Anyone regretting doing a graduate degree in clinical psych?

[ClinicalPHD5]

I There's a variety of reasons for our low pay, but I think many of the commonplace ones are just temporary band-aids until these issues are corrected. Protecting our scope of practice from mid-levels is a temporary fix if we are going to continue trying to turn psychology into a mid-level profession.

Quality control on our end has been dealt with in a pretty inhumane way so far by increasing requirements and creating licensure barriers. It should be instituted at the onset (before people invest 5-6 years of graduate school) by limiting the number of students into programs as opposed to making it increasingly more difficult to become a clinical psychologist for everyone, which is currently the case. We already have an insane amount of hoops and barriers to get through our degree. Some states have tried to manage the supply-demand imbalance by making it more difficult to become licensed (adding extra classes, adding oral exams, adding restrictions on hours), which i think is pretty unethical to some degree. The post-doctoral year did not always exist in the past, but was added more in the last few years (not sure when) even though students have many more hours than before. For many of us, the additional 3,000 hours doesn't make sense because we have already completed 4 plus years of clinical training and supervision in graduate school. The mean number of hours is pretty high these days so i think we have been focusing on "punishing" recent graduates by adding more requirements instead of dealing with the supply-demand issue and pay in a more humane way.

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[cara susanna]

Yeah, I was trying to say that if we eliminate most clinical psych programs, it would lead to fewer graduates and less job competition.

 

[docjohng]

There is no "should's" to how a free market in a democratic country operates (and Ellis wouldn't be happy to see this coming from a grad student).

Psychologists are a part of the marketplace of jobs and careers in this country. Salaries are determined by the supply and demand of a market, and not by what some people think an arbitrary "right" salary *should* be for them. Wishing it wasn't so isn't going to change anything. Getting angry about it isn't going to change anything, unless that anger results in direct, focused and planned action over an extended period of time.

Because this situation wasn't created in the past 3 years -- it was created over the past 30 years. So it's going to take more than 1 year or 3 years or even 10 years to change. And it would of course take a concerted effort on a large group of like-minded and aligned people to change it (if, indeed, it is changeable). I wouldn't necessarily look to or expect that group of people to automatically be the APA.

John

 

[Ollie123]

My point was that its a minority of programs even if it is a majority of grads. One Argosy class might have anywhere from 10-20x the number of students of a typical PhD program. If they are not quite 50% they are in the ballpark - don't believe me look up the APPIC data on the number of students applying for internships from these schools, and then consider the fact that many of the students at these schools are dissuaded from even applying for internships in the match program. While this may seem harsh to some, I'm not all that concerned about the outcomes of the mean psychologist because I don't consider a fair portion of them to be my professional "peers". I'm interested in the mean outcome of psychologists graduating from solid, university-based PhD programs. These students are definitely being affected too (that's part of my point), but the situation does not seem nearly as dismal when you have minimal debt, a stronger CV, better connections, and more diverse training. While it may suck for those who did not go that route, they chose their path. I'd prefer that path not be open since as you've indicated, it does seem a predatory way of going about things. However, I will not be crying myself to sleep over the "state" of psychology on their behalf.

I know very few students at traditional institutions taking out substantive loans for grad school, most have residual debt from undergrad (if anything) and grad school loans are relatively minimal (basically to supplement their stipends).

I agree quality control is somewhat inhumane (at least RE: the problems with internship, post-doc, etc.). I don't believe it is hard to get into the field, I actually think it is way wayyyyy too easy and we're throwing up 100 speed bumps that take years to drive over in lieu of a couple hurdles that risk impacting the shareholders and offending those who couldn't hack it.

 

[docjohng]

[...] This is what happens when you redefine education in your field for the purpose of profit of a few arseholes (the people that run professional schools). You posting those numbers just pisses me off anew. What a bunch of f'ing *****s. Oh, and can you say education bubble? What a complete pile of ****.

[...]

Me too, but it's a self-inflicted wound. I would be wondering who hit me on the head and robbed me of my intellect if I graduated with 100K in debt for a psych degree.

So one answer is that government funding of research could be increased to fully fund all PhD positions, no matter what school the student chooses to attend. Imagine research funding that follows the student instead of a specific research grant or professor. Then students would be free to pursue the research they wanted while in grad school. The answer may not always be to simply restrict supply, but to fund it in different ways.

Non-profit private universities and public universities are just as big businesses; their leader's salaries are often just as big, if not bigger, than some CEOs of for-profit schools.

Indeed, there is a lot wrong with many of the for-profit schools in this country. But the profession has only itself to blame for the current situation, since there was no reason to accredit all of those programs in the first place, if they could be shown they weren't meeting the profession's necessary and minimal standards.

If the profession had any foresight, they could've even adjusted their accreditation process to require such programs create as many new internship positions as they accepted new students. But the profession apparently didn't, putting us in the situation we are today.

Sure, it's easy to blame the for-profit schools. But trust me when I say that if nobody wanted a PhD or PsyD, those programs wouldn't exist today in the numbers they do. They satisfied a demand of students. That that demand doesn't necessarily translate into a 1:1 ratio of paid positions in the job market isn't surprising, since no school -- profit, public or non-profit -- guarantees their students a job after graduation.

John

 

[Dream1a]

To be honest, i'm very happy that I have had so much input because it helped me make my decision about what I want to do and hopefully others will be just as informed before they make their decision.

It seems I was originally wanting to do a Ph.D for the wrong reasons and now that I know what I'm doing it's as if a weight has been lifted off my shoulders.

I do believe that I am not the only one who (if had not been previously warned) would have gone into the program being blind only to be rudely awakened.

All I can say is thank god I stopped before I started.

 

[Ollie123]

Sure, it's easy to blame the for-profit schools. But trust me when I say that if nobody wanted a PhD or PsyD, those programs wouldn't exist today in the numbers they do. They satisfied a demand of students.

Would an ideal educational system be focused on satisfying the demands of the students, or demands of employers/labor markets?

Its actually an interesting question that I think is often at the heard of these debates. My position is pretty clear, I think even at universities it has gone way too far in terms of catering to the students (I'm talking undergrads more than grads now, though I'm sure there are elements of it that apply there too). I'm also a firm believer that just because someone wants to do something, doesn't mean they should get to, and am perfectly fine with throwing barriers in place that prevent them from doing (assuming they are as fair as possible, etc., etc.). You are correct on some level about the "big business" of education, though paying students to work on major grant-funded studies often has direct educational benefits to the student (its actually been the best part of mine, and I think a great deal for everyone involved - my advisor, me, the school, and NIH). BTW the grant mechanism you mentioned does exist, and many psychology grad students have them However, they are quite competitive.

 

[ClinicalPHD5]

.

Are you kidding? It's easier than ever to get a doctorate in psychology. Any idiot can do it. But you want us to make more money. Hard to argue that with a straight face what with the Argosy/Capella ads everywhere. You don't think this crap contributes to our income issues? More than half our new grads come from these programs. We need more licesure barriers, like the ability to reason.

It may be relatively easy to get a doctorate in these programs. However, those of us that go to solid programs have it way more difficult than in the past. Given how difficult landing an internship is, many of us have years of clinical experience and many publications before we apply. Trust me, we have enough inhumane licensure laws to the point that it take 2-4 years for students of good programs to get licensed in some states. In the meantime they are not able to earn decent salaries. The quality control should occur at the admissions point (limiting these programs) not after graduation and investment of many years.

 

[futureapppsy2]

Yeah, I was trying to say that if we eliminate most clinical psych programs, it would lead to fewer graduates and less job competition.

