Thoughts on the proposed Minnesota Guidelines for neuropsych training?

[Freud’sMommy]

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I was looking forward to substantive, impactful changes and recommendations, but instead I found the guidelines vague and mostly redundant. Coming from a profession where the competencies and expectations were clear and practical, it's confusing (and low-key embarrassing) to see our field adopt guidelines of this caliber.

Maybe my expectations are what need calibrating? Are guidelines supposed to read like this?

 

[WisNeuro]

There is considerable and sometimes heated discussion happening across several listservs at the moment. From my read, very few people are happy with the first draft.

 

[erg923]

Can you post some of the concerns here? Not in the loop with all this.

And what is with psychology and naming stuff after states or cities? Doesn't that just make it look like it one possible way or group's position vs something with authority that the profession as a whole will actually adopt, promote, stick to, etc?

 

[WisNeuro]

Can you post some of the concerns here? Not in the loop with all this.

And what is with psychology and naming stuff after states or cities? Doesn't that just make it look like it one possible way or group's position vs something with authority that the profession as a whole will actually adopt, promote, stick to, etc?

The two biggest concerns are probably the lack of specificity when it comes to training and competencies specific to neuropsychology, as opposed to broader societal issues. Luckily, there has been a lengthening of the comment window, so we'll see what happens.

 

[Justanothergrad]

Can you post some of the concerns here? Not in the loop with all this.

And what is with psychology and naming stuff after states or cities? Doesn't that just make it look like it one possible way or group's position vs something with authority that the profession as a whole will actually adopt, promote, stick to, etc?

Bring it up at next year's Fargo Festival

 

[cara susanna]

What are the proposed guidelines? Also not in the neuropsych loop.

 

[WisNeuro]

I'm not sure that they are published outside of the delegate organizations at the moment. But, I could be wrong, I have access to them through some of my membership orgs.

 

[PsyDr]

There are severe problems with it.

1) They tell us how to consume research. Not that we have to stay current. They want us to interpret the research through political lens.
2) They are dictating how you behave outside of your professional activities. They demand you act humbly, engage in ill defined behaviors (ie., self reflection), and do uncompensated advocacy work. Who defines "humble", "advocacy" and "self reflection"? There are no definitions, until they want to punish you. What if someone wins a Nobel? Are they supposed to be humble about it?
3) They dictate how you run your business. Notice none of the authors have any business education, and this is a direct contradiction with instructions about staying in your area of competence.
4) There are a bunch of political terms in there, that they want us to be bound by. Historically, science that is based upon politics end up as an embarrassment.

 

[Freud’sMommy]

The guidelines are not public yet, but I accessed the draft via SCN membership. Here are the top line "competencies":

Foundational Competencies
Integration of Science and Practice
Ethics, Standards, Laws, and Policies
Equity, Justice, Cultural Respect, and Inclusion
Self-reflection and Self-care
Professional Relationships

Functional Competencies
Assessment
Intervention and Recommendations
Interdisciplinary Systems and Consultation
Research and Scholarly Activities
Teaching, Supervision, and Mentoring
Administration, Management, and Business
Advocacy
Technology and Innovation

As PsyDr and WisNeuro explained, much of the document (probably 30 to 50%) is political activism/social advocacy. Of the parts pertaining to actual neuropsychological practice, the amount of fluff would impress any college freshman. There's a stark difference in quality when comparing these new guidelines side-by-side with Houston Conference Guidelines.

Edit: link to the guidelines courtesy of SBN

 

[WisNeuro]

Yeah, the full draft is fairly chock full of ill-defined buzzwords. One of the issues getting a lot of play in discussions.

 

[Pragma]

I think most people would agree that communication about the process has left a great deal to be desired. Updating the HCG is a big task. There are a lot of neuropsychology organizations out there and there was a whole process for selecting delegates that happened last year, and only a small number of interested parties were selected to serve. What got sent around for comment was unexpected and incomplete, and I do not believe that has been clear to membership. In short, it is an interesting time to be a neuropsychologist right now.

