PhD/PsyD Whats the future of clinical psychology like?

[Pharmohaulic]

Is the future or outlook good or bad?

I keep hearing numerous things like the salaries aren't enough to keep up with the growing cost of getting the education necessary.. And that with mid-levels taking over more and more therapy and with NP's and psychiatrists able to prescribe meds that profession of psychology is going to go "belly-up" (as one clinician told me) unless there's a change.

Is this true?

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[smalltownpsych]

There are always problems, but that is not true. Psychological research is conducted by us and that isn't going anywhere. Neuropsychological assessments are done by us. Forensic evaluations typically require psychologists. Private pay people with money prefer psychologists for treatment. Many mental health organizations (should be more) prefer having psychologists in leadership positions. Even in providing psychotherapy which is what I do primarily at this time, I compete with many mid-levels and I don't have a problem keeping my schedule full. The more mid-levels there are and the easier it is to become one, the worse it will be for them and the better for us. Especially if we can control some of the high cost diploma mills from cranking out too many psychologists and decreasing our quality.

 

[Fan_of_Meehl]

Is the future or outlook good or bad?

I keep hearing numerous things like the salaries aren't enough to keep up with the growing cost of getting the education necessary.. And that with mid-levels taking over more and more therapy and with NP's and psychiatrists able to prescribe meds that profession of psychology is going to go "belly-up" (as one clinician told me) unless there's a change.

Is this true?

It has only been in the past couple of years that I've actually settled into a firm sense of gratitude that I chose a career in clinical psychology over medicine. I think the future for clinical psychology is bright indeed with the general public (and public policy, generally) beginning to really appreciate--and in some senses 'over- or mis-appreciate'--the influence of psychological variables on many issues of importance to society. Making your way through a doctoral program in clinical psychology puts you head and shoulders above most folks in terms of being able to separate the wheat from the chaff (the useful/valid information from the BS) in the area of mental health (which is awash in a sea of BS theories and trendy advice). I still don't think that we're generally compensated at a level that we deserve (but, hey, I'm biased and I imagine most people would say that about their own field), which I think is attributable to the fact that the majority of folks in mental health (not all, but the majority) can get away with providing low-effort 'supportive therapy' type interventions and charging as much (or more) than more high-effort evidence-based treatment. It also hurts us that people seem to have a real mental block to paying someone money for talk therapy...although they have no problem paying attorneys, accountants, interior decorators, etc. for their time (as professionals)...there's something uniquely under-valued about 'talk therapy.'

However, being able to make a pretty good living (financially speaking) in an office environment that allows you the opportunity to connect to patients-as-people (we still get to spend about 50 min per session with folks, which is enough time to have a 'real' encounter with them and not feel rushed) and provide them with an opportunity ('cause you can never do therapy FOR them or TO them...only WITH them) to grow, develop, and recover by teaming up with you (as you provide information and occasional guidance based on the best clinical science available) and rolling up their sleeves to confront difficult truths about themselves and live more authentic lives...this is an immensely rewarding experience that's hard to beat when you consider all the other forms of 'work' out there that people have to do to get paid and to pay the bills. Of course, there's the daily slog that you'll encounter in any profession--mindless bureaucracies, needless/endless documentation at times, ups and downs as you fall in and out of love with what you're doing (although I've never failed to 'fall back in love' with psychotherapy after being disenchanted for a few days/weeks...if I stop doing that, it will be time to do something different). Above all, I think that two main things keep me coming back for more:

1. I get to get paid for helping people in the context of them being at their most vulnerable and, therefore, most honest/authentic they can be...I have always found authentic conversations (you know, 'cut the bull****') to be very enjoyable and therapy offers a lot of those...and even when there is inauthenticity, you're still on a pathway TOWARDS authenticity as the patient's distress will tend to push them in that direction over time if you offer a safe, accepting, and authentic relational environment.

2. I get to exercise both humanism and technical/scientific aspects of my being and I get to read and study a broad range of subject matter that truly interests me and that I find fascinating and I get to call this 'work'

Finally, in a society that appears increasingly to be focused on who can 'con' people on the most consistent basis to 'make a buck' or to gain political/administrative power, it's really cool to be in a profession where you're actually trying to accomplish the opposite of that---you're trying to discover (and help you're client discover) the 'truth' as best you can make it out at all times. 'Cleverness' is not wisdom, as they say. This, I find, leads to very little difficulty being able to sleep at night since you're not trying to screw anyone over or pull the wool over anyone's eyes in the course of your workday--quite the opposite, in fact. And, at the end of the day, you can work 40 hour weeks, pay the bills, and have a life outside of work.

 

[deleted343839]

profession of psychology is going to go "belly-up" (as one clinician told me) unless there's a change.