You may be joking(?), but I've actually thought from time to time that this wouldn't be a bad idea. I mean, FSPS typically score lower on every objective--admittedly imperfect--quality measure we have (internship match, student-faculty ratio, EPPP scores, attrition, etc), so can it really be said that they're providing the same quality of education as university-based PhD and PsyD programs? If so, is there an ethical issue with accrediting them and allowing them graduate huge cohorts?

I'll admit I have issues with FSPS--beyond the very important debt issue (which I think is a serious disservice to the students), I just don't see how you can replicate the same quality of research and clinical training (practica coordination, supervision, etc) with 80-100(+?) students per cohort as you do with 8-10. I know my university-based cohort (n=9) eat up a ton of your faculty's time, and I just don't see how it would be functional if my cohort was multiplied times 10, even if we added a few more faculty (and FSPS don't have that many more faculty, if any, than we do).

 

[AcronymAllergy]

Somewhat-relatedly, I noticed that just this morning, my APPIC postdoc listserve summary showed a handful of new messages regarding APA internships and VA employment. It looks as though a few of the posters there take issue with the fact that APA accreditation at the internship level is required for all VA positions and, nowadays, many post-docs. What scares me a bit is that soon, this might be the prevailing view of the field, given the quantity of individuals being graduated from programs that have relatively atrocious internship match rates.

Personally, I share an opinion similar to T4C's in that APA accreditation really should be seen as a minimal standard rather than a gold standard, and thus I have no issues with it being required. What I do find problematic, though, would of course be the current imbalance, which ties directly to the large number of applicants being churned out by a potentially-questionable programs.

 

[ClinicalPHD5]

If things don't change, of course it will be. APA will become increasingly "elite" instead of minimum. 60% of PsyDs in this round matched to APA accreddited internships. More than half of our new psychologists are graduating with massive debt. We are redefining psychology education as unfunded professional school. That is why we are getting the push to have licensure upon graduation, and relax APA standards. DocJohn, I believe, has repeatedly stated that we are the only field that shoots at itself. But, is there really any other way to view this than a malignant cancer? 'Bout time for some surgery and maybe a bit of chemo.

The standards are not becoming more relaxed. APA accredidation is becoming a minimum criteria that is posted on many entry level jobs and post-docs---not including the VA. APA accredidation is a new requirement that is becoming increasingly common for many beginning jobs and post-docs in the clinical field. Because post-docs are so competitive now and have hundreds of students vying for 1 or 2 positions, APA accredidation is one way in which people differentiate applicants. people who don't get APA internships are more likely to work in private practice settings.

 

[ClinicalPHD5]

(APA matched internships for PsyDs = ~60%) and probably contributing to income decrements for all of us. This is what happens when you redefine education in your field for the purpose of profit of a few arseholes (the people that run professional schools). You posting those numbers just pisses me off anew. What a bunch of f'ing *****s. Oh, and can you say education bubble? What a complete pile of ****.

I wish the match rate was 60% for PsyD graduates. In reality, only 59% of both PhD and PsyD graduates are matching to APA accredited internships. The rest are matching to appic or non-accredited positions (the 75% often quoted match rate includes the many unaccredited positions in the match). In 2011, only 2,278 students matched to APA/CPA internships out of a total of about 4,000 applicants who went through the match. This number doesn't include the people who forgo the match entirely and do Capic internships. Our overall APA match rate is now in the minority--i'd say like 40% if you include total that don't go through the match.

 

[docjohng]

It's not a free market, DocJohn. Need I remind you about the trillion dollars or so of student loan debt. Without the current f'd up system, all those nonsense "schools" wouldn't exist. Not a free market, at all.

I'm trying to follow your line of reasoning here, but am failing to do so.

So the housing market isn't considered a "free market" because it provides loans to would-be home buyers?

Loans exist to help people obtain a good or service they ordinarily wouldn't be able to obtain. Loans exist in free markets too, and always have.

John

 

[ExpressYourself]

Sometimes, but that's mainly due to financial reasons, loans, and being able to get a job earlier in my life.

Overall, I don't regret it. I love the work I do. As cliche as it sounds ,the rewards of the job give me greater benefit than making a lot of money at something I don't like.

 

[edieb]

Folks, it's going to get worse for our salaries: At the V.A. hospital where I work, they are going to stop hiring psychologists to conduct compensation and pension exams. Instead, to save money, the V.A. is starting an internship so they can just pay interns to do the evals under a licensed psychologist.

In sum, the V.A. is taking advantage of the demand for internships to replace positions usually held by degreed psychologists!

 

[edieb]

actually not unlikely at all: increasing #s of students are being asked to take completely unfunded non-appic member internships because they have not matched. THose would have a mean income of $0.00

An even more basic research methodology is to refrain from making senseless and harmful claims that only serve to further one's personal agenda. You question survey statistics and yet do not seem to be as strict in your approach regarding your own personal misgivings about the field. Show me data that support your belief that 99% of internships pay 18k or less.

There was a 65% response rate. In order for 99% to earn < 18k (your claim), the 35% of non-responders would have had to have a mean salary of $6452.29. Very unlikely.

684 internship sites total on APPIC directory:
45 internship sites (6.6%) offer < $15,000
639 internship sites (93.4%) offer > $15,000
481 internship sites (70.32%) offer > $20,000
180 internship sites (26.32%) offer > $25,000

Are internship salaries lower than they perhaps "ought" to be? Yes. Are 99% of them 18k or lower? No.

 

[edieb]

An important caveat to your posting is where do you live? I remember someone on here bragging that psychologists made $70K out of internship but forgot to mention that this salary was in nyc.

We are out of the workforce for around 5-6 years. Thus, while were living on stipends or accruing debt, others are making $$$. Our salaries need to be higher to make up for this lost time.

There are ways to command more money (prescribing, forensics, etc) but not everybody can go into these specialities. This is especially true now because there are more and more psychologists being minted.

While there is a greater and greater demand for psychiatric services, their numbers are staying the same or declining. While more fields are encroaching into ours (everybody is a therapist), our numbers are increasing.

This is my first post here -- had to chime in and provide another voice to the "positive" end of the spectrum.

I am 4 years post-licensure, working full time at a VA, earning over $90K. I specialize, but there are more generalists (read: psychologists doing outpatient psychotherapy) in my hospital than specialists. Based on the GS scale, I'll probably top out around $110K, which is certainly much less than I could make in private practice. However, the job security, flexibility (clinical work, staff education/training, and a bit of research) and fantastic benefits more than make up for the salary difference.

I went to a funded PhD program, had a VA internship and a VA postdoc, which certainly played a role in my ending up with a VA job. I was a strong student but not a superstar -- I think I'm fairly representative of the average PhD student in terms of CV. All the members of my PhD cohort are happily employed, making in the same range as I. The same is true for my internship and post-doc cohorts.

Would I do it again? In a heartbeat.

 

[WestIndiPsych]

I don't know if this has been answered already, but do Counseling Psychology programs fall under the same umbrella as Clinical Psychology? I keep hearing clinical clinical but want to check if all the same prospects/issues exist in the counseling Phd field.

 

[DrGachet]

Perhaps there are different groups of people in this thread. One group may be the idealists who came into grad school, a bit naive, a bit optimistic, hoping that if they do their part, if they study and get good grades, if they have good intentions, then the field and their various representatives will take care of the political and the business side of things, so they can take care of their patients and not worry about paying the bills or future of the field.

