed. I'm an intern and will definitely be pursuing ABPP certification. My grad program even offered to pay for the early entry ABPP option for all of its students.

This article was circulating on the AACN list serve a few days ago. Re-certification requirements seem like they could be one of the benefits of board certification in general...although I'm curious to see how it works in terms of ABPP's execution in the next few years.
http://www.nytimes.com/2014/12/16/opinion/board-certification-has-gone-too-far.html?_r=0

 

[AcronymAllergy]

I support the idea of re-certification, but agree with the article that it could quite easily go too far.

 

[WisNeuro]

Agreed, in practice, re-cert is a good idea. As a professional, you should be keeping up with research as it pertains to your clinical work. If the process were geared towards actual clinical competence, I fully support it. If you're doing this as a professional, then the exam should be a piece of cake with minimal studying needed.