"Can Licensed Mental Health Counselors Administer and Interpret Psychological Tests?"

[LadyHalcyon]

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Was reading the attached article and was interested in thoughts about this? I know psychiatry is very protective of prescription privileges and psychology is very protective of assessment. However, I think there is value in mid-levels being able to have some testing abilities, as long as they are properly trained. View attachment Can Counselors Test (1).pdf

 

[sfgucadoc]

Only if they work in a practice with a psychologist who can supervise and CACREP changes their accreditation standards A LOT. I know too many LPCs who present themselves as testing experts, sometimes even in a legal case.

I'm licensed as an LPC, psychologist, and social worker. (Don't ask.) I manage an agency with quite a few LPCs on staff as therapists. I know how they were trained and what their limitations are. Not a good idea.

 

[LadyHalcyon]

Only if they work in a practice with a psychologist who can supervise and CACREP changes their accreditation standards A LOT. I know too many LPCs who present themselves as testing experts, sometimes even in a legal case.

I'm licensed as an LPC, psychologist, and social worker. (Don't ask.) I manage an agency with quite a few LPCs on staff as therapists. I know how they were trained and what their limitations are. Not a good idea.

Yes, I work with many LPC's and there is a WIDE variety in regard to training. I think the field of psychology should move toward training/supervising midlevels; more like a "roll with the resistance" approach. I see a lot of anger/fear/condescension toward mid-level providers, but we need them, as there are not enough psychologists to provide services. Especially in rural areas.

 

[WisNeuro]

The rural argument is bunk. It's true for all medical providers, and there is no evidence that more providers leads to addessing the issue.

 

[MAClinician]

The article comes from counselors so of course they would argue for this. This is NOT a good idea.

 

[Therapist4Chnge]

Horrible idea. They don’t know what they don’t know.

 

[Sanman]

Yeah, let's give away what's left of the profession so none of us can put food on the table.... a big fat NO from me.

 

[psychstudent5]

Why is our field always so eager to play martyr and give away everything that makes us unique??? I don't understand this. No other profession (that I know of) is constantly advocating for other professions to do some of their work. I also don't like this idea of psychology moving towards supervision/training midlevels. Where are the jobs and money in that? Hospitals are always looking to cut staff. They'll be advocating for needing 1-2 psychologists rather than 3-4 since we will be mostly supervising midlevels because they think we could supervise and training half or all the midlevel staff.

Like @WisNeuro said, there rural argument holds no water. We have PLENTY of psychologists (see: diploma mills) to provide care. The larger problem is that hospitals are hiring fewer and fewer psychologists because...midlevels can do what we do (except assessment for now) at a lower cost. This is not a "supply and demand" problem.

I get so frustrated with this field.

 

[psych.meout]

Yes, I work with many LPC's and there is a WIDE variety in regard to training. I think the field of psychology should move toward training/supervising midlevels; more like a "roll with the resistance" approach. I see a lot of anger/fear/condescension toward mid-level providers, but we need them, as there are not enough psychologists to provide services. Especially in rural areas.

I'd argue that there are more than enough psychologists to meet the demand of services. The problem is not supply, but of distribution. Many major metropolitan areas are oversaturated with psychologists. There's not much incentive for them to move to underserved areas, and I'd surmise that many of them are the same people who balked at moving to obtain research experience to be competitive for grad school, for grad school itself, or for internship and post doc. Do you think any of these people, after they have earned their doctorate and been licensed want to move for the even longer term of their careers to underserved areas?

Regardless, even if, for argument's sake, we accepted that there was a shortage of psychologists, allowing mid-levels to do this work doesn't necessarily alleviate that problem. You're still not providing any incentive or motivation for these counselors to go to underserved areas. Furthermore, if the rebuttal to that argument is that mid-levels are cheaper to employ than psychologists, so underserved areas can afford to pay them when they can't afford psychologists, you're ignoring the whole underlying point of mid-levels arguing in favor of psychological testing and assessment parity. They want to do testing, because they can bill and get reimbursed more for it than what services they already provide. They're clearly motivated to increase their own income, which I don't necessarily blame them for doing, but again, that's not really solving the problem.

The end result isn't going to be more access to services in underserved areas or for underserved populations. It will be mid-levels competing for the same limited pie as psychologists with minimal, at best, expanded access.