 

[WisNeuro]

I think most people would agree that communication about the process has left a great deal to be desired. Updating the HCG is a big task. There are a lot of neuropsychology organizations out there and there was a whole process for selecting delegates that happened last year, and only a small number of interested parties were selected to serve. What got sent around for comment was unexpected and incomplete, and I do not believe that has been clear to membership. In short, it is an interesting time to be a neuropsychologist right now.

I agree, I think some of the follow-up communication was helpful, but that initial drop was...not great. I think we as a specialty could have done a much better job of keeping greater stakeholders in the loop about the process and procedures without having to get too granular.

 

[erg923]

There are severe problems with it.

1) They tell us how to consume research. Not that we have to stay current. They want us to interpret the research through political lens.
2) They are dictating how you behave outside of your professional activities. They demand you act humbly, engage in ill defined behaviors (ie., self reflection), and do uncompensated advocacy work. Who defines "humble", "advocacy" and "self reflection"? There are no definitions, until they want to punish you. What if someone wins a Nobel? Are they supposed to be humble about it?
3) They dictate how you run your business. Notice none of the authors have any business education, and this is a direct contradiction with instructions about staying in your area of competence.
4) There are a bunch of political terms in there, that they want us to be bound by. Historically, science that is based upon politics end up as an embarrassment.

Oh my stars!

 

[erg923]

The Boulder Model was gramps thing. Then there was the "Vail Conference/Model." Then the "Houston Conference Guidelines" thing. Then the "Delaware Project" thing. Now the "Minnesota Guidelines." Can we stop this silliness? Who else does **** like this?

 

[WisNeuro]

The Boulder Model was gramps thing. Then there was the "Vail Conference/Model." Then the "Houston Conference Guidelines" thing. Then the "Delaware Project" thing. Now the "Minnesota Guidelines." Can we stop this silliness? Who else does **** like this?

This piece is a non-issue.

 

[erg923]

This piece is a non-issue.

I'm asking why we are naming supposedly empirically-based guidelines for training/treatment/assessment in this profession after states and cities?

I don't get it. It is confusing to me and it is obviously confusing to any other medical profession seeking to understand standards of applied psychology/neuropsychology. To any outsider, it expresses little authority or standardization.

 

[WisNeuro]

I'm asking why are naming supposedly empirically-based guidelines for training/treatment/assessment of this profession after states and cities? I don't get it. It is confusing to me and it is obviously confusing to any other medical profession seeking to understand standards of psychology/neuropsychology.

You are literally the first person I have encountered that has an issue with this naming convention.

 

[erg923]

You are literally the first person I have encountered that has an issue with this naming convention.

Most physicians don't know what applied neuropsychology is at all. Why are we naming supposedly empirically-based guidelines for training/treatment/assessment in this profession after states and cities?

 

[WisNeuro]

Most physicians don't know what applied neuropsychology is at all. Why are naming supposedly empirically-based guidelines for training/treatment/assessment in this profession after states and cities?

I fail to see how what the guidelines are named changes this perceived issue?

 

[erg923]

I fail to see how what the guidelines are named changes this perceived issue?

It gets confusing to other applied health professionals. And for other psychologists too, frankly. Minnesota vs Houston. How do the "Boulder" and "Vail" models factors into this? What do "Delaware Conference" people think about all this? Lets get rid of state and city names and present a united front to the world.

I am aware these are all about very different things/aspect of Psychologist training, but we shouldn't expect other professions or people to know that.

 

[WisNeuro]

It get confusing to professions not involved. And for other psychologists too. Minnesota vs Houston. How does the "Boulder" and "Vail" models factors into this? What do "Delaware Conference" people think about all this? Lets get rid of state and city names and present a united front to the world.

I'm still confused about how changing a name of a guideline would instantly make everything suddenly clear to people outside of the field. How does the name somehow magically give someone insight into the particulars of what is inside of the document? There are many substantive issues with the document, but the name of it is largely irrelevant. Also, no one else is confused about this issue as thousands of documents are named for where they were created/signed as this is a very regular thing, like pretty much every treaty ever. This is a weird non-issue to pick as a hill to die on.

