PhD/PsyD From Psychotherapy to Assessment/Testing

[hum1]

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Hello,

I have been doing psychotherapy for the past 20 something years and am in need of a career change. I also teach for a PsyD program during the Summer and I really enjoy it. However, I would not want to leave my clinical practice to become a full time adjunct and have a precarious and highly unstable job situation.

I thought about starting to do some psychological assessment/testing and am wondering what first steps I would need to take? In the past I have applied some tests such as the MMPI, WAIS, WISC, BDI, TAT, etc. however I did not do my internship nor my post doc in assessment. I thought about applying some of the aforementioned tests, do autism evaluations, or do simple court evaluations, etc. but would not want to do more complex evaluations such as e.g. neuro psych evaluations.

I am aware that applying tests and writing reports is an extremely difficult and very specialized task, however I was wondering if it would be possible to do a career change without having to go back in training an do an internship and post doc in testing? If so, which steps should I take? Is there training, supervision? Thank you for your thoughts.

 

[psych.meout]

What do you mean by "simple court evaluations?"

 

[hum1]

What do you mean by "simple court evaluations?"

In the state where I live, Massachusetts, there are clinicians who do immigration evaluations for attorneys. I meant a diverse group of legal evaluations and reports, not forensic evaluations.

 

[psych.meout]

I'm confused. How are "legal evaluations" not forensic evaluations? How are you defining and operationalizing these terms to differentiate them?

 

[hum1]

I'm confused. How are "legal evaluations" not forensic evaluations? How are you defining and operationalizing these terms to differentiate them?

I am sorry, I know very little of forensic and legal assessment. The point I was trying to make is that I believe that psychologists that conduct neuropsych and forensic assessments start this route in their practicum/internship/post docs, therefore I would exclude pursuing such assessments.

 

[AcronymAllergy]

Hello,

I have been doing psychotherapy for the past 20 something years and am in need of a career change. I also teach for a PsyD program during the Summer and I really enjoy it. However, I would not want to leave my clinical practice to become a full time adjunct and have a precarious and highly unstable job situation.

I thought about starting to do some psychological assessment/testing and am wondering what first steps I would need to take? In the past I have applied some tests such as the MMPI, WAIS, WISC, BDI, TAT, etc. however I did not do my internship nor my post doc in assessment. I thought about applying some of the aforementioned tests, do autism evaluations, or do simple court evaluations, etc. but would not want to do more complex evaluations such as e.g. neuro psych evaluations.

I am aware that applying tests and writing reports is an extremely difficult and very specialized task, however I was wondering if it would be possible to do a career change without having to go back in training an do an internship and post doc in testing? If so, which steps should I take? Is there training, supervision? Thank you for your thoughts.

First, I don't think it'd be possible to go back and do an internship, at least via the APPIC route. A formal or informal postdoc is possible, but it'd likely be full-time and you'd probably take a pay cut. Peer-to-peer consultation (combined with self-study) is typically how folks go about expanding their competence once they're already practicing.

Beyond that, it's all going to depend on what types of assessments you're wanting to provide, which will probably be dependent in (large) part on what's in-demand in your area.

If it's been a while since you've done any type of assessment, which it sounds like is the case, I'd stay away from anything court-related, at least initially. When you want to start dipping your toes into that, you're going to need peer-to-peer consultation/supervision at the very least. Ideally, you'd conduct evaluations in partnership with another psychologist, maybe even observe a couple done by them to start. I have no experience with immigration evaluations, so I can't speak to how simple they are. But it's a niche, and you'd need someone knowledgeable in that area, which includes not just knowledge of whatever assessments are appropriate, but of how to use and interpret those assessments in the context of the overall purpose of the eval.

From a clinical perspective, you're still going to want some peer-to-peer consultation. I'd start by selecting probably one type of assessment to gain experience with. Maybe ADHD evals, maybe adult autism evals, maybe broader psychological assessments based on referrals from a psychiatrist. Ideally something you have some prior training and experience with, and something someone else in the area is already doing and willing to consult with you on.

