Future of the Clinical Psychologist Role

[PsychadelicChick]

Simple question, for those currently practicing or in doctoral programs: what will the role of the doctoral-level clinical psychologist be in the future? What will the clinical psychologist 20-30 years in the future do, esp. relative to other mental health providers?

--------------------------------------------------------------------------------------
What follows is my analysis of the current problem facing doctoral psychologists here in the America. Most probably already know why I'm asking this question, given the state of things--for those that don't, I'm including the tl;dr analysis based on what I understand to be some of the problems facing psychologists. Please don't nit-pick or speculate on the little things (ex: you don't think MSN-trained PMHNPs could ever out-therapy psychologists--might be true, but difficult to prove and probably irrelevant)--what matters is the big picture (i.e., the rampant role confusion) and what YOU think clinical psychology will look like 30-40 years down the road.

Caveat: I do not work in the field, but as a person in her late twenties with a good career interested in investing thousands of dollars and--more importantly--years of my life by applying to PhD programs in Clinical Psychology, I have devoted a great deal of time and resources in attempting to discover what the field will look like by the time I'm in the middle of my career.

We all know the reasons behind this question, but especially role confusion between the numerous kinds of providers who can [at least] bill for similar services. [ex: PMHNPs, LCSW, psychiatrists, and miscellaneous therapists]

The obvious fact that PMHNP programs often do not include extensive therapy training probably is not the most convincing rebuttal--they can catch up to become competent therapists faster than psychs can receive right to prescribe, if only due to legal limitations. Yes, PMHNPs' services currently focus almost exclusively on medication management, but only due to the dearth of psychiatrists (and other PMHNPs)--this could change with an increase of PMHNPs or psychiatrists, or telepsychiatry, which could lead to an interest in expanding their practices into therapy. Because of the same dynamic, it might become likely that medication management becomes less lucrative overall and psychiatrists rediscover their lost territory in therapy.

Further, the overall costs--economic, opportunity, etc.--of attending a challenging 5 year doctoral program versus pursuing an MSN or MSW, in (1) a shorter period of time, (2) perhaps while working, and (3) for a lower overall tuition cost makes the doctorate in clinical psychology prohibitive... prohibitive to the point of obsolescence.

Which brings us to the question: what distinguishes psychologists from other mental health providers?

1) Research and academia. This seems to be the "last redoubt" of psychology, as every college has a psychology department... On the other hand, there's a chicken-or-the-egg petitio principii fallacy behind this: historically, was psychology in itself an object of formal study, or did it become a field of study following the advent of therapy? It follows that as other fields lay claim on the practice of therapy (e.g., nurses and social workers), will Psychology Departments retain their academic stature?--or will it shift to more of a 'Biological Foundations of Behavior,' where medical doctors (i.e., psychiatrists) have an advantage? As primary care salaries plummet and match their colleagues in Continental Europe and the UK, would it be unreasonable for psychiatrists to pick up gigs adjuncting in community colleges?
2) Forensics. This seems like an awfully weak candidate for "last redoubt" of psychology--if, as mentioned above, universities shift their priorities to 'Biological Foundations of Behavior" over Psychology, wouldn't psychiatrists (assuming primary care salaries plummet, on schedule) seem like more likely candidates to opine in court on these matters?
3) Apex role. Right now, the most competent psychologists from the most prestigious universities are regarded as the experts in their field. While this is an impressive credential, is this not more a product of historical accident than institutional psychology's aggressive stance on adapting to protect its turf. Eventually the academic components of nursing and social workers will increasingly be found to have meaningful things to say about mental health and human behavior... and as their PhD-level personnel increase to train more master's-level personnel, it follows that their academic output (and the rigor of that output) will also increase.
4) Testing. Is this really something that only a psychologist can do?

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[PsychMajorUndergrad18]

Hello Psychadelic Chick,

I think this topic has been answered before in either this forum or in the MA/MSW forum. I would suggest looking through the forums to possibly find a thread on this topic.

 

[psych844]

Simple question, for those currently practicing or in doctoral programs: what will the role of the doctoral-level clinical psychologist be in the future? What will the clinical psychologist 20-30 years in the future do, esp. relative to other mental health providers?

--------------------------------------------------------------------------------------
What follows is my analysis of the current problem facing doctoral psychologists here in the America. Most probably already know why I'm asking this question, given the state of things--for those that don't, I'm including the tl;dr analysis based on what I understand to be some of the problems facing psychologists. Please don't nit-pick or speculate on the little things (ex: you don't think MSN-trained PMHNPs could ever out-therapy psychologists--might be true, but difficult to prove and probably irrelevant)--what matters is the big picture (i.e., the rampant role confusion) and what YOU think clinical psychology will look like 30-40 years down the road.

Caveat: I do not work in the field, but as a person in her late twenties with a good career interested in investing thousands of dollars and--more importantly--years of my life by applying to PhD programs in Clinical Psychology, I have devoted a great deal of time and resources in attempting to discover what the field will look like by the time I'm in the middle of my career.

We all know the reasons behind this question, but especially role confusion between the numerous kinds of providers who can [at least] bill for similar services. [ex: PMHNPs, LCSW, psychiatrists, and miscellaneous therapists]

The obvious fact that PMHNP programs often do not include extensive therapy training probably is not the most convincing rebuttal--they can catch up to become competent therapists faster than psychs can receive right to prescribe, if only due to legal limitations. Yes, PMHNPs' services currently focus almost exclusively on medication management, but only due to the dearth of psychiatrists (and other PMHNPs)--this could change with an increase of PMHNPs or psychiatrists, or telepsychiatry, which could lead to an interest in expanding their practices into therapy. Because of the same dynamic, it might become likely that medication management becomes less lucrative overall and psychiatrists rediscover their lost territory in therapy.

Further, the overall costs--economic, opportunity, etc.--of attending a challenging 5 year doctoral program versus pursuing an MSN or MSW, in (1) a shorter period of time, (2) perhaps while working, and (3) for a lower overall tuition cost makes the doctorate in clinical psychology prohibitive... prohibitive to the point of obsolescence.

Which brings us to the question: what distinguishes psychologists from other mental health providers?

1) Research and academia. This seems to be the "last redoubt" of psychology, as every college has a psychology department... On the other hand, there's a chicken-or-the-egg petitio principii fallacy behind this: historically, was psychology in itself an object of formal study, or did it become a field of study following the advent of therapy? It follows that as other fields lay claim on the practice of therapy (e.g., nurses and social workers), will Psychology Departments retain their academic stature?--or will it shift to more of a 'Biological Foundations of Behavior,' where medical doctors (i.e., psychiatrists) have an advantage? As primary care salaries plummet and match their colleagues in Continental Europe and the UK, would it be unreasonable for psychiatrists to pick up gigs adjuncting in community colleges?
2) Forensics. This seems like an awfully weak candidate for "last redoubt" of psychology--if, as mentioned above, universities shift their priorities to 'Biological Foundations of Behavior" over Psychology, wouldn't psychiatrists (assuming primary care salaries plummet, on schedule) seem like more likely candidates to opine in court on these matters?
3) Apex role. Right now, the most competent psychologists from the most prestigious universities are regarded as the experts in their field. While this is an impressive credential, is this not more a product of historical accident than institutional psychology's aggressive stance on adapting to protect its turf. Eventually the academic components of nursing and social workers will increasingly be found to have meaningful things to say about mental health and human behavior... and as their PhD-level personnel increase to train more master's-level personnel, it follows that their academic output (and the rigor of that output) will also increase.
4) Testing. Is this really something that only a psychologist can do?

