Psychological Assessment career paths?

[albatross_at_crossroads]

Hello friends,

I have been trying to figure out my next moves for my career and I am starting to feel a little stuck. I am a clinical psychology doctoral student (Ph.D), second year, at a good research university. I like my research work, but I've come to the conclusion that I won't be happy just chasing an academic position after I graduate. Honestly, I am not all that interested in building a research career on my own right now. My mentor and other professors only sees us on this path, so it has been difficult figuring out what realistic possibilities are out there.

I have been exploring the clinical sides of my degree. I have done both therapy and assessment, and I am much more drawn to assessment. I have been trying to figure out what career paths there are for someone who would like to do assessments most of the time. I searched this forum and found some information on neuropsychology and a topic on custody evaluations. I am not limited in my search for a niche. I do have mostly child/adolescent assessment experience, but I would like to get more experience with adults.

As far as I can gather from this forum, is neuropsych the only path that matches this? I am interested in neuropsychology and I did very well in my neuroanatomy class, but I am unsure of the relocating/fellowship components of this area.
What I basically want is a position that offers mostly psychological services in the form of assessment/evaluation/testing and maybe some therapy but not mandatory.

Why I am at crossroads: I am not a US citizen so most of the VA and similar opportunities would be closed to me. I would also need a work visa which is easier to obtain with a stable job than a fellowship.
I have been offered a job opportunity in my own country. That would mean leaving my program with just the Masters. The job does consist of mostly assessment, is stable, but the pay is low and it might not be as respected as would a similar position here. I did have some difficulties in my first year adapting to the program, but I have been told that things have improved considerably during this past year.

I have looked at job boards and searched forums for the past couple of months. I can't seem to find any good answers. I am hopeful that since this forum has so many helpful members working in a variety of settings, that maybe I can get a good sense if this is a possible career path or not. I would appreciate any advice in this regard. Thank you!

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[erg923]

If your question is where can I do this, the answer would be private practice (obviously), state hospitals, prisons, MR/DD facilities. Private practice straight out of grad school is nearly impossible unless you have some community connections, so joining an existing practice is more realistic. You could also do solo contract work for the state doing SSDI evals.

Relocation for post-docs and fellowships is reality of the field these days, so its hard to escape that. You can of course do general psychological assessment without specialized post-doctoral or npsych training though.

 

[albatross_at_crossroads]

Hi Erg923,

Thank you for your answer. You seem an active member of this community and I appreciate your help.
I realize that it would be difficult taking the private practice route right of out school, but I think I would like to work in a hospital/medical center or similar.
I think my question was more about whether I can build a good career just around assessment, with limited therapy.
Would this path have a good career progression financial-wise? I am not expecting six figures or anything, but a salary that grows proportionally with experience and responsibilities.

It's interesting to learn I can do this on a general basis instead of specializing.
Should I focus on more assessment courses during grad school? I already took the ones available in my program, so I guess I need to find some relevant externships.
The internship should probably have a good component of assessment, right? Although I haven't seen any yet just focused on assessment.
In any case, it's good to know that it's possible. Thank you again for your help!

 

[Therapist4Chnge]

There are many types of assessment and even more niche areas, so it is definitely worth exploring.

-SSDI (assessment-lite bc it is mostly a clinical interview. Requires volume, but plenty to go around)
-forensic (more traditional psych assessment + in-depth clinical interviewing eval'ing prisoners/accused)
-neuro (already covered elsewhere)
-medico-legal (neuro + forensic, $$$ but stressful & requires at least one fellowship & add't mentorship)
-child custody (very lucrative, but very hostile/stressful)

…and I'm sure there are a half dozen or more other options out there, but here are some to start. I've seen second-hand (so YMMV) that traditional psych assessment in the private practice setting is very hard to get covered by insurance, though it is often done by the clinician anyway for clinical use (it just won't get paid). There are more niche areas in the cog. eval arena…but those are mostly/all neuro specific areas, so I skipped them.

 

[erg923]

Hi Erg923,

Thank you for your answer. You seem an active member of this community and I appreciate your help.
I realize that it would be difficult taking the private practice route right of out school, but I think I would like to work in a hospital/medical center or similar.
I think my question was more about whether I can build a good career just around assessment, with limited therapy.
Would this path have a good career progression financial-wise? I am not expecting six figures or anything, but a salary that grows proportionally with experience and responsibilities.