 

[smalltownpsych]

In our local area, psychologists have a 3 to 4 month waiting list for assessments. If I was looking to get some experience in assessment and get that aspect of my practice rolling again, I would reach out to a couple of them and offer to help with some of their backlog and in exchange for consultation and the referral, offer a 50/50 split.

 

[cara susanna]

In the state where I live, Massachusetts, there are clinicians who do immigration evaluations for attorneys. I meant a diverse group of legal evaluations and reports, not forensic evaluations.

What is an immigration evaluation? Seems like a potentially loaded area of practice these days

 

[PsyDuck90]

What is an immigration evaluation? Seems like a potentially loaded area of practice these days

I had a professor in grad school who specializes in interpersonal violence and child abuse. She did these often, usually for people applying for U-VISAs and the like. There may be other contexts, but that’s what I’m familiar with. I would agree that this may not be the best area to jump into given the current climate, especially if you are not well versed in the process already.

 

[AcronymAllergy]

What is an immigration evaluation? Seems like a potentially loaded area of practice these days

I'm not familiar with them, but have seen requests for them come across my state psych listserv. I think they primarily speak to what effect immigrating (or rather, not immigrating) could have on the person, so as to potentially help their case to immigrate. Although I would suspect with the understanding that it, like other forensic evals, is independent and thus may not help their case.

 

[psych.meout]

A psychologist who I used work with did some of these and even specialized in it on internship and post doc. The context they did it in was asylum and other immigration applications for individuals who were in some subject to systemic discrimination or other oppression in their countries of origin. There were many people from South and Central America, SE Asia, the Middle East, and Africa who were subjected to trauma and violence by the government or other armed groups. Having an expertise in trauma and PTSD was really important, as was working with translators and cultural competence and humility. My understanding is that their psychological status is often inferred by the courts as a sign of the veracity of their concerns about being deported back to their country of origin. E.g., if they already have PTSD from systemic sexual violence perpetrated against members of their community by a different group in their country, then that's evidence that their concerns about being subjected to similar or new kinds of violence is well-founded and not a ploy to use this area of special immigration status to unlawfully immigrate to the US.

One of the problems with this area of work is that the financial aspects are wildly disparate. In this psychologist's specialty area, there's basically no money. The individuals being evaluated are destitute and therefore the evaluations are often paid for by some nonprofit or other NGO and it's a pittance, frequently relying on unpaid/low paid trainees to do a lot of the heavy lifting, as there are many individuals seeking these services. There seem to be a subset of the immigration evals that are well compensated, either because the the individual and/or their personal connections have money or if there is a well-funded group paying for it (often by expats and 2nd+ generation members of their own communities).

 

[PsyDr]

Immigration evaluations can be used to:
1) Allow access to U&T and Violence Against Women Visas (i.e., the applicant was the victim of one of the specifically enumerated crimes, which allows them a visa).
2) document "hardship", allowing them an exemption from the usual process of immigration or being removed from their family in the US,
3) Allow use of N-648 or naturalization waivers from the usual immigration process (e.g., you diagnose someone with a learning disorder, so maybe they can be exempt from the written civics test or English test).

 

[hum1]

In Massachusetts there are master level clinicians such as social workers and counselors doing all different types of evaluations: "Immigration Evaluations", "Mental Health Evaluation", etc. I think it is a difficult area to work at because master level clinicians usually charge lower fees than psychologists.

 

[docloufan]

Hello,

I have been doing psychotherapy for the past 20 something years and am in need of a career change. I also teach for a PsyD program during the Summer and I really enjoy it. However, I would not want to leave my clinical practice to become a full time adjunct and have a precarious and highly unstable job situation.

I thought about starting to do some psychological assessment/testing and am wondering what first steps I would need to take? In the past I have applied some tests such as the MMPI, WAIS, WISC, BDI, TAT, etc. however I did not do my internship nor my post doc in assessment. I thought about applying some of the aforementioned tests, do autism evaluations, or do simple court evaluations, etc. but would not want to do more complex evaluations such as e.g. neuro psych evaluations.

I am aware that applying tests and writing reports is an extremely difficult and very specialized task, however I was wondering if it would be possible to do a career change without having to go back in training an do an internship and post doc in testing? If so, which steps should I take? Is there training, supervision? Thank you for your thoughts.