Simple question, for those currently practicing or in doctoral programs: what will the role of the doctoral-level clinical psychologist be in the future? What will the clinical psychologist 20-30 years in the future do, esp. relative to other mental health providers?

--------------------------------------------------------------------------------------
What follows is my analysis of the current problem facing doctoral psychologists here in the America. Most probably already know why I'm asking this question, given the state of things--for those that don't, I'm including the tl;dr analysis based on what I understand to be some of the problems facing psychologists. Please don't nit-pick or speculate on the little things (ex: you don't think MSN-trained PMHNPs could ever out-therapy psychologists--might be true, but difficult to prove and probably irrelevant)--what matters is the big picture (i.e., the rampant role confusion) and what YOU think clinical psychology will look like 30-40 years down the road.

Caveat: I do not work in the field, but as a person in her late twenties with a good career interested in investing thousands of dollars and--more importantly--years of my life by applying to PhD programs in Clinical Psychology, I have devoted a great deal of time and resources in attempting to discover what the field will look like by the time I'm in the middle of my career.

We all know the reasons behind this question, but especially role confusion between the numerous kinds of providers who can [at least] bill for similar services. [ex: PMHNPs, LCSW, psychiatrists, and miscellaneous therapists]

The obvious fact that PMHNP programs often do not include extensive therapy training probably is not the most convincing rebuttal--they can catch up to become competent therapists faster than psychs can receive right to prescribe, if only due to legal limitations. Yes, PMHNPs' services currently focus almost exclusively on medication management, but only due to the dearth of psychiatrists (and other PMHNPs)--this could change with an increase of PMHNPs or psychiatrists, or telepsychiatry, which could lead to an interest in expanding their practices into therapy. Because of the same dynamic, it might become likely that medication management becomes less lucrative overall and psychiatrists rediscover their lost territory in therapy.

Further, the overall costs--economic, opportunity, etc.--of attending a challenging 5 year doctoral program versus pursuing an MSN or MSW, in (1) a shorter period of time, (2) perhaps while working, and (3) for a lower overall tuition cost makes the doctorate in clinical psychology prohibitive... prohibitive to the point of obsolescence.

Which brings us to the question: what distinguishes psychologists from other mental health providers?

1) Research and academia. This seems to be the "last redoubt" of psychology, as every college has a psychology department... On the other hand, there's a chicken-or-the-egg petitio principii fallacy behind this: historically, was psychology in itself an object of formal study, or did it become a field of study following the advent of therapy? It follows that as other fields lay claim on the practice of therapy (e.g., nurses and social workers), will Psychology Departments retain their academic stature?--or will it shift to more of a 'Biological Foundations of Behavior,' where medical doctors (i.e., psychiatrists) have an advantage? As primary care salaries plummet and match their colleagues in Continental Europe and the UK, would it be unreasonable for psychiatrists to pick up gigs adjuncting in community colleges?
2) Forensics. This seems like an awfully weak candidate for "last redoubt" of psychology--if, as mentioned above, universities shift their priorities to 'Biological Foundations of Behavior" over Psychology, wouldn't psychiatrists (assuming primary care salaries plummet, on schedule) seem like more likely candidates to opine in court on these matters?
3) Apex role. Right now, the most competent psychologists from the most prestigious universities are regarded as the experts in their field. While this is an impressive credential, is this not more a product of historical accident than institutional psychology's aggressive stance on adapting to protect its turf. Eventually the academic components of nursing and social workers will increasingly be found to have meaningful things to say about mental health and human behavior... and as their PhD-level personnel increase to train more master's-level personnel, it follows that their academic output (and the rigor of that output) will also increase.
4) Testing. Is this really something that only a psychologist can do?

As mentioned, this topic has been discussed many times before, so might be useful to do a search. Nevertheless, some quick points.

1. The consensus on the forum has always been that if the goal is to do just therapy, go the Masters route. It does not take 5 years to be competent at providing talk therapy, so yes many Masters level providers are very good at providing it, but I'm sure Psychologists will continue to argue they are the best at it. As you said, who is the best provider matters little if there is agreement that competence exists at the Masters level.

So for this part, I'd suggest you are absolutely correct to assume that in the future talk therapy will not necessarily be perceived as the purview or even the main strength of a Psychologist.

2. The Phd is first and foremost a research degree that is meant to make you an expert at doing independent research and also understand and be a consumer of research that your peers produce. Second, yes, you'll learn how to administer psychological tests, and assessments are only allowed to be done by licensed Psychologists.

So first, it is the skills that you learn that are the real value.

I'd argue that research (and heck even clinical work) is heading into a more collaborative and inter-disciplinary direction. Furthermore, we are past the days of going back and forth on the question of is something primarily biological or environmental, because most things in life are a combination of the two. (it is sort of silly to argue otherwise).

So this notion of certain fields "winning" out is not something I believe in (and you can view this in a couple of very different ways that end up with the same result). First, the nature of inter-disciplinary work is that you have experts from very different and specialized fields working together and combining ideas to come up with new ways of seeing things. Ie think computational theory of mind ..seeing the human brain as an information processing system and that thinking = computing. So you have psychology "stealing" from computer science theory. OR. If you do have this phenomena where so many of the new ideas are combination of what are different fields, it may not make much sense to have distinct fields at all. It may just make more sense to teach certain skills on how we can just combine different things even better.

Either way, it re-enforces the fact that what makes a Psychologist valuable is the actual skill of doing and understanding research, and the critical thinking that comes with that..less so the content of what is learned. The fact of the matter is that we live in a time where access to information is easy and information is plentiful for even the average person, so it is the application of that knowledge and especially the creative application of that knowledge, is what is most important.

3. Cost (monetary) does not have to be a major consideration if you choose to attend a fully funded program. Many good programs offer full tuition remission (so no tuition) and a stipend (so money for being a TA or RA, which can work out to 12-30k per year) depending where you go.

4. If you want to increase your odds of having a job in the future, specialize as a Psychologist. An argument could be made that Generalist Psychologists may lose out on some jobs for some of the reasons you brought up ( ie other mental health providers can provide talk therapy)..but the general consensus seems to be that if you get into neuropsych, forensic, health psychology, rehab), these areas require a lot of expertise, and it is much much less likely that you would see Psychologists lose out in these areas.