Another group, perhaps more practical, came in with their eyes wide open and they knew the reality of things, and they're not exactly happy nor truly satisfied, but it's been much easier for them to make peace with what they've got into. They'll be happy to have more money and job security of course, but they probably did their research on other career paths, on law, on medicine, and for whatever reason, they made the choice to become a psychologist. For better or worse.

I know, this is an oversimplification and I'm just speculating and perhaps a bit too much based on my own situation, but as an idealist myself, I felt like I was punched in the face when I started to see the ugly reality of things. A practically minded friend, however, told me he knew very well what he was getting himself into and knew he would not get a &quot;fair&quot; pay but that it's all market driven. Given how our economy works, it just makes sense. We don't have to like it but it makes sense. Yes, I don't like to see a certain younger guy with his MBA degree living the good life, a nice house and an expensive car, doing the sort of work that, to be honest, I have very little respect for, perhaps earning more than his fair share too, but the economy is not based on what's fair. I have made a choice; nobody forced me to go to grad school and study psychology.

There may be some pay increases in future but I don't expect anything major. If anything, I expect for things to get worse. It's about supply and demand, and there is a lot of supply, and therapists with even little education can get good results with patients too, so unfortunately, it's not like us psych grads or psychologists are the only ones holding the key. If you're only one of a handful specializing in certain type of surgery and on top of that you get great results, charge as much as you want! Or if you can make people a lot of money. But to be one of many and to get only average result with patients (after all, the patient has to be ready to change, etc), you can't expect much. It is unfortunate that psych students have to study for so many years. We don't get paid based on how many years we studied. /end of rant

 

[JuniperTree]

Is the situation the same or worse for those who are not interested in doing therapy? (I only want to do research, and would like to pursue neuroscience but don't have the science background due to misguiding by my college, so will go to cognitive psych. Is testing and rehab as flooded as therapy?)

 

[ClinicalPHD5]

I don't know if this has been answered already, but do Counseling Psychology programs fall under the same umbrella as Clinical Psychology? I keep hearing clinical clinical but want to check if all the same prospects/issues exist in the counseling Phd field.

Yes, i don't think there are many differences between counseling and clinical phd these days in terms of job prospects/issues.

 

[Dream1a]

Perhaps there are different groups of people in this thread. One group may be the idealists who came into grad school, a bit naive, a bit optimistic, hoping that if they do their part, if they study and get good grades, if they have good intentions, then the field and their various representatives will take care of the political and the business side of things, so they can take care of their patients and not worry about paying the bills or future of the field.

Another group, perhaps more practical, came in with their eyes wide open and they knew the reality of things, and they're not exactly happy nor truly satisfied, but it's been much easier for them to make peace with what they've got into. They'll be happy to have more money and job security of course, but they probably did their research on other career paths, on law, on medicine, and for whatever reason, they made the choice to become a psychologist. For better or worse.

I think that's an accurate statement, but rather than being practical I think most of them are in denial.

 

[ClinicalPHD5]

I think that's an accurate statement, but rather than being practical I think most of them are in denial.

I think many graduate students are in denial/avoidant until internship/post-doc/employment hits them in the face and they have to actually think about making money/supporting themselves and paying back loans. I think the denial works in the short-term because it allows graduate students to get through many of the requirements of a PhD program and many of the things they don't want to do. I have heard many saying, "Doing this stuff i don't like now is okay because i'm going to earn 6 figures later and charge $250 for therapy sessions." Many people also hold onto the one person they know who is earning 6 figures in private practice and think that this is normal in the field and will be easy for them to achieve. It probably is somewhat adaptive because it does help people get through the painful requirements and their dissertations etc.

 

[starsinnight]

After reading this thread, I've come up with some conclusions:

1. It is hard work starting out after a PhD - working towards licensure - getting your foot in the door, etc. It is HARD work. And don't expect to have money bags thrown at you.

2. Not everyone is happy. Maybe this is because you don't immediately get what you want or maybe it is because it is hard work.

3. The economy sucks. If I can add my two cents, it isn't JUST psychology doctorates having trouble finding jobs. It is also MASTERS level students. After completing a MHC masters degree, only a handful in my cohort of 30 have landed therapy jobs, the rest have remained at their previous jobs as if they didn't even get the degree, myself included. Was it a waste of time? Hell no. I love school personally and learned alot, gaining valuable experiences and internships along the way.

4. Comparisons are stupid. So many factors play a part (ie, work setting, experience in the field, licensure, population) that you can't really compare can you? And how can you compare to other careers too? If we wanted to be a lawyer, we would've. You couldn't pay me millions to be in law, personally speaking. My childhood friend has always made more than me, with a high school diploma, and working in sales. She works hard and moves up the business ladder, it can be done if thats what you want. School isn't for everyone and you can definitely get by in other ways, if a phD isn't what you want.

5. Is this more a question about money? What are our values and goals really? After reading so many gripes about us not getting paid enough, it can be daunting to think of our futures. As I already said, I don't get paid a penny more for my masters degree.... I also get underpaid at my Research position now. I have complained, advocated, and thought of hiring a lawyer for myself (as dream says we should speak up for what we deserve).... all to no avail (yet).

6. Can research, statistics, or case studies even prove anything? I don't know where you live nor do I want to live there, so what does it matter what so and so makes? Being in research for so long, I know that it isn't always accurate and should be taken with a grain of salt, who knows if the happier psychologists are the ones filling out the surveys? The job market not only sucks but is SO varied, it is all moot. If you become too obsessed with numbers and what you aren't getting, how can you appreciate what you do get, or that you even have a job in the field?

7. But for those of you that must know, at my non-profit FAILING psychology agency for children (we are going downhill due to budget cuts and having layoffs), the people in charge aka the PhD's in psychology make $90k (middle aged person) and $100k (nearing retirement age). Yes they are crooks for robbing from the children, in my opnion, and not providing the best the center should offer, as well as laying off while they get promoted... but positions of wealth are available if you find yourself in the right place at the right time and you know the right people.

8. Also, isn't it really about experience too? The more you work the more experience you get, and therefore the more money. Isn't this how all careers work?

9. I think I am done. Moral of the story - does this even matter? Isn't it about hard work? How can you expect to be handed anything - it is never "the end" and as a psychologist we are always going to be jumping hurdles. I will be in COLLEGE for 12 years by the time I finish - I can't expect anything handed to me at that point. And I don't plan to give up trying and putting forth the hard work required to get what I deserve.

 

[starsinnight]

I don't know if this has been answered already, but do Counseling Psychology programs fall under the same umbrella as Clinical Psychology? I keep hearing clinical clinical but want to check if all the same prospects/issues exist in the counseling Phd field.

Yes.... in my experience, it is the same. As well as the Masters level psychology field too.

 

[Therapist4Chnge]

Is the situation the same or worse for those who are not interested in doing therapy? (I only want to do research, and would like to pursue neuroscience but don't have the science background due to misguiding by my college, so will go to cognitive psych. Is testing and rehab as flooded as therapy?)

Tenure-track research is probably even worse off, particularly non-clinical (Experimental, Social, etc) because there are so few tenure-track positions availlable for early career researchers. There are more opportunities in the hard sciences for folks willing to look outside of pure academia: biotech, technical consulting, etc. Hard science + patent work = $$$ for those willing to work outside of academia.

