The Boston Process Approach

The Boston process approach is an approach to neuropsychological assessment, which was developed at the Boston Veterans Medical Center by the American psychologist, Dr. Edith Kaplan, along with her colleagues, Drs. Harold Goodglass, Nelson Butters, Laird Cermak, and Norman Geschwind. It focuses on qualitative measurements of behavior and arises from the premise that “equal performance on any given mental task can be accomplished by different processes or strategies”. That is, because different sorts of errors by different patients may attain the same total score on a test, it is important to look at underlying processes in order to understand the particular difficulties of the individual. The goal of the approach is to create an understanding of the cognitive strengths and weaknesses of a patient. It is a flexible-battery approach to neuropsychological testing, meaning the set of standardized tests given to the patient is chosen according to the patient's specific deficits. In 1976, Dr. Kaplan began training neuropsychology interns to allow them to apply what she referred to at the time as the Boston approach to neuropsychological assessment of their patients. The first fairly formalized and comprehensive description of Dr. Kaplan’s methods was published in the original 1986 version of her book chapter with Drs. Nancy Hebben and William Milberg, and it was here that the term “Boston process approach” was first used. There are no overall descriptions of the approach and no instances of that term used before that chapter. The Boston process approach is currently used as a method of neuropsychological assessment, with experience in its use being considered by some to be essential or very important for applicants to internships in clinical neuropsychology.

The neuropsychologist performing the assessment chooses a set of standardized tests to be administered based on the behaviors and complaints of the patient. On completion, the neuropsychologist analyzes the problem-solving method that the patient used to address each question. Any unusual errors are further investigated by re-administration of modified versions of the standardized tests, with the focus of identifying the specific problem area.

The qualitative analysis focuses on closely observing the process by which a patient arrives at a final answer. An example of qualitative analysis is in regard to the Block design test, which measures spatial visualization ability and motor skills. During the task the patient is asked to recreate a viewed pattern by arranging a set of blocks that have colored patterns on each side, The examiner observes the method by which the patient approaches and solves the problem, focusing, for example, on what quadrant the patient started at, which hand was used to arrange the blocks, whether the patient rotated the blocks on the table or had to lift them into space, if the image produced was either a mirror image or reversal of the pattern that the patient was supposed to create, and which side the patient made more errors on,. This is considered qualitative analysis because it focuses on how the patient came to their final design, rather than the final design itself.

...
Wikipedia