 

[erg923]

I'm still confused about how changing a name of a guideline would instantly make everything suddenly clear to people outside of the field. How does the name somehow magically give someone insight into the particulars of what is inside of the document? There are many substantive issues with the document, but the name of it is largely irrelevant. Also, no one else is confused about this issue as thousands of documents are named for where they were created/signed as this is a very regular thing, like pretty much every treaty ever. This is a weird non-issue to pick as a hill to die on.

Come on, son. This isn't a "Treaty of Versailles" issue. I am just suggesting how things could be expressed as more united/authority carrying and less confusing to unfamiliar health provider and physician audiences.

 

[calimich]

a little more background and some info re: SBN's process

 

[WisNeuro]

Come on, son. This isn't a "Treaty of Versailles" issue. I am just suggesting how things could be expressed as more united/authority carrying and less confusing to unfamiliar health provider and physician audiences.

Dad, go sit out on the porch and yell at clouds.

 

[erg923]

Dad, go sit out on the porch and yell at clouds.

I love looking at "mow lines" in my suburban yard whilst I shake my fist at the "young people."

 

[Therapist4Chnge]

The Boulder Model was gramps thing. Then there was the "Vail Conference/Model." Then the "Houston Conference Guidelines" thing. Then the "Delaware Project" thing. Now the "Minnesota Guidelines." Can we stop this silliness? Who else does **** like this?

You forgot the Baltimore Conference (rehab psych).

 

[WisNeuro]

You forgot the Baltimore Conference (rehab psych).

 

[Sanman]

You forgot the Baltimore Conference (rehab psych).

What's the matter, they couldn't find a better place to vacation? At least the Boulder and Vail folks had style. Minnesota can be nice in the summer as well.

 

[Fan_of_Meehl]

The guidelines are not public yet, but I accessed the draft via SCN membership. Here are the top line "competencies":



As PsyDr and WisNeuro explained, much of the document (probably 30 to 50%) is political activism/social advocacy. Of the parts pertaining to actual neuropsychological practice, the amount of fluff would impress any college freshman. There's a stark difference in quality when comparing these new guidelines side-by-side with Houston Conference Guidelines.

Edit: link to the guidelines courtesy of SBN

It strikes me that this is a general trend hitting our discipline (psychology), medicine, academia, etc and this is merely the latest front.

You can do science or you can do ideological/ political activism...pick one. These are diametrically opposed value systems.

 

[Ollie123]

Just glanced through the draft guidelines. Not surprisingly, people here seem to be harping on the DEI aspects.

I'm personally far more concerned by the fact that it seemingly has little-to-nothing to do with neuropsychology. I'm not talking about the DEI stuff, I'm talking about literally the whole thing. Honestly, you could probably just delete the word "neuropsychology" and "brain" in a couple sentences and it would work just fine as a general guideline for clinical/counseling psychology.

Not a neuropsychologist so maybe I should stay out of this. However, I imagine part of the goal is to establish boundaries for neuropsychology training specifically (to help discourage the "dabblers" I often hear you folks complain about). If anything, this document makes it seem like anyone with halfway decent training is a perfectly competent neuropsychologist and can do dementia evaluations to their heart's content...

 

[WisNeuro]

Just glanced through the draft guidelines. Not surprisingly, people here seem to be harping on the DEI aspects.

I'm personally far more concerned by the fact that it seemingly has little-to-nothing to do with neuropsychology. I'm not talking about the DEI stuff, I'm talking about literally the whole thing. Honestly, you could probably just delete the word "neuropsychology" and "brain" in a couple sentences and it would work just fine as a general guideline for clinical/counseling psychology.

Not a neuropsychologist so maybe I should stay out of this. However, I imagine part of the goal is to establish boundaries for neuropsychology specifically (to help discourage the "dabblers" I often hear you folks complain about). If anything, this document makes it seem like anyone with halfway decent training is a perfectly competent neuropsychologist and can do dementia evaluations to their heart's content...