 

[erg923]

1) Research and academia. This seems to be the "last redoubt" of psychology, as every college has a psychology department... On the other hand, there's a chicken-or-the-egg petitio principii fallacy behind this: historically, was psychology in itself an object of formal study, or did it become a field of study following the advent of therapy? It follows that as other fields lay claim on the practice of therapy (e.g., nurses and social workers), will Psychology Departments retain their academic stature?--or will it shift to more of a 'Biological Foundations of Behavior,' where medical doctors (i.e., psychiatrists) have an advantage? As primary care salaries plummet and match their colleagues in Continental Europe and the UK, would it be unreasonable for psychiatrists to pick up gigs adjuncting in community colleges?
2) Forensics. This seems like an awfully weak candidate for "last redoubt" of psychology--if, as mentioned above, universities shift their priorities to 'Biological Foundations of Behavior" over Psychology, wouldn't psychiatrists (assuming primary care salaries plummet, on schedule) seem like more likely candidates to opine in court on these matters?
3) Apex role. Right now, the most competent psychologists from the most prestigious universities are regarded as the experts in their field. While this is an impressive credential, is this not more a product of historical accident than institutional psychology's aggressive stance on adapting to protect its turf. Eventually the academic components of nursing and social workers will increasingly be found to have meaningful things to say about mental health and human behavior... and as their PhD-level personnel increase to train more master's-level personnel, it follows that their academic output (and the rigor of that output) will also increase.
4) Testing. Is this really something that only a psychologist can do?

1. Research is the cornerstone of psychology, obviously. So no, academic psychology isn't going anywhere.
2. No.
3. The premise to this is completely false.
4. No. Monkeys can test. Only individuals trained in psychometrics, stats, psychology, personality theory, intelligence, cognition/brain-behavior relationships should interpret it. What field gets this training?

 

[Ollie123]

1. Several incorrect premises. Academic psychology long predates psychotherapy. No one adjuncts at community colleges for the (piss poor) money unless they have few/no other options - salaries will have to fall a LOT further for that to happen. Biology is not synonymous with prescribing, nor are we likely to see it fully take over the field in our lifetimes anyways.
2. They serve slightly different roles in evaluations. That said, I agree its a narrow field and clinical psychology would have trouble if that became its sole focus. I can't imagine any situation where that would happen.
3. I'm not really sure what you are getting at here or what institutional prestige has to do with the broader point you are making. They are all somewhat different fields, with somewhat different approaches. Roles can certainly blur, but that's true for a lot of different fields and it doesn't mean one will go away. Will they all continue to evolve? Absolutely.
4. Testing - no. Assessment - yes (right now and sort of). Lots of folks are developing automated tools for doing so with minimal training, but these largely seem to be junk (at least that I have seen). I have yet to see a computer program that produces "canned" interpretations that isn't wrong more than its right. Of course, quality of care is at best peripherally relevant in our current healthcare system (unfortunately).

 

[PsyDr]

This is what happens when someone without familiarity of the actual factors of the profession tries to analyze something.

1) False premises.

A. Psychology as an academic field did not start with therapy. The converse is actually the case.

B. Assuming psychiatry's supremacy is a reductionist argument based upon understanding psychology as abnormal psych. This ignored psychphysics, cog, learning theory, etc which is not taught in psychiatry.

2) No. This postulate's foundation is lacking in understanding of basic forensic concepts such as daubert standards, in which psychology far outpaces psychiatry or other mental health fields.

3) this is incorrect. I'm guessing you are not familiar with nursing' theoretical foundations.

4) anyone with advanced training in cog psych, bio psych, test construction, stats, personality theory, the research base of the tests and populations under consideration, etc can perform testing. There are no other professions with that training. This is a reductionist argument that assumes you give a test and the results are spit out, which is not the case.

 

[PsychadelicChick]

2. The Phd is first and foremost a research degree that is meant to make you an expert at doing independent research and also understand and be a consumer of research that your peers produce. Second, yes, you'll learn how to administer psychological tests, and assessments are only allowed to be done by licensed Psychologists.

So first, it is the skills that you learn that are the real value.

I'd argue that research (and heck even clinical work) is heading into a more collaborative and inter-disciplinary direction. Furthermore, we are past the days of going back and forth on the question of is something primarily biological or environmental, because most things in life are a combination of the two. (it is sort of silly to argue otherwise).

So this notion of certain fields "winning" out is not something I believe in (and you can view this in a couple of very different ways that end up with the same result). First, the nature of inter-disciplinary work is that you have experts from very different and specialized fields working together and combining ideas to come up with new ways of seeing things. Ie think computational theory of mind ..seeing the human brain as an information processing system and that thinking = computing. So you have psychology "stealing" from computer science theory. OR. If you do have this phenomena where so many of the new ideas are combination of what are different fields, it may not make much sense to have distinct fields at all. It may just make more sense to teach certain skills on how we can just combine different things even better.

This may fit well for academia, where a "crowded room" can mean the cross-germination of ideas, but does this work for the clinical realm? I understand your prediction is that clinical psychologists might cede therapy as their centerpiece--but would this really be sustainable?

PhDs in Clinical Psychology might object to your quickness to cede this function. Imagine a world where therapy dried up to only a fraction of what it is for the income of many clinical psychologists--would PhD clinical psychologists appreciate having to function like their peers in academia, the majority of whom only derive income from university-level teaching in their chosen field? This is to say nothing of many PsyDs (and PhDs from less prestigious universities). In a word, there are not 6-10 teaching slots opening up at each university every year to accommodate the 6-10 scientist-practitioners graduating from each PhD program annually.

What I'm getting at is that even with the interdisciplinary approach, there is a zero-sum game at work. While a PMHNP and LCSW can both bring different things to talk therapy, a client will not go to a PMHNP for some good-old fashioned nursing therapy and then a LCSW for some solid social work therapy. Rather, they will stick with one practitioner. The same goes for forensics--there will be one seat on the stand, to speak for the client's mental state. Yes, psychologists have this pretty well locked down, for now...

This is what I meant by saying that PhDs from the most prestigious universities would continue to be unaffected, regardless of what lows the market for therapy falls to--there will always be professorships for Ivy League-trained psychologists. However, the educational-industrial complex is churning out psychologists (both PhD and PsyD) that it expects to meet the demand for the multitude of different applications psychologists fulfill today (e.g., therapy, teaching, research, forensics, tests, etc.). If the role of the psychologist is slowly being whittled down to pure teaching, is it not wise to only go to a top-10 university, where it would be reasonable to expect employment at most universities/research projects?

Either way, it re-enforces the fact that what makes a Psychologist valuable is the actual skill of doing and understanding research, and the critical thinking that comes with that..less so the content of what is learned. The fact of the matter is that we live in a time where access to information is easy and information is plentiful for even the average person, so it is the application of that knowledge and especially the creative application of that knowledge, is what is most important.

3. Cost (monetary) does not have to be a major consideration if you choose to attend a fully funded program. Many good programs offer full tuition remission (so no tuition) and a stipend (so money for being a TA or RA, which can work out to 12-30k per year) depending where you go.

This is precisely what I meant. Like lawyers and veterinarians, the existence of for-profit doctoral-level psychology programs allows students with marred academic records--deserved or not--to pursue their education... at a price. [N.B., this is not the case for me, but not that I am asking my original question on an industry-scale] This price is that they will essentially have what society still considers to be a "top shelf" job, but while being compensated using 1099MISC slave wage practices.