Clinical but non-therapy jobs can be a bit better, though it depends on your niche, training, and location. Insurance rates have been slashed, so more volume is needed to make up the difference. Fellowship trained folks (forensic, neuro, rehab, etc) should be fine, but they are the vast minority when compared to all of the clinicals that do assessment work "on the side" or go into it after the therapy route fails. The assessment market is as competitive or more competitive than the therapy market because there are less cases, more board cert./elligible requirements for employment, and it tends to attract top-end clinicians. Personal bias noted.

It isn't all doom and gloom, but a generalist trying to go up against a flood of mid-levels who will work cheaper & longer will need to bring something more to the table. Administration/Supervision work is probably more realistic for job stability, though many clinicians don't want to bother with employee problems, budgets, meetings, etc. Private practice is always a toss up, and community mental health....quite variable.

 

[ClinicalPHD5]

After reading this thread, I've come up with some conclusions:

3. The economy sucks. If I can add my two cents, it isn't JUST psychology doctorates having trouble finding jobs. It is also MASTERS level students. After completing a MHC masters degree, only a handful in my cohort of 30 have landed therapy jobs, the rest have remained at their previous jobs as if they didn't even get the degree, myself included. Was it a waste of time? Hell no. I love school personally and learned alot, gaining valuable experiences and internships along the way.

7. But for those of you that must know, at my non-profit FAILING psychology agency for children (we are going downhill due to budget cuts and having layoffs), the people in charge aka the PhD's in psychology make $90k (middle aged person) and $100k (nearing retirement age). Yes they are crooks for robbing from the children, in my opnion, and not providing the best the center should offer, as well as laying off while they get promoted... but positions of wealth are available if you find yourself in the right place at the right time and you know the right people.

I agree with many of your summaries/points overall. But take issues with these two points above.

I agree that the economy sucks and many people are suffering--no doubt. However, i am one of those doctoral psychologists that happens to think that most M.A. level people have no business conducting psychotherapy after only 2 years of graduate school anyhow. Perhaps they can't get therapy jobs because they actually aren't really qualified to conduct psychotherapy beyond supportive counseling and the public should be protected. Why do you think you can do psychotherapy after only 2 years of graduate training? I think this position is entitled. I don't know your particular situation, but just curious as to the reasoning overall. The PhD and MA are completely different animals. We get 6 years of supervised training before we even graduate and then still accumulate the 3,000 hours before licensure. Therapy is a powerful thing that can harm people's lives and really does require extensive training like this.

The experienced PhD's in psychology at your agency are earning their 90K salaries because they completed 4 more years of graduate school than a typical MA person and have like 30 plus years of work experience that you don't have. That is not due to luck and being in the right place at the right time. I'm not commenting on their ethical/unethical practices, just the overall issue you take with the salary etc.

 

[Dream1a]

After reading this thread, I've come up with some conclusions:

2. Not everyone is happy. Maybe this is because you don't immediately get what you want or maybe it is because it is hard work.

3. The economy sucks. If I can add my two cents, it isn't JUST psychology doctorates having trouble finding jobs. It is also MASTERS level students. After completing a MHC masters degree, only a handful in my cohort of 30 have landed therapy jobs, the rest have remained at their previous jobs as if they didn't even get the degree, myself included. Was it a waste of time? Hell no. I love school personally and learned alot, gaining valuable experiences and internships along the way.

4. Comparisons are stupid. So many factors play a part (ie, work setting, experience in the field, licensure, population) that you can't really compare can you? And how can you compare to other careers too? If we wanted to be a lawyer, we would've. You couldn't pay me millions to be in law, personally speaking. My childhood friend has always made more than me, with a high school diploma, and working in sales. She works hard and moves up the business ladder, it can be done if thats what you want. School isn't for everyone and you can definitely get by in other ways, if a phD isn't what you want.

5. Is this more a question about money? What are our values and goals really? After reading so many gripes about us not getting paid enough, it can be daunting to think of our futures. As I already said, I don't get paid a penny more for my masters degree.... I also get underpaid at my Research position now. I have complained, advocated, and thought of hiring a lawyer for myself (as dream says we should speak up for what we deserve).... all to no avail (yet).


7. But for those of you that must know, at my non-profit FAILING psychology agency for children (we are going downhill due to budget cuts and having layoffs), the people in charge aka the PhD's in psychology make $90k (middle aged person) and $100k (nearing retirement age). Yes they are crooks for robbing from the children, in my opnion, and not providing the best the center should offer, as well as laying off while they get promoted... but positions of wealth are available if you find yourself in the right place at the right time and you know the right people.

2. Personally, i'm not aversive to hard work. I am, however, perturbed at the fact that hard work seems to be irrelevant in clinical psychology. The words "damned if you do, damned if you don't" come to mind, but I think, poor if you do, poorer if you don't, is more appropriate.

3. BECAUSE the economy sucks, it is all the more important NOT to do things that are risky i.e. a Ph.D in clinical psychology, JD.

4. Comparisons aren't stupid. Any comparison that is made should necessarily take into account of these factors. The problem is even when this is being taken into account it is still low. Comparison to another profession is also important because these are also PROFESSIONAL degrees and roughly take the same time (MD anyway). Everything is relative, and it is stupid to think that one profession's salary should be exclusive and not relevant to any other profession.

5. it's not a question about money than about time and effort expenditure. If everyone had a free ride then it would be somewhat appealing. People are taking loans to do a Ph.D and then are getting screwed at the end. This is what is absurd (also happens with JD).

7. 100k isn't a lot for someone who is at retiring age. This is not even the starting salary for a psychiatrist who has had no experience as of yet.

 

[starsinnight]

I agree with many of your summaries/points overall. But take issues with these two points above.

I agree that the economy sucks and many people are suffering--no doubt. However, i am one of those doctoral psychologists that happens to think that most M.A. level people have no business conducting psychotherapy after only 2 years of graduate school anyhow. Perhaps they can't get therapy jobs because they actually aren't really qualified to conduct psychotherapy beyond supportive counseling and the public should be protected. Why do you think you can do psychotherapy after only 2 years of graduate training? I think this position is entitled. I don't know your particular situation, but just curious as to the reasoning overall. The PhD and MA are completely different animals. We get 6 years of supervised training before we even graduate and then still accumulate the 3,000 hours before licensure. Therapy is a powerful thing that can harm people's lives and really does require extensive training like this.

The experienced PhD's in psychology at your agency are earning their 90K salaries because they completed 4 more years of graduate school than a typical MA person and have like 30 plus years of work experience that you don't have. That is not due to luck and being in the right place at the right time. I'm not commenting on their ethical/unethical practices, just the overall issue you take with the salary etc.

As far as Dream's comments, I totally agree... I think you said what I meant in other words. Although I'd like to be more of the optimist and think our hard work does pay off, perhaps more intrinsically in ways than monetarily.

And for Clinical PHd, I'll PM you more of an explanation.... I think you totally misunderstood my comments really, I am in a PhD program now but first received my Masters and know that many of these complaints are exactly the same for therapists too.

I find the Psychology hierarchy amazing in some respects. Will Psychiatrists always believe they are better and more qualified than Psychologists? And will Psychologists always think the same way of Therapists? Shouldn't we all be teaming up and working together in order to offer the best multisystemic treatment possible, because in my opinion, we can all offer something different that the other can not, (whether it be cheaper care, medications, assessments, therapy, evaluations, etc).

And I am definitely not equating a masters level pay with a PhD pay in NO means whatsoever. If you can even get a masters level pay, you will be lucky. I was commenting and contributing to the pay ranges for comparison of PhD level pay ranges to show that it can be done in the long run. It is about being in the right place (VA, forensics, govt) at the right time (not this economy) and knowing the right people (connections and networking), in my opinion, that's why some psychologists get paid 50k and others get paid 100k. Isn't it?