I think this is the crux of the discussions within neuro as well. These seem to mirror the APA guidelines about DEI. Most people seem to be saying, we already abide by the APA ethics and aspirational codes, and that this document should focus on the specifics of the competency of what it takes to specialize in neuropsychology. The first draft was deeply disappointing, but I am somewhat cautiously hopeful about the member feedback process. But then there's the cynical side of me which has seen what is happening to state associations and is very pessimistic. In all, though, I think some of this mirrors broader issues of how much focus an org should be on bread and butter "guild" issues, vs. broader attempts for advocacy and political stances.

 

[Ollie123]

Glad I'm not the only one who caught that🙂

 

[Freud’sMommy]

It strikes me that this is a general trend hitting our discipline (psychology), medicine, academia, etc and this is merely the latest front.

You can do science or you can do ideological/ political activism...pick one. These are diametrically opposed value systems.

The clinical psych students at my AMC are seemingly more passionate about attending rallies and protests than research seminars and professional workshops. I wish they had the same zeal for psychometrics as they do for writing useless position letters. Prognosis not looking good 😅

I think this is the crux of the discussions within neuro as well. These seem to mirror the APA guidelines about DEI. Most people seem to be saying, we already abide by the APA ethics and aspirational codes, and that this document should focus on the specifics of the competency of what it takes to specialize in neuropsychology. The first draft was deeply disappointing, but I am somewhat cautiously hopeful about the member feedback process. But then there's the cynical side of me which has seen what is happening to state associations and is very pessimistic. In all, though, I think some of this mirrors broader issues of how much focus an org should be on bread and butter "guild" issues, vs. broader attempts for advocacy and political stances.

Can you expand on this?

 

[erg923]

The clinical psych students at my AMC are seemingly more passionate about attending rallies and protests than research seminars and professional workshops. I wish they had the same zeal for psychometrics as they do for writing useless position letters. Prognosis not looking good 😅

About what?

 

[Freud’sMommy]

About what?

There's been a letter of support written and signed by the majority of students (along with castigating the faculty for "not doing enough") for almost every social injustice that's made national news in the past half decade... it's "thoughts & prayers" with a roll-call. In contrast, there's bare minimum effort expended on professional development activities.

 

[erg923]

There's been a letter of support written and signed by the majority of students (along with castigating the faculty for "not doing enough") for almost every social injustice that's made national news in the past half decade... it's "thoughts & prayers" with a roll-call. In contrast, there's bare minimum effort expended on professional development activities.

Work is called work for a reason. I work. I go home. There is no firable offense there. The young people will do what young people do.

 

[WisNeuro]

The clinical psych students at my AMC are seemingly more passionate about attending rallies and protests than research seminars and professional workshops. I wish they had the same zeal for psychometrics as they do for writing useless position letters. Prognosis not looking good 😅


Can you expand on this?

Just that, less and less focus on things like reimbursement and state guild legislation, more on political advocacy. Some associations are straining the limits of their tax exempt status. Back when I was still a member and involved in leadership I fairly routinely had to remind people not do things that were either illegal, or that would jeopardize our 501 status.

 

[neurofreakout]

There's been a letter of support written and signed by the majority of students (along with castigating the faculty for "not doing enough") for almost every social injustice that's made national news in the past half decade... it's "thoughts & prayers" with a roll-call. In contrast, there's bare minimum effort expended on professional development activities.

Token whippersnapper neuropsych trainee here. Can I (out of genuine curiosity, promise) ask what you make of the student activism/open letters/DEI focus bring pushed by trainees? I'm sensing a lot of similar attitudes in the faculty at my program, but they just smile and say "we're working on it!" and move on with their lives until something else happens. I am almost certain their responses to students are misleading, either intentionally or unintentionally, so it would be great to get an honest take on what the "adults" in the field think about all of this.

 

[WisNeuro]

Token whippersnapper neuropsych trainee here. Can I (out of genuine curiosity, promise) ask what you make of the student activism/open letters/DEI focus bring pushed by trainees? I'm sensing a lot of similar attitudes in the faculty at my program, but they just smile and say "we're working on it!" and move on with their lives until something else happens. I am almost certain their responses to students are misleading, either intentionally or unintentionally, so it would be great to get an honest take on what the "adults" in the field think about all of this.

