A Letter to APA Regarding the Internship Imbalance

[DreamInterpret]

So many interesting ideas and opinions here.

A little about me: I am just applying to sit for the licensing exam in PA. And to say that this process is utterly dissociated from the reality of my life and how I understand my role as a psychologist is a gross understatement.

I empathize with everyone who has gone through the process of education, externships, and internships. My understanding is that APA has made it even harder than it was for my cohort, most of whom graduated in 2005-2006, and many of whom still don't have adequate or decent work. We had to do 1500 hours of post-doc hours, while the requirement now is 1750 hours. I don't know what that extra 250 hours is going to do for anyone except to require them to be dishonest and pad their hours even more than is probably already the case. It just seems to me that with the passing of time, the whole profession is becoming more and more divorced from reality.

I also understand that APA now frowns upon non-APA internships. How unfortunate! I was able to do both my pre and post-doc internships at a college counseling center where I was intellectually stimulated and challenged, treated with respect and dignity, and received excellent supervision, but was not paid for the work I did. Something always has to give, it seems. It was still a good solution, I felt, but one that I could not have availed myself of were it not for my husband's and family's support. I won't get into the feelings of dependency and infantilization that had then to be dealt with...

I agree that APA should tighten up the front end of the process (interesting metaphor, there...), but also abolish the indentured servitude required of newly minted professionals upon graduation. And that would not even begin to get to the most fundamental problem, IMO: forcing the practice of psychology into a medical model has been disastrous for the profession. The human mind is of the human body, but so much more complex than the physical self, and there is no way to know who we can help, and how we help them attain permanent change. We have no definitive idea as to what is actually mutative in our contact with those who seek our counsel. In many ways, we are the fraudulent products of a fraudulent system, in spite of the lofty and altruistic reasons we had for entering the profession to start with.

Since the end of my post-doc, I have been working under a senior colleague's license, grateful to be working at all while paying a lot for supervision which often feels superfluous. I feel like I have to be very careful about not letting my own frustration with the state of my profession pollute the work I do with my patients.

Before APA can examine us on our ethics, it should really go and examine how it forces us to think and consider acting unethically. APA needs to examine its own ethics.

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[Therapist4Chnge]

There are definitely anti-trust considerations, though as some have mentioned, there are other avenues that can accomplish a similar means to an end. The "alternative" acred. risk is already out there (regional acred. programs & state acred. internships), so to have that be a barrier to not address systemic changes is a bit short-sighted.

Significant change will most likely come in one of two ways:

1. File suits against the contributing bodies: An APA-acred. program, APPIC, and the APA. The legal claims are for a licensed attorney to craft, though it isn't outside of reason to see an argument for breach of contract by the university program. The tennants of contract law all seem to be present, and there are multiple avenues a lawyer could target (APA-acred internship req., coersive recruiting practices, etc). Claims of malfeasance/misfeasance (depending on your approach) on the part of APPIC and the APA could make some waves. I don't agree with these approaches, but if I were one of the 800+ students who didn't match, I'd understand their motivation.

I'm not saying these lawsuits would be successful, but I do know it would get ugly for the involved organizations because there is blood in the water. Given the current state of the economy, a news outlet would jump on these proceedings and run with it. Universities are very risk averse, and an aggressive enough lawsuit could really stir things up.

2. Lobbying for changes in the educational requirements. This is a very expensive proposition that would take years in the best of circumstances because of needing to secure sponsorship, $ for a PAC, and enough political leverage to make a difference.

I'm not sure which approach would "cost" more in the long run, but I do know that there is far too much $ involved for any vested party to make significant change that would threaten the flow the of $. I'd love to believe that our profession could work this out amongst ourselves, but that ship sailed long ago. Wallstreet is invested, lending institutions reap huge fees on interest and defaults, and there is no shortage of demand.

Btw, I'm not a lawyer, so please to not consider my post as anything but thoughts from a young professional who in a former life put in enough time lobbying on the Hill to get jaded by "change you can believe in".

ps. While more clinical psychologists would be nice, but the market will not bear the additional cost when there are cheaper options (mid-levels) who have lobbied far more effectively for increased scope and political positioning.