It's interesting to learn I can do this on a general basis instead of specializing.
Should I focus on more assessment courses during grad school? I already took the ones available in my program, so I guess I need to find some relevant externships.
The internship should probably have a good component of assessment, right? Although I haven't seen any yet just focused on assessment.
In any case, it's good to know that it's possible. Thank you again for your help!

Well,
1. a.) Reimbursement rates are higher for 96101 (psychological testing) than 90834 (therapy). b.) Insurance companies pay you the same rate whether you have been doing it for a year or for for 30 years. Thus, forensic contexts are the most "upwardly mobile," I suppose, since one can set their own rates. A cash only assessment PP is hard, unless its you are doing psycho-ed assessments, in which case parents will often shell out.

2. Yes, if you want to do a certain thing, its probably a good idea to get as much supervised training in it while you can.

3. All (accredidited) internships should provide a balance of asssessment and psychological intervention. Thats a requirment for APA accredidation.

 

[albatross_at_crossroads]

There are many types of assessment and even more niche areas, so it is definitely worth exploring.

-SSDI (assessment-lite bc it is mostly a clinical interview. Requires volume, but plenty to go around)
-forensic (more traditional psych assessment + in-depth clinical interviewing eval'ing prisoners/accused)
-neuro (already covered elsewhere)
-medico-legal (neuro + forensic, $$$ but stressful & requires at least one fellowship & add't mentorship)
-child custody (very lucrative, but very hostile/stressful)

…and I'm sure there are a half dozen or more other options out there, but here are some to start. I've seen second-hand (so YMMV) that traditional psych assessment in the private practice setting is very hard to get covered by insurance, though it is often done by the clinician anyway for clinical use (it just won't get paid). There are more niche areas in the cog. eval arena…but those are mostly/all neuro specific areas, so I skipped them.

Therapist4Chnge thank you for the list. I actually wasn't aware of some of those fields. As I have previously mentioned, professors in my program are more interested in research.
To be honest, neuropsych seems to me the most attractive, although I am a little intimidated by that path.

Erg923,

Thanks for your suggestions. My internship will be an APA accredited one, and thankfully my program has very good match rates.
I didn't even realize about reimbursements. That's a very good point. I knew that what I thought in theory might not match the reality That's why I always try to seek out new perspectives from people in the field.
I need to do some extra research on forensic, and maybe more on neuropsychology. But this was a great starting point. Thank you both for your contributions.

 

[AcronymAllergy]

RE: rates staying the same, as erg mentioned, it won't change based on how long you've been doing it (at least with insurance companies). What can change is how efficient you are at handling the various components of the assessments such that you might be able to do more of them in the same amount of time.

Health psych, like neuro, offers the potential for significant assessment work: transplantation surgery, living donor, bariatric surgery, and hormone and sex reassignment therapies are the ones that immediately spring to mind, and I'm sure there are others I'm forgetting.

 

[smalltownpsych]

Another good path for assessment can be in employment settings. One of my professors did these for the police department. Also, since you like research and assessment, I am thinking you might be able to a bit of both. Not all researchers are tenure-track full-time. Most of the faculty at my program had a mix of activities that they did - private practice, teaching, research, consultation, writing books, program development, etc.

 

[PsyDr]

I would rather set my hair on fire than do an SSDI eval .

 

[albatross_at_crossroads]

RE: rates staying the same, as erg mentioned, it won't change based on how long you've been doing it (at least with insurance companies). What can change is how efficient you are at handling the various components of the assessments such that you might be able to do more of them in the same amount of time.

Health psych, like neuro, offers the potential for significant assessment work: transplantation surgery, living donor, bariatric surgery, and hormone and sex reassignment therapies are the ones that immediately spring to mind, and I'm sure there are others I'm forgetting.

Thank you for the suggestion! Those assessments do sound quite varied and interesting. I will look more into this.

Another good path for assessment can be in employment settings. One of my professors did these for the police department. Also, since you like research and assessment, I am thinking you might be able to a bit of both. Not all researchers are tenure-track full-time. Most of the faculty at my program had a mix of activities that they did - private practice, teaching, research, consultation, writing books, program development, etc.

The job I've been offered is actually just that - doing employment eval for police and other law enforcement agencies. So it can definitely be an option.

I would rather set my hair on fire than do an SSDI eval .

