The Professional Training of Clinical Psychologists

1. The Professional Training of Clinical Psychologists Melody N. Mickens, B.A. 3rd year Clinical Psychology Doctoral Student Virginia Commonwealth University

2. Learning Objectives • Describe what clinical psychology is and how clinical psychologists are trained • Discuss some of the career paths available to clinical psychologists • Explain key challenges for the field of clinical psychology

3. What is Clinical Psychology? “The integration of science, theory and practice to understand, predict and alleviate maladjustment, disability and discomfort as well as to promote human adaptation, adjustment and personal development.” -American Psychological Association, Society of Clinical Psychology (Division 12)

4. Clinical Psychology

5. Scientist-Practitioner Model of Training Scientist Practitioner

6. Ph.D versus Psy.D. : What’s the difference? • Ph.D programs • Follow a “scientist-practitioner” model of training • Heavy emphasis on research and preparation for a career in clinical and academic settings • Smaller class sizes (4-15 students) and funding for students • masters thesis and dissertation research with data collection • Psy.D programs • Follow a “practitioner-scholar” model of training • Heavier emphasis on clinical work and research related to clinical practice • Larger class sizes (100+), high tuition costs, no financial support, lower internship match rates that result in students completing internships at non-accredited sites • Rarely involves masters thesis and dissertation can be a theory paper in many programs

7. Counseling Psychology PhD Leads to same license as clinical psychology PhD Smaller number of programs, with slightly different emphasis (similar to D.O. vs. M.D. training) VCU Psychology Department has both programs (very unusual) with large overlap in courses and training. Both work on MCV campus and in primary care.

8. Applying the Scientist-Practitioner Model

9. The Training of Clinical Psychologists Undergraduate education Graduate education 5-6 years to earn Ph.D. Internship required to earn Ph.D (shortage of accredited internships has created stress for students and training programs) Post-doctoral fellowship (Optional in some cases) Licensure and board certification Continuing education to maintain license and certifications Training Overview

10. Two Tracks in Clinical Program at VCU Behavioral Medicine* Child and Adolescent • Generalist training focused on psychopathology, assessment, treatment and research with adults • Specialist training for research and clinical work in health settings * Also know as Health Psychology. VCU Counseling PhD has same track. • Training focused on understanding human development, family and social aspects of human development, research, assessment and the treatment of children and adolescents with psychopathology.

11. Year One • Complete coursework • Intellectual & personality assessment, psychopathology, biological basis of behavior, statistics, behavior therapy and clinical interviewing skills • Work ~ 20 hours at an assistantship • Teaching a course or the lab/discussion section of an undergraduate or graduate course • Recruiting participants for a faculty member’s research, running intervention groups or collecting data from participants or analyzing data • Independent research • Collaborating with a faculty advisor or mentor • Reading and discussing literature for thesis • Analyzing data for an abstract or poster for a conference

12. Year Two • Complete coursework • Research methodology, psychometrics, health psychology, learning and cognition and neuropsychology • Work ~ 20 hours at an assistantship • Begin clinical practicum at CPSD • Independent Research • Thesis proposal and data collection

13. 2nd year students begin working as staff therapists at the CPSD in the fall semester • CPSD is a clinic operated by VCU’s Psychology department • Services are provided on a sliding fee scale based on patient’s income and insurance • Services include • Individual therapy for children and adults • Couples therapy • Assessment (court ordered evaluations, ADHD/LD, therapeutic & neuropsychological) • Family therapy • Group therapy • Career counseling Clinical practicum at the Center for Psychological Services and Development (CPSD)

14. Additional Department Clinics • Anxiety Clinic (CPSD) • Cognitive Behavioral Therapy (CBT) focus for individuals with anxiety disorders • Training in exposure therapy • Peer supervision model • Primary Care Psychology Clinic • Students treat patients at MCV’s ACC Resident Clinic for a variety of psychological and health related disorders • Weight loss, depression, smoking cessation, diabetes management, anxiety and adjustment to chronic illness • Students collaborate with residents, a medical social worker and pharmacist students to integrate patient care • Assessment Clinic (CPSD) • Students administer, score and report findings from psychological assessments • Students gain experience in case conceptualization and assessment administration, scoring and report writing • Child and Adolescent Primary Care Clinic • Similar to PCPC, but with children, adolescents and families at Children’s Pavillion • To begin in January, 2011 • Funded by same HRSA grant as PCPC

15. Year Three • Complete elective coursework • Work ~ 20 hours at an assistantship (one option is Primary Care via grant funding) • Complete clinical practicum at CPSD and apply for off-campus practicum • Independent research • Thesis defenseobtain Masters’ degree • Dissertation proposal • Complete comprehensive examinations (50 page paper worthy of journal submission)

16. Year Four • Begin off-campus practicum • Continue with clinical work at Anxiety clinic or Primary Care Clinics • Independent research • Internship applications and interviews • Work ~ 20 hours at assistantship

