The Clinical Neuropsychologist

1999, Vol. 13, No. 1, pp. 1-11

1385-4046/99/1301-001$15.00
Swets & Zeitlinger

DIVISION 40 PRESIDENTIAL ADDRESS

Mediocrity is No Standard:
Searching for Self-Respect in Clinical Neuropsychology*
Linas A. Bieliauskas
Veterans Affairs Medical Center/University of Michigan, Ann Arbor

ABSTRACT
While medicine moved from a training based in proprietary schools to university-based education and
board specialty examinations during the early part of this century, psychology has seemed to move in the
opposite direction during the past 20 years. Clinical Neuropsychology, as a specialty, has established
training and practice guidelines, and more recently, produced an integrated model of education and training, not unlike the models developed by medicine and its specialties. Nevertheless, there are pressures
within the field of Psychology in general, and Clinical Neuropsychology in particular, to abrogate standards and weaken credentials. These pressures are seen as stemming from prioritizing the interests of the
practitioner over the needs of the patient and the profession. The thesis is presented that upholding standards leads to the benefit of the patient and the long-term health of the profession.

Permit me to paint a scenario for you. Instead of

being a health care provider, I would like you to
imagine yourself in the role of being part of a
patient family. You find that your daughter, age
14, is complaining of persistent headaches. She
says the headaches are fairly dull, and that they
are worse in the morning, but do not interfere
with sleep. Your daughter also has become increasingly moody and she complains of bouts of
nausea. Being a caring parent, you think it is
time for you to take your daughter for a medical
check-up and you thus embark upon an adventurous journey into the contemporary health care
system.
At first, you are seen by the nurse practitioner
who looks over your daughter and says there is
nothing seriously wrong and prescribes aspirin.
You are generally satisfied, but feel a little uneasy because your daughter was not seen by a
physician as you were expecting. After all, you
*

do believe that medical school training is the

standard for health care and would not want
your child short-changed. After several days,
your daughters symptoms seem unchanged and
she also complains of some visual symptoms
things looking funny on her left side. You again
contact your health care provider and, this time,
insist on seeing a physician.
When you arrive, you are escorted into the
examining room with your child and while waiting, cannot help worrying about the quality of
the care you are receiving. When your physician
arrives, he seems to be an older man. Being an
educated neuropsychologist, you ask a few
friendly questions about his credentials. Where
did you go to medical school? you ask. I
went to the Smithauskas Institute he replies.
Thats funny you say, I never heard of it.
Where is it located?

Address correspondence to: Linas A. Bieliauskas, Psychology Service (116B), V.A. Medical Center, 2215
Fuller Road, Ann Arbor, MI 48105, USA. E-mail: Linas@umich.edu.
Accepted for publication: October 15, 1998.

LINAS A. BIELIAUSKAS

Oh, their offices are in Illinois.

I still havent heard of it, are they wellknown for any sports?
No, they dont have sports teams.
Maybe they have a famous medical library
there?
No, they dont really have a library.
Hmmm, do they have a really pretty campus?
No, they dont really have a campus.
I dont get it if they dont have any sports
teams and dont have a library and dont
have a campus, where do they hold
classes?
Well you can go to class anywhere there
is a computer.
You mean you went to class on the
internet?
Well, yes, but its just as good as physically
going to class. We take tests and everything.
How about your anatomy classes?
The computer is like virtual reality the
pictures are really good.
And you passed the tests?
All of them.
What was your class rank?
Well, Im not sure. I didnt really meet
many classmates, and those that I did
meet, I only saw once or twice.
Hmmm is there a doctor here on staff who
physically went to medical school?
Well, just let me look at your daughter for a
few minutes and then I can send you to a
specialist.
Feeling distinctly uncomfortable with the doctor from the Smithauskas Institute, you
nevertheless hold your tongue for his brief physical examination. He tells you he does not think
its anything to worry about he has seen lots of
kids with headaches and its probably just due to
teenage hormones. However, if it would make
you feel better, he will refer you to a neurological specialist who is just down the hall.
You begin to feel a little better as you go
down to the office and notice that there is a diploma, bearing the name of a state medical
school, in the hall outside (note that in most

