This article summarizes evidence and issues associated with psychological assessment. Data from more than 125 meta-analyses on test validity and 800 samples examining multimethod assessment suggest 4 general conclusions: (a) Psychological test validity is strong and compelling, (b) psychological test validity is comparable to medical test validity, (c) distinct assessment methods provide unique sources of information, and (d) clinicians who rely exclusively on interviews are prone to incomplete understandings. Following principles for optimal nomothetic research, the authors suggest that a multimethod assessment battery provides a structured means for skilled clinicians to maximize the validity of individualized assessments. Future investigations should move beyond an examination of test scales to focus more on the role of psychologists who use tests as helpful tools to furnish patients and referral sources with professional consultation.

Two long-term analytic inpatient groups comprised of severely disturbed neurotic and personality disordered patients were intensively investigated through process ratings and therapist and patient reports with regard to five therapeutic factors: cohesiveness, self-disclosure, feedback, interpersonal learning-output, and family re-enactment. The process variables were correlated with outcome assessments at 12 and 18 months following treatment. The study applied a single case (group) approach with replication to cross-validate the findings from one group to the next. Results demonstrated that all five therapeutic factors were meaningfully associated with clinical improvement. Although different treatment groups may generate unique psychological climates for producing change, the findings suggest that group cohesiveness is an important ingredient for effective group process to occur. The multimethod, multiperspective nature of this study lends considerable credence to the findings, despite the small sample size.

Psychologists report limitations on psychological assessment services and problems gaining authorizations and reimbursement for these services from third-party payers. Documentation and categorization of these problems and limitations is based on responses from well over 500 psychologists responding to a broad solicitation for feedback. This article explores the barriers to access for assessment services, including resistance to psychological assessment, difficulties in the preauthorization process, problems with reimbursement, the clinical decision-making process, and larger systems issues. The authors make recommendations for redress of these problems through work with the profession, other mental health professionals, managed care, and patients-consumers and through political action. Psychological and neuropsychological assessment services are under assault from organized health care delivery systems, managed mental health care organizations, and health care payers. As a profession, psychology must respond to this attack with advocacy and a credible explanation of the value and usefulness of assessment if it is to survive as a covered health care service. This article reviews issues in the current applications of psychological assessment in health care settings and recommends appropriate responses. The message from health care delivery systems is clear. Critics argue that psychological assessment is time consuming, expensive, ELENA J. EISMAN received her EdD in 1975 from Boston University. She is currently the executive director of the Massachusetts Psychological Association and a faculty member at the Massachusetts School of Professional Psychology. She maintains an independent practice in Newton Highlands, MA.

Psychologists in health care settings today find it increasingly difficult to obtain authorization and appropriate reimbursement for psychological assessments from 3rd party payers. Authorization and reimbursement denials often are based on allegations that empirical support for the utility and validity of psychological tests is nonexistent or limited. This article reviews a sample of the considerable empirical support that exists for the utility and validity of a variety of psychological tests for a wide range of clinical health care applications. Informed by data such as these, psychologists should become more effective in their abilities to seek authorization and reimbursement for assessment and overturning denials. Obtaining authorization and reimbursement for psychological assessments from third party payers has become increasingly difficult for psychologists (Eisman et al., 2000; Piotrowski, Belter, & Keller, 1998). Difficulty obtaining preanthorization, limitations in instrument selection and time, and reduced or nonexistent remuneration for psychological assessments have become the norm. As a result, psychologists now use psychological assessment less frequently than in the past (Eisman et al., 2000; Piotrowski et al., 1998). Eisman et al. (2000) described a variety of reasons for these developments. One is the erroneous belief among third party payers and others that psychological assessment lacks empirical support for its validity and utility in clinical health care settings and provides nothing more than can be gained by a clinical

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