Professional Issues and Graduate School/ Misapplication of CBT

Professional Training

• Prior to the 1940’s, the only “training” available was experiences

• WWII, VA, and US Public Health Service helped clinical psychology establish and identity and establish training programs. 

Dr. David Shakow

• Most influential psychologist in founding training programs

• Chaired committee on Training in Clinical Psychology that prepared a report for APA (1947)

  • A clinical psychologist should be trained first and foremost as a psychologist

  • Clinical training should be as rigorous as for non-clinical areas of psychology

  • Preparation of clinical psychologists should be broad and directed towards assessment, research, and therapy

• The report suggested a 4 year curriculum, but most current programs take 6 years

• Proposed the scientist-practitioner model. 

Boulder Conference

• First major training conference on clinical psychology 

• Boulder, CO in 1949

• Financially supported by VA and US Public Health Service

• The participants accepted the Shakow report and established the Boulder model

  • Identified programs that satisfied the recommendations 

  • Led to mechanisms to evaluate and accredited programs

• Currently, programs are visited by an APA accreditation team every five years

• In 2021, 311 active PHD programs

• Established these parameters

  • Programs award the degree of PhD

  • Programs located at universities, typically in an arts and science departments

  • Prepare students to work in both academia and practice

  • Require research-based dissertation

  • Provide maximum funding to a small number of students. 

Vail Conference

• Financially supported by NIMH

• Participants spanned the range of psychological specialties and training

• Led to the recognition of programs whose mission is to prepare students to deliver clinical services (PsyD)

• Led to the recognition of masters level as professional psychologists, but rules regarding masters level practitioners vary by states. 

• Established these parameters

  • Programs can award a degree of PsyD

  • Programs can be in psychology departments at universities, university-affiliated professional schools, or independent free-standing schools

  • Training focuses on clinical practice

  • Enroll a lot more students and don’t offer much financial support

Salt Lake Conference

• Convened to discuss changes that had occurred since the Vail conference

  • Scientists split from APA to for APS in 1980s

• Also, desire to reduce tensions between scientists and practitioners

  • One of the main changes was that all accredited programs must train students in the core psychological knowledge 

Training Today

• All university-based clinical psychology graduate programs offer training in both clinical and research. Emphasis differs

• Scientists-practitioner mode. Is the most common

  • Clinical scientists model: heavy emphasis on scientific research 

  • Scientist-practitioner model: (boulder model), equal emphasis on research and application to practice

  • Practitioner-scholar model: (Vail model), stresses human services and less emphasis on scientific training, common in PsyD programs. 

• Some programs believe that APA accreditation guidelines are not good enoch and have formed other accreditation systems

Internship Crisis

• APA accredited programs require their students to complete a full-time, one year clinical internship at an APA approved site

• Coordinated by the Association of Psychology Postdoctoral and Internships Center

• Submit application online in November, interview in December-February, submit rank order list, and then match day in February. 

• Internship imbalance existed for years, but is better

  • Last year approximately 13% of applicants did not match.

Professional Regulations

• Standards of competence that members of the profession must meet before they are authorized to practice

• Primary purpose is to protect the public

  • Lay people are not knowledgeable enough to know when providers are engaging in problematic practices

Certification and License

• State laws establish requirements for practice and restrict who can call themselves clinical psychologists. 

• Licensure: More restrictive, specify the services a psychologist is authorized to offer

Licensed Psychologists

• Differ by state, but generally the first step is that the state board determines whether you are eligible for examination: 

  • Administrative requirements: age, US citizenship, and no major crimes

  • Education: doctoral degree in relevant subfield of psychology from accredited university

  • Experience: 1,000 of hours of supervised practice

  • If eligible you then take a test called the EPPP 

Other types of Schools and Degrees

• One of the biggest shifts in the field in the past 50ish years has been the emergence of the PsyD

  • Training focuses on professional skills and clinical services, typically don’t require masters nor research dissertation

  • As of 2021, there were 102 APA accredited PsyD programs compared to 311 APA PhD programs

  • Because of larger class sizes, there are more PsyD students every year than PhD students. 

PsyD

• Less likely to offer financial support

• Tend to admit students with lower GPAs and GRE scores.

• More likely than PhDs to be employed in independent practice or managed care setting

• Some troubling features, particularly for free-standing PsyDs

  • Have higher acceptance rates and lower admission criteria

  • Slightly lower internship acceptance rates (79% for PsyD and 88% for PhDs)

  • Score lower on EPPP than PhD graduates

  • Less likely to receive specialty diploma from American Board of Professional Psychology

Research Options

• If your interest are in research on mental health

  • PhD in clinical psychology is the most obvious choice

  • Other PhD programs may be appropriate (developmental, social, cognitive neuroscience).

    • Often less competitive than clinical programs

    • Often get same financial support if it;s a PhD program

    • Won’t get any clinical service training or experience

    • Can’t get licensed. 

Clinical Options

• PhD, PsyD, MD, MA/MS, LCSW

• Clinical, counseling, school, social work, psychiatry, social work, marriage and family therapists. 

Economics of Mental Health Care

• Initial debate was whether clinical psychologists should be eligible for insurance reimbursement for their services. 

  • By 1983, most of the US had passed legislation to do so

• In 2008, Congress approved legislation that required insurance companies to provide the same coverage for mental health as they do for physical health. 

  • But there are still limitations on the types of services and number of sessions. 

MA’s and Doctorates

• You can stop at the master’s level

  • Faster and cheaper

  • Don't have to do research training (can be a limitation too)

• 3x as many students get MAs as PhDs

• Most States

  • Can’t be a licensed psychologist

  • Can practice in a limited role

  • Lower income

  • Fewer advancement opportunities

  • Less flexible degree

• Other related degrees: LCSW

• Community mental health clinics, VA, and department of corrections are the most common places to work. 

Misapplication of CBT- Need to know this!

The misapplication of CBT is when we use CBT as harmful. It is more likely to impact minoritized individuals. CBT doesn’t work in all situations

Prescription Privleges

• Specially trained clinical psychologists can prescribe psychoactive meds. in some states (e.g. New Mexico, Iowa, Louisiana)

• 75% of clinical psychologists refer patients for meds. on a monthly basis.

  • already apart of practice

  • the knowledge can be learned in a brief period of time.

  • access to care issues

• physicians and even some clinical psychologists oppose this.

Independent Practice

• Clinical psychologists used to be able to easily open a private practice and make six figures.

• now the average PhD psychologist in private practice with 20-24 years of experience is $89,000.

  • options

    • solo practice

    • group practice: 2+ join forces/ offer services together and share the costs.

    • mixed-model practice: 2+ clinicians work together but are financially independent.

Burnout

• Psychological reaction to chronic stressors on the job.

  • emotional exhaustion

  • depersonalization (detachment from the job)

  • perceived failures

• some types of patient populations are associated with higer risk

• self-care and consultation.

Clinical Scientist Model

heavy emphasis on scientific research 

Scientist-practitioner model

(boulder model), equal emphasis on research and application to practice

Practitioner-scholar model:

(Vail model), stresses human services and less emphasis on scientific training, common in PsyD programs.