PhD/PsyD Abandoning therapy in favor of psychometrics

[mildlyacceptable]

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I'm currently preparing my applications for this year's doctoral cycle, and I've bumped into a serious quandary. For the longest time, my career goal has been to work as a psychotherapist, with an emphasis on depth therapies and developmental work. I prepared a list of schools to apply to that would help with that specialization, and have begun work on those applications.

Long story short, I've had a bit of a personal reckoning recently and have realized that I might not have the temperament to do that sort of work long-term and at a high level of competence. I have determined my personality and personal history just aren't suited for the demands that long-term, relational work requires. I take the quality of my work extremely seriously, and I wouldn't want to enter a vocation where the best I can do would be sub-par. That said, I don't want to abandon psychology entirely. This has been my life for years, and I have a great deal of academic and personal interest in the field.

I'm considering switching my specialty to psychological assessment. This way, I can still interact with patients, study psychopathology, and work in this field that I love, without the interpersonal rigors of long-term psychotherapy. Problem is, I have no clue what a career in psychometrics or assessment looks like. I feel like I need to completely restructure the pool of schools I'm applying to.

Are there programs that specialize in it? Is a doctorate strictly necessary? Are there resources for me to get up to speed for the standard-of-care these days? Are there any examples of schools that specialize in assessment as a greater part of their curriculum? What is the path to becoming someone who primarily works in assessment? Thanks.

 

[hne]

Psychological assessment is more providing assessments to patients, psychometrics is more about the measurement itself (test validation, stats) and can involve little to no patient contact.

I'm wary about pursuing psychological assessment purely on the presumption that it's less interpersonally rigorous than long-term relational psychotherapy. First, there's a lot of therapy work that is very different what you're describing. Second, in some ways, assessment can be highly interpersonally taxing in its own way (building enough rapport to obtain often highly personal information from someone within a very short window of time, dealing with challenging approaches to testing, obtaining collaterals, delivering feedback to patients that they don't want to hear and/or majorly impacts their life). And, outside of that, there's the added, demanding writing component.

This is a concern, not a judgment—“temperament and personal history" will continue to pop up as you get into the marathon of grad school and all that it entails, even with a specialty focused on assessment. The question is do you like what you’re doing enough to view that experience as worth it? So, for example, would testing, interpretation, and report-writing make that worth it for you?

A doctorate is pretty much necessary for an assessment career (for now at least...). Beyond that, what type of assessments are you looking to do? That will define your program search. Neuropsychology, for example, is a highly assessment focused speciality, there are programs that have much more opportunities and better placement for this speciality than others. Like anything else, you'd be looking for increasingly specialized practicum experiences, a specialized internship, and then an even more specialized postdoc (which is required for board certification in neuro in particular).

 

[mildlyacceptable]

Thanks for the thoughtful response.

I definitely am not opposed to a career where I have patient contact. I think I lack the academic chops to spend much time in psychometrics research, so assessment is the clear lane. I've spent some time in clinical settings, as well as in research settings where I am administering limited assessments, so I'd like to think I have at least a fragmentary understanding of what the differences in the work look like.

The temperament issues I'm referring to are pretty subtle, not a general aversion to people or interpersonal work. At a high level, I think I have trouble with the ambiguity, frustration, and potential for strong countertransference in long-term therapy. I have a tendency toward over-intellectualization when triggered, and I don't know if I have the patience to see clients for years without definitive markers of a "job well done." I understand those things can be taught, and no one would expect someone to have mastered their ability to hold frame prior to receiving training, but still - I just think my aptitude is elsewhere.

I understand there are different forms of therapy that are less demanding in this sense - manualized CBT and DBT, ERP, etc. - but they do not interest me as much. I have some image in my mind of assessment for the purpose of differential diagnosis, followed by referrals to treatment. This "flow" appeals to me because there is some concrete outcome of my work (the written report and diagnoses/lack thereof) that I can look to and say that I "did my job."

In this sense, I am mostly interested in general clinical assessments, not quite neuropsych. ADHD, Autism, intelligence testing, mood disorders, personality disorders. I'm also interested in psychodynamic diagnosis, which is a somewhat developing field. Truth be told, I'm not exactly sure what I'm interested in because I don't know what's out there, necessarily.