 

[DreamInterpret]

"ps. While more clinical psychologists would be nice, but the market will not bear the additional cost when there are cheaper options (mid-levels) who have lobbied far more effectively for increased scope and political positioning."

Yes, there are cheaper options, but very recently I witnessed the travesty that goes down when patients have to rely on psychiatrists (mostly interested in prescribing), social workers (hired mostly for their case management functions), and nursing and tech staff (to make sure patients swallow their pills and to keep patients in line). A patient of mine (in private individual therapy) was admitted to an acute care facility where there was no one to offer an adequate evaluation, a disposition, or treatment recommendations. In fact, all the patients were admitted, medicated, "managed", and discharged. My patient, a very intelligent borderline, was clearly able to "work" the system to her liking, was discharged and put in a partial hospital program, with pretty standard "step-down" protocols (a week in partial-inpatient, six weeks in an after school program, etc..., regardless of what happens during those set time frames), which she will also work to her liking. The Psychological Counselor in the partial hospital setting never considered the options of testing (at least give her an MMPI, for Pete's sake!), and there was no doctoral-level psychologist on staff (much less a doctoral or post-doctoral intern) to do any of that work anyhow. I am very pessimistic about the future of this patient because she will not get the help she needs, and she will be back in the system again before long. And it's doubly sad that as a private practitioner in my particular situation, I am not set up to offer her the concerted, intensive treatment that she needs, and that I believe would give her a shot at a happy, full, productive life.

Ultimately, the patients are the ones who suffer the most. I've come to the realization that whatever BS has been happening in terms of health care in America has been and is happening on a geometric scale in mental health care.

The whole system is a mess. One way to address the problem of insufficient internship possibilities for doctoral students might be to abbreviate or eliminate the post-doctoral internship requirement. Get the graduates out there working, getting paid (many of us would have worked for very little straight out of grad school), and starting to repay their loans, and open up all of those post-doc positions to the pre-docs. The lack of internships is just one symptom of a broken, dissociative system. Psychologists at all points in their careers need to confront the system and think about ways to make it a profession that can actually serve those who most need our help. As it stands now, our profession serves absolutely no-one but the institutions that are supported by the tuitions that we are paying (grad programs, banks who hold our loans, etc...), and the insurance companies that are defining the way mental health is delivered in this country. Any change that doesn't address the full scope of the problem will only result in an eventual return to the current sad status-quo.

 

[Therapist4Chnge]

Yes, there are cheaper options, but very recently I witnessed the travesty that goes down when patients have to rely on psychiatrists (mostly interested in prescribing), social workers (hired mostly for their case management functions), and nursing and tech staff (to make sure patients swallow their pills and to keep patients in line).

This happens every day, probably in thousands of different hospitals, though it isn't going to change the economics of the matter. Psychologists are too expensive in the eyes of insurance companies, hospitals, and similar because we have failed to adequately differentiate AND provide enough viable opportunities to create profit. Poor but not neglectful management of patients is often acceptable when the alternative is far more costly and not proven to make a meaningful enough difference in the eyes of the people paying our salaries. In positions where we have established expertise AND show profitability (or at least value), we have done fine....though trying to compete against a mid-level for therapy services is a lost battle before the first patient is even seen. Sure there are instances when it does make a difference, but unless you can prove that your services are worth the added cost, you will not be competitive in a tight market.

 

[DreamInterpret]

I guess the fact that the same patients are getting cycled through the same system over and over is proof of the profitability of the current model? There are different models available for consideration, but it would require an admission of an irreparably broken existing system.

 

[AcronymAllergy]

I guess the fact that the same patients are getting cycled through the same system over and over is proof of the profitability of the current model? There are different models available for consideration, but it would require an admission of an irreparably broken existing system.

It's information that seems to be glossed over in favor of the fact that the patients are, at some point, having their symptoms reduced to the point of being able to be discharged.

Reminds me of a quip one of my supervisors made the other day--apparently there was a recent news article saying that it's estimated drivers here waste approximately $900M/year in lost productivity sitting in their cars due to traffic. The estimated cost of meaningfully improving infrastructure and reducing traffic was $800M. However, no one wants raised taxes, so we're stuck with horrid traffic. Just goes to show that most of us, in some degree, are very resistant to change, to the point of frequently and consistently taking the less-efficient/effective alternative unless nearly-forced into it.

