The Evolution of Clinical Military Psychology

U.S. Marines stand in a foxhole near the front lines of combat on Saipan, July 1, 1944. Clinical psychology was mobilized by the needs of returning WWII veterans.

Source: U.S. Navy photo by Katie Lange, in the public domain

As with many medical fields, progress in clinical psychology has been very closely tied to the military. Clinical psychology was a fledgling profession during World War II but the mental health demands of returning veterans of that war propelled clinical psychology forward rapidly. The war led not just to the increased use of psychologists in a clinical capacity, but, necessarily, kick-started the country's education and training infrastructure.

The nation’s first psychology internships were created right after the war, in 1946, in Veteran’s hospitals. The Department of Defense (DoD) followed closely after, with the Army establishing its first clinical psychology internships in 1949.

Even with that auspicious beginning, as clinical psychology was expanding and maturing, separate standards developed between military and civilian practitioners. Military psychologists were initially held to lower formal standards than civilian psychologists. Specifically, clinical military psychologists were permitted to practice unlicensed until 1988 (Jeffrey, 1989) despite the fact that 32 states had enacted psychologist licensure legislation by 1967 and all states had such legislation by 1977.

However, the military has closed this divide, now boasting some of the nation’s most highly trained and qualified (and highly paid) psychologists. To practice in the military, psychologists must complete a Ph.D. or Psy.D. from a program accredited by the American Psychological Association (APA), as well as an APA-accredited internship. The Air Force, Army, and Navy all offer APA-accredited internships and this route into the military continues to be the largest accession pipeline for clinical psychologists into all of the Services.

Once in the military, psychologists have opportunities for formal, post-doctoral fellowship training in a variety of areas of practice. While these vary from Service branch to Service branch, in general, the military offers fellowships in areas such as neuropsychology, child psychology, forensic psychology, operational psychology, psychopharmacology, and health psychology. Some of these training experiences are “in-house,” meaning that they are formal military programs, such as the forensic psychology fellowship at Walter Reed National Military Medical Center, the nation’s only APA-accredited fellowship in forensic psychology. Other training experiences are outsourced to highly-desirable civilian fellowships, where military fellows train alongside civilian fellows.

Between accredited doctoral programs, internships, and fellowship training, military psychologists are trained in the latest evidence-based practices so that service members are afforded the full range of empirically-based treatments. The DoD and Veterans Health Administration value scientifically-backed treatments and devote significant resources to researching and translating the science for distribution to military health professionals.

Additionally, military psychologists outpace their civilian counterparts in board certification rates. In 1994, the military officially recognized board certification as an important milestone for psychologists, and offered military psychologists their first financial incentive beyond their military pay. The latest increase to board certification pay was in October 2023, when it was raised from $6,000 to $8,000 annually for all board-certified specialists throughout military medicine.

Due to the benefits of board certification (e.g., licensure mobility, enhanced employment options post-military, increased promotion chances, and earning the highest credential in the field), as well as the tangible augment to salary, military psychologists are board certified at a rate 5 times that of civilian psychologists in the U.S.

The majority of board-certified military psychologists are boarded in clinical psychology, but with a growing number of certified psychologists, more are branching out into other specialties, as well as getting double-boarded. Throughout the services, there are military psychologists boarded in clinical, child and adolescent, neuropsychology, health, counseling, behavioral and cognitive, organizational and business consulting, forensic, and police and public safety psychology. This expansion of board-certified psychologists throughout the military means that the military population has more access to board-certified psychologists than most people in the country.

Military psychologists continue to advance and expand the field. As examples, operational psychology has emerged as a significant asset to national security and embedded psychology is leaving the traditional office and bringing psychological services of all kinds directly to service members and command leadership. The days of lower standards have rapidly morphed into an expectation of the highest training and clinical standards in the nation.