Clinical Psychology:

Nature and Training

(Chapter 1)

PSYC 4500: Introduction to Clinical Psychology

Brett Deacon, Ph.D.

August 29, 2013

Announcement

• Pignoitti response paper questions

What is Clinical Psychology?

• “The field of clinical psychology integrates science, theory, and practice to understand, predict, and alleviate maladjustment, disability, and discomfort as well as to promote human adaptation, adjustment, and personal development. Clinical psychology focuses on the intellectual, emotional, biological, psychological, social, and behavioral aspects of human functioning across the lifespan, in varying cultures, and at all socioeconomic levels” (Society of Clinical Psychology, 2002).

• Emphasis on science (at least in this class)

• Emphasis on maladjustment

• Emphasis on the individual

• Emphasis on helping

What Do Clinical Psychologists Do?

• Psychotherapy

• Assessment

• Research

• Teaching

• Supervision

• Consultation

• Administration

What do I do (for example)?• In the past year, I have:

• Seen psychotherapy clients • Written a clinician treatment book• Supervised graduate students’ psychotherapy• Conducted research studies• Written and published research papers• Presented research at national conferences• Mentored undergraduate and graduate student research• Reviewed manuscripts submitted to journals for publication• Served on journal editorial boards• Taught undergraduate and graduate classes• Served on numerous administrative committees at UW and at

national organizations• Presented clinical workshops on anxiety treatment and the

DSM-5 at national conferences and to community clinicians in the US and internationally

Clinical Psychology vs. Related Professions

• Psychiatry• Requires undergraduate background in physical sciences • Medical specialty - 4 years of medical school, one year internship

in general medicine, three-year psychiatry residency, exams for board certification

• Philosophy, training, and practice• Little training in research or the scientific method; emphasizes

memorization over critical thinking • Strongly dominated by biological models of mental disorders• Treatment is overwhelmingly biological• Minimal psychotherapy training• See very large number of patients for small number of visits

Contemporary Psychiatric Practice

• The practice of psychiatry in the United States (Mojtabai & Olfson, 2010; Olfson & Marcus, 2010)

• In 2004-2005, the percentage of psychiatrists who provided psychotherapy to all their patients was 10.8%

• At the first office visit, the average outpatient who sees an American psychiatrist receives 2 medications; approximately 1/3 receive 3 or more

• “There has been a recent significant decline in the provision of psychotherapy by psychiatrists in the United States. This trend is attributable to a decrease in the number of psychiatrists specializing in psychotherapy and a corresponding increase in those specializing in pharmacotherapy--changes that were likely motivated by financial incentives and growth in psychopharmacological treatments in recent years.”

Clinical Psychology vs. Related Professions

• Counseling psychology (doctoral-level)

• School psychology (masters- or doctoral-

level)

• Counseling (masters-level)

• Social work (masters-level)

• Psychiatric nursing (masters-level)

• Marriage and family therapy (masters-level)

Getting into Graduate School in Clinical Psychology: Relevant Qualifications

• Undergraduate course work

• GPA, overall, last 2 years, and in major

• GRE, both general and psychology tests

• Research/scholarly experience

• Clinically-relevant experience

• Strong letters of recommendation

• Personal statement

An Example: The UW Clinical Psychology Application Process

• Application: http://www.uwyo.edu/PSYCHOLOGY/graduate/Graduate%20Application%20Process.html

• Relevant Data: http://www.uwyo.edu/psychology/graduate/clinical%20phd%20program%20student%20data.html

Getting into Graduate School in Clinical Psychology: Insider Tip

• Must-know: At most Ph.D. programs, you are

applying to work with a particular faculty

member, not to join the graduate program per

se

Getting into Graduate School in Clinical Psychology: Insider Tip

• Must-know: Admission to most Ph.D.

programs is heavily influenced by your ability

to demonstrate clearly articulated research

interests that match well with those of the

faculty member(s) to whom you’re applying.