managed care settings the doctors dont have

offices with big desks in which to hang their
diplomas). However, you dont notice any residency certificate or other indication of the doctors neurological training. Again, when he comes in, you ask him Well, doctor, I see you
went to American State University nice place
good football team! Yep he replies,
there are some happy memories there.
Tell me, where did you do your neurology
residency?
Well, I didnt really do a residency.
How did you get your specialty training?
I took a couple of workshops and then I got
a certificate of proficiency in neurology!
Its just as good as a residency and I was
able to do it while I was already working
in the local emergency room.
I see. Are you board certified in neurology?
No, its really not important, but Ive been
thinking about it. There are some neat new
boards Ive heard about and Im going to
look into them.
Thanks I think well check back with you
later.
This scenario probably sounds ridiculous to you
physicians do not get their degrees on the
internet and medical specialists do not get their
training over a weekend or in study groups. I
sincerely doubt that, knowing what you know,
you would entrust the health of your child, with
a potentially serious condition, to someone with
that kind of background.
Yet, sad to say, Psychology in general, and
Clinical Neuropsychology in particular, has a
number of its practitioners who advocate exactly
that. Why would we propose accepting standards at this level as practitioners when, as patients, we would never submit to someone with
those kinds of credentials?
I think I have a few answers to propose and I
will share them with you. I shall also indicate
what I think this is doing to our profession, and
it is not good. Afterward, I will discuss several
things we might consider to make things better.

MEDIOCRITY IS NO STANDARD

PRIMARY CONCERNS
There are two concerns that I believe we (or any
other health care practitioners) must always put
before everything else: (1) the welfare of the
patient; and (2) the welfare of the profession
(that serves the patient). As you hopefully can
see from the scenario I have painted above,
things look a lot different when you are a patient
than when you are the treater. Everything must
be done to see to it that the patient gets the best
possible care and that includes the method of
training of the health care practitioner. Yet, the
kinds of things psychology is doing, as a profession, leave much doubt about how often the patient enters into the sphere of concern. Rather,
the concern seems to focus on how everyone can
do whatever they want, regardless of how their
training was acquired. The operative word is
inclusiveness of practitioners rather than any
discrimination of what constitutes the best practice for the patient.
Medicine got their house in order a long time
ago:
...during the last quarter of the nineteenth
century and the first years of the twentieth,
the focus of reform was on upgrading standards of entry into the profession: to level
the whole profession above a recognized base
rather than to create an educational elite. In
the twentieth century this process was to be
known as standardization. (Stevens, 1978, p.
38)
Part of what engendered the need for reform was
the presence of multiple proprietary medical
schools and Abraham Flexner (1910) was commissioned to provide a report on the state of
medical education. The report
...provided for the first time a detailed exposure of the medical schools by name, and in
so doing it brought to public notice the appalling conditions of many of the schools.
Kentucky was delineated as one of the largest producers of low-grade doctors in the entire Union; Chicago the plague spot of the
country. The most devastating invective