 

[KayJay85]

Wow. Looks like the petition is almost half-way there. Hopefully, people send it along.

 

[aagman01]

Hey everyone:

I am just curious as to why the "for-profit" nature of many of these professional incubators has not been discussed within this thread. Wasn't there a comparable "for-profit" medical school system evolving in the 1980s? And wasn't there a law or legislation passed (I am not sure at what level), which banned for-profit medical schools? Is it not in the realm of possibility to ban for-profit psychology programs? Is it not possible, in the very least, to prohibit such programs from accreditation? Could not (rather easily, I would think) an argument be made that the "for-profit" nature of professional schools is the antithesis of quality training and preparation? Just curious. Thanks!

Wow. Looks like the petition is almost half-way there. Hopefully, people send it along.

 

[aequitasveritas]

I don't see much difference between for-profit and not for profit. I bet there's little difference in cost or outcome when accounting for funded/un-funded. Basically, Alliant = Argosy.

In a lot of ways, yes. I agree from a financial stance. From a training stance, I disagree whole-heartedly.

However, if we're talking about financial offenses we must include: Nova Southeastern, Pepperdine, PGSP (Palo Alto), Adelphi, Widner, MSPP, Chicago School, Seton Hall, etc etc.

BTW, I learned last night that Alliant has started offering tuition remission. I spoke with a newly admitted student who received 75% of her tuition covered in scholarships for the San Diego PhD program.

 

[RileyG]

BTW, I learned last night that Alliant has started offering tuition remission. I spoke with a newly admitted student who received 75% of her tuition covered in scholarships for the San Diego PhD program.

I didn't know they offered tuition remission. Do you know if this is common for all students in her cohort or is she just one of the lucky few?

 

[aequitasveritas]

I didn't know they offered tuition remission. Do you know if this is common for all students in her cohort or is she just one of the lucky few?

At this point it looks like they have a number of scholarships upon credentials at admission...so I was mistaken in saying tuition remission.

As far as I know this is not granted to everyone. Most likely the funds are limited, especially given the size of the cohort.

As I find out more I will inform the SDN cosmos.

This is certainly progress though. If Alliant can start funding the majority of the tuition for it's PhD students it has the capacity of becoming one of the most competitive clinical programs in the country. I know that may sound silly to some on this forum. However, Alliant is one of the rare applied schools that trains PhDs...so they're immersed in the same quantitative sciences and training that research programs are while they get substantially more clinical practitioner experience and training. If that ever becomes free or mostly free it will take a giant leap into the ranking.

 

[edieb]

If you haven't already, please sign. Remember not to sign the petition as "anonymous" if at all feasible


http://www.thepetitionsite.com/1/letter-to-apa-regarding-the-applicant-internship-imbalance/

 

[Therapist4Chnge]

If you haven't already, please sign. Remember not to sign the petition as "anonymous" if at all feasible


http://www.thepetitionsite.com/1/letter-to-apa-regarding-the-applicant-internship-imbalance/

I believe your name still shows up on the actual petition, the "anonymous" is just on the public facing side.

 

[ClinicalPHD5]

Hey everyone:

Please read and sign this petition regarding the internship imbalance that is affecting every psychology graduate student. We only need 500 more signatures to reach our goal.

http://www.thepetitionsite.com/1/letter-to-apa-regarding-the-applicant-internship-imbalance/

Thanks!

 

[edieb]

Thank you for posting a new link. I forwarded the petition to everybody in my New Mexico State University psychpharm class, so hopefully that will generate some signatures. I urged ppl to sign their names/identify themselves rather than decline to reveal their respective identities.

If anybody is a member of any state psychological associations (SPA), you can usually forward the petition on the spa's listserv

 

[stigmata]

I have sent this all over the place too!

 

[futureapppsy2]

Hi all,

I merged the new thread on the internship imbalance with the old one but changed the title, so it would be clear that the letter is now finished.