The Department of Labor appears to think otherwise:

Employment of psychologists is projected to grow 19 percent from 2014 to 2024, much faster than the average for all occupations. Job prospects should be best for those who have a doctoral degree in an applied specialty.

http://www.bls.gov/ooh/life-physical-and-social-science/psychologists.htm

 

[Fan_of_Meehl]

The Department of Labor appears to think otherwise:

Employment of psychologists is projected to grow 19 percent from 2014 to 2024, much faster than the average for all occupations. Job prospects should be best for those who have a doctoral degree in an applied specialty.

http://www.bls.gov/ooh/life-physical-and-social-science/psychologists.htm

Add to this the fact that the efficacy of psychopharmacology for run of the mill anxiety and depressive disorders, in particular, has probably been oversold in the past few decades by big pharma and the whole 'decade of the brain' mantra from the 1990's...and the efficacy of evidence-based psychosocial interventions is solid while these interventions (e.g., behavioral treatment for insomnia) are grossly underutilized...I think there will be good prospects for those well trained in clinical psychology to do well in future job markets.

 

[Pragma]

So no one has referenced the fire and brimstone yet?

 

[WisNeuro]

Add to this the fact that the efficacy of psychopharmacology for run of the mill anxiety and depressive disorders, in particular, has probably been oversold in the past few decades by big pharma and the whole 'decade of the brain' mantra from the 1990's...and the efficacy of evidence-based psychosocial interventions is solid while these interventions (e.g., behavioral treatment for insomnia) are grossly underutilized...I think there will be good prospects for those well trained in clinical psychology to do well in future job markets.

To be fair, we've oversold our efficacy with depression a bit too. But yeah, we definitely have the market on things that actually work for anxiety and sleep problems. Medications actually just make things worse in most cases for that one. Doesn't stop irresponsible prescribing in the majority of settings, though.

 

[Ollie123]

I think the traditional "I book 45 minute outpatient therapy appointments and do nothing else" model is on the way out. And really by on the way out I just mean sinking reimbursement and difficult to derive as strong an income as available via other models (> 90k). So I guess fire and brimstone for the folks firmly committed to that being the one and only thing they want to do in their life.

Otherwise, I think its a fantastic time to be entering the field. Like most fields, we need to continue to evolve. Particularly on the research side of things, I expect tremendous growth in psychology in the coming years/decades. "Big data" is going to help us more than just about anyone.

 

[smalltownpsych]

It has only been in the past couple of years that I've actually settled into a firm sense of gratitude that I chose a career in clinical psychology over medicine. I think the future for clinical psychology is bright indeed with the general public (and public policy, generally) beginning to really appreciate--and in some senses 'over- or mis-appreciate'--the influence of psychological variables on many issues of importance to society. Making your way through a doctoral program in clinical psychology puts you head and shoulders above most folks in terms of being able to separate the wheat from the chaff (the useful/valid information from the BS) in the area of mental health (which is awash in a sea of BS theories and trendy advice). I still don't think that we're generally compensated at a level that we deserve (but, hey, I'm biased and I imagine most people would say that about their own field), which I think is attributable to the fact that the majority of folks in mental health (not all, but the majority) can get away with providing low-effort 'supportive therapy' type interventions and charging as much (or more) than more high-effort evidence-based treatment. It also hurts us that people seem to have a real mental block to paying someone money for talk therapy...although they have no problem paying attorneys, accountants, interior decorators, etc. for their time (as professionals)...there's something uniquely under-valued about 'talk therapy.'

However, being able to make a pretty good living (financially speaking) in an office environment that allows you the opportunity to connect to patients-as-people (we still get to spend about 50 min per session with folks, which is enough time to have a 'real' encounter with them and not feel rushed) and provide them with an opportunity ('cause you can never do therapy FOR them or TO them...only WITH them) to grow, develop, and recover by teaming up with you (as you provide information and occasional guidance based on the best clinical science available) and rolling up their sleeves to confront difficult truths about themselves and live more authentic lives...this is an immensely rewarding experience that's hard to beat when you consider all the other forms of 'work' out there that people have to do to get paid and to pay the bills. Of course, there's the daily slog that you'll encounter in any profession--mindless bureaucracies, needless/endless documentation at times, ups and downs as you fall in and out of love with what you're doing (although I've never failed to 'fall back in love' with psychotherapy after being disenchanted for a few days/weeks...if I stop doing that, it will be time to do something different). Above all, I think that two main things keep me coming back for more:

1. I get to get paid for helping people in the context of them being at their most vulnerable and, therefore, most honest/authentic they can be...I have always found authentic conversations (you know, 'cut the bull****') to be very enjoyable and therapy offers a lot of those...and even when there is inauthenticity, you're still on a pathway TOWARDS authenticity as the patient's distress will tend to push them in that direction over time if you offer a safe, accepting, and authentic relational environment.