PSYDR, you are funny I'm assuming you have direct experience?
I am willing of course to do extra training and work in more stressful environments, but I am aware some of them are more hostile than others. I don't think I could work efficiently for custodial evals for example. But your response is pretty specific

Thanks again for the suggestions everyone. You gave me a lot to think about, and I am starting to have a more positive outlook about this.

 

[erg923]

Thank you for the suggestion! Those assessments do sound quite varied and interesting. I will look more into this.



The job I've been offered is actually just that - doing employment eval for police and other law enforcement agencies. So it can definitely be an option.



PSYDR, you are funny I'm assuming you have direct experience?
I am willing of course to do extra training and work in more stressful environments, but I am aware some of them are more hostile than others. I don't think I could work efficiently for custodial evals for example. But your response is pretty specific

Thanks again for the suggestions everyone. You gave me a lot to think about, and I am starting to have a more positive outlook about this.

I would also suggest that some of that work comes with cogintive dissonance attached.

I do not think there is a work around to the fact that if one a does SSDI evals they are, by proxy, buying into the notion that (mostly treatable) psychiatric illness is truly "disabling" to the point where a person CANNOT work. Either you buy into this or you hold your nose and swallow. Which is it?

 

[smalltownpsych]

I would also suggest that some of that work comes with cogintive dissonance attached.

I do not think there is a work around to the fact that if one a does SSDI evals they are, by proxy, buying into the notion that (mostly treatable) psychiatric illness is truly "disabling" to the point where a person CANNOT work. Either you buy into this or you hold your nose and swallow. Which is it?

I do disability evals and I don't like them much, but it's part of my job. I also get the opportunity to report that they are capable of working and for many of them that with treatment they should be able to obtain meaningful employment. Very few people have I seen where they are truly disabled and I found out just recently that is because the referrals I get have already been screened and are the more questionable cases.

 

[Therapist4Chnge]

The plethora of questionable psych disability cases bug me because many of my TBI/similar patients are apply for disability, and it takes them forever to be evaluated because of others clogging up the system. There are legitimate psychiatric cases that should qualify for some level of disability, but it irks me that those are the exception and not the rule.

 

[psych84]

It seems if someone plans things right (gets the experience they need), Psychology can give you some of the most variety (in terms of work)

 

[albatross_at_crossroads]

It seems if someone plans things right (gets the experience they need), Psychology can give you some of the most variety (in terms of work)

That's what I am starting to learn as well.
During undergrad, I was told in vague terms that clinical was the most flexible psych career, but nobody could elaborate because it was mostly a teaching/research environment. That's why I like this forum so much. I get to read about the day to day life of psychologists in many settings. I do wish programs would give grad students more guidance on what's available though. Maybe more balanced programs give more info.

 

[erg923]

One of the most unfortunate missteps in the training of clinical psychologists over the years has been the shift towards having programs run by people who do not see patients, and often, have never worked in the clinical setting, sans internship and post-doc year.

Some of the worst, most impractical assessment advice I ever heard was from an academic psychologist who hadn't done a clinical evaluation outside a university run clinic in 20 years.

 

[albatross_at_crossroads]

One of the most unfortunate missteps in the training of clinical psychologists over the years has been the shift towards having programs run by people who do not see patients, and often, have never worked in the clinical setting, sans internship and post-doc year.

Some of the worst, most impractical assessment advice I ever heard was from an academic psychologist who hadn't done a clinical evaluation outside a university run clinic in 20 years.

I can definitely relate to this. My cognitive assessment instructor hadn't seen anyone for a looong time - maybe except a few assessments a year in a research capacity, and those were students who volunteered for credit. I didn't realize that there has been a shift in programs being run by people who do not see patients. In my program, very few still do actual clinical work. We get passed on for psychotherapy to the university clinic, where there are practicing psychologists who have trouble relating to the amount of research we do. My mentor is quite ok in general, but he hasn't done any real clinical work since his post doc. Somehow I thought it was normal that professors in the doctoral program aren't as in touch with clinical work anymore. The tenure-track ones are too busy chasing grants, and the tenured ones feel too far removed to go back there I guess.
The PsyD model sounded ok in theory, but in practice to me it just feels wrong. There are a few very good PsyD programs out there, but most are not exactly attractive.
I personally admire the UK doctoral system; but there clinical psychologists are integrated nicely into the national healthcare system, so it couldn't be implemented here.