was reserved for the small proprietary

schools: schools such as Bennett Medical
College, a stock company practically owned
by the dean of the school and Jenner Medical College, an out-and-out commercial enterprise. The National Medical University,
also in Chicago, was distinguished by giving
a free trip to Vienna to any student who paid
fees regularly, in cash, for three years.
(Stevens, 1978, p. 67)
And what was the solution which Flexner proposed?
Medical education was strongly endorsed as
a university function, thus denying any role
for proprietary schools. The need for raising
standards of admission and of teaching was
also emphasized.
...no more than one medical school per
city...the drastic reduction in the number of
schools from 155 to 31, each giving a four
year course and each with no more than seventy graduating students. In the immediate
shock, Flexners life was reportedly threatened, libel suits were mentioned, and in one
case, an action was brought claiming
$150,000.
The medicine was strong, but it was effective......by 1925, 46 states refused to recognize low grade medical schools as a preparation for the license. (Stevens, 1978, p. 68)
Among other things, Medical schools one by
one began to establish full-time clinical professorships and, more slowly, to replace the old
system of part-time teaching by local practitioners. (Stevens, 1978, p. 58). I bring this up as
some of what medicine corrected in their training sounds hauntingly familiar in a contemporary sense for psychology training.
Clinical Psychology, at the time it began to
make significant strides as a profession in the
1940s, was firmly established in graduate
schools at universities of significant size, granting Ph.D. degrees, and requiring all students to
be familiar with the scientific method, at least to
the point of producing a doctoral dissertation.

LINAS A. BIELIAUSKAS

Where has psychology gone from there? Peterson (1976a, 1976b) essentially interpreted
Flexners call for schools of medicine as a justification for creating similar schools of psychology, even though psychology was starting from
an academic base whereas medicine was starting
from a largely proprietary base. With the subsequent development of professional schools and
degrees, psychology, it seems to me, has done a
complete retroversion establishing proprietary
schools at breakneck speed, even providing degrees without the need to be physically present
in class; commercialism seemed to be strongly
linked to the development of these schools
(Zimet, 1982). Much of the teaching is done
part-time by local practitioners or psychologists
moonlighting from other institutions. Any active
training in the scientific method has been minimized in many of these schools.
Even though strong arguments have been
raised that the Ph.D. degree continued to be appropriate for the training of practitioners (Perry,
1979; Shoben, 1980), those who argued for the
need to separate academic from professional
training and to establish the Psy.D. degree
seemed to prevail (Fox, 1980; Peterson, 1976b;
Rodgers, 1964; Sechrest, 1985).
I see this very much as the establishment of a
standard of mediocrity. Strupp (1976) argued
eloquently:
What we are being asked by the irrationalists... is to abandon clinical psychology as
a science....what is being sold short in the
process is the basic science component of our
field the patient nurturance of an inquiring
and critical attitude in our students, the kindling of intellectual curiosity, the furtherance
of investigative skills... (p. 565)
Belar (1998, p. 463) in her presidential address
to Division 38 last year, argued similarly that
programs in professional psychology must ensure training in the conduct of research and the
integration of research and practice and that
advocacy for psychology as a health profession should highlight research skills as integral
to the practicing psychologist.

With the proliferation of proprietary training

programs and abandonment of active research
training in many of our professional psychology
programs, we seem to have distanced ourselves
from any pretense at holding individuals to any
level of accountability in terms of meeting training needs. It is no secret that if one has the financial resources, one can obtain some kind of
doctorate in psychology, somewhere in America. And, while there is certainly nothing to prevent this kind of enterprising in a free country,
there is something to be concerned about when
we are then faced with multiple demands from
every quarter that all those trained, at all these
schools, now be recognized as equivalent practitioners. Meehl (1973) points out:
So long as we operate on the principle that
there are no standards of performance in this
field, that everybody is equally bright,
equally well read, equally skilled, equally
logical, and equally experienced, Greshams
law will, as usual, operate in the clinical case
conference. (p. 299)
Greshams law, known in the field of economics, very roughly paraphrased, states that among
similar currencies, the weakest one will be the
most widely circulated.
Now I do not mean to make a case that we
should emulate everything being done by the
profession of medicine, but I do believe that we
do not have to relive history when another profession has already gone through the same questions and concerns that psychology now faces.
And, the solutions reached have served their
profession well. Medicine basically established
an integrated model of training, meaningful
training standards, and legitimate board certification. Why should we not take some lessons
from this? Again, from Strupp (1976):
I have never heard anyone argue that a physician should not achieve the highest level of
expertise before he is entrusted with the lives
of patients. In clinical psychology, however,
there exists considerable ambivalence concerning standards of training, the kinds of
skills a well-trained clinical psychologist