• Match demonstrated by: (a) verbal

persuasion, (b) evidence from research

and/or clinical experience

Getting into Graduate School in Clinical Psychology: Insider Tip

• Must-know: Although overall admission rates

for Ph.D. programs are useful to know,

admission rates can vary dramatically among

individual faculty members

• Range at UW last year: 5 to 31

• Reasons for this variation

Useful Resources about Graduate School

• American Psychological Association (2005). Graduate study in psychology 2006. Washington, DC: Author.http://www.psichi.org/pubs/articles/article_540.asp - see also the library

• Excellent links page about entire process: http://www.uni.edu/walsh/linda2.html

• Difference between clinical & counseling psychology: http://www.psichi.org/pubs/articles/article_73.asp

• Differences between Psy.D. and Ph.D.: http://www.psichi.org/pubs/articles/article_171.asp

• Obtaining a good letter of recommendation: http://www.psichi.org/pubs/articles/article_75.asp

• Great list of resources: http://www.psichi.org/pubs/search.aspx?category1=7

• Writing a good personal statement: http://www.psichi.org/pubs/articles/article_98.asp

Graduate Training in Clinical Psychology

• Depends on training model of program

• Coursework:• Basic psychology: social, developmental, cognitive,

biological• Statistics (typically 2-4 classes)• Clinical coursework: psychopathology,

psychotherapy, cognitive and personality assessment, ethics and diversity

• Often has either child or adult focus• Specialized coursework: neuropsychology, health

psychology, forensic psychology, consultation in medical settings, psychopharmacology, etc.

• No direct training for prescribing – this is postdoctoral

Graduate Training in Clinical Psychology

• Research activities (for Ph.D. programs):• Relationship with research advisor• Masters thesis and oral defense• Doctoral dissertation and oral defense• Additional involvements: research assistantships,

presenting posters or papers at conferences, publications

• Teaching (if applicable)

• Doctoral candidacy examination

• Graduate assistantships

Graduate Training in Clinical Psychology

• Practicum training• Often at in-house psychology clinic• Offsite community externships

• Predoctoral internship• Yearlong, full-time internship, competitive

application process (very much like grad school)

• Postdoctoral training (if desired)• Opportunity to develop clinical specialty• Opportunity to further develop research specialty• Earn hours for licensure

• Continuing education and credentialing

My Training (for example)

• Graduate school (5 years)

• Internship (1 year)

• Post-doc (2 years)

• Continuing education and licensure

How Should Clinical Psychologists be Trained?

• How to balance training in the science and

practice of clinical psychology?

• Finding the right balance between training

in science and practice

• Different types of programs with different

emphases, for different types of student

interests and career goals

How Should Clinical Psychologists be Trained?

• Training models differ in their philosophy

about:

• The relevance of science to clinical

practice

• The degree of scientific training

necessary to produce competent

practitioners

Training Models in Clinical Psychology

• Boulder model

• Also known as “scientist-practitioner” model

• Usually associated with Ph.D. degree

Scientist-Practitioner Training

• Training in three broad areas:

• Research

• Assessment

• Intervention

• Intensive research training in addition to

clinical training

Common Criticisms of Boulder Model

• Scientific and clinical training is not integrated

• Faculty are poor role-models

• Many applicants interested in practice

• Few clinical psychologist do research

• Intensive research training may not be necessary to be a good clinician

Training Models in Clinical Psychology

• Vail model

• Also known as “scholar-practitioner” model

• Usually associated with Psy.D. degree

• De-emphasis on research experience (although receive some training in research)

• Greater emphasis on psychological service delivery

• Usually associated with Psy.D. degree

Scholar-Practitioner Training

The Psy.D.

• Doctor of Psychology (Psy.D.)