 

[Justanothergrad]

Doctoral students are hardly trained adequately for basic testing, and they know this. The performance standards are horrible on basic tests that people train with in all programs.

I cant imagine less training producing better outcomes. Besides that, let's stop giving our field away and relegating the use of the degree. We did it in billing practices, we are letting it happen in testing, substance use getting separated was a killer to us, and traditional therapy has long since sailed.

 

[PsyDr]

I’d like to introduce the sister article, “Can PsyDr date 21 year olds?”. It has similar arguments.

 

[NeuroTrope]

I’d like to introduce the sister article, “Can PsyDr date 21 year olds?”. It has similar arguments.

So it sounds like both are happening?

 

[erg923]

Most psychologists suck at doing this in a way that actually contributes valid, substantial, and/or usable insights that impact the course of treatment. Why do you want someone else to do it....likely even worse.

 

[Sanman]

So it sounds like both are happening?

Well, to paraphrase the article, trying to prevent PsyDr from dating 21 year olds would be impractical and unethical.

 

[PsyDr]

Since my humor is lost: just because you can legally do something doesn’t make it a good idea.

Damn, watch a lifetime movie. The 33% of about the husband leaving the wife for a younger woman. Not the 33% about kids with leukemia. Or the 33% about justified reasons to murder a husband.

 

[Sanman]

Since my humor is lost: just because you can legally do something doesn’t make it a good idea.

Damn, watch a lifetime movie. The 33% of about the husband leaving the wife for a younger woman. Not the 33% about kids with leukemia. Or the 33% about justified reasons to murder a husband.

Not so much lost on us (well not me at least) as amused by the thought of you dating a 21 yo, especially a sorority girl who was a psych major. The conversations would be epic!

 

[NeuroTrope]

Since my humor is lost: just because you can legally do something doesn’t make it a good idea.

Damn, watch a lifetime movie. The 33% of about the husband leaving the wife for a younger woman. Not the 33% about kids with leukemia. Or the 33% about justified reasons to murder a husband.

Not lost, but the way you phrased it made it ripe for the plucking...

 

[PsyDr]

Not so much lost on us (well not me at least) as amused by the thought of you dating a 21 yo, especially a sorority girl who was a psych major. The conversations would be epic!

 

[cara susanna]

I found statistics so critical to understanding assessment. I would be worried about anyone doing assessment interpretation without that background.

 

[psych.meout]

I found statistics so critical to understanding assessment. I would be worried about anyone doing assessment interpretation without that background.

And this is the problem with their argument. It rests on counselors being "appropriately trained," which they haven't specifically operationalized. Sure, CACREP is requiring them to meet some kind of assessment standard, but two-year programs have far less didactics in general than doctoral programs and are generally lacking in statistics and other related, but assessment-specific areas. And justanothergrad stated, the quality of assessment training overall in doctoral programs isn't great, so it's quite obtuse to let people with even less training do that same level of assessment.

Furthermore, the requirements from CACREP are just about coursework and the programs themselves, not hands-on experiential clinical training, which mostly occurs after the program for counseling students. Thus, there's clearly no uniform standard of assessment training and there's far less training in general than doctoral programs.

 

[psychRA]

However, I think there is value in mid-levels being able to have some testing abilities, as long as they are properly trained. View attachment 274726

The proper training is key here.

The problem with other disciplines doing testing is that (unless they've pursued additional training independently) they're not qualified to do assessment correctly, but they may have just enough information to feel that they're qualified. They don't know what they don't know, and some are overconfident as a result. In my few years as a licensed psychologist so far, I've run into many issues with other disciplines stepping outside their scope of practice when it comes to assessment. It's not just mid-levels; I actually have found this to be more of an issue with psychiatrists.

For example: although I have several years of experience with cognitive testing in addition to my years of graduate education on cognition, intellectual ability, psychometric measurement, and test construction, I am not a neuropsychologist. However, I have the background to understand what I'm measuring and why, and so I also understand why cognitive assessments need to be administered in a very specific way without deviations. I understand the limits of the assessment, and whether or not it's appropriate to make a diagnosis based on that assessment. I don't overstep my scope of practice by giving an assessment battery if I'm not qualified to interpret it accurately. And I certainly don't give an assessment until I've practiced it independently and can give it correctly. Unlike some physician coworkers I've encountered, who will make a diagnosis of cognitive impairment based on a single (incorrectly administered) screening measure that they found online.