MEDIOCRITY IS NO STANDARD

should acquire, the structure and contents of

academic courses, what constitutes appropriately supervised clinical experience, and so
on. Is it that we do not want to be clear about
standards? (p. 566)
Or is it, alternatively, that psychologists want to
establish mediocrity as the gold standard?
You may not agree with the analogy I have
drawn with the profession of medicine. My reasons for this will become clear later. But for the
sake of argument, let us draw an analogy with
the description of a different profession that may
have a history more similar to ours Education.
For many years, the main degree in Education
was the Ph.D. ...But with the coming of
progressivism and the professionalizing of
school administration, pressures from the
field against the rigor and alleged narrowness
of the Ph.D. made themselves felt. What was
needed...was a field-oriented doctorate for
educational administrators not concerned
with original research but with practical
school problems and with the application of
research findings to concrete situations.
(Koerner, 1963, p. 181)
Does this also sound familiar? Koerner goes on:
The reasons for the popularity of the Ed.D.
are plain enough. It is an easier degree than
the Ph.D. Course work for it is often entirely
in Education (the Ph.D. used to be attacked as
narrow!), it carries no foreign language requirements, it usually carries no dissertation
requirement, and control over it is vested entirely in the Education division of the university... (that is) the doctoral standards of the
arts and sciences division do not have to be
met (p. 181)
More familiarity? How about the future?
The Ed.D. continues to grow in popularity
and will for the foreseeable future because of
the comparative ease with which it can be
earned. In the case of either the Ed.D. or the
Ph.D., however, the quality of the degree is

notably below that of the arts and sciences

doctorate....both are at the bottom of the graduate ranks of the universities. (p. 183)
Although this judgment of what the Ed.D. degree has done to the profession of education is
the opinion in one text, I would ask that you
read it and judge the soundness of the argument
for yourself. Regardless, it gives us something
to think about in terms of what our increasing
professionalism in training programs is doing to
the profession of psychology. To those who
claim that professional degrees in psychology,
divorced from rigorous and active training in
research, will do no harm to our profession or to
education in psychology itself, I offer the above
historical observations about training in Education.
The focus on practical applications rather
than grounding in theory and research, which
seems to be the forte of professional schools and
degree programs, seems to me to lose the point
of the necessity of having a strong, integrated
basis for our practice. Borrowing once again
from Koerner (1963) in his text on training in
Education (1963):
Why should ...attention be diverted during
these pregnant years to the trivialities and
applications with which common sense can
deal adequately when the time comes?....Atomistic learning the provision of
endless special courses, instead of a small
number of opportunities that are at once
broad and deep is hostile to the development of intellectual grasp. (p. 162)
It is my contention that psychology in general,
and Clinical Neuropsychology in particular, has
fallen prone to these kinds of practices. We
teach practical skills without solid foundations in theory and the empirical method of determining truth. Research has been de-emphasized, standards have been lowered, and quality
of offered degrees thrown aside as a meaningful
consideration. And, this has been done because
we have lost sight of the necessary basic concerns with which I began, that is, the welfare of
the patient and the welfare of the profession. If

LINAS A. BIELIAUSKAS

those are our main concerns, there would be little argument about upholding standards because
anything less would affect that welfare. Put
yourself, again, in the role of the patient family
as I illustrated at the start of this manuscript. If
you are receiving the service, would you want
anything less than full training for your health
care professional?