Maybe this is all pointless waxing and I'm hopelessly naive about what work in assessment looks like. I just don't have a great frame of reference, so I figured I'd ask here.

 

[futureapppsy2]

There are many therapy jobs where you will likely never see a client for years, and the focus is on shorter term therapy when concrete outcomes--the VA is one.

 

[PsyDr]

1) Very frankly, you are unlikely to have enough information to make an informed decision. If I was trying to imagine how being a professional baseball player worked, I would be able to guess at some of the job task requirements (e.g., athleticism, determination, hand-eye coordination, etc). The other factors would probably be guesses, based upon my own imagination. That imagination is probably wrong. Similarly, you simply don't know what it takes to be a depth psychologist, how they react in private, and what competence means for that arena.

2) Psychologists have created their own "culture". Some of that culture is regional.

3) Get into a program first. Then worry about what kind of psychologist you want to be.

 

[mildlyacceptable]

@futureapppsy2
Interesting. Not seeing a client for years? What sorts of tasks are involved in the day-to-day, then?

@PsyDr
Understood, good advice. What do you mean by regional culture? Also, is there any value in looking at programs that have a greater emphasis on assessment? You're right in that I don't know right now what that work is really like. However, I've also been told that the school you choose is very important in determining your specialty. Is this true?

 

[futureapppsy2]

@futureapppsy2
Interesting. Not seeing a client for years? What sorts of tasks are involved in the day-to-day, then?

@PsyDr
Understood, good advice. What do you mean by regional culture? Also, is there any value in looking at programs that have a greater emphasis on assessment? You're right in that I don't know right now what that work is really like. However, I've also been told that the school you choose is very important in determining your specialty. Is this true?

I meant, you won't see an individual client for years. not that you will go years without seeing any clients. Many, many therapy providers emphasize short-term therapy. Seeing the same client for years is probably the outlier more than the norm, these days.

 

[mildlyacceptable]

I meant, you won't see an individual client for years. not that you will go years without seeing any clients. Many, many therapy providers emphasize short-term therapy. Seeing the same client for years is probably the outlier more than the norm, the days.

Right, lol. I'll brush up on my reading comprehension skills before I send out any applications.

 

[hne]

The temperament issues I'm referring to are pretty subtle, not a general aversion to people or interpersonal work. At a high level, I think I have trouble with the ambiguity, frustration, and potential for strong countertransference in long-term therapy. I have a tendency toward over-intellectualization when triggered, and I don't know if I have the patience to see clients for years without definitive markers of a "job well done." I understand those things can be taught, and no one would expect someone to have mastered their ability to hold frame prior to receiving training, but still - I just think my aptitude is elsewhere.

Your aptitude may very well be in assessment. And assessment may provide a more structured environment and more concrete results for you, where there are fewer opportunities for those particular challenges to arise.

What I meant is, you will still be triggered and tasked with navigating ambiguity, frustration, and potentially experience countertransference even if you ultimately specialize in some form of assessment. You will still receive training in therapy in grad school, and, moreover, such experiences are the nature of mental health work. Clinical supervision will also, as you started to get at, absolutely focus on addressing these issues to ensure your competence.

If the definitive markers of assessment provide you with a protective sense of “job well done,” or you genuinely enjoy the tasks involved enough to still be willing to face the issues to some extent, it makes sense to change your direction. If the basis of the change is “if I do assessment, my issues won't come up,” you would be mistaken.

I understand there are different forms of therapy that are less demanding in this sense - manualized CBT and DBT, ERP, etc. - but they do not interest me as much. I have some image in my mind of assessment for the purpose of differential diagnosis, followed by referrals to treatment. This "flow" appeals to me because there is some concrete outcome of my work (the written report and diagnoses/lack thereof) that I can look to and say that I "did my job."

You can both not do years-long depth therapy AND not do brief, uber-structured cognitive behavioral or exposure treatment. I dare say the majority of therapy that goes on is actually somewhere in between.