 

[ClinicalPHD5]

As for this comment by ClinicalPhD, I am baffled to think you believe this and perhaps should PM you more to discuss in more detail. I am personally pursuing my PhD in Psychology but have first received (and practiced clinically) with my Masters. I don't think like you do and many insurance agencies don't either. As far as my experiences, I received my Masters at a top university and was taught and trained alongside PhD students with the same professors and clinical supervisors. My internship was at an agency alongside PhD students and we received the same supervision. And my Masters was 3 years, not 2. If this discredits my training in some way, please explain. Again there is always variance, with education as well as personal differences. Some of the PhD students I've met have been at a career style college that isn't even accredited and not NEARLY as trained as I believe my cohort was, but thats besides the point I guess. As well as some of my cohort that should never be allowed alone with clients. My reasons for pursuing a PhD have nothing to do with whether I was trained enough to do psychotherapy, I fully believe I was.... my reasons are to pursue more research and academia opportunities.

I wasn't commenting on your particular situation, just my overall view of the M.A. degree. Sure, not everyone has this opinion in the field. I only developed this opinion after getting training in psychotherapy in my PhD for about 6 years. I am so much more competent after completing 6 years of training as opposed to where i was in year 3 of graduate school---not even a comparison as well as for all of my cohort. I don't believe 3 years of an M.A. program would be full training for psychotherapy either. This is just my opinion and why i believe the doctorate offers full training in psychotherapy. I know there is wide variation in M.A. programs, but most are also 2 years and don't actually teach psychotherapy but more case management etc.

I can give you a quick glimpse to my phd training so you can compare it to your M.A. I took at least 15-20 psychotherapy related courses that were very applied and only had about 6-8 students in each class (e.g. many had videotape review and involved write up and presenting cases). Each year for 4 years, I did a clinical externship and worked at a student clinic (about 20 hours per week) where I received about 4-6 hours of mostly individual supervision from licensed psychologists. During internship, I completed 2,000 hours and got approximately 6 hours of supervision per week (i had 5-6 individual supervisors on internship). By the time i was done with internship and PhD, i would say that I had about 5,000 hours of supervised experience total, many of this included audiotape and videotape review with expert psychologists. Sorry, but you cannot replicate this type of extensive and individualized training in a 3 year degree program. Many of my supervisors listened to individual therapy tapes from start to finish and this was common practice on internship. My description doesn't include my master's thesis, clinical comprehensive exams, and dissertation either. I really believe that to be really competent at delivering psychotherapy you need this type of hands-on extensive training that can only be completed in a small program that is 5 years plus.

The PHD students you describe are in a professional program that isn't even accredited by the APA. There training is very lax compared to any university based program and not really representative.

 

[ClinicalPHD5]

And for Clinical PHd, I'll PM you more of an explanation.... I think you totally misunderstood my comments really, I am in a PhD program now but first received my Masters and know that many of these complaints are exactly the same for therapists too.

I find the Psychology hierarchy amazing in some respects. Will Psychiatrists always believe they are better and more qualified than Psychologists? And will Psychologists always think the same way of Therapists? Shouldn't we all be teaming up and working together in order to offer the best multisystemic treatment possible, because in my opinion, we can all offer something different that the other can not, (whether it be cheaper care, medications, assessments, therapy, evaluations, etc).

And I am definitely not equating a masters level pay with a PhD pay in NO means whatsoever. If you can even get a masters level pay, you will be lucky. I was commenting and contributing to the pay ranges for comparison of PhD level pay ranges to show that it can be done in the long run. It is about being in the right place (VA, forensics, govt) at the right time (not this economy) and knowing the right people (connections and networking), in my opinion, that's why some psychologists get paid 50k and others get paid 100k. Isn't it?

I hope i didn't offend you. I sent you a private PM message. That's great that you are doing your PhD now and your M.A. program sounds like it was way above average compared to most that i've seen/researched when applying to graduate school.

I still think the PhD speaking in generalities offers much more complete psychotherapy training. It would be impossible to replicate my training on an M.A. level because my class size was way smaller and i got 4-6 hours of mostly individual supervision with videotape review. It would be tough to do this with a class size of 30 plus and shorter training.

I think psychotherapy is so complex and involves so many variables/factors. The risk is high too if you work in a hospital setting. I think you really need this type of extensive training in order to make alot of difficult judgement calls and work effectively with very distressed individuals who are not motivated often. This really comes with experience and many years of training. I still think you need some supervision/consultation for life.

 

[StellaB]

Hi Everyone,

I've been reading this board for a while but this is my first post. I am a high-level employee with a company that produces educational materials for psychotherapists at all levels (from members of NADAAC all the way up to Psychiatrists). So take my words with the grain of salt that this is in reference specifically to psychotherapy, not to the other aspects of a psychologist's potential job.

As I see it, the main issue is one of the public's sense of what is valuable. Individual Medical Insurance is a poor partner of psychology due not in small part to the fact that it is an industry interested in direct outcomes and profit. Talk therapy has so many variables that affect outcome; the most important of which is the clients themselves, with modality of treatment (what most "evidence-based" ideals are actually referring to) accounting for a paltry 8% of the outcome variance (data from Norcross meta-analysis). Let alone the fact that insurance has shaped the field of psychotherapy in ways that yield a practice most potential clients are not impressed with (i.e. too focused on symptoms or surface issues, not enough investment in the relationship). Here in California, with a market completely flooded with therapists of all pedigrees, there are even successful "life coaches" who have essentially no training at all.

You have to ask yourself if you are actually providing a service that your clients value, and you have to ask yourself if you are really entrepreneurial enough to make it in private practice.

As for the sense that psychologists are owed large sums of money because of the upfront time and money investment, I would like to point out that the biggest barrier to higher pay for therapists of all levels is that we live in a society that does not value social services. What is the first thing to be cut when the local/state coffers run dry? Social services, naturally.

There are a lot of opportunities to change this perception and to find good paying work. Many psychologists here are beginning to work with family lawyers on what's called collaborative divorce. With less time spent bickering in court, a collaborative approach offers the couple a way to have a less painful and less expensive experience, and affords the psychologist a unique way to get direct-pay services. If that seems far-fetched, ask yourself how many lawyers are being paid by insurance companies.

The reality is that if you want to make a lot of money offering direct services to high-functioning clients, you need to know your market and seriously consider your value to them. Why should you get paid $150 an hour in a day and age when nearly everyone's incomes are flat (at best)?

 

[PsychPhDone]

Talk therapy has so many variables that affect outcome; the most important of which is the clients themselves, with modality of treatment (what most "evidence-based" ideals are actually referring to) accounting for a paltry 8% of the outcome variance (data from Norcross meta-analysis). Let alone the fact that insurance has shaped the field of psychotherapy in ways that yield a practice most potential clients are not impressed with (i.e. too focused on symptoms or surface issues, not enough investment in the relationship). Here in California, with a market completely flooded with therapists of all pedigrees, there are even successful "life coaches" who have essentially no training at all.

Welcome to the board, StellaB. I think it's great to get another perspective on the issue. I agree a lot has to do with how insurance companies (and people) value therapy. I welcome legislation that requires equal coverage for mental and medical diagnoses, and I am heartened to see this occurring in some locales. But...I disagree on your conclusion about EBPs...and that's for another thread...