MISLEADING CONCERNS
When there is a failure to uphold standards, then
it becomes apparent that another concern has
reached the top of the agenda. I would suggest
that the substitute concern has become the
welfare of the practitioner. As I mentioned earlier, the current buzz word in professional psychology seems to be inclusiveness. It carries
the connotations of brotherhood and sisterhood,
everyone being treated as equal, and everyone
liking everyone else. Inclusiveness is entirely
appropriate when referring to citizenship, civil
rights, and respect for ones fellow man these
domains are all linked to the concept of entitlement as prescribed by our constitution, our
religion, or our personal sense of values.
Inclusiveness does not, however, refer to the
welfare of the patient or to the welfare of the
profession as it is usually discussed. It is applied
to practitioners within the context of psychology
and has multiple corollaries such as:
1. The policies you embrace are exclusionary.
2. Licensing should not just be for people
with doctorate degrees.
3. I have learned just as much or more in
workshops as in any coursework.
4. Board certification means nothing.
5. It is those academics who are grabbing for
power; they are not practitioners.
In common with all these points, however, is
the central theme of welfare of the practitioner. Of course, there are many others. Now, is
this a bad thing? I maintain that it is not in line
with what should be our primary concerns. To
be frank, as our profession faces continuing onslaughts both at the general practitioner and specialty practice level, we will not find much re-

course when focusing on the concerns of the

practitioner.
NIMH stipends were available during the
1960s and 1970s when the federal government
determined there was a need for more psychologists to serve the nations needs. When that determination changed, the stipends disappeared.
The VA has been the largest employer of psychologists for many years because it determined
that psychologists served the needs of the veteran population. The VA is reappraising what
the needs of veterans are and, in consequence,
psychology positions have been significantly
reduced. When I have had dealings with government officials regarding Medicare practices in
reimbursing for services of Clinical Neuropsychologists, there is never a concern shown by
them about what effect their practices are having
on neuropsychologists. They always ask
How does the practice affect patient care?
In other words, focusing on the welfare of the
practitioner can not only be regarded as selfish;
it is short-sighted and nonproductive in the long
run. It will get us nowhere! And, to the extent
that the welfare of the practitioner continues to
influence how we train psychologists in general
and Clinical Neuropsychologists in particular,
our profession will be trivialized by our health
care colleagues and marginalized by health care
management.

SELF-RESPECT FOR OUR SPECIALTY

In addition to reform of basic medical education,
specialty societies also developed in medicine in
the early 1900s, though it is clear they represented the specialty rather than the specialist....specialism had (also) advanced in some
fields to a second stage of professionalism: concern over the educational standards and competence of those claiming specialist skills.
(Stevens, 1978, p. 77). In the end, the various
medical specialties themselves offered the public the definition of who was a specialist and did
it through a voluntary professional system, residency training, and board certification, rather
than restrained choice (Stevens, 1978). An ex-

MEDIOCRITY IS NO STANDARD

ample of one of the earliest such endeavors can

be gleaned from the presidential address of Dr.
Derrek Vail to the American Academy of
Opthalmology and Otolaryngology in 1908,
where he raised the idea of a board similar to a
state examining board to license opthalmic practice for physicians after one or two years of
graduate training. His proposal was designed to
exclude the claims of the six-week specialist,
and other ill-prepared medical men. (Stevens,
1978, p. 109). In 1916, the first medical board,
the American Board of Opthalmology, was created and its procedures culminated in a
..diploma not a degree which would be
recognized by the profession and by public
authorities as evidence of proper preparation
for professional work...(it) thus turned away
from two alternatives for professional recognition licensure and the reliance on university degrees... The board described its chief
functions as being to establish standards of
fitness to practice the specialty and to arrange, control, and conduct examination to
test qualifications and then confer certificates
on the qualified. It stated that it made no attempt to control practice by license or legal
regulation: standards were to be maintained
on a voluntary basis. (Stevens, 1978, pp. 112114)
A profession is respected if it is regarded as important (for the welfare of the patient), valid
(has demonstrated effectiveness), and reliable
(can be defined in a meaningful way). It is for
these reasons that our division has been significantly involved in developing standards for the
specialty of Clinical Neuropsychology. Standards are designed to address our primary concerns, to protect the welfare of the patient, and
to protect the welfare of the profession. To this
end, our division has adopted multiple policy
statements, in many of which I have had the fortune to participate. These include the Definition of a Clinical Neuropsychologist (1989),
guidelines for training at multiple levels (Re-

