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Alternatives to APA/What to do about the internship imbalance

Discussion in 'Psychology [Psy.D. / Ph.D.]' started by alienarms, Feb 22, 2012.

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  1. alienarms

    alienarms Senior Member

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    I posted this in the APPIC application thread and someone asked that I start a new thread. It's different from the petition threads, so hopefully people won't think it's redundant. It's worth talking about.

    We're all deeply affected by the internship imbalance, but I don't think petitioning APA is the best solution, IMHO. You're asking the governing body that created the problem to put aside their investments in the current, "broken" system, and I doubt it will work. Yes, I read the petition. :)

    However, alternatives exist. I particularly like the work that PCSAS has been doing to create an independent, rigorous accreditation system which emphasizes the need for a recognition that clinical psychology education must be based on psychological clinical science. They propose a body that accredits programs based on outcome measures (e.g., licensure, publications). Their main goal is to provide a system that provides students with the best training and the public with a valid measure of expertise and competence, which APA has not done.

    From the McFall (2012) article in Behavior Therapist: "Programs with a chief mission of preparing graduates primarily for service delivery roles are not appropriate candidates for PCSAS accreditation. PCSAS-accredited programs must provide first-rate applied training, thereby qualifying their graduates to administer and oversee the delivery of psychological clinical services; however, science must be the central focus of all training, with a thorough integration of the research and applied components." (emphasis added)

    Such a system might discourage the proliferation of clinical psychology training in for-profit educational institutions, because students would have an objective, outcome-based measure by which to judge potential programs.

    I'm sure I'm going to light some fires with this, and that isn't my intent. I think we do have to change things, but I don't believe that change will come from APA. And this is NOT an indictment of individuals in programs of which PCSAS disapproves. The problem lies with the APA.

    See McFall, R. M. (2012). Psychological Clinical Science Accreditation System: FAQs and Facts. the Behavior Therapist, 35(1), 11-15.

    Also: http://pcsas.org
  2. MCParent

    MCParent SDN Bronze Donor Bronze Donor

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    APA is the only body accredited to accredit (yes, that is a thing) in psychology. PCSAS (of which I am a huge fan) will not get off the ground as an accredited accrediting system in the next decade. Until it is an accredited accrediting body, it is nice, but it is not viable as an alternative to APA.
  3. erg923

    erg923 Psychologist-Department of Veterans Affairs (VA)

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    I would be much more open to McFall and collegues accrediting system if they got rid of the not so suble disdain for practitioners that eeks into their writing. :D
  4. alienarms

    alienarms Senior Member

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    I hear you, but I think it's valuable to discuss alternatives rather than blindly hope (as some seem to be doing) that APA is going to change anything, next decade or any other time.

    Also, PCSAS is applying to CHEA for accreditation to accredit (that "thing" you mention), and is currently reviewing programs for accreditation. I'm a huge fan too, and I think we have to spread the word!
  5. AcronymAllergy

    AcronymAllergy Neuropsychologist Moderator

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    The problem I could see arising is that having multiple organizations lobbying for accrediting rights: a) further fragments our field (and as we all know, we're fairly infamous for our in-fighting), and b) might detract from our credibility to the "outside world," who may say to themselves, "well heck, they can't even come to a consensus on who/what should be accrediting them, so why should we care?"

    I think some of the suggestions made by PCSAS are great, but I'd personally prefer to first exhaust all efforts to have APA implement some of those suggestions and standards rather than attempting to establish an entirely new system altogether. After all, APA is the most wide-spread standard, and thus already has the infrastructure in place.

    Having a Plan B is of course necessary, but I feel we're still working our way through all of Plan A's options right now.
  6. alienarms

    alienarms Senior Member

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    I don't know, I don't think it's as bad as "disdain for practitioners". Their main argument is that clinical psychology training DOES mean training students to "administer and oversee delivery of services". They just don't agree with that training occurring in an environment that encourages tossing science out the window.
  7. MCParent

    MCParent SDN Bronze Donor Bronze Donor

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    I don't have any hope about APA changing--I think our actions have the potential to enact change. I'm definitely not thinking they are going to magically see the error of their ways and fix things themselves (hence the petition). In fact, I've been trying to ram it through the system for a while now. :)

    Good that they're moving forward. I'd jump ship as soon as it happens. The process is insanely arduous and complex, though.
  8. KillerDiller

    KillerDiller

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    Yeah, this. I am on board with McFall's ideas, but I worry that the free standing professional schools (which we all know train people who want to primarily be practitioners) will simply say "well, that accreditation doesn't apply to us," and students will still fall in line to attend in the same large numbers.