 

[StellaB]

Welcome to the board, StellaB. I think it's great to get another perspective on the issue. I agree a lot has to do with how insurance companies (and people) value therapy. I welcome legislation that requires equal coverage for mental and medical diagnoses, and I am heartened to see this occurring in some locales. But...I disagree on your conclusion about EBPs...and that's for another thread...

Thanks for the welcome! To be clear, I don't know about local legislation that requires equal coverage for mental and medical diagnoses, I certainly didn't say anything about that.

One of the things that gets a little sticky in this area is, yet again, the impact insurance has on psychotherapy. It's not always a positive one. I sometimes wonder whether medical insurance as it was designed was ever really intended to pay for therapy. In some instances it seems appropriate, and in others it does not. It may encourage the concept in the non-psychology world that psychotherapy should be a quick-fix, and cheap. Sometimes it can be. Other times, when you're dealing with something like the high-functioning adult of childhood sexual abuse / neglect... it's not going to be quick, and it's probably not going to be cheap. Was medical insurance intended to help with that kind of issue? Probably not. Should these kinds of cases be pushed to the wayside because they don't fit the medical model? Definitely not.

If the road forward is to chase what little money can come from mediacl insurance companies, what are the potential consequences on the field as a whole, and to get back to what I think is the root of the problem, society's perception of psychology?

In my direct work experience which puts me in touch with hundreds of mental health professionals, those who take the medical model of emotional/psychological issues with a grain of salt are the most well-off and successful. I interview well-known professionals (all PhD and MD) in the field and frequently hear their sense that academic "evidence-based" modalities and the medical model in general don't jibe at all with their experiences. The most important thing, according to them as well as the research, is to have a real emotional connection with your clients.

From my experience, which is totally different from academia, the therapists who spend their time honing their expertise connecting with others are the most successful, financially and otherwise, with self-paying clients. A degree in clinical/counseling psychology is no golden ticket to riches; you have to be good at what you do so that people want to open up to (and open their wallets too). END OF RANT!

 

[ClinicalPHD5]

In my direct work experience which puts me in touch with hundreds of mental health professionals, those who take the medical model of emotional/psychological issues with a grain of salt are the most well-off and successful. I interview well-known professionals (all PhD and MD) in the field and frequently hear their sense that academic "evidence-based" modalities and the medical model in general don't jibe at all with their experiences. The most important thing, according to them as well as the research, is to have a real emotional connection with your clients.

From my experience, which is totally different from academia, the therapists who spend their time honing their expertise connecting with others are the most successful, financially and otherwise, with self-paying clients. A degree in clinical/counseling psychology is no golden ticket to riches; you have to be good at what you do so that people want to open up to (and open their wallets too). END OF RANT!

Developing the therapeutic alliance is very important for the success of therapy. However, this is a minimal criteria that all therapists should be doing anyhow and by no means the end all and be all of therapy. This is like the first thing you learn in your 1st year graduate courses. This is not to be confused with actual therapeutic techniques. Therapeutic techniques are quite complex. For example, if someone is coming in for OCD treatment or Trauma, having a strong alliance with his/her therapist is an important initial criteria that any decent therapist would attend to. However, this is not going to improve OCD or PTSD on its own. The behavioral and cognitive treatment is quite complex and involves extensive training and supervision to administer appropriately and well. This is where the expertise comes in and has great value.

Its not very accurate that actual technique doesn't matter. For example, 80% of people no longer meet criteria for panic disorder after undergoing CBT therapy. This is extremely powerful and a better outcome than any medication can offer in the long-term. The studies that demonstrate CBT and psychodynamic therapy effectiveness are also compared to "therapy as usual," and show significantly better outcomes.

Another common confusion is that making money as a therapist means that you are good at what you do and have good outcomes. If you are particularly good at selling/marketing yourself you can earn decent money up to a certain point. People who do coaching aren't doing therapy at all, but they can earn decent money if they know how to sell themselves. Let's be clear that this is not psychotherapy though.

 

[deleted106747]

Developing the therapeutic alliance is very important for the success of therapy. However, this is a minimal criteria that all therapists should be doing anyhow and by no means the end all and be all of therapy. This is like the first thing you learn in your 1st year graduate courses. This is not to be confused with actual therapeutic techniques. Therapeutic techniques are quite complex. For example, if someone is coming in for OCD treatment or Trauma, having a strong alliance with his/her therapist is an important initial criteria that any decent therapist would attend to. However, this is not going to improve OCD or PTSD on its own. The behavioral and cognitive treatment is quite complex and involves extensive training and supervision to administer appropriately and well. This is where the expertise comes in and has great value.

Its not very accurate that actual technique doesn't matter. For example, 80% of people no longer meet criteria for panic disorder after undergoing CBT therapy. This is extremely powerful and a better outcome than any medication can offer in the long-term. The studies that demonstrate CBT and psychodynamic therapy effectiveness are also compared to "therapy as usual," and show significantly better outcomes.

Another common confusion is that making money as a therapist means that you are good at what you do and have good outcomes. If you are particularly good at selling/marketing yourself you can earn decent money up to a certain point. People who do coaching aren't doing therapy at all, but they can earn decent money if they know how to sell themselves. Let's be clear that this is not psychotherapy though.

I agree with what you're saying, except the part that you learn the therapeutic alliance - I'm not sure anyone can teach you that if you don't have it already. It's also, in my opinion, one of the hardest/most taxing things about conducting psychotherapy, and not minimal at all but highly complex and nuanced, right along with specific techniques.

 

[ClinicalPHD5]

I agree with what you're saying, except the part that you learn the therapeutic alliance - I'm not sure anyone can teach you that if you don't have it already. It's also, in my opinion, one of the hardest/most taxing things about conducting psychotherapy, and not minimal at all but highly complex and nuanced, right along with specific techniques.

it depends how you define therapeutic alliance. Whether you are referring to overall rapport and empathy vs. a more psychodynamic view of the therapeutic relationship. There are degrees of course. I still think this is minimal criteria in that most decent therapists would strive to have a good working alliance, rapport, and showing concern/empathy to the client overall. To me this is a minimum standard that i set with my clients and one of the first things i focused on early on in graduate training. I would say that i have a good working relationship with all my clients, which is why they attend therapy sessions even when the treatment is difficult. To me being empathic, trying to understand the client's experience, and showing concern is a minimum standard for the field and something that most therapists can show even early on in training.

 

[deleted106747]

it depends how you define therapeutic alliance. Whether you are referring to overall rapport and empathy vs. a more psychodynamic view of the therapeutic relationship. There are degrees of course. I still think this is minimal criteria in that most decent therapists would strive to have a good working alliance, rapport, and showing concern/empathy to the client overall. To me this is a minimum standard that i set with my clients and one of the first things i focused on early on in graduate training. I would say that i have a good working relationship with all my clients, which is why they attend therapy sessions even when the treatment is difficult. To me being empathic, trying to understand the client's experience, and showing concern is a minimum standard for the field and something that most therapists can show even early on in training.

Hm. You make good points - I come from a psychodynamic/CBT background and work in an interpersonal/CBT model so I utilize the relationship a good deal; hence I see it as a complex and nuanced aspect of the therapy. I do disagree that most therapists show this ability early in training - I have met quite a few that, unfortunately, don't have an empathic bone in their body. Very sad to see; I think for them the idea of being a psychotherapist was more about power than about an alliance toward change.

 

[Therapist4Chnge]

Behavioral interventions for all!! Stimulus, condition, response...and possibly extinction. One size fits all. Who's with me?!!

Okay, not really. I'll go back to my neuropsych report writing.