17. Training sites • Hunter Holmes McGuire VAMC • Virginia Treatment Center for Children • Central State Psychiatric Hospital, Petersburg, VA • UVA Center for Addiction Research and Education • VCU Department of Psychiatry: burn unit, transplant and gastric bypass evaluations and treatment Off-campus Practicum Training 3rd year students apply to work at several training sites within the Metro Richmond area or DC area

18. Year Five or Six • Complete internship • Defend dissertation • Graduate OR • Off-campus practicum • Dissertation data collection • Internship applications and interviews

19. Internship • Application process includes a written application, an invitation to interview, interviews and then match process similar to medical residency • Internships typically begin in July or August and include extensive training for one year • Internship allows students the opportunity to work autonomously in a new setting and to experience some of the challenges that licensed clinicians face • Interns continue to receive supervision and training through clinical rotations, where they often have the opportunity to practice in sub-specialties such as neuropsychology, forensic psychology, integrated primary care psychology, rehabilitation psychology, sports psychology, program evaluation and development.

20. Internship sites • Agency Types: • VA hospitals • Community mental health centers • Medical schools • Prisons and correctional facilities • Private and state owned hospitals (general or psychiatric) • University counseling centers • Outpatient clinics

21. Post-graduate training • Post-doctoral fellowship • 2 year training opportunity • Training in a sub-specialty area such as neuropsychology, addiction psychology, primary care psychology and health disparities research • Mixture of research and clinical focus with some programs emphasizing one area over the other • Provides clinical hours needed to achieve board credentials in sub-specialty areas • Licensure and credentialing • Licensure by state board • Credentialing by specialty boards and professional organizations • American Board of Professional Psychology • Continuing education requirements

22. What do clinical psychologists do? • Assess intellectual development, psychopathology, adjustment and personal growth • Treat psychological disorders and individuals experiencing symptoms of psychological distress in a variety of settings • Teach at university psychology and psychiatry departments • Conduct research in the community • Consult with government agencies, private institutions, businesses and organizations • Lead and participate in professional organizations • Publish and edit journals and books

23. Career paths of VCU grads 65% work at academic medical centers or VA hospitals with adult or pediatric populations and are frequently involved in both clinical service and research 20% work in private practice 5-10% work at universities or colleges as tenure track professors 5-10% work as administrators for various health care organizations

24. Differentiating clinical psychologists from other mental health providers (MSW, MA level counselors, Psychiatrists) • Major differences • Different training models, professional degrees and areas of competency • Different ethical standards • American Psychological Association • Psychologists complete training in intellectual, cognitive and personality assessments • Research skills and clinical competencies provide leadership expertise

25. Five challenges for the profession of clinical psychology: • Are for-profit programs creating too many psychologists and how will this affect the field over time? Note: most limitations placed on the “free market” of training would be considered illegal • Shortage of accredited internships, required by many programs and licensure boards • Differentiating competencies and justifying higher reimbursement rates for doctoral trained psychologists relative to masters level mental health providers • Moving toward an outcomes oriented reimbursement model that still embraces diverse orientations to practice • Clinical psychologists continuing to find new niches that capitalize on unique expertise in measurement and research skills

26. Summary Complete rigorous training to achieve a Ph.D. or Psy.D., licensure and credentials Use their knowledge of science and research to understand and treat a variety of disorders or promote adjustment Practice in a variety of settings Fulfill many roles as researchers, educators, consultants and clinicians Clinical psychologists:

27. References Slide 3: Society of Clinical Psychology. (2010) “What is Clinical Psychology?” Available from http://www.div12.orgabout-clinical-psychology Comic courtesy of http://www.zjobs.com.au/imagespsychologist.jpg Slide 4: Graphic courtesy of http://www.uaa.alaska.edu/dssinformation/images/NM0504-PSYCHOLOGY.jpg Slide 5: Scientist comic courtesy of http://www.age-of-the-sage.orgpsychology/pavlov.html Practitioner comic courtesy of cartoonstock.com Slide 7: Graph courtesy of http://ed-web3.educ.msu.edu/CEPSE/cpimages/table.gif Slide 8: Comic courtesy of phdcomics.com Slide 9: Rat in Skinner box courtesy of http://www.superstock.com/stock-photos-images 1566-0123734 Photo courtesy of http://www.wm.edu/research/ideation/issues/2010-spring/facing- race-008.php Slide 14: Photo courtesy of CPSD staff Slide 19: Photo courtesy of http://www.richmond.va.gov/ Photo courtesy of http://yourunitedway.org/images/jewish_family_services.bmp Photo courtesy of http://www.virginiakids.net/pics/logo.jpg Photo courtesy of http://www.medicine.virginia.edu/clinical/departments/psychiatry/sections/neurobiologicalstudies/uvacare/home-page Slide 20: Photo courtesy of http://2.bp.blogspot.com/_bWyMZGz_G0c/TNi5zjznt8I/AAAAAAAAA3c/oK95SU73EfQ/s1600/The+Light+At+the+End+of+the+Tunnel.jpg Slide 24: Photo courtesy of http://www.paranormalknowledge.com/articles/5-articles-on-psychology.html