2. I get to exercise both humanism and technical/scientific aspects of my being and I get to read and study a broad range of subject matter that truly interests me and that I find fascinating and I get to call this 'work'

Finally, in a society that appears increasingly to be focused on who can 'con' people on the most consistent basis to 'make a buck' or to gain political/administrative power, it's really cool to be in a profession where you're actually trying to accomplish the opposite of that---you're trying to discover (and help you're client discover) the 'truth' as best you can make it out at all times. 'Cleverness' is not wisdom, as they say. This, I find, leads to very little difficulty being able to sleep at night since you're not trying to screw anyone over or pull the wool over anyone's eyes in the course of your workday--quite the opposite, in fact. And, at the end of the day, you can work 40 hour weeks, pay the bills, and have a life outside of work.

Loved this post and just wanted to highlight the bolded because we don't emphasize the importance of this enough. I would also add that our knowledge and awareness of legal and ethical issues is another area where psychologists are head and shoulders above the crowd.

 

[smalltownpsych]

I think the traditional "I book 45 minute outpatient therapy appointments and do nothing else" model is on the way out. And really by on the way out I just mean sinking reimbursement and difficult to derive as strong an income as available via other models (> 90k). So I guess fire and brimstone for the folks firmly committed to that being the one and only thing they want to do in their life.

Otherwise, I think its a fantastic time to be entering the field. Like most fields, we need to continue to evolve. Particularly on the research side of things, I expect tremendous growth in psychology in the coming years/decades. "Big data" is going to help us more than just about anyone.

Ugh. Who would want to do that anyway? Probably mostly students who haven't quite done the real thing for 40 hours a week or part-timer private practice types who have less than half the productivity that I do. I have a job now where booking those psychotherapy appointments is about 80% of what I do and it is so awful that I almost look forward to the extra work when I am on-call at the hospital just for the change of pace. Just a couple more years of loan repayment funds and I am getting out of this gig to get back to where I want to be with a much more balanced mix of applying the broad skillset of a psychologist.

 

[bmedclinic]

OP,
I might get lambasted on here- but the future of clinical psychology to me seems to be inevitable- how it plays out is up for grabs. What seems inevitable to me is that many of us who work in the community will eventually be integrated into medicine (somehow). Whether you're integrated into primary care, bariatrics, pain, oncology, peds, etc, I think there will be a significant shift that way. And I dont think our training model is largely ready for that shift.

How it plays out remains to be seen. Will RxP come through? Will we be mid-level providers, or psychiatrist jr? Or a valued part of the integrated health team?

Note: I have a heavy bias, largely due to training in health psych and primary care psych. That's my game, so my bias is towards that.

 

[PsyDr]

Unlike most here, I have a fairly negative outlook for the profession. This is based on a few factors.

Demand dynamics:

1) Epidemiological studies indicate there is only so much mental illness to go around. In a given area, there will mean that there is X people who need treatment, of which a smaller percentage will want psychological interventions, of whom an even smaller group will have either the means and/or insurance to cover this.
2) Time: So long as the US continues to attempt to increase workers' productivity, taking time off from work will continue to be difficult for the average American worker. This will make engagement in psychological services difficult. Do people want to use PTO to get to a therapist once a week?
3) Preference: There are only so many people who prefer psychological services over other treatment modalities including medical and pastoral interventions

Supply Dynamics:

1) Midlevel stuff.
2) Increase in graduates from large cohort program.
3) The career span of psychologists seems to be longer, with many working well past 65 years of age. This hinders advancement for younger people entering the field, which propagates the cycle. This was not always the case. Also indicates something about the financial savvy of the last generation and their motivations/expectations should they be in leadership positions.

Lack of Innovation:

1) There seems to be little significant innovation in the field. Maybe some new psychotherapies, new tests. But we have not seen something on the level of the advent of objective personality measures or behaviorism for some time. I would count the Netflix algorithm as one of the most important things in the field in recent history.
2) If one looks at RxP, this is adoption of another field's model; not a unique advent.
3) Historically, psychology has thrived by innovation including participation in high level gov't stuff, marketing, celebrity participation, etc.

Economic Factors:

1) The increase in graduates from high tuition schools, has increased the number of people desperately taking low salaries. See Forbes study regarding the effects of a low starting salary.
2) If the older generation remains in positions of authority, there will be continued financial exploitation of the ECPs. 100k in 1990 dollars is substantially more than 100k in 2016 dollars.

 

[Ollie123]

Ugh. Who would want to do that anyway?

I think its mostly romanticized notions that don't map onto the reality of practice. I've long maintained that the diversity of the training is one of our biggest strengths - only doing one thing is quite limiting.