 

[psychstudent5]

Unlike some physician coworkers I've encountered, who will make a diagnosis of cognitive impairment based on a single (incorrectly administered) screening measure that they found online.

This is so frustrating!!! Far too many non-psychologists health professionals are making diagnoses based off of screeners. I know we advocated for screeners being used in environments that are not traditional mental health clinics, like primary care, but it has caused many patients to be inaccurately diagnosed. In some cases, it can be difficult to remove the diagnoses. I think screeners are good for detecting symptom as well as symptom intensity and referring them to psychologists for diagnostic clarity, but that's it.

 

[PsyDr]

This is so frustrating!!! Far too many non-psychologists health professionals are making diagnoses based off of screeners. I know we advocated for screeners being used in environments that are not traditional mental health clinics, like primary care, but it has caused many patients to be inaccurately diagnosed. In some cases, it can be difficult to remove the diagnoses. I think screeners are good for detecting symptom as well as symptom intensity and referring them to psychologists for diagnostic clarity, but that's it.

If only there were federal rulings about this... some handsome MFer could make an awesome living at that...

 

[Sanman]

This is so frustrating!!! Far too many non-psychologists health professionals are making diagnoses based off of screeners. I know we advocated for screeners being used in environments that are not traditional mental health clinics, like primary care, but it has caused many patients to be inaccurately diagnosed. In some cases, it can be difficult to remove the diagnoses. I think screeners are good for detecting symptom as well as symptom intensity and referring them to psychologists for diagnostic clarity, but that's it.

Agreed with this and I see it all the time. Sometimes they don't even bother with the screening before giving the dementia dx. On the flip side, this is a great example about how psychology has failed to adapt to the changing medical environment. Had we adapted more appropriately, we would be THE standard in assessing these cases rather than a nice to have gold standard.

 

[Therapist4Chnge]

If only there were federal rulings about this... some handsome MFer could make an awesome living at that...

I recently did an IME where yet another mid level (an SLP this time) completely screwed up an RBANS and then used that data to support a bogus diagnosis of brain damage, which was also used to support many months of unnecessary treatment. In the span of a paragraph that case was dead in the water. I was really looking forward to eviscerating their findings on the stand, but the case never made it to court.

I have since come across the same mid-level for multiple other cases and likely could cherry pick cases from their practice and stay busy for the rest of the year and well into 2020 and beyond.

 

[WisNeuro]

I recently did an IME where yet another mid level (an SLP this time) completely screwed up an RBANS and then used that data to support a bogus diagnosis of brain damage, which was also used to support many months of unnecessary treatment. In the span of a paragraph that case was dead in the water. I was really looking forward to eviscerating their findings on the stand, but the case never made it to court.

I have since come across the same mid-level for multiple other cases and likely could cherry pick cases from their practice and stay busy for the rest of the year and well into 2020 and beyond.

I love it when SLPs/OTs report the "% correct" on the RBANS confrontation naming test and report that 70% is a good finding. "Norms? What are those?"

 

[Therapist4Chnge]

I love it when SLPs/OTs report the "% correct" on the RBANS confrontation naming test and report that 70% is a good finding. "Norms? What are those?"

That was the tip of the iceberg...

 

[WisNeuro]

That was the tip of the iceberg...

Yeah, I've also seen some.........VERY generous scoring on figure copy and recall. If that's what we can expect from midlevels someday, that sector of healthcare is screwed. I look forward to opening a PP, maybe doing some concierge stuff to go along with the neuropsych stuff. Maybe get my spouse on board for primary care. 🙂

 

[erg923]

As a per diem peer reviewer for a local worker's comp entity, I have poked holes in testing results and the subsequent diagnostic interpretation of many licensed psychologists, so I cant even imagine how this would get even more out of control and sad if it was farmed out to others (with less training)? That said, its mostly just poking holes is sloppy interviews and/or the diagnostic and treatment planning statement that this results in.

We need better testing assessment for many cases, not just more testing overall.

 

[Therapist4Chnge]

Workers Comp companies seem surprised when I skip testing and just recommend talk therapy.

I agree about the lazy diagnostic stuff. I’ve seen quite an uptick in my PTSD differential dx referrals. Upwards of 75% are just run of the mill anxiety disorders and/or driving anxiety post-MVA. PTSD gets slapped on cases waaaaay too easily. Not surprisingly, the vast majority have lawyers involved....

