Psychological tests often include a standardized protocol, which gives specific instructions to clinicians on how the tests are to be administered. This protocol is intended to minimize variation across test administrations, allowing the test to yield reliable and valid measurements. Clinicians are advised to adhere to the test protocol as closely as possible, though departures from protocol are often necessary, as many assessments require clinicians to clarify instructions, modulate client anxiety, and intervene to maintain the client\u27s motivation. Protocols provide little guidance on how clinicians are to make these departures. The clinical literature on assessment contains some advice on when and how to depart from protocol, but this advice is based on casual, unsystematic observation, not empirical research. In my dissertation, I used two qualitative research methods – Conversation Analysis (CA) and Discourse Analysis (DA) – to study empirically how clinicians administered cognitive tests, focusing particular attention on when and how clinicians made departures from the standardized test protocol. Three cognitive assessments were recorded and transcribed in their entirety. I then analyzed those transcripts closely, focusing particular attention on times when clinicians made utterances that were not dictated by the protocol. I found that these utterances were relatively common, though most were not major violations of protocol. In most instances, these departures functioned as a way of addressing an area of interactional difficulty and keeping the client on task. However, departures also functioned as ways of positioning the clinician as a neutral observer of the testing process, managing the power asymmetry between clinician and client, addressing the awkwardness occasioned by the test administration, permitting the client to save face for incorrect answers, and allowing the clinician to make public their professional commitment to administering the tests in a standardized fashion. Based on these findings, I concluded that adherence to standardized protocol should be thought of as a spectrum, with different degrees of adherence being appropriate at different times. I also used my findings to discuss how clinicians can administer tests in a way that is sensitive to the client and the context of the test administration without violating the standardized protocol
