The process approach to neuropsychological assessment of psychiatric patients

T he growing interest in the biological basis of psychiatric disorders has led researchers to apply neuropsychological methods derived from the study of patients with lateralized focal cerebral pathology.”2 The neuropsychological instruments that have been largely used, however, are for the most part “achievement” oriented. Test items are scored right or wrong and summed to provide an overall total score. The underlying assumption is that such scores are an objective measure of an underlying unitary mechanism. (For a review of such test instruments, see Kane3 and Lezak.4) Over fifty years ago, Werner5 cautioned that conclusions based exclusively on achievement scores may be quite misleading. He demonstrated that individuals could arrive at the solution by distinctly different processes reflecting the activity of distinctly different structures in the central nervous system. Werner6 believed that since every cognitive act involves an unfolding process over time (microgenesis), careful monitoring of the behaviors used by the individual while working toward solving a problem (process) would provide more useful information than that obtained from right-wrong scores of final solutions (achievement). This presentation delineates the advantages of a process-oriented approach to the evaluation of the cognitive status of neurologic and psychiatric patients.7