As for your second sentence, something that develops with time is confidence that you did your job even if the outcome is ambiguous or against what you want. You don't need a product, a diagnostic label, or clinically significant change to have practiced competently.

In this sense, I am mostly interested in general clinical assessments, not quite neuropsych. ADHD, Autism, intelligence testing, mood disorders, personality disorders. I'm also interested in psychodynamic diagnosis, which is a somewhat developing field. Truth be told, I'm not exactly sure what I'm interested in because I don't know what's out there, necessarily.

Maybe this is all pointless waxing and I'm hopelessly naive about what work in assessment looks like. I just don't have a great frame of reference, so I figured I'd ask here.

Not pointless waxing nor hopelessly naive. As you bring up, though, I think some more research about (and exposure to, if you can get it) assessment would not only inform where you want to apply and help you put together a convincing application, but also give you more clarity about this as a new direction.

 

[PsyDr]

@futureapppsy2
Interesting. Not seeing a client for years? What sorts of tasks are involved in the day-to-day, then?

@PsyDr
Understood, good advice. What do you mean by regional culture? Also, is there any value in looking at programs that have a greater emphasis on assessment? You're right in that I don't know right now what that work is really like. However, I've also been told that the school you choose is very important in determining your specialty. Is this true?

1) If you are in Manhattan or Boston, you are likely to be trained by people who treat patients, for years, with depth psychotherapy. If you are in.... Birmingham Alabama, you are likely to be trained by people who treat people with short term CBT (I'm guessing, I don't know anything about Birmingham). The analysts believe in the "blank slate" approach, which implies a certain behavior. That behavioral expectation is somewhat different for CBT.

2) I have no idea about schools and specialties. Ask futureapppsy, acronym, or others. My career is atypical.

 

[AcronymAllergy]

@futureapppsy2
Interesting. Not seeing a client for years? What sorts of tasks are involved in the day-to-day, then?

@PsyDr
Understood, good advice. What do you mean by regional culture? Also, is there any value in looking at programs that have a greater emphasis on assessment? You're right in that I don't know right now what that work is really like. However, I've also been told that the school you choose is very important in determining your specialty. Is this true?

The school itself is generally less important than the advisor (for PhD programs), but it's difficult/impossible to divorce the two, since advisors are tied to specific schools. But in general, yes, your advisor can have a significant impact on your professional career. Although even then, it's possible to branch out beyond what your advisor focuses on if you get adequate training.

Beyond that, there are lots of different types of assessment. If getting broad exposure to assessment as a whole is important, you'll just want to be sure that the program has ample training opportunities in that regard. Current students can be a great resource for that sort of information.

 

[oliversacks4thewin]

I've spent some time in clinical settings, as well as in research settings where I am administering limited assessments, so I'd like to think I have at least a fragmentary understanding of what the differences in the work look like.

When you say "limited assessments" can you explain further? I wonder, if based on your comments above of being aversive to the research side, if a career in "assessment psychology" is really the direction you are drawn to, based on what you have experienced.

Not to complicate matters further, but I have to wonder if a career in medicine, with specialization in psychiatry or neurology may be a better fit for you. For one, psychiatry tends to lean a bit more towards psychodynamic approaches than psychology, although this can be influenced by region, as @PsyDr alluded to. Additionally, their field and that of neurology tends to focus on assessment during initial and subsequent evaluations, as the medical model skews more towards the approach that you described as a bit more comfortable (typically less talk-therapy and more focused on evaluating if current therapies are working or need adjustment).

Similarly to other suggestions, I would strongly recommend you shadow a variety of different but similar fields to better inform your decision-making process.

 

[mildlyacceptable]

Thanks for the helpful nudges, everyone.

I will be sure to investigate training opportunities and reach out to current students as best I can. More information always helps! There is a lot of truth to the fact that I can always attend a program and then determine my specialty. I currently have the least amount of experience I will ever have, so trying to plan things exactly right will be as hard as it will ever be.

@oliversacks4thewin
I am currently working in a research setting where I am administering the SAGE-SR, and I have previously administered the ADIS and the DIAMOND, though these were more for general estimates of symptoms rather than use for differential dx. I am not opposed to working in research, per se, it's just that I don't think I have a ton of passion for developing new assessments. I'd rather be the guy that gives, interprets, and advises on existing assessment protocols in a clinical setting, though I know academics and practice are not mutually exclusive.

