The neuropsychology fellowship has run in combination with the clinical psychology internship at MMHC since 1986. Like the internship, the fellowship retains the core mission of increasing access to mental health services in the severely mentally ill. Neuropsychological testing is an important component of psychological assessment, and plays an essential role in guiding patients to the most useful treatment options available. Because neuropsychological evaluations assess multiple domains of higher cortical functioning (such as such as reasoning, problem-solving, planning, abstraction, attention, language, learning and memory, overall cognitive abilities and academic achievement) and then integrate test findings with clinical, medical, educational and historical information, they provide a multidimensional picture of individuals and their problems. This is especially important in coming to an understanding of mentally ill patients, who are likely to present with complicated psychiatric problems (e.g., many patients at MMHC have dual diagnoses or show symptoms of psychosis that are common to any of several disorders), along with other medical, emotional and interpersonal difficulties.
Neuropsychology fellows learn to administer, score and interpret neuropsychological (and personality) tests, and integrate that data with other sources of relevant information for three broad purposes. First, a neuropsychological assessment may be useful in making a differential diagnosis. Many referrals at MMHC, for example, involve patients with psychotic disorders whose diagnoses are unclear. Until the correct diagnosis is determined, the most appropriate treatments may be delayed or unidentified. Fellows use a combination of clinical interviews (including structured interviews, as appropriate), neuropsychological and psychological test data, records review and other interviews to assist in making diagnoses. Moreover, the assessment might point to a hitherto unsuspected etiology in a mentally ill patient, such as a seizure, metabolic or brain injury disorder. Related to the issue of diagnosis is the course of a disorder, which is often clarified by knowledge of cognitive levels of function.
The second major reason for neuropsychological evaluations in this setting is to determine a profile of patient’s cognitive and emotional strengths and weaknesses. This is particularly important in formulating treatment/rehabilitation strategies based on the cognitive and emotional level of function of each individual patient. The third reason for the neuropsychological evaluation is to provide objective and repeatable measures of treatment outcome. For example, positive changes in cognition (e.g., better attention) often accompany administration of the newer antipsychotic medications. Improvements in cognition may also accompany psychotherapeutic and psychosocial treatments, as emotional distress and symptoms of depression decline. On the other hand, problems in cognition may remain or even get worse after treatment. In the latter case, the neuropsychological assessment might be the first to identify an adverse effect of one or more medications, or detect an unexpected negative turn in the course of the disorder.
Fellows are trained to provide the above services through immersion in different clinical rotations and in a series of didactic experiences. They conduct 2-3 evaluations per week, for which they receive 3-4 hours of supervision. They will typically have a different supervisor for each rotation, in order to give them experience with different supervision styles, areas of expertise and emphases. The Fellowship is for one year, but Fellows may apply for a second year. Breadth of training is enhanced by rotations in the Department of Psychiatry at Beth Israel Deaconess Medical Center (BIDMC) and in Behavioral Neurology at BIDMC. Thus, in addition to experience with severe mental illness, Fellows will see higher functioning patients with general medical conditions, and patients with a broad range of psychiatric or neurological problems.
The Core Training Program
All first-year Fellows, regardless of their rotations, share these core training program elements:
- The Core Curriculum
- Other Didactic Activities
- Supervision
The Core Curriculum
Neuropsychology Seminar – This is a year-long weekly seminar for post-doctoral Fellows in neuropsychology. In addition to our own Fellows, Fellows from other postdoctoral programs in the area also participate in the seminar. The first part of the course covers the theoretical foundations of the field, followed by sections focusing first on general neuroanatomy and then on the neuroanatomy of major cognitive domains. About half the year is then spent examining the neuropsychology of selected psychiatric and neurologic disorders. The course is team taught, and directed by Larry Seidman, Ph.D., and Bill Stone, Ph.D.
Neuropsychology Case Conference – Following the neuropsychology seminar, the neuropsychology case conference involves a case presentation by a fellow, with a faculty member serving as a consultant. In many cases, the consultant is the faculty member who taught the neuropsychology seminar that day.