If the real hustlers in this profession are owner-operators (this is true for successful solo/small firm partner lawyers and vet clinic owners, as well), this practice of allowing a "for-profit" trained underclass essentially clips the wings of many of these would-be professionals by crippling all but the wealthiest with debt. For these unlucky souls, private clinics don't get opened, speaking tours and books are simply not an option.

On the other hand, although it remains to be seen (mainly as a result of demographics of the people drawn into these professions, I think--i.e., hate to say it, predominantly female "helper" or "save-the-world" types), those PMHNPs and LCSWs entering mental health with (1) less debt than any given for-profit psych doctorate, (2) generally more time of "real work" that can be put on, say, a mortgage or SBA loan app, and (3) more connections to a local community, might be found to have an edge in setting up and managing private practice clinics. They could even hire debt-laden psychologists to work for them. This is the effect of educational debt.

4. If you want to increase your odds of having a job in the future, specialize as a Psychologist. An argument could be made that Generalist Psychologists may lose out on some jobs for some of the reasons you brought up ( ie other mental health providers can provide talk therapy)..but the general consensus seems to be that if you get into neuropsych, forensic, health psychology, rehab), these areas require a lot of expertise, and it is much much less likely that you would see Psychologists lose out in these areas.

Very interesting, and I do intend to specialize in a genuinely underserved population. [/QUOTE]

 

[PsychadelicChick]

This is what happens when someone without familiarity of the actual factors of the profession tries to analyze something.

What happens? Forum stalwarts make snappy retorts to OP?

1) False premises.

A. Psychology as an academic field did not start with therapy. The converse is actually the case.

Would science exists for science's sake without engineering or technical applications? Perhaps, but probably not at the extent it is currently pursued and [big one] FUNDED. Likewise, psychology departments, without practical applications in arenas like therapy, testing, assessment, etc. would likely atrophy and shed personnel if there was no direct application of the theory... Think Philosophy departments.

If you're tracking William Wundt as the first academic psychologist, you'll note that he is remembered for establishing the first psychology lab--no, there wasn't a couch, but the practical intent of his research is clearly demonstrated by its subject (e.g., identification of mental disorders, brain-related issues). One academic generation later, his student founded the first clinic.

Simply following the money, would psychology departments continue to be as well-funded if their product (clinicians) lost their apex role?

B. Assuming psychiatry's supremacy is a reductionist argument based upon understanding psychology as abnormal psych. This ignored psychphysics, cog, learning theory, etc which is not taught in psychiatry.

The AMA has historically been an extremely strong union. If the scope of psychiatry does not include certain things (for instance, recently relinquishing its claim on talk therapy--to which it has historically given some distinguished practitioners), it is almost certainly because psychiatrists as a group do not consider it lucrative enough. For now 15min med management is lucrative enough--what if that is no longer the case?

By my (OK, admittedly, slippery slope) argument, it follows that if the acquisition of these skills would be properly incentivized, that psychiatrists would be on top of acquiring them.

2) No. This postulate's foundation is lacking in understanding of basic forensic concepts such as daubert standards, in which psychology far outpaces psychiatry or other mental health fields.

You're absolutely right, I do not have extensive exposure to forensics--but do I need it to point out that (1) it truly is a zero-sum game, as there is only one seat on the stand, (2) while it might be lucrative now, is this really where psychologists of the future can look forward to practicing, and (3) you mention the "daubert standards"--is that really enough of a 'moat' to keep out other practitioners, who might be intelligent enough to acquire these skills piecemeal, without the doctoral experience (speaking mainly of psychiatrists here)?

On (3), I'll just leave you with this: most of the lawyers griping about the collapse of the legal industry assert that the digital revolution and rise of the millennial-generation are a big problem for the industry. Namely, a generation that is largely college-educated, comfortable expressing themselves in print, relatively good readers, and proficient at internet searches usurps many of the core skills of the attorney. Is this really the kind of moat that psychologists can put their trust in?

3) this is incorrect. I'm guessing you are not familiar with nursing' theoretical foundations.

If you're referring to nursing's hokey academic profile, please try to put this into its historical context. A generation ago, nursing was the destination of underachieving teenaged women--with the emergence of advanced practiced nurses effectively shouldering a good deal of what was formerly "medicine," there is a deluge of new intellectual talent into this field. Yes, currently many of the PhD-level nurses training the trainers and advanced practice nurses are relics of a time when nurses' scope of practice was restricted to making beds--this will change in your lifetime. If they haven't already, institutions are waking up and realizing that the lion's share of patients are now being treated by DNPs trained in a combination of pseudo-medicine and fluff... It is a matter of time before the PhD-level nurse educators match the task of educating the practitioners that are on the frontline of diagnosis and treatment.

 

[psych844]

What happens? Forum stalwarts make snappy retorts to OP?

I'm slightly confused about the intention/purpose of your thread. At first I thought it be that you wanted responses from people who work in this field or know a lot about it..but not so sure anymore. Yeah, maybe the responses are a bit snappy, but you certainly seem to have a lot of your mind made up.

 

[PsychadelicChick]

I'm slightly confused about the intention/purpose of your thread. At first I thought it be that you wanted responses from people who work in this field or know a lot about it..but not so sure anymore. Yeah, maybe the responses are a bit snappy, but you certainly seem to have a lot of your mind made up.

Please don't get me wrong, I'm appreciative of everyone's input who has responded, no matter how snappy.

What this thread is about: My purpose is the subject line and normal font size text in my OP. I want to know what practitioners and students in clinical psych programs see the role of clinical psychologist in 20-30 years.

What this thread is NOT about: I'm really not attached to my analysis--I know there's serious challenges to the field, you know there's serious challenges to the field... super, we all get it. [There was a reason the analysis was posted in smaller print] Now, in spite of those challenges, what do you think the profession will look like 20-30 years down the road?

This is not another whiny "help me decide to be a master's level clinician vs. PhD/PsyD"--yes, my mind is made up, I'm going to apply to PhD programs. I'm comfortable with the uncertainty of the challenges the profession is facing, BUT I'd be interested in knowing what the current practitioners see the profession trending toward.

Sorry if that was difficult to discern from my OP.

 

[PsyDr]

The problem is that you are coming across as condescending, while simulataneously arguing using incorrect pieces of evidence. Instead of just asking "I believe that xyz. Do you think this will have any impact on the profession? Where do you think the profession is going?" You are implicitly stating "people with 20yrs of education in this field, let me teach you some things. So now that you know, where do you think the field is going?".


1) you're reducing the many products of psychology into 1-2, which is false.

A. there are many products that psychologist produce, including human factors engineering in such fields as software, cognitive psych in product design, educational psych in course design/spec Ed laws, etc.

B. You are wrong. Psychologists were asked to become therapist after ww2. They did not invent psychotherapy, they were drafted into it.

2). Saying it you are "leaving me with something" is ridiculously condescending. I do this for a living. Yes daubert is that important that it is a moat. The legal system has standard for evidence. Psychology has a unique ability over psychiatry in this. Without a basic understanding of forensics on your part, further discussion is useless.