ports of the INS-Division 40 Task Force, 1987),

and guidelines for education and training of
nondoctoral personnel (Report of the Division
40 Task Force, 1991), among others. The American Board of Clinical Neuropsychology was
incorporated in 1981 (Bieliauskas & Matthews,
1987) as a means of providing board certification, equivalent to that available in medical specialties. And, our division, along with the other
major organizations in Clinical Neuropsychology, co-sponsored the recent Houston Conference on Specialty Education and Training in
Clinical Neuropsychology (Hannay et al., 1998)
to establish an integrated model of training for
the specialty. These are all means of assuring
patient welfare and the welfare of our profession. To the extent that they remain strong and
guiding principles for our profession, they serve
us well. To the extent that they become weakened, our profession will begin to die a slow
death.
Now I am well aware that many, if not all, of
these initiatives have been attacked. I will not go
into a debate on these points here I have done
it in multiple forums in the past. What I do ask
is that when these initiatives are attacked, you
should ask yourself who is the beneficiary? Is it
the patient, the profession, or the attacking individuals involved? Whose concerns are being
served?
I will repeat that if we are to be held in the
same respect as our medical colleagues, and I
have always been taught and believe that this is
completely deserved, then we need to act like
them. They have fought these battles before.
These include:
1. Having an integrated model of formal education, including residency training. A profession without a model commands no respect.
2. Having meaningful training standards. In
the case of psychology, a strong scientific base
is necessary, as is solid accreditation.
3. Supporting legitimate board certification.
As in medicine, meaningful examination of the
performance of the practitioner assures patient
welfare.

LINAS A. BIELIAUSKAS

WHY WORRY ABOUT STANDARDS?

Apart from the primary concerns of welfare of
the patient and welfare of the profession, what
are practical issues regarding professional standards? I believe there are some that are universal
and some that are immediate.
General issues center around respect for Clinical Neuropsychology from outside the profession. Regardless of what you may think, when
one individual calling him/herself a Clinical
Neuropsychologist, or a psychologist, renders
poor professional service, the profession is affected as a whole. When multiple such individuals render poor service, the reputation of the entire profession suffers. This affects all of us, no
matter how good we may think we are. If Clinical Neuropsychology acquires the reputation of
being a trivial profession, we all suffer. Patients
suffer because they will not have access to service if health care professionals are not paid to
do it. Our profession suffers because reimbursement and job security are tied to the same kind
of respect. Academics will suffer if students no
longer seek entry into the profession because
they do not respect it. We must have the selfrespect to insure that we level the whole profession above a recognized base, as did medicine, and we need to do it in a way that is clear
and measurable.
On the more immediate front, I reiterate what
I have described as a pressing danger for Clinical Neuropsychology. There is some pressure to
lower or abandon standards of training and practice. Combined with this is pressure from the
managed health care industry to reduce costs
and minimize services. Put together, its what I
call a deal with the devil. Lowered priorities
for services mix in unholy water with decreased
expectations for quality training and practice.
When the primary concern of health care management is reducing costs, a deal for thirty
pieces of silver is likely to be made. When the
deal is made, the push for lower level standards
meets the push for lower costs. Quality of service is nonessential, and concern for training
and practice standards is secondary, if present at
all. This will result (and in some cases has already resulted) in:

1. Lower salary rates for neuropsychologists

in health care settings.
2. Lower staff rank for neuropsychologists in
health care settings, including academic ones.
3. Lower reimbursement rates across the
board (Saeman, 1998).
4. Questioning of the necessity of neuropsychological services.
5. Proliferation of courses in neuropsychology in multiple kinds of programs at all levels.
6. Provision of neuropsychological-like services by other health-related providers (e.g.,
occupational therapists, speech therapists).
If there are no particular standards which
need to be met, anyone can provide the service.
If anyone can provide the service, it becomes
trivialized and relegated to the rank of ancillary
care. Large numbers of individuals, from multiple backgrounds, all claiming similar expertise,
compete for the same jobs, regardless of training
background (nondoctoral level and nonpsychologists included) or any reference to appropriate
credentials. Neuropsychology is not bundled
as a necessary service in the provision of health
services, and work values for that service are not
recognized by health financing organizations a
battle we have endured all year. In short, we all
suffer when we do not maintain self-respect, no
matter what schools we attended or what our
training backgrounds were.