Probably wouldn't do any of this is, as most of these are somewhat specialized. ASD has been hot-topic for years now and appropriate dx has HUGE implications for tx/services, resource allocation, and can followed Pts for many years. And no court evaluation should be viewed as "simple" for similar reasons...and other reasons.

If it has been 20 years of mostly being a treating psychotherapy provider, you really need some specialized training and supervision if you want to switch to this. I don't know how one would go about this without sacrificing current work/hours? It's also likely to cost you money for a while too.

 

[WisNeuro]

Personally, I wouldn't touch the medicolegal world without the prerequisite experience and a mentor/senior colleague in the area willing to guide you somewhat. Lot of potential pitfalls for those naive to the games that go on in such evaluations. And, mistakes here can follow you for a long time.

 

[Therapist4Chnge]

Personally, I wouldn't touch the medicolegal world without the prerequisite experience and a mentor/senior colleague in the area willing to guide you somewhat. Lot of potential pitfalls for those naive to the games that go on in such evaluations. And, mistakes here can follow you for a long time.

Came in to basically write this.

Even for people who have a mentor and some prior exposure to medicolegal work, it can still have a steep learner curve. Too many things can go wrong bc many people don’t know what they don’t know.

Some of the least prepared “experts” are clinicians who want to do legal work “on the side”. They often will take on bad cases and that’s not good for their reputation. I purposefully am picky with cases I accept bc a bad case can follow you for years.

 

[hum1]

Thank you all for your thoughts. So after reading everybody's comments would it be fair for me to conclude that a change of career from psychotherapy to assessment would be a very difficult change? And that the change is almost as if I am changing to a complete different professional area? Moreover, this change would involve a lot of years of investment of time/training/money/supervision?

I take my professional work very seriously and am still supervised in my clinical work. However, I have been doing psychotherapy for a very long time, and am wondering for those who do psychotherapy if they do other jobs/tasks which involve less direct hours with clients/patients?

 

[psych.meout]

Thank you all for your thoughts. So after reading everybody's comments would it be fair for me to conclude that a change of career from psychotherapy to assessment would be a very difficult change? And that the change is almost as if I am changing to a complete different professional area? Moreover, this change would involve a lot of years of investment of time/training/money/supervision?

I take my professional work very seriously and am still supervised in my clinical work. However, I have been doing psychotherapy for a very long time, and am wondering for those who do psychotherapy if they do other jobs/tasks which involve less direct hours with clients/patients?

Why are you still being supervised after two decades in the field?

Getting consultation is one thing, but being "supervised" after so long seems a bit odd.

 

[hum1]

Why are you still being supervised after two decades in the field?

Getting consultation is one thing, but being "supervised" after so long seems a bit odd.

Why would it be odd? I believe that doing clinical work is something that we need to learn over and over again, that every psychotherapy process and client/patient are unique, so it is a lifelong learning process. So having a supervisor with whom I meet every week or every two weeks has been very helpful to discuss clinical cases. I also attend to seminars, courses, reading groups, where I see much older people, in their 50s, 60s, 70s, who also enjoy discussing clinical cases and learning from others.

 

[docloufan]

Why would it be odd? I believe that doing clinical work is something that we need to learn over and over again, that every psychotherapy process and client/patient are unique, so it is a lifelong learning process. So having a supervisor with whom I meet every week or every two weeks has been very helpful to discuss clinical cases. I also attend to seminars, courses, reading groups, where I see much older people, in their 50s, 60s, 70s, who also enjoy discussing clinical cases and learning from others.

Because it is. As in its not a common practice. Who pays this supervisor?

And I think the literature strongly disagrees that every psychotherapy process is unique.

 

[psych.meout]

Because it is. As in its not a common practice. Who pays this supervisor?

And I think the literature strongly disagrees that every psychotherapy process is unique.

Exactly. Consultation is definitely a thing for when a provider wants a second opinion, feedback, etc. about a given patient case, but it's as-needed and not a regularly scheduled thing and does not cover most or all of the patients they are seeing in a given week. It's ad hoc to solve or explore specific issues. Consultation groups exist as well, but while they might be regularly scheduled, they are not meant to go over cases for every group member and be like a trainee supervision session. They are meant to address consultation needs for select individual cases brought to the group, address more general practice and professional issues, and as a learning experience for all the members.