3). Where is your evidence for any of this?

 

[PsychMajorUndergrad18]

I agree with what PSYDR is saying. Psychology is not just Clinical/Counseling Psychology. Psychology is more than just these two fields (athought these two are the most popular choices). Its a common misoconception that every Psychologist does therapy, assess mental illness and conduct research on mental illness. Clincial/Counseling Psychologists do this but there is also fields such as Social Psych, I/O Psych (which will be my future area after undergrad ), Cognitive Psych and Human Factors Psych just to name a few.

Now back onto the topic at hand: I agree with a lot of what was said before especially in regards to a lot of the fields can blur in some job duties and a few other points made by the people, no professionals and students, on this thread

 

[PsychadelicChick]

The problem is that you are coming across as condescending, while simulataneously arguing using incorrect pieces of evidence. Instead of just asking "I believe that xyz. Do you think this will have any impact on the profession? Where do you think the profession is going?" You are implicitly stating "people with 20yrs of education in this field, let me teach you some things. So now that you know, where do you think the field is going?".

I apologize that this is the way my posts came across. I blame part of the disconnect on the format being text, so you can't receive any inflection or exactly how flexible my tone is. My "analysis" is based on obsessively reading on my own and discussions with professionals who do work in the field--its an amateurish product, but that's something I readily admit. I didn't mean to assert it as "more true" than what the professionals here have experienced, but more of a starting point for where my frame of reference is operating out of.

I'm going to respond to your points below, but I would be more interested to know what your thoughts are on the original topic.

1) you're reducing the many products of psychology into 1-2, which is false.

If you revisit my OP and all foregoing posts, you'll see that I'm only concerned with Clinical Psychology. Yes, I referenced Psychology as a field-- in (1) of my OP--and I'm aware that it is a broad field with many applications and subspecialties. But what follows are genuine questions: Would Psychology departments remain as robust without Clinical Psychology? Would Clinical Psychology remain as robust without its practitioners being held as the apex professionals of therapy and other practical applications?

A. there are many products that psychologist produce, including human factors engineering in such fields as software, cognitive psych in product design, educational psych in course design/spec Ed laws, etc.

Sure, but you'll have to admit that the client-facing roles outside Clinical Psychology are extremely limited when compared to the number of opportunities associated with Clinical Psychology where therapy, assessment, and testing are concerned, wouldn't you? While there are certainly more than a few consulting, teaching, and research opportunities, how does the number of these positions compare to number of seats in chairs opposing couches (or supervising such operations)?

B. You are wrong. Psychologists were asked to become therapist after ww2. They did not invent psychotherapy, they were drafted into it.

Incidentally, our disagreement is over the term 'therapy'--when I initially wrote 'therapy' (which you responded: "A. Psychology as an academic field did not start with therapy. The converse is actually the case.") it was in the context of the basket of practical services clinical psychologists offer as opposed to research and academia. While you may be correct that therapy was only added as a staple of Clinical Psychology's inventory of services following WWII, the practical services offered by clinical psychologists certainly do extend to the days of Wundt.

But, OK, what would you say the net effect of being "drafted" into psychotherapy was for Clinical Psychology? Would you disagree that it raised the profile of Psychology and contributed to more jobs/funding for trained psychologists?

2). Saying it you are "leaving me with something" is ridiculously condescending. I do this for a living. Yes daubert is that important that it is a moat. The legal system has standard for evidence. Psychology has a unique ability over psychiatry in this. Without a basic understanding of forensics on your part, further discussion is useless.

Then I take it you are well-compensated for an extremely specialized, demanding line of work. That's an enviable situation to be in. What I wrote really wasn't meant to be demeaning, so let me put it this way: would you enjoy it if the bottom fell out of the market for therapy/etc. and clinical psychologists flocked en masse to forensics?--making forensics the "bread and butter" or chief sideline of the majority of clinical psychologists?

I'm sure you wouldn't, as it would likely drive down rates in a zero-sum market.

3). Where is your evidence for any of this?

Historical precedent--but do you genuinely disagree with this?

There are professors emeritus who weren't even allowed to use stethoscopes during their bedside days. Second-career nurses who are essentially medical school-applicant caliber are flooding into the field in record numbers. As a profession, nurses have been tremendously successful at improving their work product and then receiving belated recognition/compensation. This is just following the natural trajectory of the profession.

 

[PsyDr]

1) I disagree. There are many many ways to apply psychology to other fields. And many industries are willing to pay top dollar. The fact that there are more patient facing roles is a tautology. Most go into clinical psych to do psychotherapy. Consequentially, that is what most do when they graduate. That does not mean that there are fewer outside jobs. I make money consulting for a wide range of industries.

2)

A. yes, depts would remain robust. revenue comes from student enrollment which is rising and research grants, which the nih has now mandated to include interdisciplinary cooperation.

B. it changed the role of many psychologists. It did not enhance or decrease the role. For example: pigeon guided missiles.

3). More people coming into forensics would be an incredible boon for me. The job is substantially more difficult than therapy due to the legal requirements of evidence. Poor dilligance results in more work for opposing experts who do a good job. 90% of my work is trashing mental health experts who are not doing a good job. People flocking to the courts would result in more work for me.

4) more nurses is meaningless. First, there is limited to no history of psychotherapy training which is a limiting factor. Second, their stats courses are straight up bs. Third, their training is substantially shorter than psychologists. Fourth, the reimbursement is not worth their while. Fifth, rxp. Sixth, there are tons of other mid levels who have tried to overtake psychologists and have not been able to create any convincing arguments. Seventh, a little term called "malpractice" when you involve testing or bad therapy. Eighth, ah screw it.

I'm going to quit wasting my time. You're totally right. Avoid psychology like the plague, please. Thanks for being argumentative

 

[PsychadelicChick]

1) I disagree. There are many many ways to apply psychology to other fields. And many industries are willing to pay top dollar. The fact that there are more patient facing roles is a tautology. Most go into clinical psych to do psychotherapy. Consequentially, that is what most do when they graduate. That does not mean that there are fewer outside jobs. I make money consulting for a wide range of industries.

So C-suite types will be heard to bellow: "Get me a psychologist, NOW--ANY one will do!" Somehow I doubt that. You mention jobs in industry--like I/O? Like a division of psychology that already has its own practitioners, who went to school for that? While I'm not saying that a decrease in Clinical Psychology's profile will necessarily affect its sister disciplines, clinical psychologists can't be expected to secure these jobs with any reliability when there are already dedicated experts being trained to fill them (e.g., I/O, child psych, ed psych, etc.).

I'm sure some clinical psychologists can cross-train or market themselves in such a way to score gigs in industry, I'm not disagreeing with you. But in terms of a reliable number of jobs, specifically for Clinical Psychologists (i.e., the only kind I care about), I doubt there are enough such gigs to support them should the traditional lines of employment cease to exist in their current abundance. Further, this top drawer work will likely be dominated by top drawer consultants--what about the vast expanse of PhDs and PsyDs with middle-of-the-road pedigrees?

2)

A. yes, depts would remain robust. revenue comes from student enrollment which is rising and research grants, which the nih has now mandated to include interdisciplinary cooperation.