 

[futureapppsy2]

Developing the therapeutic alliance is very important for the success of therapy. However, this is a minimal criteria that all therapists should be doing anyhow and by no means the end all and be all of therapy. This is like the first thing you learn in your 1st year graduate courses. This is not to be confused with actual therapeutic techniques. Therapeutic techniques are quite complex. For example, if someone is coming in for OCD treatment or Trauma, having a strong alliance with his/her therapist is an important initial criteria that any decent therapist would attend to. However, this is not going to improve OCD or PTSD on its own. The behavioral and cognitive treatment is quite complex and involves extensive training and supervision to administer appropriately and well. This is where the expertise comes in and has great value.

Its not very accurate that actual technique doesn't matter. For example, 80% of people no longer meet criteria for panic disorder after undergoing CBT therapy. This is extremely powerful and a better outcome than any medication can offer in the long-term. The studies that demonstrate CBT and psychodynamic therapy effectiveness are also compared to "therapy as usual," and show significantly better outcomes.

Another common confusion is that making money as a therapist means that you are good at what you do and have good outcomes. If you are particularly good at selling/marketing yourself you can earn decent money up to a certain point. People who do coaching aren't doing therapy at all, but they can earn decent money if they know how to sell themselves. Let's be clear that this is not psychotherapy though.

I'd go further to say that if you're doing something that's actually adversive to the client, at least initially, like exposure therapy for OCD or PTSD, a very good therapeutic rapport is not only important but *absolutely necessary*. Of course, it's not sufficient, but I think very, very few clients are going to take part in an EBT that *causes* so much initial emotional distress unless they have a strong, secure relationship with their therapist and really trust them. So, I'd think a strong therapeutic relationship would be even more important in these circumstances, as otherwise it seems unlikely that you could actually carry out the EBT successfully. JMHO.

 

[StellaB]

Developing the therapeutic alliance is very important for the success of therapy. However, this is a minimal criteria that all therapists should be doing anyhow and by no means the end all and be all of therapy. This is like the first thing you learn in your 1st year graduate courses. This is not to be confused with actual therapeutic techniques. Therapeutic techniques are quite complex. For example, if someone is coming in for OCD treatment or Trauma, having a strong alliance with his/her therapist is an important initial criteria that any decent therapist would attend to. However, this is not going to improve OCD or PTSD on its own. The behavioral and cognitive treatment is quite complex and involves extensive training and supervision to administer appropriately and well. This is where the expertise comes in and has great value.

Its not very accurate that actual technique doesn't matter. For example, 80% of people no longer meet criteria for panic disorder after undergoing CBT therapy. This is extremely powerful and a better outcome than any medication can offer in the long-term. The studies that demonstrate CBT and psychodynamic therapy effectiveness are also compared to "therapy as usual," and show significantly better outcomes.

Another common confusion is that making money as a therapist means that you are good at what you do and have good outcomes. If you are particularly good at selling/marketing yourself you can earn decent money up to a certain point. People who do coaching aren't doing therapy at all, but they can earn decent money if they know how to sell themselves. Let's be clear that this is not psychotherapy though.

Therapeutic alliance is absolutely critical - you're right about that. Where I think you're wrong is the assumption that people learn it early and learn it well. I happen to agree with Psycycle that the alliance is not really something that can be taught, people either get it and honestly care about their clients, or they don't.

Regarding therapeutic intervention techniques: I was specifically citing a meta-analysis by John Norcross that the modality of treatment accounts for only 8% of the variance in therapeutic outcomes and the context of my statements was in regards to medical insurance pay. Obviously techniques do matter, especially when you look at specific kinds of disorders, but other kinds of problems don't fit neatly into medical-style categories, so what do we do with those people? What would medical insurance providers have us do?

You're also right that life coaching is NOT therapy. My point was: in a flooded market, if people with no education are making it, what's the excuse for failing as a psychologist? If you (the 'royal you') are interested in private practice but have no marketing skills, get some help with that. No one will hand you a job just because you worked hard and got good grades in school. I don't know of many professions that do.

 

[Buzzwordsoldier]

Now you have me curious. What was the extent of your psychotherapy training before embarking on your PhD training?

I can give you a quick glimpse to my phd training so you can compare it to your M.A. I took at least 15-20 psychotherapy related courses that were very applied and only had about 6-8 students in each class (e.g. many had videotape review and involved write up and presenting cases). Each year for 4 years, I did a clinical externship and worked at a student clinic (about 20 hours per week) where I received about 4-6 hours of mostly individual supervision from licensed psychologists. During internship, I completed 2,000 hours and got approximately 6 hours of supervision per week (i had 5-6 individual supervisors on internship). By the time i was done with internship and PhD, i would say that I had about 5,000 hours of supervised experience total, many of this included audiotape and videotape review with expert psychologists. Sorry, but you cannot replicate this type of extensive and individualized training in a 3 year degree program. Many of my supervisors listened to individual therapy tapes from start to finish and this was common practice on internship. My description doesn't include my master's thesis, clinical comprehensive exams, and dissertation either. I really believe that to be really competent at delivering psychotherapy you need this type of hands-on extensive training that can only be completed in a small program that is 5 years plus.

The PHD students you describe are in a professional program that isn't even accredited by the APA. There training is very lax compared to any university based program and not really representative.

 

[Buzzwordsoldier]

Therapeutic alliance is absolutely critical - you're right about that. Where I think you're wrong is the assumption that people learn it early and learn it well. I happen to agree with Psycycle that the alliance is not really something that can be taught, people either get it and honestly care about their clients, or they don't.
...
My point was: in a flooded market, if people with no education are making it, what's the excuse for failing as a psychologist?

Alliance building is taught, largely, by the person in treatment. I suspect the development of the skills supporting the therapist's teachability do follow a learning curve.

I like your attitude about the sorry state of those in the industry who would piss on others while swimming in the same lame-stream.

(Yeah, it's finals time, and I just used a Palin-ism. Gag.).

 

[Buzzwordsoldier]

Behavioral interventions for all!! Stimulus, condition, response...and possibly extinction. One size fits all. Who's with me?!!

Okay, not really. I'll go back to my neuropsych report writing.

It was a brave attempt...

 

[docjohng]

This is a great point deserving of being highlighted:

[...] You're also right that life coaching is NOT therapy. My point was: in a flooded market, if people with no education are making it, what's the excuse for failing as a psychologist?

If you (the 'royal you') are interested in private practice but have no marketing skills, get some help with that. No one will hand you a job just because you worked hard and got good grades in school. I don't know of many professions that do.

It still surprises me to look at how the coaching market basically came out of nowhere, requires no specific education or background, and yet is already often seen on par for people needing helping with specific areas in their lives -- help that traditionally was provided in a psychotherapy environment.

Coaching became so popular so fast because some very smart people understood the value of re-branding issues of living to someone just needing some "coaching." This is brilliant marketing, and an entire profession was born nearly overnight.

John

PS - All the talk about one degree being better for doing therapy than another degree is hogwash and personal opinion. Show me scientific evidence of better client outcomes between degrees; otherwise it's just anecdotal.

 

[StellaB]

This is a great point deserving of being highlighted:


PS - All the talk about one degree being better for doing therapy than another degree is hogwash and personal opinion. Show me scientific evidence of better client outcomes between degrees; otherwise it's just anecdotal.

 

[ClinicalPHD5]

Therapeutic alliance is absolutely critical - you're right about that. Where I think you're wrong is the assumption that people learn it early and learn it well. I happen to agree with Psycycle that the alliance is not really something that can be taught, people either get it and honestly care about their clients, or they don't.

