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The Battle for the Identity of Clinical Psychology

Is the core identity of a clinical psychologist a practitioner or researcher?

The field of psychology has had a serious identity problem for a long time, and perhaps nowhere is the identity more confused and fragmented than the specialty that I was trained in, that of clinical psychology. This is particularly important because clinical psychology is, by far, the biggest subspecialty within psychology, representing about 40% of all psychology doctoral degrees conferred. Students interested in going into clinical psychology should know that the field is enormously fragmented in terms of philosophy, identity, training models, and emphasis. Indeed, the field right now is in the midst of an emerging battle for the very soul of the discipline.

At the heart of the issue is that there are two fundamentally different visions of the identity of clinical psychologists. One is that the central identity of a clinical psychologist is that of a scientific researcher. In this view, a clinical psychologist is essentially like a social or developmental psychologist, but is someone who happens to focus their research on abnormal behavior and mental health applications.

The other view of the field is that the fundamental identity of a clinical psychologist ought to be that of a health service provider, a licensed practitioner and healer who works in the broad domain of health/mental health.

These two identities have long competed for dominance in the philosophy and training of clinical psychologists. In the late 1940s, clinical psychologists met in Boulder, Colorado and generated the now famous scientist-practitioner model of training , which is the model I was trained in and remains one of the dominant models of training today. The scientist-practitioner model was that the individual could be both and that the training was geared toward expertise in behavioral science that a clinical psychologist would then apply to working with individuals in practice. It is important to understand that up to this point in history, psychology in general was essentially a research discipline. However, in the aftermath of WWII there was a huge societal need to help returning veterans with their post-war adjustment, and thus there was an enormous pressure to shift the focus of the discipline to more applied and therapeutic endeavors.

In the 1970s, a group of psychologists argued that the time was right for the profession of psychology to emerge as an independent discipline. At a conference in Vail, Colorado, the practitioner-scholar model of training emerged, whereby the primary focus was on being a clinician, a practitioner who was grounded in scientific knowledge, but not primarily or necessarily focused on generating original scientific research (although it was of course fine if they did so).

In the last two decades, the “clinical scientist” model has emerged. It returns to the pre-Boulder days, where the term psychology strictly denotes the identity of a behavioral scientist. Critical of the American Psychological Association’s Commission on Accreditation because they view it as lax on science training, the promoters of the clinical scientist view have recently started their own accreditation system, the Psychological Clinical Science Accreditation System . This growing group of approximately 25 programs includes some of the country’s most prestigious universities (including some of places where I trained, the University of Pennsylvania and University of Virginia).

My view is that the clinical scientist model is completely wrongheaded ( see here for a major article on the clinical scientist model ). When you dig into it, its philosophy of science is largely anchored to an outmoded 1940s logical positivism. My experience is that clinical scientists are very smart people who are primarily skilled at getting grants, writing research reports, and running labs; but many seem largely clueless when working with a general clinical population. At my most cynical, I see the PCSA as having an essentially self-serving view of the field, generated by cloistered academics who are methodological fundamentalists who believe that the scientific method is the answer to all our ills. What drives my ire the most, however, is that in many of their writings they communicate thinly veiled contempt for mere “practitioners”. Given their power and prestige, and the arrogance with which they sometimes promote their vision, I believe that the clinical scientist training model in clinical psychology represents a clear and present danger to the future of the field.

Instead of returning to a pre-Boulder model in which clinical psychologists are academics in their ivory towers lamenting the wayward practices of feel-good practitioners, what clinical psychology ought to be doing is moving toward a coherent identity for professional psychology, one that is grounded in a balanced, scientific humanistic philosophy and a sophisticated understanding of the body of psychological knowledge. In this view, the science of psychology is not reducible to behavioral scientific methodology, but refers to a coherent body of knowledge that actually helps make sense out of the human condition in a comprehensive and intelligent way ( see here for this argument developed more fully ). This is what we teach at the Combined-Integrated Clinical and School Doctoral Program that I direct at James Madison University.