 

[DrRedstone]

How to you feel about master's level clinical psychologists administering these tests? I know I was specifically trained to administer the Wechsler IQ family of tests (didn't finish the full degree because I went to med school).

 

[WisNeuro]

How to you feel about master's level clinical psychologists administering these tests? I know I was specifically trained to administer the Wechsler IQ family of tests (didn't finish the full degree because I went to need school).

Being trained to administer, and being trained to interpret are two very different things. That being said, if the point is to just get an iq, doesn't matter. Anyone can be trained to administer and report a largely meaningless number.

 

[AbnormalPsych]

Being trained to administer, and being trained to interpret are two very different things. That being said, if the point is to just get an iq, doesn't matter. Anyone can be trained to administer and report a largely meaningless number.

I Agree. I know several masters level providers that do assessment, mostly with kids. They know their administration well. Their test selection, quality of interpretations, and report writing could be improved.

 

[PsyDr]

How to you feel about master's level clinical psychologists administering these tests? I know I was specifically trained to administer the Wechsler IQ family of tests (didn't finish the full degree because I went to need school).

1) There is no such thing as a master's level clinical psychologist. The APA definition of psychologist is doctoral. Yeah, I know some states allowed holdovers from way back. I don't care.

2) Back in the day, there were official publications about the difference in the level of interpretations of tests. There is a near nill chance that someone who completes a 30hrs MA has anywhere close to the skill of 7-9 years of formal education of a psychologist.

 

[Spydra]

Even though I'm still a student I don't like the idea of this at all. I worked hard to get into a doctoral program and am working even harder to get quality assessment training and I don't want to be passed over for master's level (who likely will settle for lower salaries) peeps by the time I'm ready to enter the job market.

In thinking about the problem of a lack of services in rural areas, wouldn't this problem be solved with a psychology equivalent of traveling nurses? I completely understand why a lot of psychologists wouldn't want to spend years/decades in a rural environment, but the occasional month or two might be tolerable for enough to improve service provision. How come this isn't a thing?

 

[Sanman]

In thinking about the problem of a lack of services in rural areas, wouldn't this problem be solved with a psychology equivalent of traveling nurses? I completely understand why a lot of psychologists wouldn't want to spend years/decades in a rural environment, but the occasional month or two might be tolerable for enough to improve service provision. How come this isn't a thing?

It is in the VA system, it called Home Based Primary Care. That said, the rural argument is largely a strawman. Lower salaried mean nothing if there is not enough of a population for full-time work. A regular psychologist that is not board certified in neuropsych is still better than a master's level clinician in scenarios where assessment is needed, but there is no staffing. Truth is most places get along fine without assessment services. It really is a specialty niche.

 

[Spydra]

It is in the VA system, it called Home Based Primary Care. That said, the rural argument is largely a strawman. Lower salaried mean nothing if there is not enough of a population for full-time work. A regular psychologist that is not board certified in neuropsych is still better than a master's level clinician in scenarios where assessment is needed, but there is no staffing. Truth is most places get along fine without assessment services. It really is a specialty niche.

I guess this is why I thought of kind of a traveling psychologist option. Its possible services (specifically assessment) wouldn't be needed full time, so the arrangement could be very flexible and it'd probably be easier to find psychologists willing to do it.

 

[Sanman]

I guess this is why I thought of kind of a traveling psychologist option. Its possible services (specifically assessment) wouldn't be needed full time, so the arrangement could be very flexible and it'd probably be easier to find psychologists willing to do it.

At that point, it is likely more cost effective to transport the patient to the nearest metro area for the assessment. Certainly, there are hospital specialists that do rotations at rural hospitals in their system once a month or so.

I also think there was an article somewhere in APA monitor or grad psych about a psychologist taking an RV out to do mobile crisis work.

 

[LadyHalcyon]

I amend my previous statement. Administration yes. Interpreting, choosing assessments, and and scoring? No

Maybe we should just put everyone in front of a computer and have sessions that way. You don't even need a person on the other end, all you need is a smartphone.

 

[PikminOC]

Most psychologists suck at doing this in a way that actually contributes valid, substantial, and/or usable insights that impact the course of treatment. Why do you want someone else to do it....likely even worse.

