imaging (MRI) scans (Benton, 1992). These measures allowed for localization of brain dysfunction, and neuropsychologists were able to help “map” the associations between psychological processes and brain location. The founding of organizations and the publication of journals in the 1970s and 1980s contributed further to the identity of neuropsychology as a specialty (Boake & Bieliauskas, 2007). The National Academy of Neuropsychology (NAN) was founded in 1975 and held its first annual meeting in 1981. The first journal devoted to clinical neuropsychology – the Journal of Clinical and Experimental Neuropsychology – was published in 1979. Division 40 of the American Psychological Association, now known as the Society for Clinical Neuropsychology , was founded in 1979 to represent the research and clinical arms of neuropsychology in the parent organization. Board certification in clinical neuropsychology can now be obtained through the American Board of Clinical Neuropsychology, which was incorporated in 1981 and is a component of the American Board of Professional Psychology and is supported by the American Academy of Clinical Neuropsychology (Boake & Bieliauskas, 2007). The Houston Conference Although the need for standards in education and training in neuropsychology was initially addressed by an INS task force in 1976, guidelines were not formally developed and disseminated until a conference was held in 1997 in Houston, Texas. The mission of the conference was to develop an integrated model of training in clinical neuropsychology. The resulting guidelines are often referred to as “aspirational” goals that neuropsychologists should strive to achieve through their training (Hannay et al., 1998). Ten years before the Houston Conference, Arthur Benton observed that it would be a challenge to identify training criteria for clinical neuropsychology because some degree of expertise is needed in basic neuroscience, clinical neurology, psychopathology, and clinical psychology (Benton, 1987). These varied challenges are reflected in the training model used to educate neuropsychology students. First, clinical neuropsychologists are trained in the scientist-practitioner model (Belar & Perry, 1992). They are clinicians who know how to read, understand, and apply scientific principles to their clinical work, and they are scientists who know how to study clinical phenomena and produce research that will advance clinical practice. Clinical neuropsychologists are skilled in assessment, treatment and intervention, consultation, research, teaching, and supervision. Training opportunities Most clinical neuropsychologists obtain their doctor of philosophy (PhD) degree in clinical psychology from an accredited, university-based training program and then pursue specialized training in neuropsychology at the internship and postdoctoral level. Persons obtaining their doctoral degree in clinical psychology are required to complete a one-year predoctoral internship, and often clinicians choose to specialize their training during this year. A number of internships offer intensive training in neuropsychology, in addition to continued training in general aspects of clinical neuropsychology (e.g., ethics, multicultural competency, psychotherapeutic intervention). For advanced, independent practice in clinical neuropsychology, a two-year post-doctoral training experience is required; often this postdoctoral experience is called a “residency” to reflect the medical roots of the profession. As with other mental and behavioral health professions, continuing education is necessary for clinical neuropsychologists throughout their careers.
Normative data were essential for the field’s growth. Test scores for research and clinical purposes are interpreted in association with normative data, which are means and standard deviations of test scores collected from a large sample of a population and are assumed to represent usual performance for persons from the group of interest. Demographic variables influence test performances. Normative data corrections for biological sex and education are common for many tests but most existing normative data lack information about other important variables, such as race, ethnicity, socioeconomic status, quality of education, and reading level. Inadequate normative data for a patient could result in misdiagnosis, so efforts are underway to provide better normative data for racial and ethnic groups in the U.S. (Fujii, 2016), and to identify other demographic factors that are necessary to consider, such as reading level and socioeconomic status (Flores et al., 2017; Zahodne et al., 2020). The expansive growth of the field indicated a need for the particular skills and knowledge of neuropsychologists to elucidate brain function and to apply these skills in clinical contexts (Benton, 1987). The specialized training obtained by neuropsychologists will be explained next, to illustrate how and why neuropsychologists occupy a unique niche in mental and behavioral health fields.
TRAINING IN CLINICAL NEUROPSYCHOLOGY
The requisite knowledge base outlined at the Houston Conference includes a (1) generic psychology core, (2) generic clinical core (including training in psychotherapy, ethics, and multicultural issues), (3) foundations for the study of brain- behavior relationships, and (4) foundation for practice of clinical psychology. For example, for the foundations of brain- behavior relationships, neuropsychologists spend many years learning about the intricacies of the brain. Courses include basic neuroscience, detailed neuroanatomy, and neurophysiology, and often involve lab work with the autopsied brains of humans or animals. This knowledge base about brain function and behavior is applied in clinical practicums, internships, and postdoctoral residencies. Students learn to understand and incorporate medical record documentation, including results from CT and MRI scans, with data obtained from cognitive assessments to identify areas of potential neuropathology. There are competency benchmarks for training in clinical neuropsychology (Rey-Casserly et al., 2012), as well as a Taxonomy for Education and Training in Clinical Neuropsychology to guide training in the discipline (Sperling et al., 2017). Revisions to the Houston Conference guidelines are underway, with a lens towards improved multicultural training in the field. Some clinical neuropsychologists obtain a doctorate degree in counseling psychology or earn a doctor of psychology (PsyD) degree from a professional school of psychology. Some programs offer a PhD specifically in clinical neuropsychology. These persons would seek continued, specialized, and intensive neuropsychological training during internship and residency. In rare instances, a clinical neuropsychologist has obtained a doctoral degree in a nonclinical field of psychology (e.g., cognitive psychology, experimental psychology, or developmental psychology) and then, at some point, has decided to engage in clinical work or clinical research. These persons seek training in clinical psychology from a respecialization program .
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