 

[edieb]

bump

 

[Therapist4Chnge]

523 signature thus far, not bad!

 

[ClinicalPHD5]

How does the APA internship petition work? I am not familiar with the website so I don't really understand how it gets delivered to APA and how we follow up on this?

 

[Therapist4Chnge]

How does the APA internship petition work? I am not familiar with the website so I don't really understand how it gets delivered to APA and how we follow up on this?

Those petition sites are generally a way to aggregate signatures/support. Someone still needs to let the APA know that there has been a concerted effort on the subject, and that there are X number of people in support of it.

*edit*

From the petition website:

How will my petition be submitted to the target?

It is your responsibility to deliver the petition to the target. The PetitionSite provides tools to export your signatures.

It looks like whomever published the petition needs to export it and send it to the APA.

 

[edieb]

We need to finish what we started, so I am bumping this up:

http://www.thepetitionsite.com/1/letter-to-apa-regarding-the-applicant-internship-imbalance/

Note:When click on the link, the petition is gone.. anybody know what happened?

 

[cara susanna]

I have a question, guys. What exactly are the benefits of doing a non-APA or non-APPIC internship? It seems like there wouldn't be any to me, so why even bother with them?

 

[futureapppsy2]

I have a question, guys. What exactly are the benefits of doing a non-APA or non-APPIC internship? It seems like there wouldn't be any to me, so why even bother with them?

As I understand it, there are no benefits per se, just that they're easier to get, especially if you're geographically bound. Hence why so mean California people do CAPIC.

 

[cara susanna]

They're easier to obtain, but you don't really "get" anything because they're not accredited. Well, aside from valuable experience of course. Is it to fulfill a program requirement usually?

 

[futureapppsy2]

They're easier to obtain, but you don't really "get" anything because they're not accredited. Well, aside from valuable experience of course. Is it to fulfill a program requirement usually?

IIRC, it's an APA requirement that programs require a year-long internship as part of the PhD/PsyD program requirements, so, yeah. Also, not all (or even most, I think) states require APA accredited internships for licensure, so a person could theoretically go to an APPIC, non-APA internship and be fine career-wise (obviously not the best option--esp. given the current job market--but it has been done).

 

[Horseluv9]

Let me first state I understand that some of us just have to have an APA internship but we must not forget that some of us really don't care. It is not as detrimental for SOME individuals given their own current life and personal choices to choose a non APA site. I personally know many licensed psychologists who did not get an APA internship and are still just as competetive as their counter parts on the field. I just so sick of hearing the constant bashing of others who do not get an APA internship. It is as if people think they are doomed for life and will never be as good as a therapist if they dont get APA... Not true!!!!
We all have different choices to make on this career path and no one is better than the next. Kinda sad....

 

[Neuropsych2be]

Let me first state I understand that some of us just have to have an APA internship but we must not forget that some of us really don't care. It is not as detrimental for SOME individuals given their own current life and personal choices to choose a non APA site. I personally know many licensed psychologists who did not get an APA internship and are still just as competetive as their counter parts on the field. I just so sick of hearing the constant bashing of others who do not get an APA internship. It is as if people think they are doomed for life and will never be as good as a therapist if they dont get APA... Not true!!!!
We all have different choices to make on this career path and no one is better than the next. Kinda sad....

Remember your coursework on personality pathology! The narcissist is driven to not only inflate their own importance but to denigrate others whom they regard as deficient. Where such deficiencies are not present, they will be imputed or invented. The narcissist may project onto others the very weaknesses they perceive within themselves but attempt to actively defend against. There is a whole lot of projecting, imputing and inventing on this board.

 

[cara susanna]

My coursework on personality pathology also stated that you can't diagnose people with it just from reading their internet forum posts.

 

[Neuropsych2be]

My coursework on personality pathology also stated that you can't diagnose people with it just from reading their internet forum posts.

True, one can't give a formal diagnosis based on DSM criteria, but one can observe behavioral trends such as incivility, disrespect, and obnoxiousness. In some places on the net, this behavior is endemic.

 

[erg923]

True, one can't give a formal diagnosis based on DSM criteria, but one can observe behavioral trends such as incivility, disrespect, and obnoxiousness. In some places on the net, this behavior is endemic.