Medical school isn't a bad suggestion, though I don't know if I have the prerequisites or if I have the will to do residency and all that rigamarole.

Good idea to shadow. I'll reach out to some local psychologists to see if they'd be willing to speak to me.

 

[oliversacks4thewin]

I'll confess, I am left with more questions following your answer lol.

I think we define "assessment" and "research" differently. For example, the three tools you mentioned have two semi-structured diagnostic interviews and one screening measure. The goal of these being, I presume, to arrive at some diagnostic label. The assessment that most psychologists perform (e.g., personality, cognitive, neuropsychological, etc.) is more to describe the picture of function of the individual being assessed, with sometimes a diagnostic label being a by-product of those sometimes lengthy generated reports. If my job was to simply say "yes, this person has X" I don't know that an assessment may always be necessary, in the same way a physician does not always require labs to arrive at a diagnosis, but is aided by them in moments of uncertainty.

As for research, I have certainly never set out to create a new measure, but, boy howdy, would that make me some money! Instead, I was more referencing the need for in-depth understanding of research principles to inform the use of psychological measures, and how we all typically pull from assessment data to conduct research, usually enroute to completely and defending our dissertation.

Finally, if you feel medical school is arduous from it's residency and "all that rigamarole" I may strongly advise against a psychology doctorate, as our supervised training hours are also quite lengthy and stressful.

 

[mildlyacceptable]

I'll confess, I am left with more questions following your answer lol.

I think we define "assessment" and "research" differently. For example, the three tools you mentioned have two semi-structured diagnostic interviews and one screening measure. The goal of these being, I presume, to arrive at some diagnostic label. The assessment that most psychologists perform (e.g., personality, cognitive, neuropsychological, etc.) is more to describe the picture of function of the individual being assessed, with sometimes a diagnostic label being a by-product of those sometimes lengthy generated reports. If my job was to simply say "yes, this person has X" I don't know that an assessment may always be necessary, in the same way a physician does not always require labs to arrive at a diagnosis, but is aided by them in moments of uncertainty.

As for research, I have certainly never set out to create a new measure, but, boy howdy, would that make me some money! Instead, I was more referencing the need for in-depth understanding of research principles to inform the use of psychological measures, and how we all typically pull from assessment data to conduct research, usually enroute to completely and defending our dissertation.

Finally, if you feel medical school is arduous from it's residency and "all that rigamarole" I may strongly advise against a psychology doctorate, as our supervised training hours are also quite lengthy and stressful.

Hey, I've got plenty of questions myself. I appreciate you taking a stab at it and attempting to parse my hand-waving. I'm not averse to a hefty workload - the specifics of residency and how residents are treated just really turns me off. Anyway, good food for thought. Thanks.

 

[R. Matey]

As for research, I have certainly never set out to create a new measure, but, boy howdy, would that make me some money! Instead, I was more referencing the need for in-depth understanding of research principles to inform the use of psychological measures, and how we all typically pull from assessment data to conduct research, usually enroute to completely and defending our dissertation.

Yeah, I came here to say basically the same thing:

OP, you will be limited in your assessment capabilities if you do not understand the psychometrics behind them. You need to understand the population sampling, the factor structure, the scoring methods etc for you to be competent at your job. You do not want to be the people who administer every instrument under the sun for a simple ADHD referral, for example. The only thing that signals to me is that you probably failed the Type I error inflation question on the EPPP.

I agree with @PsyDr et al that it seems like you're still not quite sure what you want your career to look like...and, I would add, that's ok. I think we sometimes put way too much pressure on students to say exactly what job they want without leaving any room for career exploration in graduate school. What you do know is that you want to do patient facing clinical work of some kind, you know that you want to have expertise in psychology, and you know that you would like to do assessment of some kind. If you want to get into a decent PhD program, the best method would be for you to hone a research interest and show potential labs what you're able to offer them. Your graduate school training will give you a chance to explore your clinical interests well enough.