Talk about tautological: student enrollment is rising (i.e., largely to fulfill the multitude of practical applications Clinical Psychology offers), so therefore there's a need for more teaching/researchers regardless of whether Clinical Psychology remains an important employment venue? You're seriously contending that National Institute of Health money would keep rolling in, full steam ahead, if Clinical Psychologists no longer held their place as the apex of mental health professional?

B. it changed the role of many psychologists. It did not enhance or decrease the role. For example: pigeon guided missiles.

Speaking more to the role of Clinical Psychology, the dicipline, within academia and its effect on Psychology as a field--which is why this is relevant to my initial point.

3). More people coming into forensics would be an incredible boon for me. The job is substantially more difficult than therapy due to the legal requirements of evidence. Poor dilligance results in more work for opposing experts who do a good job. 90% of my work is trashing mental health experts who are not doing a good job. People flocking to the courts would result in more work for me.

This wouldn't make sense, as an increase of professionals entering forensics would likely increase the talent of your competition at some point.

4) more nurses is meaningless.

Not more--the caliber of personnel entering is increasing. Professionals considering a career change who once imagined nursing as bedmaking and handholding now see it as a cheaper, faster route to a physician-like role, and a good use of their talents.

First, there is limited to no history of psychotherapy training which is a limiting factor.

Improving.

Second, their stats courses are straight up bs.

Can be improved... by taking a better stats course.

Third, their training is substantially shorter than psychologists.

In theory, yes, their formal training is short, but in practice, this is often the opposite of the case, as many are veteran mental health nurses.

Fourth, the reimbursement is not worth their while.

The market will determine this, but cash-based practices exist.

Note also that "worth their time" is a much more flexible term for a PMHNP, many of whom have been working during their entire schooling and graduated debt-free. Compare this to physicians and psychologists, who spend years of opportunity and oftentimes excruciating ed debt that accompanies them throughout their early career.

Fifth, rxp.

Legally limited, and adds years and $$$ onto what is already a journey that is far too long and expensive for some.

Sixth, there are tons of other mid levels who have tried to overtake psychologists and have not been able to create any convincing arguments. Seventh, a little term called "malpractice" when you involve testing or bad therapy.

Physicians are still waiting to have the "last laugh" from the deluge of malpractice suits where nurse practitioners have eaten into their territory.

Eighth, ah screw it.

I'm going to quit wasting my time. You're totally right. Avoid psychology like the plague, please. Thanks for being argumentative

You clearly spend a lot of time in court.

I politely asked you several times to address my original question, but you chose to argue about minutiae and what I identified as semantic differences. That's fine, sorry this was a frustrating experience for you.

 

[PsychMajorUndergrad18]

Hello OP,

Based off of seeing some of your posts it seems to me that you don't really see the benefit in doing a Clinical Psych degree and only see the crappy aspects of getting the degree and then practicing as a Clinical Psychologist. You seem to identify more with a PMHNP so why don't you go with that? It seems to me that you came here with the intention of inferring about the future of clinical psych but are now arguing with a professional with years of experience and this seems to me that you are trolling on this subject.

Also what mental health RNs and what psychologist learn and do are a whole different ball game. A Mental Health RN usually starts in a BSN or a Associates program in Nursing and is trained in the various fields of nursing and usually is the one to administer medication, keep track of a patient's symptoms and also handle the patient's hygiene needs. Clinical Psychologists are trained in a narrowed down field of psychopathology and abnormal psychology and also learning how to assess a person for mental illness and do therapy.

 

[psych844]

If there is anyone on this forum that I would trust on a topic like this it is PSYDR.

 

[PsychMajorUndergrad18]

Me too. He has helped me a lot and I trust his advice and his experiences

 

[DynamicDidactic]

I think its really difficult to predict 20-30 years from now. Psychology is highly tied to what is happening in society. I don't think people in the 80s could have predicted what is happening nowadays.

 

[erg923]

Please don't get me wrong, I'm appreciative of everyone's input who has responded, no matter how snappy.

What this thread is about: My purpose is the subject line and normal font size text in my OP. I want to know what practitioners and students in clinical psych programs see the role of clinical psychologist in 20-30 years.

What this thread is NOT about: I'm really not attached to my analysis--I know there's serious challenges to the field, you know there's serious challenges to the field... super, we all get it. [There was a reason the analysis was posted in smaller print] Now, in spite of those challenges, what do you think the profession will look like 20-30 years down the road?

This is not another whiny "help me decide to be a master's level clinician vs. PhD/PsyD"--yes, my mind is made up, I'm going to apply to PhD programs. I'm comfortable with the uncertainty of the challenges the profession is facing, BUT I'd be interested in knowing what the current practitioners see the profession trending toward.

Sorry if that was difficult to discern from my OP.

Largely the same. Our role hasn't really changed in the past 50 years. Many other things will change, but the role will remain the same.

 

[deleted343839]

What will the clinical psychologist 20-30 years in the future do, esp. relative to other mental health providers?

I agree with erg. Maybe there will be a larger proportion of us in integrated care settings; maybe we'll have "physician" status in Medicare; maybe there will be a few more in healthcare administration or leadership roles. There will be new trendy therapies and diagnoses. But I see no reason to anticipate any truly fundamental shake-ups or structural changes.

 

[PsychadelicChick]

Hello OP,

Based off of seeing some of your posts it seems to me that you don't really see the benefit in doing a Clinical Psych degree and only see the crappy aspects of getting the degree and then practicing as a Clinical Psychologist. You seem to identify more with a PMHNP so why don't you go with that? It seems to me that you came here with the intention of inferring about the future of clinical psych but are now arguing with a professional with years of experience and this seems to me that you are trolling on this subject.

Also what mental health RNs and what psychologist learn and do are a whole different ball game. A Mental Health RN usually starts in a BSN or a Associates program in Nursing and is trained in the various fields of nursing and usually is the one to administer medication, keep track of a patient's symptoms and also handle the patient's hygiene needs. Clinical Psychologists are trained in a narrowed down field of psychopathology and abnormal psychology and also learning how to assess a person for mental illness and do therapy.

Undergraduate Student,

Please don't take this the wrong way, but re-read the first sentence in my thread.

I'm emphasizing this rather than ignoring your posts, because you clearly spent some time reading this thread and replying to what you understand my point to be.

...

But for those of you who agree with the post I'm replying to:

Please understand that my approach is to be realistic to the point of pessimism, because dollars and time ride on my conclusions. If some of my conclusions seem a little prickly, I think we can all agree that my approach would've benefited some of the people who now hold advanced degrees after a costly education (whether because of opportunity cost, lost wages, low ROI, or educational debt).

For instance, I was looking at an APA-published powerpoint that placed the percentage of Clinical and Counseling doctoral graduates at ~45% of all doctoral grads produced--to pretend that a drastic reduction in main street, client-facing therapy (and other such services) wouldn't (1) produce a glut of underemployed psychs and flood ancillary services (e.g., forensics), (2) reduce the number of job opportunities for teaching positions--nevermind the fact that most undergrads take psych classes because of their personal experiences with a therapist or expectations for what it's like (rather than desire to dive into research), etc. seems like a desire to win an argument and not present a sober reality to future psychs.