• Emphasis is on training for clinical practice

• Compared to Ph.D., far less scientific training

• First program 1968 – University of Illinois

• Currently – about 25% of APA accredited doctoral training programs in clinical psychology offer Psy.D.• Majority of new clinical psychologists are

from Psy.D. programs

Internship Match Process

• 2013 internship applicant data:

• 1,272 clinical applicants with Ph.D.• Match rate: 79.2%

• 1,419 clinical applicants with Psy.D.• Match rate: 69.2%

• What does it mean not to get matched with a predoctoral internship site?

Psy.D. vs. Ph.D.

• Affiliation with a university• Financial costs• Class size• Admission requirements• Faculty involvements• Faculty theoretical orientation• Research training• Duration of training

Getting into Psy.D. Vs. Ph.D. Programs

Free-

stan

ding

PsyD

Univer

sity-

base

d Psy

D

Pract

ice-o

rient

ed P

hD

Equal-

emph

asis

PhD

Resea

rch-

orien

ted

PhD0

10

20

30

40

50

60

% Offered Admission

Paying for Psy.D. Vs. Ph.D. Programs

Free-

stan

ding

PsyD

Univer

sity-

base

d Psy

D

Pract

ice-o

rient

ed P

hD

Equal-

emph

asis

PhD

Resea

rch-

orien

ted

PhD0

20

40

60

80

100

% with Full Tuition Waiver and Assistantship

• Mean Psy.D. student debt = $53,000-$60,000• Mean Ph.D. student debt = $22,000• ≈60% of Psy.D. students have > $100,000 in debt

In the News (2011)

• New York Times: “For-Profit College Group Sued as U.S. Lays Out Wide Fraud”

• Education Management Corporation, majority owned by Goldman-Sachs, runs Argosy University PsyD schools (18 campuses)

• “…the case is the first in which the government intervened to back whistle-blowers’ claims that a company consistently violated federal law by paying recruiters based on how many students it enrolled...The complaint said the company had a “boiler-room style sales culture” in which recruiters were instructed to use high-pressure sales techniques and inflated claims about career placement to increase student enrollment, regardless of applicants’ qualifications. “

Argosy University, Denver

• http://www.argosy.edu/programs/clinical-psychology-degrees-1211.aspx

• Median debt: $174,231

Training Models in Clinical Psychology

• Clinical scientist model and the Academy of

Psychological Clinical Science

• Excerpt from “Manifesto for a science of

clinical psychology (McFall, 1991)

Training Models in Clinical Psychology

• “The dichotomy between science and practice is the classic one-the one codified in the Boulder Model of clinical training with its hyphenated characterization of clinical psychologists as "scientist-practitioners." The implication commonly attributed to the hyphenated Boulder Model is that there are two legitimate types of clinical psychology: clinical science and clinical practice.”

Training Models in Clinical Psychology

• “This is the dichotomy one hears, for example, from undergraduates who are applying to graduate training programs in clinical psychology and are struggling with making what they perceive to be the difficult, but necessary, career choice between science and practice. When I counsel these undergraduates, I try to persuade them that they are not framing the issue correctly-that there really is no choice between science and practice. I tell them that all clinical psychologists must be scientists first, regardless of the particular jobs they fill after they earn their degrees; that becoming a clinical scientist does not mean that they are committed to working in a laboratory or university; and that choosing not to receive the best scientific training possible, by purposely opting for a training program that does not emphasize scientific training, means that they will not be prepared to do any form of psychological activity as well.”

Training Models in Clinical Psychology

• “What I am saying to them, of course, is that all

forms of legitimate activity in clinical psychology

must be grounded in science, that all competent

clinical psychologists must be scientists first and

foremost, and that clinicians must ensure that their

practice is scientifically valid.”

Training Models in Clinical Psychology

• The American Psychological Association uses the

same criteria to accredit all clinical psychology doctoral

programs

• How broad do the criteria have to be accommodate the

curriculum at, say, Harvard University’s Ph.D. program

and Argosy University’s Psy.D. program?

• Comments from Walter Mischel (2009) http://

psi.sagepub.com/content/9/2/i.full