Behavioral Neurology Seminar – This weekly seminar runs the academic year, and is held at Brigham and Women’s Hospital. Each of several institutions, including MMHC and BIDMC, organize talks for a month.
Fellowship Conference – On the first Thursday of the month, Fellows and training faculty meet to discuss current issues in the Fellowship.
Annual Testing Conference – The Clinical Psychology Faculty organizes an annual three-day conference on Contemporary Applications of Psychological Testing. Fellows both help with the organization of the conference, and participate as attendees.
Other Didactic Opportunities
There are many didactic opportunities available for Fellows at MMHC, BIDMC and the Longwood Medical area. Among these are the Psychopharmacology lecture series, Longwood Area Grand Rounds and the Outpatient Case Conference. Fellows will also attend various seminars or rounds that are associated with their specific rotations.
Supervision
Like the Internship, The Fellowship has a long-standing commitment to intensive supervision. Each Fellow is assigned a Training Director for the year, for guidance and for a general overview of the program. In addition, Fellows are assigned a supervisor for each of their rotations.
Staff and Administration of HMS/MMHC Fellowship in Clinical Neuropsychology
Core Training Staff
The Clinical Neuropsychology staff includes the following core members:
Margaret O’Connor, Ph.D. (Boston U.) – Director of Neuropsychology, Department of Neurology, Beth Israel Deaconess Medical Center; Assistant Professor of Psychology, Harvard Medical School
William Stone, Ph.D. (Wayne State University; respecialization at U. Virginia) – Director of Neuropsychology Training and Clinical Services, MMHC; Director of Neuropsychology Fellowship Program at MMHC and BIDMC; Assistant Professor of Psychology, Harvard Medical School.
Cheryl Weinstein, Ph.D. (Boston College) – Director of Neuropsychology, Department of Psychiatry, Beth Israel Deaconess Medical Center; Clinical Assistant Professor of Psychology, Harvard Medical School.
Additional Training/Teaching staff includes:
Brina Caplan, Ph.D. (Harvard U.) – Supervising Neuropsychologist, MMHC; Instructor in Psychology, Harvard Medical School.
Sara Hoffschmidt, Ph.D. (U. Virginia) – Supervising Neuropsychologist, MMHC; Instructor in Psychology, Harvard Medical School.
Mark Greenberg, Ph.D. (Boston U.) – Supervising Neuropsychologist, MMHC; Instructor in Psychology, Harvard Medical School.
John Miner, Psy.D. (MSPP) – Supervising Neuropsychologist, MMHC; Instructor in Psychology, Harvard Medical School.
Win Sachs, Ed.D. (Boston U.) – Supervising Psychologist, MMHC; Instructor in Psychology, Harvard Medical School.
Larry J. Seidman, Ph.D. (Boston U.) – Director, Commonwealth Research Center and Neuropsychology Laboratory, MMHC; Associate Professor of Psychology, Harvard Medical School.
Stipends and Appointments
Postdoctoral stipends, supported by the Commonwealth of Massachusetts through a training grant to the Harvard Medical School, are $26,500 in the first year, and $28,000 in the second year. The Fellowship carries an appointment as a Clinical Fellow in the Department of Psychiatry at the Harvard Medical School, and Harvard personnel policies are followed, including four weeks of vacation. A substantial part of the cost of medical and dental insurance is included and athletic privileges and other resources of the university are available on a fee basis.
Application Information
Qualifications of Applicants
The postdoctoral program requires a doctorate in clinical psychology or a related
field. With the accumulation of postdoctoral hours, applicants should
be eligible for licensure in Massachusetts. At the time of application,
predoctoral training should be complete or nearly so. Applicants should
submit a letter of application, two work samples (e.g., neuropsychological
reports), three letters of reference, and graduate transcripts, by February
1, 2005. African-American, Spanish-speaking and other minority applicants
are especially encouraged to apply. Individuals whose interests and qualifications
appear most compatible with our program will be invited for interviews.
Direct inquiries and applications to:
Bill Stone, Ph.D. Director, Neuropsychology Fellowship Massachusetts Mental Health
Center, 180 Morton Street, Jamaica Plain, MA 02130
e-mail: [email protected]