WHY IS SELF-RESPECT AN ISSUE?

Why would there be a movement among psychologists to downplay the need for standards
and focus only on practitioner needs. I think
there are several major reasons. First, we have
become victims of our own success. Ever since
the comprehensive salary, practice, and fee surveys conducted by Steve Putnam and John
DeLuca (1989, 1990, 1991) showed that the
practice of Clinical Neuropsychology was
among the most lucrative and respected of psychological practice areas, there has been a decided rush of individuals who want a piece of
the pie and programs allegedly ready to prepare
them. Combined with the recent pressures on
scope of general psychological practice and its

MEDIOCRITY IS NO STANDARD

reimbursement, psychologists have started to

look for ways to augment their income. Clinical
Neuropsychology seemed like an acquifer ready
to be tapped.
Unfortunately, the training guidelines, definitions, and board certification procedures that
had been laid out so carefully for the previous
decade, were not readily compatible with a capricious switch into specialty practice in Clinical Neuropsychology. They require supervised
and systematic training, something that is understandably difficult for someone already in general practice or practice in another specialty.
Nevertheless, many psychologists felt (and
continue to feel) that they should be able to engage in any kind of practice that they choose and
that credentialing requirements are artificial and
designed to keep them out of the guild. Perhaps the mindset that leads to this notion is akin
to that expressed by APA president Martin
Seligman (1998) in the July issue of the APA
Monitor. Though he is addressing another subject, he questions the legitimacy of child-rearing
values in America:
...individual responsibility has been replaced
by a self-esteem movement. This movement
tells parents and educators that their first duty
is to make kids feel good about themselves.
Kids are taught mantras like I am special,
and they believe them. ...We need to teach
our children warranted self-esteem and realistic optimism based on the skills of doing
well in the world, on doing well with others
and on personal responsibility.
In short, we are not entitled to do anything we
want. We must earn the right to do it. Seligman
is talking about how this kind of attitude leads to
the epidemic of violence that America now
faces. I am adapting it to the sphere of professional psychology and a perceived right to practice without respect for appropriate preparation
and accountability.

SOLUTIONS
I return to my original theme. Put yourself in the
role of the patient when you think about it. We
must continue to operate on our primary concerns, the welfare of the patient and the welfare
of the profession. They are inextricably tied to
each other. If they are respected, the need for
standards and self-respect becomes self-evident.
If practitioner needs become a driving force,
then standards become an impediment and energies are mobilized against them.
The success of Clinical Neuropsychology as
a specialty profession is due in large part to the
fact that we have been clarifying standards for
many years. It is due to the empirical underpinnings of our procedures and practices. If these
are compromised, the successful profession that
we know and love will be negatively affected.
Every time you hear of attacks on standards and
models, I urge you to consider who benefits
from the standards and who benefits from the
attacks. My thesis is that standards benefit all of
us, the patient and the profession. Attacks on
standards benefit only the attackers, for the short
run; in the long run, they do significant damage
to our profession.
There are concrete principles and steps that
we can take to safeguard our gains and continue
our progress.
1. Disregard artificial distinctions between
academics and practitioners. It is absurd to
think that those in teaching positions should
have higher or different standards than those
caring for patients. Our academic colleagues
experience no gain from supporting applicable
standards other than the ability to continue to
teach motivated students. Their positions are
relatively secure regardless of where standards
lie. Whereas some practitioners might benefit
temporarily from weakened standards, the same
practitioners will be mortally wounded in the
long run as the profession loses respect.
2. Support the implementation of the Houston
Conference. Regardless of what you may hear,
the purpose of the conference was nothing more
than the production of an integrated training
model for our profession, which has now
reached specialty status. As I mentioned earlier,