Regarding therapeutic intervention techniques: I was specifically citing a meta-analysis by John Norcross that the modality of treatment accounts for only 8% of the variance in therapeutic outcomes and the context of my statements was in regards to medical insurance pay. Obviously techniques do matter, especially when you look at specific kinds of disorders, but other kinds of problems don't fit neatly into medical-style categories, so what do we do with those people? What would medical insurance providers have us do?

You're also right that life coaching is NOT therapy. My point was: in a flooded market, if people with no education are making it, what's the excuse for failing as a psychologist? If you (the 'royal you') are interested in private practice but have no marketing skills, get some help with that. No one will hand you a job just because you worked hard and got good grades in school. I don't know of many professions that do.

Factors that would improve alliance can be taught with good supervision and hands on training if one assumes that people care about their patients. Of course people come into graduate school with different degrees and abilities. Let's just assume for now that therapists actually care about their patients (because i think this is true as a whole from my interactions with therapists). Things like asking open-ended questions, learning how to ask questions in a curious tone, overall listening skills, learning how to validate, not interrupting clients, being more collaborative can certainly be learned with videotape review and good training. Many times beginning therapists are not aware of these behaviors and just need some practice. Talking to your friends is very different than your role as a therapist so you really need to develop different skills. Listening to tapes of yourself may help with these types of issues if you are motivated to make a change. I can also say that in being in supervision groups, my collegues and I have changed pretty drastically as therapists from year 1 to professional level. I can't even compare my skills now to 1st year of graduate school.

Stella B, it surprises me that you are so confident that these skills can't be learned when you have never supervised anyone as a therapist and have not provided therapy yourself or been in a supervision group. My experience has been that if people are motivated and persistent, they can change many negative interpersonal behaviors over time as therapists--just like our clients can learn how to improve in their communication skills or become more assertive etc. This takes hard work, self-awareness, and persistence (many hours reviewing tapes and coming up with how you would do things differently etc.).

Just because there is one meta-analysis that shows that modality only accounts for 8% of the variance, doesn't mean that therapeutic technique isn't very important for most clients and problems. The insurance industry may use this study against us and therefore not support using psychologists or people who are experts at treatment. I think this is very misguided. There are also hundreds of studies that show that certain techniques (either DBT, CBT etc.) are more effective than standard supportive therapy for many different populations. I don't have studies on hand right now but the way in which they validated DBT/CBT/behavioral activation and many other treatments is by showing that they lead to superior outcomes over just "talk therapy or supportive therapy." These are validated on a wide range of populations, including anxiety, depression, axis II issues, suicidality, and do account for many people who show up to treatment. It is also very difficult to measure many psychotherapy outcomes and show a casual relationship with a particular technique. Many clients improve beyond just symptom distress, but these things are much more difficult to measure (e.g. like overall quality of life, positive emotions, more intimacy etc.).

As far as life coaches, we don't really have any data on how they are faring overall. People are just jumping to conclusions. I doubt they are doing anywhere near the salary level of psychologists. The range online says 15,000-60,000. Many are probably earning 20 grand if that. Plus, many psychologists and therapists also do life coaching so this kind of mixes the pool. They are also offering a different service and cater to people who don't have mental illnesses so this isn't really a fair comparison either way. There is no psychologist job that advertises for 15,000 so this isn't even a possibility as a psychologist. 25,000 is our internship pay (which many of us still think is very low if you live in an expensive city).

 

[ClinicalPHD5]

You're also right that life coaching is NOT therapy. My point was: in a flooded market, if people with no education are making it, what's the excuse for failing as a psychologist? If you (the 'royal you') are interested in private practice but have no marketing skills, get some help with that. No one will hand you a job just because you worked hard and got good grades in school. I don't know of many professions that do.

I like the sentiment here as well.

The majority of life coaches, however, aren't doing well. Its not like there are all these people without any degree that are making it as life coaches and we should be ashamed of ourselves. This is bull. Psychologists are doing way better overall if you look at salary surveys. The life coaches that are pulling in 6 figures are more of an anomaly. They are the ones with the MBA with 10 years of experience as executives who are actually more qualified than any psychologist to do business coaching/executive coaching. I know someone who is successful as a coach, but again she had 10+ years of work experience at a top consulting firm with a graduate degree. Nobody is paying somebody whose only qualification is attending a life coaching seminar big bucks.

 

[ClinicalPHD5]

[QUOTE

PS - All the talk about one degree being better for doing therapy than another degree is hogwash and personal opinion. Show me scientific evidence of better client outcomes between degrees; otherwise it's just anecdotal.[/QUOTE]

There is scientific evidence that shows better outcomes with expert vs. novice therapists so training and experience does matter. I read about this in graduate school. I am too lazy right now to do a psychinfo search and to try and locate this stuff. i don't know that anyone studied differences between degrees.

This came up on a quick google search and thought was interesting.

Sixty-five expert, experienced, and novice cognitive-behavioral and psychodynamic psychotherapists provided "think aloud" case formulations in response to 6 standardized patient vignettes varying in disorder and prototypicality. The 390 formulations were reliably transcribed, segmented into idea units, content coded, and rated on multiple dimensions of quality. As hypothesized, the formulations of experts were more comprehensive, elaborated, complex, and systematic. Judges did not rate them as more coherent or precise in the use of language. In addition, the treatment plans of experts were more elaborated and linked better to the formulations. Effect sizes for overall ratings of quality ranged from medium to large. Few differences based on therapy orientation were observed. Results are discussed in terms of therapist training.

 

[ClinicalPHD5]

PS - All the talk about one degree being better for doing therapy than another degree is hogwash and personal opinion. Show me scientific evidence of better client outcomes between degrees; otherwise it's just anecdotal.

Okay here is some preliminary evidence from doing a quick google search. therapists with more training have consistently better outcome and even score BETTER on the working alliance measures that clients fill out. This is particularly important since working alliance is clearly an important issue. We should send this to insurance companies that only go for cheaper providers. You can extrapolate from this that 2 years of training vs. 6 in a PhD program is going to make a difference in outcome since they studied training levels specifically:

To investigate the relation of training level to working alliance, 50 counselor–client dyads from 3 counseling agencies were surveyed. Counselors were grouped into 3 training levels: (1) novices, in their 1st practicum; (2) advanced trainees, in their 2nd practicum through predoctoral internship; and (3) experienced counselors, postdoctoral staff at the agencies. After the 3rd session, counselors and client completed the Working Alliance Inventory to provide ratings of the bond, task, and goal dimensions of their alliances. Multivariate analyses yielded significant main effects for training level. Univariate analyses indicated no difference for bond but significantly higher ratings in the higher training levels for task and goal. Clients' ratings were highest at higher counselor training levels.

ANOTHER ONE:

Graduate training in psychotherapy: Are therapy outcomes enhanced?
Stein, David M.; Lambert, Michael J.
Journal of Consulting and Clinical Psychology, Vol 63(2), Apr 1995, 182-196. doi: 10.1037/0022-006X.63.2.182

Several sources of indirect evidence supporting the value of graduate training in psychotherapy are reviewed here. An updated meta-analysis of therapy outcome studies involving within-study comparisons of psychotherapists of different levels of training and experience is summarized. It is concluded that a variety of outcome sources are associated with modest effect sizes favoring more trained therapists. In many outpatient settings, therapists with more training tend to suffer fewer therapy dropouts than less trained therapists.

Again therapists with more training (ie. phd/psyd) have consistently better outcomes.