Clinical Psychology Doctoral Programs
Part 3: A vision of what could be.
Posted Jun 30, 2020
In my last two blog posts, I outlined some suggested changes for the training of clinical psychologists in the United States. These changes included consolidating the over 400 programs granting doctorates in clinical psychology into larger Schools of Clinical Psychology, doubling the number of doctorates awarded each year, granting the doctorate after four years (not five), and requiring a 3-year postdoctoral residency leading towards Board Certification in clinical psychology. In this post, I will offer a vision of what this education and training could look like.
It's senior year of college. You're 22 years old. You might have majored in psychology. Or maybe you majored in biology, French literature, or Applied Mathematics — but the course that has really stuck with you throughout your undergrad years was that class in Abnormal Psychology you took junior year. Your GPA is pretty darn good, because you've got an extra helping of smarts and you work hard. You think that graduate school is in your future.
Under our current system, this graduating senior has a lot of work ahead of her. She will be advised to get some research experience. Get some clinical experience. Find some mentors who will write strong letters. But even those suggestions will probably be "too little, too late." After all, the acceptance rate to clinical psychology Ph.D. programs is only 12%. The vast majority of students are rejected. This senior might be advised to go ahead and apply — but to also apply to a master's in psychology program just to be safe. In one of those (costly) two-year programs, she will gain the research experience, conference presentations, publication credits, and mentor letters that might give her an edge in doctoral admissions. In the meantime, she needs to be sure to craft her application materials so as to stand out to a specific potential research mentor in each program; she's not really applying to a program — she's looking to be hired by a specific professor, in whose lab she will work for the next 4 to 7 years, publishing article after article and writing grant after grant in her mentor's area of interest. Fortunately, at least there won't be any tuition bills; those will be covered by a fellowship, paid for out of all those grants she's involved in.
The alternative I propose looks much different. Instead of a myriad of programs with only 6 or 7 students in each class year, our applicant has about 150 Schools of Clinical Psychology to select from. Together these produce twice as many clinical psychologists as we currently do, with each graduating — after only four years — a class of about 36 people. For our college senior, this higher output has one glorious implication: instead of an 8% chance of getting in, her chances are now more like 1-in-4. It's still way more selective than medical school, but at least she won't have to go to a masters program just to pump up her curriculum vita.
She signs up for the clinical psychology version of the MCAT exam — this would probably look something like the GRE Subject Test in Psychology, but with much more focus on psychopathology. The study material could be Kaplan & Sadock's Synopsis of Psychiatry (only because clinical psychotherapy lacks a similar, comprehensive volume). General Mental Ability (GMA) will certainly be a strong factor influencing variance of scores on this proposed selection test, along with GMA's associated trait of being able to learn large amounts of complex material quickly. In addition to this test, the Miller Analogies Test (MAT) is required, which measures high-level abstract thinking and also cultural knowledge. Undergraduate GPA, the psychology test, and the MAT are the primary measures used to rank order applicants. In addition, a 3,000-word Personal Statement is required, describing "who you are and how you came to be that person" and outlining the applicant's goals for graduate school and beyond.
Great news! She studied hard and crafted a Personal Statement that met with the approval of the Admissions Office of at least one School of Clinical Psychology. She will join 35 other bright and eager students in the fall. Most of her classmates are between 22 and 29 years old, with a mean age of 24. Because master's degrees, research experience, and letters of recommendation are not required for admission, the class is more diverse than any she would have experienced under the current system. And of course, because there are 36 people in the class and not just 6, there is a far wider range of interests, backgrounds, and personalities.
She is going to have to take out some serious student loans. There are no fellowships covering the $40,000 a year tuition. But a 30-year loan at 4% will end up costing less than $800 a month to repay. And she will start earning a salary as soon as she enters residency, starting at $50,000 the first year and increasing 10% each year following that. She will earn more during her three-year residency than she paid in tuition over the previous four years. She will be sharing housing with classmates and eating more than her share of beans and rice at first, but she knows that it will be worth it.
The first two years of the doctoral program are a bit of a shock to the system. The reading lists are immense. There's an entire new language of psychopathology to learn. There is coursework in human physiology, behavioral genetics, evolutionary psychology, conditioning, psychodynamic theory, and psychopharmacology. Beginning in the second semester, our intrepid doctoral student starts working in her School's community mental health clinic. She finds that this experience somehow helps her to understand more deeply her coursework, and that her coursework helps her to help her patients. In addition to her professors and her clinical supervisor, she has also begun to work with a research mentor, contributing what she can to various ongoing projects.
By the end of the second year, she has completed most of her classroom work. She continues her work in the community mental health clinic, in part because she can no longer imagine not seeing patients on a regular basis. She has been accepted at an external agency to work part-time under supervision during her third year. She has submitted a proposal for her dissertation research and it has been approved — she is now a doctoral candidate! A Master of Science degree in clinical psychology is conferred upon acceptance of her dissertation proposal. Finally, she has to take the first of three exams required for licensure as a clinical psychologist. This test (which exists as yet only in my imagination) is a national, standardized competency examination covering the material from the first two years of graduate school.
In her third and fourth year, she works on and finishes her dissertation — an original contribution to the scientific literature on clinical psychopathology and its treatment. She also continues to accrue clinical hours; she will have earned 2,000 supervised clinical hours by the time she graduates. Thus far she has worked in the community mental health clinic, a substance use treatment center, an eating disorders residential treatment center, and an inpatient psychiatric unit. She passed her first competency exam and she is studying for a second, more clinically focused competency exam that is held during the first semester of her fourth year. The scores from that second competency exam will be reviewed by the residency programs to which she applies. In the spring of her fourth year, with the completion of her dissertation, coursework, and clinical hours, she is awarded a doctorate in clinical psychology. She is 26 years old.
After a well-earned vacation, she relocates for the first time in four years and joins her residency program. There are only 5 or 6 other first-year residents, and no more than 18 clinical psychology residents overall. She has chosen a busy urban medical center in which to do her residency training. She quickly learns why such trainees are called "residents" — because it sometimes feels as if she lives at the hospital. It is somewhat gratifying, she admits, to be called "doctor," just like the medical school graduates starting their psychiatry residencies. She is essentially getting paid to learn, and at the end of her first year of residency, after passing one more clinically focused exam (the successor to the much-maligned EPPP), she becomes a licensed clinical psychologist. She earns a pay bump at that time because the hospital is now able to charge more for her services, and because she no longer requires clinical supervision (although it is still available).
She spends the last two years of residency developing her skills in a specific area of interest (e.g., addiction, geropsychology, neuropsychology, forensic psychology, psychological assessment, OCD, etc.). She is involved in a few research projects, but she has realized that she is no longer interested in a purely academic career. She would like to teach at her old School of Psychology at some point, but as a member of the Clinical Faculty, not pursuing a tenure track. At the end of her third year of residency, she has taken responsibility for the training and supervision of the first-year residents, whose respect for her could easily be mistaken for awe. She sits for one last exam, and becomes Board Certified in Clinical Psychology. She is 29 years old.
It is time that the field of clinical psychology embraces the challenge of contributing all we can to society. We have no shortage of extremely bright and hard working people who want to join our field. Our current training was designed in the 1950s for professors to replicate themselves, and not to train large cadres of professional healthcare providers. Clinical psychologists should be clinicians first, with wide and deep clinical training experiences. As things stand, we are losing out on potential colleagues by the thousands and unjustifiably delaying the professional careers of those lucky enough to enter our ranks.