People love to look they are doing something, without actually accomplishing anything. If anything, many of these initiatives are actually having the opposite effect. There was a bunch of research about it and a lot of reporting in the past couple years. NYT wrote up a few pieces on it here and there.

 

[SomeGreatNotion]

It strikes me that this is a general trend hitting our discipline (psychology), medicine, academia, etc and this is merely the latest front.

You can do science or you can do ideological/ political activism...pick one. These are diametrically opposed value systems.

These guidelines seem to hue closely to Belmont Report principles. If you consider ethics as ideology, science and ideology have been hand and glove.

 

[PsyDr]

Token whippersnapper neuropsych trainee here. Can I (out of genuine curiosity, promise) ask what you make of the student activism/open letters/DEI focus bring pushed by trainees? I'm sensing a lot of similar attitudes in the faculty at my program, but they just smile and say "we're working on it!" and move on with their lives until something else happens. I am almost certain their responses to students are misleading, either intentionally or unintentionally, so it would be great to get an honest take on what the "adults" in the field think about all of this.

Imagine your neuro professor tells you that you have to watch Fox News for an hour every week, and you get quizzes on it. You might say, “what the hell does this have to do with neuropsychology?” And “I dislike watching this crap”. That’s the problem of forcing unpaid political endeavors onto someone.

 

[Pragma]

Token whippersnapper neuropsych trainee here. Can I (out of genuine curiosity, promise) ask what you make of the student activism/open letters/DEI focus bring pushed by trainees? I'm sensing a lot of similar attitudes in the faculty at my program, but they just smile and say "we're working on it!" and move on with their lives until something else happens. I am almost certain their responses to students are misleading, either intentionally or unintentionally, so it would be great to get an honest take on what the "adults" in the field think about all of this.

It is not inaccurate for people to say "we're working on it" as a field because it is true. The Minnesota Conference was conceptualized and executed with greater attention to diversity-related issues as a central focus and is an example of that sort of work. Leadership at the organizational level seems to take trainee input seriously and focuses on trainee perspectives more now than when I was a trainee. Progress is relative, even if it is slower than what some people have patience for. That said, the discussion now has a lot more to do with coming to agreement on what is being progressed and in what context. Many people reviewing these draft guidelines are dissatisfied because of its lack of specificity to the actual specialty, significant overlap with things that already exist in other places such as the ethics code, and the ideology/political nature of things changed. Some might view this discussion as painful but important to have as a field. Advancing a political ideology within a scientific specialty rightfully raises a number of red flags.

 

[Pragma]

These guidelines seem to hue closely to Belmont Report principles. If you consider ethics as ideology, science and ideology have been hand and glove.

The Belmont Report - they just got lazy there and named the report after the name of the conference center, not even the city or state where the conference center was located!

 

[cara susanna]

I'd like to see you guys come up with names for all these things! It sounds exhausting.

It also does, hilariously, kind of make all of our field's guidelines or decisions sound like peace treaties.

 

[Sanman]

It is not inaccurate for people to say "we're working on it" as a field because it is true. The Minnesota Conference was conceptualized and executed with greater attention to diversity-related issues as a central focus and is an example of that sort of work. Leadership at the organizational level seems to take trainee input seriously and focuses on trainee perspectives more now than when I was a trainee. Progress is relative, even if it is slower than what some people have patience for. That said, the discussion now has a lot more to do with coming to agreement on what is being progressed and in what context. Many people reviewing these draft guidelines are dissatisfied because of its lack of specificity to the actual specialty, significant overlap with things that already exist in other places such as the ethics code, and the ideology/political nature of things changed. Some might view this discussion as painful but important to have as a field. Advancing a political ideology within a scientific specialty rightfully raises a number of red flags.

At a time where I am seeing fewer and fewer interns and post-docs properly trained in assessment, one wonders if the time could not be better spent discussing other topics that need to be addressed.

 

[jdawg2017]

I was fortunate to have two of the meeting's organizers give a talk to a didactic I attended recently, and I know many delegates and organizers personally. I do agree that the "drop" seems to have caught a lot of people off guard, though I guess the HCG solicited no input whatsoever from neuropsych organizations outside of the delegates who attended the HCG, so this is an improvement.