    I also wonder how this will play out in the internship process. No doubt some internship spots, like the current research-heavy ones, will elect to only accept applicants from PCSAS accredited programs. I suppose this creates some relief, though I have my doubts that people from mostly practice-oriented programs are the ones applying to these internships anyway. Meanwhile, many programs (CMHCs, UCCs) are unlikely to switch, so students form PCSAS programs who want these placements will still be competing against a plethora of other applicants. Hence, I wonder if this would really change the match numbers.

    I'm very interested to hear others' opinions on this topic.
  9. MCParent

    MCParent SDN Bronze Donor Bronze Donor

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    This is a good point--unless PCSAS were to supplant APA, how would PCSAS impact the imbalance? Other than, perhaps, PCSAS applicants having a better match rate to PCSAS internships, presuming that there would be as many PCSAS internships as doc programs. In any case, APA would still be graduating and licensing the same numbers of folks. Seems to me like fixing the APA system is still required in that scenario.
  10. Ollie123

    Ollie123

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    My hope for PCSAS is less as a way to resolve the internship crisis, and more as simply a way to create a formalized way to differentiate ourselves from what should be relative fringe groups but is fast becoming the norm. AQ posted the other day about someone whose dissertation was about a day trip they took hiking with diabetics. I don't want to have the same degree as that person as I'm not convinced a project like that should justify them being labeled a psychologist. To some extent, I think the goal is to throw some of those programs under the bus, which is unfortunate for the students but I just think needs to happen given a lot of what I have seen/heard/etc.

    That said, what I COULD see happening, relates to the recent Delaware project. I could see them forming new types of internship that are a blend of policy/consultation/administration/outcome evaluation/etc. that could potentially be accredited under this new system. That would open up an enormous range of possibilities for new internships in settings that would not have any reason to have internships at present. I'm basically making stuff up at this point - this was all just starting to be discussed and while I got some of the "scoop" I don't know if this was even discussed, but from what I do know it would make sense for them to at least look into this. The extent to which it would emphasize traditional psychological practice (e.g. one on one therapy) would obviously remain to be seen, nor am I even clear if the goal would be to lead to licensure - so it would obviously be a radical shift from traditional internship models. Even in the event my fortune-telling is spot on and things do go down this road, I doubt we would be likely to see that radical a shift even in a decades time so its clearly not a solution to the internship crisis.

    I like the idea though. Proud to be at a PCSAS accredited program, and hold little hope APA will get its act together. Would love to see them step up to the plate, but just don't see it happening. From what I know of what some of the other PCSAS programs are doing (UC-Berkeley in particular) it sounds awesome and I would LOVE to see the profession going down that road.
  11. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty Moderator Emeritus

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    Thank you for starting this thread.

    I agree with others that it won't necessarily do anything to address the imbalance in the short-term, but I think of PCSAS like a 3rd party candidate in an election....they are a legit voice (albeit in the minority) that can call out the majority on certain topics.
  12. Jon Snow

    Jon Snow Senior Member

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    3rd party candidate is the way to look at this, I think. You are right. Like an election, it's all about demographics. This is why I find it so alarming that apa accredited internships are becoming "elite" rather than standard. We are literally giving the field a way. I agree with the clinical science folks, attended a clinical science program, but I think the way to go is the petition route and internal activism NOW while we have numbers to matter.
  13. MCParent

    MCParent SDN Bronze Donor Bronze Donor

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    Also, "the APA" is not some ephemeral entity. It's just a bunch of psychologists (many of them pretty old). One strategy is to actually get INVOLVED with APA, and then not shut up about about problem. APAGS, early career board, any of the other boards. You want it changed, get a position and scream about the problem until they can't ignore you anymore.

    And sign the petition. 418 signatures now, in a WEEK.

    http://www.ipetitions.com/petition/psychology-internship/
  14. Therapist4Chnge

    Therapist4Chnge Neuropsych Ninja Faculty Moderator Emeritus

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    I applied to join the APA, so I can try and tackle this from the inside. I'm not optimistic that it'll work, but I would still like to try.
  15. edieb

    edieb Senior Member

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    yes, being an APA member and trying to fix this from the inside is what we need to do. APA has > 150K members, and I am sure there are any others like us. Running for some office within the APA is much more expedient than starting from the ground up..
  16. Duck Duck Goose

    Duck Duck Goose Senior Lurker

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    If you could share your I(n )R(eal )L(ife) name again, I'd probably vote for you. :D

    On the eve of the Phase I Match, I'll bump this thread again, probably, but (as a tiny bump) I wonder why it seems like people who joined the academic year that I applied to and started grad school are the ones primarily carrying this thread... Older psychologists don't seem aware of the issue, sadly (with the exception of Jon Snow who I disagree with on many issues but whose dedication to sdn and the field I respect - and a handful of others) and younger trainees also don't seem aware...