10

LINAS A. BIELIAUSKAS

a profession without a model commands no respect. We have reached the point where that
model is required. The conference agreed on a
policy that education and training for the specialty of Clinical Neuropsychology should be
formal and that it should include components at
the doctoral, internship, and postdoctoral residency levels. This is not rocket science. If one
disagrees with this, then I maintain that one has
no respect for their profession; one simply acknowledges that vis--vis our fellow health care
professions, we do not warrant peer status.
I would also like to remind everyone that the
policy statement of the Houston Conference is
not retroactive it is a blueprint for our professional future. Despite what you might have
heard, most of the conference organizers and
participants themselves wouldnt qualify as specialists under the terms of the policy produced.
This includes myself. Nevertheless, the policy
does represent the current state of training in
Clinical Neuropsychology and it must be so recognized. Failure to do so is a failure to support
the solid progress our field has made over the
past 20 years.
3. Support legitimate board certification.
There are now arguments being made for multiple boards in Clinical Neuropsychology. I maintain that this does a major disservice to the profession and to consumers of our services. Board
certification procedures, again, support our peer
status with our medical health service colleagues, and offer an assurance to patients that
individuals have had their credentials carefully
reviewed and have passed a thorough examination by their peers. Some take the position that if
they do not pass such an examination, the board
must be capricious. Others maintain that we
need different boards for academics and practitioners. I hope you appreciate the illegitimacy of
these arguments. In medicine, the American
Board of Medical Specialties is the oversight
board for the 22 major board certifying agencies. In psychology, the American Board of Professional Psychology oversees 11 component
board certifying bodies, including Clinical Neuropsychology. We must keep parity and quality
in the health care system or we will be regarded
as second rate.

4. Support quality standards at all levels,

teaching, supervising, recruitment, hiring, administration, practice, and quality control/
performance improvement. Support strong educational models, the role of science in psychological teaching, and respected credentials. Most
good teachers and parents will tell you that they
are most pleased when their student or child
does better than they do. That same attitude
must prevail in our profession if it is to develop.
The standards are out there we should make
every effort to use and support them.

FINAL THOUGHTS
Let me close with an interchange which James
Michener describes in his book Chesapeake.
Two men, named Paxmore and Steel, are discussing the Watergate affair (Paxmore is a
Quaker, as you will divine from the conversation):
Paxmore: Men without character slip from
one position to the next. And never comprehend the awful downward course theyre on.
Steel: Couldnt Nixon have stopped it?
Paxmore: Woodrow Wilson could have. Or
Teddy Roosevelt. And does thee know why?
Because they had accumulated through years
of apprenticeship a theory of government. A
theory of democracy if thee will. And they
would have detected the rot the minute it
started.
Steel: Why didnt the Californians?
Paxmore: For a simple reason. They were
deficient in education. Theyd gone to those
chrome-and-mirror schools where procedures
are taught, not principles. I doubt if any of
them contemplated a real moral problem, in
the abstract, where character is formed. (p.
1049)
I am fully aware that not all agree with my
views and that, by now, there may even be
stirrings of resentment among those reading this
address. I can only state, unequivocally, that I
firmly believe the concerns and principles I have
outlined are fundamental to our prosperity as a
profession. I asked you at the beginning to think

MEDIOCRITY IS NO STANDARD

of these issues from the perspective of a patient

and family and what benefits them. I believe it is
not appropriate to establish professional guidelines solely from the viewpoint of the needs of
the practitioner. If you do as I suggest, I hope
that you will see that prioritizing the patient,
prioritizes the profession, and prioritizing the
profession benefits us all. Please join me in the
celebration and nurturing of Clinical Neuropsychology as the millennium approaches.

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