I find discussion boards that lack these elements to be boring.

 

[cara susanna]

True, one can't give a formal diagnosis based on DSM criteria, but one can observe behavioral trends such as incivility, disrespect, and obnoxiousness. In some places on the net, this behavior is endemic.

Personality pathology is across all domains of the person's life and behavior. On the internet, you are observing one. Also, I don't see how those behaviors alone point to narcissism. One of the big components of it is entitlement, and IMO the side you are criticizing is displaying the opposite of that.

My program doesn't allow non-APA internships. Guess our DCT is a narcissist!

 

[Therapist4Chnge]

Yep, all equal. Standards don't matter. Mentioning standards = narcissism. Kumbaya.

This is the drum beat that I hear often, but people forget that APA-acred. was originally proposed to set the minimum standard of training needed to be a competent provider. Political and financial factors are what changed the standard, not clinical factors.

My program doesn't allow non-APA internships. Guess our DCT is a narcissist!

That is the way it should be, but unfortunately many programs are afraid of bad match rates in today's internship match process.

 

[roubs]

True, one can't give a formal diagnosis based on DSM criteria, but one can observe behavioral trends such as incivility, disrespect, and obnoxiousness. In some places on the net, this behavior is endemic.

Anonymity allows for greater bluntness. There are both positive and negative aspects to this. In my opinion, acting like APA internship standards don't matter is knowingly placing your head in the sand. Sure, people have used more colorful language but in the end this is about an academic / policy-related topic, not something personal. Is being blunt about this issue uncivil, disrespectful or rude?

People typically counter the evidence(locking yourself out of certain job areas) and stats-based(certain programs producing lower quality graduates) arguments using anecdotes of people who have succeeded without an APA accredited spot. Haven't our programs taught us how much weight to assign anecdotes?

 

[AcronymAllergy]

Anonymity allows for greater bluntness. There are both positive and negative aspects to this. In my opinion, acting like APA internship standards don't matter is knowingly placing your head in the sand. Sure, people have used more colorful language but in the end this is about an academic / policy-related topic, not something personal. Is being blunt about this issue uncivil, disrespectful or rude?

People typically counter the evidence(locking yourself out of certain job areas) and stats-based(certain programs producing lower quality graduates) arguments using anecdotes of people who have succeeded without an APA accredited spot. Haven't our programs taught us how much weight to assign anecdotes?

I think it could also be the case that non-APA internships were less-hindering in the past than they are now, given the current economy and the larger number of psychologists being churned out. Just look at the differences in the internship application process between now and only five or ten years ago.

That being said, I don't know that I've seen anyone actually say something along the lines of, "I'm better than you if you go to a non-APA site because mine is APA-accredited." The anti-non-accredited sentiment generally seems to stem from a few points: 1) protection of the interns (e.g., non-APA accredited sites aren't required to pay interns, or to meet certain standards regarding due process in the event of supervisor complaints), 2) protection of the field (e.g., non-APA accredited sites aren't necessarily required to meet the minimal standards determined by the APA with respect to clinical and supervision hours, didactics, etc.), and 3) general paranoia about the state of mental health employment.

 

[Buzzwordsoldier]

any movement here?

Over a steep cliff.

 

[AcronymAllergy]

I'm guessing some of the forward momentum has been stalled by many of the advocates being tied up with internship for the next year. I definitely plan on staying in contact with friends at my program who're going through the current cycle, and will be sure to at least let them know about this situation so that they can make their own informed decisions.

 

[Therapist4Chnge]

Whomever setup the petition is the person who needs to send it on, as I don't believe anyone else has that ability.

 

[Therapist4Chnge]

Hey all, I looked around different petition sites and worked on this today as I had some time. I used JS's letter, others' citations and the latest edits. Please take a look and share your thoughts/comments as any info can be changed before this gets forwarded on. The petition can be emailed and/or posted on sites such as facebook, twitter, etc.

It looks like widmup is the one who posted it. S/he will need to e-mail it to the appropriate parties.

*edit*

It looks like they haven't posted since August. Does someone want to PM them and see if they can e-mail it to the APA?