What I'm saying is that it's to the benefit of the applicant to put the profession on trial, and see what defense it can offer for its existence. Further, I was hoping to crowd-source the opinions and experience of multiple experienced practitioners and consider them. Audacious, but instructive. Sorry if this offended anyone.

 

[Ollie123]

Are you referring exclusively to how direct patient-care activities will be different in the coming years? That seems to be the case and its tough to answer. Likely not a lot. I imagine greater emphasis on EBP and some shift in settings (primary care, etc.). I do think there will be increasing squeeze in this realm for folks who are hell-bent on a traditional practice model of "I do one-hour therapy sessions all day in my private practice." There is always going to be room for that - particularly among those performing at the highest level - but I see it getting much more difficult in the near future.

I think the main change that will be coming is psychologists spending less time having direct patient contact. Administration is one piece, but dissemination/implementation, supervision (I increasingly picture setups akin to the "attending" in a hospital with residents - or in our case, master's level clinicians - handling much of the hands-on), non-profits, accountability organizations, government (DCF, CDC, FDA), etc. are all roles we are really ideally suited for and have MUCH less competition for (how many midlevels have anything approaching on our stats training?). Basically, positions that take advantage of our ability to function as both scientists and practitioners, rather than treating than the traditional "two hats" approach to the field.

I do think folks on this board tend to discount just how many jobs like the above are out there. They aren't easy to find just because they generally aren't advertising in the usual locations we'd think to look (and they aren't necessarily advertising for psychologists specifically), but they are definitely out there in increasing numbers, tend to pay well and folks I know who have gone that route have had tremendous success in finding work. Enough to mitigate increased competition from traditional hang-a-shingle private practices and a concordant reduction? Who knows...

I do think it is a VERY silly time for anyone to be entering the field looking to minimize their research training. Not everyone has to, should, or can plan on a research career, but I think its very important to be diversifying skills right now (just like a stock portfolio).

 

[PsychadelicChick]

No one adjuncts at community colleges for the (piss poor) money unless they have few/no other options - salaries will have to fall a LOT further for that to happen.
Positive?
3. I'm not really sure what you are getting at here or what institutional prestige has to do with the broader point you are making.
Clinical Psychology currently benefits from a multitude of employment settings for its doctoral-level practitioners. If these avenues were limited to strictly academia, institutional prestige would have the same role it plays in the employment of academics in every other field. So graduating from an elite or flagship state university would probably be a guarantee for employment--everyone else? Perhaps not so much...

 

[PsychadelicChick]

Are you referring exclusively to how direct patient-care activities will be different in the coming years? That seems to be the case and its tough to answer. Likely not a lot. I imagine greater emphasis on EBP and some shift in settings (primary care, etc.). I do think there will be increasing squeeze in this realm for folks who are hell-bent on a traditional practice model of "I do one-hour therapy sessions all day in my private practice." There is always going to be room for that - particularly among those performing at the highest level - but I see it getting much more difficult in the near future.

I think the main change that will be coming is psychologists spending less time having direct patient contact. Administration is one piece, but dissemination/implementation, supervision (I increasingly picture setups akin to the "attending" in a hospital with residents - or in our case, master's level clinicians - handling much of the hands-on), accountability organizations, government (DCF, CDC, FDA), etc. are all roles we are really ideally suited for and have MUCH less competition for (how many midlevels have anything approaching on our stats training?). Basically, positions that take advantage of our ability to function as both scientists and practitioners, rather than treating than the traditional "two hats" approach to the field.

I do think folks on this board tend to discount just how many jobs like the above are out there. They aren't easy to find just because they generally aren't advertising in the usual locations we'd think to look (and they aren't necessarily advertising for psychologists specifically), but they are definitely out there in increasing numbers, tend to pay well and folks I know who have gone that route have had tremendous success in finding work.

Sorry, you literally posted this as I noticed your first post and replied.

I find this post encouraging, and I can't thank you enough for addressing my actual question.

I like that there are a multitude of "less thought of" jobs for Clinical Psychologists. I've noticed and I appreciate the number of clinical psychologists who have managed to spin their way into what are pretty much I/O or other sub-fields--but, personally, I think it would be irresponsible to bet on this happening for myself.

One question, though, on the ascendency of psychologists to a more supervisory role: would prestige of alma mater play a big role in this? Namely, would lower tier, for-profit, and many PsyDs be shut out of these roles?

 

[PsychadelicChick]

Largely the same. Our role hasn't really changed in the past 50 years. Many other things will change, but the role will remain the same.

@erg, @placebo and @mama,

Thank you for the insight--no change sounds better than bad change!

 

[Ollie123]

Positive?

Yes. There is a whole movement going on right now because of the treatment of adjuncts. Its generally terrible. Folks don't pursue it if they have other options. I have never heard of a psychiatrist doing it (though I imagine there are a few). At a few thousand dollars for a semesters work, it would be a terrible financial move unless reimbursements fell enormously though some may do it for other reasons (interest, giving back, etc.).

RE: Supervisory roles - perhaps somewhat. Alma mater plays a role for most any job and a candidate from Harvard is going to fare better for most any job than one from East Idaho Community College (if such a school exists). To the extent that tier of school also seems heavily confounded with research training and emphasis on evidence-based practice, folks from those programs could have significantly more difficulty. I think its much less about prestige itself than it is about differences in the training emphasis. Prestigious schools almost necessarily have strong research training and emphasize EBP. Non-prestigious schools may or may not. My school certainly wasn't a "Harvard" but was a clinical science model program that emphasized the above heavily. I don't expect it will hurt me much down the line.

 

[PsychadelicChick]

Yes. There is a whole movement going on right now because of the treatment of adjuncts. Its generally terrible. Folks don't pursue it if they have other options. I have never heard of a psychiatrist doing it (though I imagine there are a few). At a few thousand dollars for a semesters work, it would be a terrible financial move unless reimbursements fell enormously though some may do it for other reasons (interest, giving back, etc.).

RE: Supervisory roles - perhaps somewhat. Alma mater plays a role for most any job and a candidate from Harvard is going to fare better for most any job than one from East Idaho Community College (if such a school exists). To the extent that tier of school also seems heavily confounded with research training and emphasis on evidence-based practice, folks from those programs could have significantly more difficulty. I think its much less about prestige itself than it is about differences in the training emphasis. Prestigious schools almost necessarily have strong research training and emphasize EBP. Non-prestigious schools may or may not. My school certainly wasn't a "Harvard" but was a clinical science model program that emphasized the above heavily. I don't expect it will hurt me much down the line.

I only asked about the adjuncting thing because my PSYCH101 professor (PhD Counseling Psych, from a not entirely bad program) way back (he owns and manages a rural clinic--the only in his area) adjuncted at a regional branch of a mid-tier college.

I'm also aware of several other psychologists who adjunct. That's the only reason why I asked.