    I can honestly say that I wouldn't have gone for the doctorate if I'd known all my options going in. (I know people will say, "You should have done your research," and they are completely right.) I didn't know where to start looking into career options. Any ideas for how to better educate all those undergrad Psych majors looking for something to do after college? (I had an interest in doing therapy and thought that the PsyD was my best bet... It took me literally 3 years of grad school to figure out that there were other options and I was at an APA accredited program.)

    Thanks for all the information and support (even if I was just lurking :)) over the years. Good luck with the petition!
  17. Kappadocia

    Kappadocia

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    Do you feel this way mainly because of the internship crisis?
  18. Duck Duck Goose

    Duck Duck Goose Senior Lurker

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    No, mainly, with some yes. No because my goals do not require a doctoral degree (mainly do therapy and administer testing). Yes because here I am (average PsyD student has 120k in student loan debt, though I do not, at the time of applying for internship) unable to obtain my degree without getting an internship and unwilling to start a family until I complete my degree. Life is on hold until I get an internship and this is my second time around. I had no idea about the importance of internship or the difficulty in obtaining one (my program's match rate is about 80%, so around the national average, though some of those are APPIC member internships, not APA) when I applied to programs. I also didn't know that many other degrees would allow me to do therapy (I picked up the assessment interest in grad school). I wish more undergrads were educated about this kind of thing (and I went to an Ivy League school for undergrad so you might think there are smart kids there... nope!).
  19. alienarms

    alienarms Senior Member

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    It's so great to see that this thread has taken off. The fact that we can discuss this is really encouraging.

    Per the above: I advise all my undergrads who want to continue with psych to consider their options. I've definitely changed some minds, I think. I always ask students whether they enjoy research, or if they've even thought about it, and I give them a realistic assessment of what their graduate career will be should they choose the Ph.D. route. And I also sometimes discourage students from pursuing Psy.D.s, not least because of the debt that is (usually) involved, but I do tell them to do their research and find a good school if they go that route. I discuss options like LICSWs, etc. and try to suss out their goals. I had one girl whose parents were pushing her toward a Ph.D. because they wanted the "D", and she really just wanted to do therapy. This happens a lot. Basically, I try to make sure that my students understand that a Ph.D. is a long and worthwhile road, IF you know what you're getting yourself into. Knowing what I know now, I would still pursue a Ph.D., but I had to research it on my own, and nobody ever gave me the info I try to give students.

    And per the imbalance discussion: Yes, getting involved with APA is one way to try to "change the system from the inside". But then I wonder how that hasn't happened already. The imbalance is not a new problem, and yet APA continues to accredit schools that offer poor training and have absurdly high admission rates and also high costs (forgive me, I do have a bias here).

    I think the way that PCSAS can change things is by encouraging clinical psychology training programs to hold themselves to a higher standard, and to distinguish between "practitioner" programs and "clinical scientist" programs, in a sense. In the end, yes, I think that internship sites might begin to offer spots only to students from PCSAS-accredited programs, thus reducing the pool of applicants. This would encourage students to seek higher-quality training from the get-go. And frankly, I think that even if "all" you want to do is practice, you ought to have a solid foundation in psychological clinical science, and you ought to have respect for ESTs. Anything less is dangerous. It's a real problem that thousands of people are trained to treat patients with less rigorous standards than people who pursue research. I'm sorry, but I know several people personally who are in for-profit Psy.D. programs that offer entire courses on Freud but nothing on current research in abnormal psychology. People are getting doctorates without understanding the basic science that underlies our field. To my mind, that is definitely putting the cart before the horse.