It's unusual for someone so many years out from training and licensure to be having supervision like that received by trainees, though maybe you're operationalizing it differently and it's more like consultation. If it is more like trainee supervision, it's unusual in the sense of both being uncommon and also not what be the appropriate level of consulting on cases and other matters for someone at that stage of training. It's like a mathematician asking someone to check their everyday budgeting on a regular basis vs. consulting with another mathematician on a proof for a previously unsolved mathematical problem.

Also agreed that the literature doesn't show that therapy is so unique. That's why we have evidence for efficacy and effectiveness of various treatments. If they were so unique that you need supervision on cases throughout your career, then there likely wouldn't be enough commonality for treatment, diagnosis, taxonomy of psychopathology (whether categorical or spectra, depending on what taxonomy you are using), discerning underlying processes of psychopathology (e.g., dysexecutive functioning, emotional dysregulation), and other areas in which we do have reams of research. Yes, treatments need to be adapted to the unique situation of the individual (contrary to the mischaracterization of CBT and other ESTs), but those are the flavor or character of their lives and concerns and do not necessarily mean that a patient is so unique that we can't determine important similarities to patients in general and use that for conceptualization and treatment (e.g., that they have GAD and therefore difficulties with uncertainty even though their particular worries related to it are unique to their experience and background).

 

[hum1]

I was wondering if there are others who changed areas from psychotherapy to assessment. It is interesting because I have seen more of the opposite direction, meaning psychologists who always wanted to do assessment, focused on assessment during training and post docs, and then moved to psychotherapy because preferred doing psychotherapy then doing assessment.

 

[psych.meout]

That's because it's much easier to switch in that direction. Basically everyone gets a good amount of psychotherapy and intervention training in grad school and other levels of training, even if they are assessment focused. That's for a variety of reasons, one of which is that many of those intervention skills (eg establishing rapport, assessing and building motivation, etc) are also very important for assessment. Thus, while someone who is in assessment has at least a good foundation in therapy (though they may need some refreshing or extra training and consultation depending on what they choose to do for therapy), someone who has significant therapy training and experience may have minimal assessment training, again, for a variety of reasons. It's also significantly harder (though not impossible) to train to proficiency or even competence in assessment later in your career than to get more therapy training too build off of grad school, internship, etc.

And not all assessment is the same. There are many different forms of assessment, including psychoed, neuropsych, forensic, presurgical, autism, etc. There is significant overlap in general skills and knowledge for each of these assessments, but there are also many specific aspects to them that you have to learn. They can also be contextual where there may be differences in a specific kind of assessment depending on the setting, population, and other factors. Eg if you are doing presurgical assessment in an interdisciplinary AMC setting, there are many other skills you need compared to if they farmed it out to you in PP.

 

[ForensicPsychFightClub]

Immigration evaluations can be used to:
1) Allow access to U&T and Violence Against Women Visas (i.e., the applicant was the victim of one of the specifically enumerated crimes, which allows them a visa).
2) document "hardship", allowing them an exemption from the usual process of immigration or being removed from their family in the US,
3) Allow use of N-648 or naturalization waivers from the usual immigration process (e.g., you diagnose someone with a learning disorder, so maybe they can be exempt from the written civics test or English test).

Excellent list. I would just add one more, particularly because it is very timely: The INA has a competency standard as well, so there are also competency to be deported evaluations that are done through immigration court.

 

[oliversacks4thewin]

That's because it's much easier to switch in that direction. Basically everyone gets a good amount of psychotherapy and intervention training in grad school and other levels of training, even if they are assessment focused. That's for a variety of reasons, one of which is that many of those intervention skills (eg establishing rapport, assessing and building motivation, etc) are also very important for assessment. Thus, while someone who is in assessment has at least a good foundation in therapy (though they may need some refreshing or extra training and consultation depending on what they choose to do for therapy), someone who has significant therapy training and experience may have minimal assessment training, again, for a variety of reasons. It's also significantly harder (though not impossible) to train to proficiency or even competence in assessment later in your career than to get more therapy training too build off of grad school, internship, etc.