 

[AcronymAllergy]

I only asked about the adjuncting thing because my PSYCH101 professor (PhD Counseling Psych, from a not entirely bad program) way back (he owns and manages a rural clinic--the only in his area) adjuncted at a regional branch of a mid-tier college.

I'm also aware of several other psychologists who adjunct. That's the only reason why I asked.

Some folks adjunct simply because they enjoy teaching, they see the pay as a nice bonus to their existing employment, and/or they are interested in some of the other potential benefits (e.g., "foot in the door" at the institution and with its faculty, such as for collaborative research; for the sake of affiliation; library and other services access; etc.). I would agree that few, if any, individuals would do it as their primary source of income if they have other options.

 

[smalltownpsych]

I personally have taught at a community college because I enjoy it and it also is good business to be involved in various aspects of the community. The extra couple grand were more like a bonus.

 

[WisNeuro]

I can't imagine adjuncting full-time unless I was so very desperate for work. Could probably make more money, and be less frustrated, doing bartending work.

 

[AcronymAllergy]

I've seen a blog and article or two from folks who are having to adjunct full-time. It doesn't sound enjoyable, but I'd imagine it beats unemployment.

There really does need to be a serious examination of the way adjuncting is used/treated by universities.

 

[Therapist4Chnge]

Pay for adjunct work is piss poor. People often do it for a change of pace (or as someone mentioned above maybe networking?), but it is definitely not economically viable in the long-term.

 

[deleted343839]

I'd like to adjunct on the side every now and then but if that were my only option to string together a career I'd go into a different line of work. I know someone who was in that boat and then went on to medical school.

 

[psych844]

I feel bad for the part-time profs at my Uni (especially those who've been doing it 10+ yrs). At my Uni they don't get their own office (they share office space), and I'm sort of sad to see a about 40yr old dude not be able to get a full time gig.

 

[ClinicalABA]

I personally have taught at a community college because I enjoy it and it also is good business to be involved in various aspects of the community. The extra couple grand were more like a bonus.

I do the same- Adjunct 1-2 evening graduate courses per semester. Keeps me connected and learning, and the additional 5-10k per semester is nice. Plus, it's kind of a requirement of my day job- the majority of students work for my company, and all the profs are adjuncts who also work for my company. For courses in applied work, I think it makes sense for instructors to be working in applied fields.

 

[smalltownpsych]

Simple question, for those currently practicing or in doctoral programs: what will the role of the doctoral-level clinical psychologist be in the future? What will the clinical psychologist 20-30 years in the future do, esp. relative to other mental health providers?

--------------------------------------------------------------------------------------
What follows is my analysis of the current problem facing doctoral psychologists here in the America. Most probably already know why I'm asking this question, given the state of things--for those that don't, I'm including the tl;dr analysis based on what I understand to be some of the problems facing psychologists. Please don't nit-pick or speculate on the little things (ex: you don't think MSN-trained PMHNPs could ever out-therapy psychologists--might be true, but difficult to prove and probably irrelevant)--what matters is the big picture (i.e., the rampant role confusion) and what YOU think clinical psychology will look like 30-40 years down the road.

Caveat: I do not work in the field, but as a person in her late twenties with a good career interested in investing thousands of dollars and--more importantly--years of my life by applying to PhD programs in Clinical Psychology, I have devoted a great deal of time and resources in attempting to discover what the field will look like by the time I'm in the middle of my career.

We all know the reasons behind this question, but especially role confusion between the numerous kinds of providers who can [at least] bill for similar services. [ex: PMHNPs, LCSW, psychiatrists, and miscellaneous therapists]

The obvious fact that PMHNP programs often do not include extensive therapy training probably is not the most convincing rebuttal--they can catch up to become competent therapists faster than psychs can receive right to prescribe, if only due to legal limitations. Yes, PMHNPs' services currently focus almost exclusively on medication management, but only due to the dearth of psychiatrists (and other PMHNPs)--this could change with an increase of PMHNPs or psychiatrists, or telepsychiatry, which could lead to an interest in expanding their practices into therapy. Because of the same dynamic, it might become likely that medication management becomes less lucrative overall and psychiatrists rediscover their lost territory in therapy.

Further, the overall costs--economic, opportunity, etc.--of attending a challenging 5 year doctoral program versus pursuing an MSN or MSW, in (1) a shorter period of time, (2) perhaps while working, and (3) for a lower overall tuition cost makes the doctorate in clinical psychology prohibitive... prohibitive to the point of obsolescence.

Which brings us to the question: what distinguishes psychologists from other mental health providers?

1) Research and academia. This seems to be the "last redoubt" of psychology, as every college has a psychology department... On the other hand, there's a chicken-or-the-egg petitio principii fallacy behind this: historically, was psychology in itself an object of formal study, or did it become a field of study following the advent of therapy? It follows that as other fields lay claim on the practice of therapy (e.g., nurses and social workers), will Psychology Departments retain their academic stature?--or will it shift to more of a 'Biological Foundations of Behavior,' where medical doctors (i.e., psychiatrists) have an advantage? As primary care salaries plummet and match their colleagues in Continental Europe and the UK, would it be unreasonable for psychiatrists to pick up gigs adjuncting in community colleges?
2) Forensics. This seems like an awfully weak candidate for "last redoubt" of psychology--if, as mentioned above, universities shift their priorities to 'Biological Foundations of Behavior" over Psychology, wouldn't psychiatrists (assuming primary care salaries plummet, on schedule) seem like more likely candidates to opine in court on these matters?
3) Apex role. Right now, the most competent psychologists from the most prestigious universities are regarded as the experts in their field. While this is an impressive credential, is this not more a product of historical accident than institutional psychology's aggressive stance on adapting to protect its turf. Eventually the academic components of nursing and social workers will increasingly be found to have meaningful things to say about mental health and human behavior... and as their PhD-level personnel increase to train more master's-level personnel, it follows that their academic output (and the rigor of that output) will also increase.
4) Testing. Is this really something that only a psychologist can do?

Sounds like a really complicated question that is somewhat loaded. In other words, it sounds like a "how long have you been beating your wife ?" type of question.
I work primarily as a psychotherapist with some assessment and consultation work. The hospital where I work wants psychologists in this role and it pays well. We also have a PMHNP and they do not have psychotherapy privileges. I know, I just reviewed those privileges as part of the peer review process. I also get referrals from MA level counselors in the community when patients are more severe. I also get people who self-refer to me because they believe that a psychologist has more expertise. Finally, I don't see the influx of mid-levels as that much of a threat because we do a much better job of ensuring both our competence and our reputation as psychologists. Ultimately, the consumer will decide who they will pay for their services and some of it will be based on science, some on marketing, and some on economics. I believe that psychologists are well-positioned in this ever-changing landscape, and at the same time, we need to keep vigilant and advocate for the health of our profession.

 

[Therapist4Chnge]

As long as people pursue competent training and specialize (in most anything), they should be fine. If they take on $300k in debt, and/or attend a bad program, and/or live in LA/CHI/NYC, and/or try and be everything to everyone....then that is a different story. People living in high-cost areas can still be fine, it just is more competitive and crowded (often w hacks and charlatans).