    Sorry, I really didn't mean to rant. Please don't skewer me; these are only my opinions. :)
  20. Jon Snow

    Jon Snow Senior Member

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    I don't think the issue is about being smart or not. People entering grad/medical/law school are generally young and, even if not, understanding the politics/depth of a field from the outside is very challenging. Further, information can be true to one person and not, to another. For example, you are on the cusp of graduating with a doctorate in psychology from an apa accredited program with some student loan debt that, with the right jobs, can be discharged within 10 years. You can achieve your career goals doing therapy and assessment. A psychology doctorate is a flexible things. And you'll likely make, what most people in the country, think of as a good income, with the potential to make much more. It's not all bad. As we flip the coin from personal to field issues, we can see that we can do a better job educating interested students on how to navigate the profession and education. We can do a better job regulating programs and preventing exploitation of students that want to go into psychology. We can do a better job advocating for the finances of students and professionals.
  21. Jon Snow

    Jon Snow Senior Member

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    I think students often don't know what they really want to do. Shadowing is unusual prior to graduate school. Further, they can't know what they'll feel like 5, 10, 15 years into the profession. If you have the aptitude, drive, and interest and you are going into mental health, I'd get a PhD or an MD.
  22. AcronymAllergy

    AcronymAllergy Neuropsychologist Moderator

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    I was going to make many of these same points, so I'll just say that I completely agree. With med and law school, because so many more people go that route, the paths (in terms of preparation, actual schooling/training, and employment/outcome) are generally very well documented and understood. Conversely, in clinical psych, things are much more nebulous, due in no small part to the sometimes substantial inconsistencies across departments/programs. There are fewer people involved in the field in general, and fewer still who are in a place to provide accurate and meaningful insight to prospective students. Heck, even APA's own website can be confusing and obtuse in some respects. I would imagine that this lack of foreknowledge is a significant contributing factor to why some people seem so dissatisfied with the field in general (i.e., it's not at all what they expected when they started).
  23. alienarms

    alienarms Senior Member

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    Completely agree.
  24. alienarms

    alienarms Senior Member

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    That's true. However, she was fairly certain that she had no interest in doing research (and had some experience). I mean, yes, I agree with you, but I think the "drive" part implies a desire to do some research and she wasn't interested. This is true for many of my (Ivy League) students.
  25. Jon Snow

    Jon Snow Senior Member

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    There are many doctoral level activities that don't require doing hardcore research. Further, learning how to think in that manner, I am convinced, leads to better professionals. Also, doing research as an undergraduate is not the same thing as doing research as a professor or industry person. Design, asking questions, interpreting data. . . these are the high level skills, not running subjects, submitting IRB forms, coding data, and running rudimentary stats.
  26. Duck Duck Goose

    Duck Duck Goose Senior Lurker

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    I have nothing against the doing and understanding research part (I'm pretty good at that). I just didn't know that there were alternative degrees that would allow me to do therapy. I guess it's good that, in my younger mind, therapist was equal to psychologist. Good lobbying. :p

    Now that I haven't matched 2 years in a row, I think it's too bad that I did therapy for free for 3 years when I could have been getting paid for it, had I pursued a non-doctoral degree. If there are no sites near me in Phase II or if I don't match in Phase II, I will drop out of my program (dissertation unfinished) and start learning computer programming. There's a field where you don't need licensing, accreditation, or even formal education to help people and do well financially (and in other ways).

    (Also, I don't have student loan debt at all, though more than half of PsyDers do.)
  27. erg923

    erg923 Psychologist-Department of Veterans Affairs (VA)

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    Im sorry to hear you didnt match.
  28. Duck Duck Goose

    Duck Duck Goose Senior Lurker

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    Thanks. :cool: I really did like Phase II better than Phase I last year, though, so I'll have to see if there are any sites near me available. Waiting til 11 is harder than waiting til 8:30 this morning was!
  29. Jon Snow

    Jon Snow Senior Member

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    duck,

    is your problem geographical restriction?
  30. Duck Duck Goose

    Duck Duck Goose Senior Lurker

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    That's definitely part of it. (If I were't geographically restricted, my complete lack of experience with adult populations wouldn't matter because I would only apply to child/adolescent/family sites.)

    I am not an outstanding internship applicant. I am a "good enough" internship applicant. I have one publication (not first author) and enough hours with kids/teens/families. I have limited assessment experience, though I would like to get a lot more. At least two of my letters of recommendation are excellent/glowing and the other is probably pretty good. I am a fantastic writer and my essays were appropriate and memorable.

    If you look at stats from last year's match survey, you'll see that there were 234 people applying a second time and their match rate was only 69%. That means about 73 people applying for a second time didn't match. And that's only including the approximate half of applicants that completed the survey. Only 18 people applied for a third time, which makes me wonder what happened to the other 75%.

    So it's hard to say what my problem is, though it seems that 3-4% of applicants are probably in the same boat as me. Leads me to believe it's system-based and due to my unwillingness to relocate for the degree (also, I am not a fan of my particular grad school program or its faculty and part of that is because I wasn't allowed to rank an APPIC site last year but the faculty allowed another student to rank and match to that same site... personal bias of faculty members shouldn't negatively impact students' lives, in my opinion :rolleyes:).

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