I refer to people who are phd with fellowship in neuropsych testing

 

[erg923]

I refer to people who are phd with fellowship in neuropsych testing

ok....

 

[psych.meout]

I refer to people who are phd with fellowship in neuropsych testing

Like, for everything assessment-related or when there is a neuropsych-specific referral question (e.g., does this patient have MCI?)?

 

[PikminOC]

Certain cases

 

[Justanothergrad]

I refer to people who are phd with fellowship in neuropsych testing

Here are a wonderful set of articles about board certified neuropsychologists and test interpretation variability (short version: most psychologists still suck because assessment, even with a fellowship, is not easy to interpret). Neuro does a good job pushing for more standardized interpretation practice in many ways relative to other assessment fields, but variation is the rule and not the exception.

Assigning qualitative descriptions to test scores in neuropsychology: forensic implications - PubMed

Board-certified neuropsychologists were surveyed and asked to assign a descriptive label (e.g., superior, average, normal, impaired) to 12 different standard scores (SS), from 50 to 130, of a memory test based on a brief case scenario. Surveys were returned by 49% (n = 110) of the target sample...

www.ncbi.nlm.nih.gov

Towards reporting standards for neuropsychological study results: A proposal to minimize communication errors with standardized qualitative descriptors for normalized test scores - PubMed

The Q-Simple qualitative descriptor system is aimed as a means to improve and standardize communication of standardized neuropsychological test scores. Research are needed to further evaluate neuropsychological communication errors. Conveying the clinical implications of neuropsychological...

www.ncbi.nlm.nih.gov

 

[PikminOC]

Here are a wonderful set of articles about board certified neuropsychologists and test interpretation variability (short version: most psychologists still suck because assessment, even with a fellowship, is not easy to interpret). Neuro does a good job pushing for more standardized interpretation practice in many ways relative to other assessment fields, but variation is the rule and not the exception.

Assigning qualitative descriptions to test scores in neuropsychology: forensic implications - PubMed

Board-certified neuropsychologists were surveyed and asked to assign a descriptive label (e.g., superior, average, normal, impaired) to 12 different standard scores (SS), from 50 to 130, of a memory test based on a brief case scenario. Surveys were returned by 49% (n = 110) of the target sample...

www.ncbi.nlm.nih.gov

Towards reporting standards for neuropsychological study results: A proposal to minimize communication errors with standardized qualitative descriptors for normalized test scores - PubMed

The Q-Simple qualitative descriptor system is aimed as a means to improve and standardize communication of standardized neuropsychological test scores. Research are needed to further evaluate neuropsychological communication errors. Conveying the clinical implications of neuropsychological...

www.ncbi.nlm.nih.gov

That's why there are only two places I recommend. I am very familiar with their work.

 

[mkberry85]

The broad, short answer; yes. LPC's are trained in the selection, administration, scoring, and interpretation of measures. Assessment and evaluation are within the competency for our program. With that said, each jurisdiction determines the scope of practice; that is, one state may allow them, another may not, and one may limit the type of measure. The key is to know your competency; this is your responsibility.

This comes from someone with training in both MHC and clinical psychology.

 

[psych.meout]

The broad, short answer; yes. LPC's are trained in the selection, administration, scoring, and interpretation of measures. Assessment and evaluation are within the competency for our program. With that said, each jurisdiction determines the scope of practice; that is, one state may allow them, another may not, and one may limit the type of measure. The key is to know your competency; this is your responsibility.

This comes from someone with training in both MHC and clinical psychology.

So we're doing this again? Great.....

 

[DrRedstone]

Somewhat related question, how do you feel about psychologists (PsyD/PhD) prescribing medication?

 

[AcronymAllergy]

Somewhat related question, how do you feel about psychologists (PsyD/PhD) prescribing medication?

There's actually a sticky in this forum devoted specifically to that topic (RxP). Short answer: psychologists tend to be split. I want to say surveys used to indicated the majority were against it, but I couldn't cite a source for you, nor do I know if that's changed in recent years.

 

[R. Matey]

This comes from someone with training in both MHC and clinical psychology.

Dude, same and I don't trust R. Matey from five years ago to know how to do anything aside from provide therapy. You can't seriously believe that a three credit run through of psychological tests and a mansplaination of classical test theory makes someone qualified to interpret a neuropsychology testing battery? Training, at that level, is completely inadequate.