And not all assessment is the same. There are many different forms of assessment, including psychoed, neuropsych, forensic, presurgical, autism, etc. There is significant overlap in general skills and knowledge for each of these assessments, but there are also many specific aspects to them that you have to learn. They can also be contextual where there may be differences in a specific kind of assessment depending on the setting, population, and other factors. Eg if you are doing presurgical assessment in an interdisciplinary AMC setting, there are many other skills you need compared to if they farmed it out to you in PP.

This. A thousand times this. I consult with our neurology team at the AMC where I work and have been taking the time to review the outpatient neuropsychology reports our team receives with my trainee, with a massive focus on teaching the concept "yes, anyone can administer a test and write up a report, but it takes incredibly critical training and knowledge to interpret and fully conceptualize the data in a meaningful way for the patient."

Case in point, we literally had a report where the WISC and WRAT scores were extremely low, so the evaluating psychologist diagnosed the patient with a severe IDD. Family was confused, and stated the feedback simply stated he has low scores on these measures and therefore has severe IDD. The major problem with this, the patient has a complex neurological condition that presents with profound gross and fine motor coordination skills...you know... the kind you use for almost everything measured by those tests. So the test measured the kid's spasticity, dyskinesia, and ataxia, which are all known factors already, but likely missed the mark on actually measuring actual cognitive functioning. Sure, this is an extreme (but very real) example, but it demonstrates just how much training you truly have to experience and be supervised on with these assessment tools to be effectively utilizing them. It's not something you can just pick up on a whim.

 

[R. Matey]

So the test measured the kid's spasticity, dyskinesia, and ataxia, which are all known factors already, but likely missed the mark on actually measuring actual cognitive functioning.

I'm just a simple man leading a simple life, but all this time I thought intelligence tests measured cognitive functioning.

 

[PsyDr]

I'm just a simple man leading a simple life, but all this time I thought intelligence tests measured cognitive functioning.

Here I am, thinking dyskinesia and ataxia are functions of the CNS. That Freud fella should have changed his cerebral palsy classifications about spasticity, if that's not his area.

But in all seriousness, I think Oliversacks4thewin just phrased the idea poorly. Maybe he/she should have said that the content validity of the subtest scores was confounded by motor covariates.

 

[oliversacks4thewin]

Here I am, thinking dyskinesia and ataxia are functions of the CNS. That Freud fella should have changed his cerebral palsy classifications about spasticity, if that's not his area.

But in all seriousness, I think Oliversacks4thewin just phrased the idea poorly. Maybe he/she should have said that the content validity of the subtest scores was confounded by motor covariates.

Caught on semantics, again! That's what I get for quickly typing this before running down to clinic. Yes, I was implying that the use of these measures was profoundly impacted by the already known deficits, and the evaluator would have benefitted tremendously from switching to more appropriate measures that would better account for these concerns and therefore more accurately assess the targeted function of IQ and/or academic function.

As an aside, I looked into the Freud reference with CP, and I have to say, I am always fascinated to learn more about "Freud the neurologist" as opposed to his reputation in psychiatry/psychology. Thanks for deepening my further interest in his other, less known works. I have On Aphasia on my desk, and it's a shockingly insightful take on aphasia and the associated neurophysiology of the brain, given the time it was written.

 

[PsyDr]

Caught on semantics, again! That's what I get for quickly typing this before running down to clinic. Yes, I was implying that the use of these measures was profoundly impacted by the already known deficits, and the evaluator would have benefitted tremendously from switching to more appropriate measures that would better account for these concerns and therefore more accurately assess the targeted function of IQ and/or academic function.

As an aside, I looked into the Freud reference with CP, and I have to say, I am always fascinated to learn more about "Freud the neurologist" as opposed to his reputation in psychiatry/psychology. Thanks for deepening my further interest in his other, less known works. I have On Aphasia on my desk, and it's a shockingly insightful take on aphasia and the associated neurophysiology of the brain, given the time it was written.

Also invented the gold chloride neuron stain technique.