What's more concerning is that only the hardcore researchers in my cohort are attracted to an academic career at the top programs, so their students will probably have an experience similar to mine. Sorry for the off-topic

 

[erg923]

My mentor was not even licensed and had not seen patients outside a research context since internship. Great lady. Talked with her about actual clinical issues (other than dx) exactly twice in 5 years.

It is less common than it used to be, certainly. And the shift I was taking about started in the 5os, so this isnt a recent development. If anything it's improving at the clinical science model programs.

 

[AcronymAllergy]

I'd be curious to see/know how common this is today vs. (as erg mentioned) 40-50 years ago, as I'm honestly not sure. I can say that in my slightly more research- than clinically-oriented grad program, nearly every clinical faculty member (including our DCT) was involved in actual clinical work, and the majority had external positions in addition to their faculty appointment (e.g., private practice, contracts with state facilities, etc.). Our psych clinic was run by some of these same folks as were many of our external practicum sites, so there wasn't any disconnect between what we did there and what we learned in class/supervision/etc.

 

[erg923]

I'd be curious to see/know how common this is today vs. (as erg mentioned) 40-50 years ago, as I'm honestly not sure. I can say that in my slightly more research- than clinically-oriented grad program, nearly every clinical faculty member (including our DCT) was involved in actual clinical work, and the majority had external positions in addition to their faculty appointment (e.g., private practice, contracts with state facilities, etc.). Our psych clinic was run by some of these same folks as were many of our external practicum sites, so there wasn't any disconnect between what we did there and what we learned in class/supervision/etc.

Tenure track at an RI, clinical practice, and involvment in student supervision/training. 60 hours per week on work related activities, at the least?

 

[smalltownpsych]

At my PsyD program, all of the faculty had current clinical work. That was a job requirement. They all had research experience but the amount varied. Some were heavy into research and publications and some were very involved in clinical settings outside the institution. The director seemed to be able to do it all. He was of the 60+ hours type.

 

[WisNeuro]

At our PhD program, most of the faculty actively saw patients in some way or another. The clinical supervisors were more heavily involved in clinical work. And, obviously, our external poractica were all practicing clinicians.

 

[AcronymAllergy]

Tenure track at an RI, clinical practice, and involvment in student supervision/training. 60 hours per week on work related activities, at the least?

For the folks who weren't yet tenured, that's probably pretty accurate; most had already cleared that hurdle, though. Additionally, much of the clinical work was funneled/worked in to research projects.

 

[smalltownpsych]

That's what I am starting to learn as well.
During undergrad, I was told in vague terms that clinical was the most flexible psych career, but nobody could elaborate because it was mostly a teaching/research environment. That's why I like this forum so much. I get to read about the day to day life of psychologists in many settings. I do wish programs would give grad students more guidance on what's available though. Maybe more balanced programs give more info.

I got a lot of vague and inaccurate information from undergrad, too. My undergrad did not have a doctoral program so that might have been part of the issue. I know that I got more info from a couple of the adjunct faculty than the full-time because they adjunct were also doing things outside the U. Some of the full-time psychology faculty appeared to have been there a little too long. Of course, I think there were at least 5000 psychology majors so it was easy to get lost in the shuffle. I only met a couple of students who actually wanted to be psychologists the entire time I was there. At least I didn't have to pay much to go there as it was a second-tier state institution.

 

[erg923]

I got a lot of vague and inaccurate information from undergrad, too. My undergrad did not have a doctoral program so that might have been part of the issue. I know that I got more info from a couple of the adjunct faculty than the full-time because they adjunct were also doing things outside the U. Some of the full-time psychology faculty appeared to have been there a little too long. Of course, I think there were at least 5000 psychology majors so it was easy to get lost in the shuffle. I only met a couple of students who actually wanted to be psychologists the entire time I was there. At least I didn't have to pay much to go there as it was a second-tier state institution.

Missinformation/missunderstanding about the field, the focus of training, and the types of work most psychologists actually do is rampant at most large universities.

 

[smalltownpsych]

Missinformation/missunderstanding about the field, the focus of training, and the types of work most psychologists actually do is rampant at most large universities.

That is good to know that it wasn't just the school I attended. I actually did learn some valuable information while I was there and my research methods professor in particular really helped me to understand the science of psychology and the critical thinking skills necessary to be a psychologist regardless of type of work or setting.