Guidelines inherently are not enforceable, unlike APA's ethical standards, for example. It begs the question of what is the point of making guidelines or updating them aside from providing "guidance" to the field. My understanding is the guidelines are intentionally vague becuase there are many different types of nueropsychologists (e.g., board-certified, research-primary, etc.).

I do think personally that the policy shift, while definitely political in nature, is not off base. Anyone paying attention to the science of the field over the past 20 years or so has learned that there are many aspects of DEI that come into every assessment, and having competency in how to navigate these issues is key to being competent as a clinician and a researcher. The advocacy is interesting, as someone who stays away from it for the sake of my own energy, but I think the interpretation is being taken a bit extreme (e.g., we should go to protests, etc.). In reality, there are simpler things we can do to advocate that are necessary, like ensuring interpreter availability for our assessments in our clinics, etc.

IDK... I am very glad I was not accepted to be a delegate because this is quite the mess.

 

[Ollie123]

In reality, there are simpler things we can do to advocate that are necessary, like ensuring interpreter availability for our assessments in our clinics, etc.

My reading is that this was likely their intent, but the fact that it was so incredibly vague created a different impression - at least for some folks. We can discuss the rationality of seeing DEI boogeymen everywhere (which I think has also become overblown), but regardless of what side you fall on, its common sense that this is a politically charged topic right now and some degree of caution should be taken. However I suspect even the folks against its inclusion here would be taking a very different stance if advocacy was more clearly operationalized as ensuring interpreter availability, taking precautions when relying on norms that may not be representative for a given individual, understanding the limits of assessment in non-native languages, acknowledging generalizability limitations in research products, etc., etc.

I do understand neuropsych, despite being a narrow subspecialty within psychology, is still a reasonably broad umbrella but my goodness they need to do something to differentiate themselves if they want to lay claim to a given scope of practice. I could claim myself to be an exceptionally well-trained neuropsychologist per these guidelines.

 

[WisNeuro]

My reading is that this was likely their intent, but the fact that it was so incredibly vague created a different impression - at least for some folks. We can discuss the rationality of seeing DEI boogeymen everywhere (which I think has also become overblown), but regardless of what side you fall on, its common sense that this is a politically charged topic right now and some degree of caution should be taken. However I suspect even the folks against its inclusion here would be taking a very different stance if advocacy was more clearly operationalized as ensuring interpreter availability, taking precautions when relying on norms that may not be representative for a given individual, understanding the limits of assessment in non-native languages, acknowledging generalizability limitations in research products, etc., etc.

I do understand neuropsych, despite being a narrow subspecialty within psychology, is still a reasonably broad umbrella but my goodness they need to do something to differentiate themselves if they want to lay claim to a given scope of practice. I could claim myself to be an exceptionally well-trained neuropsychologist per these guidelines.

Exactly.

 

[Pragma]

However I suspect even the folks against its inclusion here would be taking a very different stance if advocacy was more clearly operationalized as ensuring interpreter availability, taking precautions when relying on norms that may not be representative for a given individual, understanding the limits of assessment in non-native languages, acknowledging generalizability limitations in research products, etc.,

Is that advocacy though or culturally competent practice? I wouldn’t define what you listed as advocacy, nor do I believe that they mean those things. Advocacy as defined by post-2020 neuropsychologist writers is more political.

 

[Ollie123]

Is that advocacy though or culturally competent practice? I wouldn’t define what you listed as advocacy, nor do I believe that they mean those things. Advocacy as defined by post-2020 neuropsychologist writers is more political.

Well, advocating to hospital staff about the need for interpreters is by definition advocacy🙂 I take your point though. I certainly won't claim to know the exact line that the authors draw on this. My definitions differ somewhat from yours and I'd posit at least some of that is advocacy. Either way, the need to do a better job operationalizing things is pretty much my point.

My default assumption would be that the individuals involved are professional/rationale/reasonable individuals and that advocacy within the context of a professional guideline would be intended as the forms of advocacy that would occur within typical professional contexts (e.g., examples above). Maybe I'm wrong. I literally don't know a single one of the organizers, much to my surprise.