As a combined program, the faculty in our program believe that professional psychology should eschew the outdated distinction between clinical and counseling psychology, and instead should view these "specialties" as representing the conceptual center of the field of professional psychology. In this view, the central identity of professional psychologists should be that of a health service provider who has interpersonal grace and sensitivity, well-developed capacities for critical thought and self-reflective awareness, the capacity to understand the human condition via the lens of psychological science, the demonstrable ability to develop healing relationships that lead to the effective assessment and treatment of psychological problems. This is in direct contrast to the central competencies of the clinical scientist model, which is in behavioral science methodology, advanced measurement and statistics, running randomized controlled clinical trials, grant writing, and publishing in high impact journals.

With the essence of the argument laid out, let me make a few other points, so that my position is clear. First, let me state very clearly that I am not against science. Indeed, as anyone familiar with my work knows, I am hugely pro science. Let me also state that to be valid and credible, the profession of psychology needs both psychological science and sophisticated research methodology. It is a scientific profession, and both research and theory in professional psychology are crucial. Those who specialize in generating empirical research used to be called, appropriately, clinical researchers. We need clinical researchers. Indeed, for four years at the University of Pennsylvania, I worked fully as a clinical researcher. And there are certainly many clinical researchers out there doing good work. But expertise in generating original research should NOT be the CENTRAL, defining competency of professional psychology, as the clinical scientists claim. This is the key point of disagreement.

A second point to be made is that although the Vail model was strong at the conceptual level, it experienced an enormous problem at the level of implementation. In short, the Vail model provided justification for professional schools that are free-standing, for profit, private organizations. This fact is made very clear in a 2003 American Psychologist article by the model’s primary founder, Donald Peterson titled, Unintended Consequences: Ventures and Misadventures in the Education of Professional Psychologists . In it, Peterson lamented that a strong case could be made that these schools have flooded the field, sometimes with weakly trained individuals. Thus, at an implementation level, the professional model has had serious problems, and that has weakened the strength of the argument for adopting a general professional psychological identity.

A third point is that there are many supplemental skills that a professional psychologist might develop, advanced research competencies being one. Scholarship in theory and philosophy of psychologist, administration and policy development might be others. We need researchers, academics, teachers, policy makers, administrators, public educators and so forth. All of these things are good and every health profession needs them. The point, though, is that the center of the field should be that of a health service provider, not academic/scientific researcher.

The APA Commission on Accreditation is current very confused about this issue (among others), but I am pleased to say that there is current a push to recognize health service psychology ( see here ). That is, many in the APA are beginning to recognize that accreditation functions in the public to protect consumers and its central role is to work with licensing bodies to ensure competent, ethical practitioners. As such, it should function to determine the competencies of professional psychologists in general and not focus on research competencies per se, or on the minor differences between the practice areas like clinical and counseling psychology or on the degree (PhD or PsyD), as this is not their role.

The bottom line is that undergraduates and prospective applicants should know that the field is fragmented with many different philosophies and ideas about what is the best identity and approach to training. Students who think about themselves as future practitioners will generally not get good training at clinical scientist programs because those programs operate from a totally different conception of the field. Unfortunately, free-standing, professional schools are sometimes not well-suited to train students in the depth and breadth necessary. Thus, it really behooves prospective graduates to do much exploration about the field prior to applying. My recommendation to all prospective students is to read carefully the book, The Insider’s Guide to Graduate Programs in Clinical and Counseling Psycology . For those qualified students interested in being a professional psychologist (i.e., a health service provider specializing in mental health grounded in the science of psychology), I recommend looking for programs that highlight their training of practitioners, that emphasize a meta-level perspective on the field of psychology that addresses the current fragmentation, that are integrative in orientation, that are associated with universities, have good student to faculty ratios, have a large portion of core faculty that identify as clinicians (that take scientific psychological knowledge very seriously), provide good financial support, and have good outcomes in terms of APA internship matches, graduation rates, and future employment.