I also agree with the above post about integration with medicine. I'd actually push it a step further and say that integration across all fields (education, public health, engineering/computer science, etc.) is increasingly becoming the norm. The field will undoubtedly survive and those who continue to push the boundaries will thrive, but I don't think those looking for a cushy gig where they can "coast" will do very well. Positions like that still exist and may well continue to exist throughout our lifetime, but the model is changing. Of course, the same thing could be said about medicine, tech and many other fields that folks tend to have romantic notions about.

 

[entitlement]

Unlike most here, I have a fairly negative outlook for the profession. This is based on a few factors.


Lack of Innovation:

1) There seems to be little significant innovation in the field. Maybe some new psychotherapies, new tests. But we have not seen something on the level of the advent of objective personality measures or behaviorism for some time. I would count the Netflix algorithm as one of the most important things in the field in recent history.
2) If one looks at RxP, this is adoption of another field's model; not a unique advent.
3) Historically, psychology has thrived by innovation including participation in high level gov't stuff, marketing, celebrity participation, etc.

I agree with many of these points and will also add that we have major issues in regards to our training infrastructure, which includes all the diploma mill schools, as well as just in general the focus of many doctoral programs. We can no longer expect our clinical training to be primarily oriented toward treatment when we are competing against cheaper labor from LCSWs/LMFTs/LPCs - that ship sailed a long time ago. As others have mentioned, training future generations of clinical/counseling psychologists to tackle primary care and integrative medicine issues where we can have a bigger and more valuable impact is in my opinion, a better plan for our field's future - at least in regards to health care and how we fit within that paradigm. Right now is the time to carve out those specialties so that we have something that is our "bread and butter" aside from testing.

I would have to disagree though with saying there have not been any significant innovations in clinical psychology research in the last 10-15 years. I would say the dissemination and implementation science field has been a huge leap forward in regards to clinical science and has been largely driven by folks trained as clinical psychologists (e.g., Glasgow). In terms of research, the interdisciplinary approach is indeed the wave of the future and I think, at least from my experience, all the ECPs and grad students I've come across are largely on board. NIH and other major funding agencies are definitely on board. The only ones not moving with the times are those vestiges in the upper floors of the ivory tower clinging to their silos. Retirement and/or loss of funding will take care of those folks.

We are well poised as a field to be the facilitators of change, both at the research and clinical/health care levels, because of our flexibility and breadth of training. We need to do a better job as a field of selling that flexibility (and thus increasing its value), rather than continue to focus on being "treatment" providers (when treatment means therapy).

 

[PsyDr]

I would have to disagree though with saying there have not been any significant innovations in clinical psychology research in the last 10-15 years. I would say the dissemination and implementation science field has been a huge leap forward in regards to clinical science and has been largely driven by folks trained as clinical psychologists (e.g., Glasgow). In terms of research, the interdisciplinary approach is indeed the wave of the future and I think, at least from my experience, all the ECPs and grad students I've come across are largely on board. NIH and other major funding agencies are definitely on board. The only ones not moving with the times are those vestiges in the upper floors of the ivory tower clinging to their silos. Retirement and/or loss of funding will take care of those folks.

I can appreciate that, but I think we are referring to different ideas. I don't disagree with some of your points.

When I talk about innovation, I am comparing the more remote history of the field to today in terms of frank dollars and cents. For example, Anna Freud's marketing work, Skinner's pigeon guided missile, Murray's participation in OSS/CIA work, Hathaway's promulgation of the MMPI, Piaget's work in education, etc. I don't know what Hathway or Wechsler's families are pulling in on royalties, but I imagine they are doing a crap ton better than the average grant funded psychologist.

My personal take is that the academic field pays pretty poorly. There are some civil servants that make as much a the chair of psychology programs. That's a problem in my book.

 

[Ollie123]

Academics has always paid like crap relative to other options. That's pretty much true across fields (with the possible exception of fields where non-academic jobs don't really exist). There are a lot of pros, but finances usually aren't one of them. At least not in salary from the institution anyways. That said, its tough to compare apples to apples here. A successful AMC academic will probably do a better than someone seeing patients in an outpatient PP, but that's not likely to be their alternative career path anyways. They probably make less than the person who owns/runs the clinic.

That said, I really have no idea what the future holds there. The landscape is shifting, partnerships with industry and community are evolving. No better example than what just happened with Insel - that would have been an unheard of move 20 years ago but I don't think anyone batted an eye when the press release came out.

I agree that innovation in our field has been limited of late. I love ACT and mindfulness, bit these were not exactly mind-blowing breakthroughs when you look at treatment effect sizes. I think any major innovations are likely to come from partnering with tech (like everything else these days), but few psychologists are tech savvy.

 

[futureapppsy2]

Academics has always paid like crap relative to other options. That's pretty much true across fields (with the possible exception of fields where non-academic jobs don't really exist). There are a lot of pros, but finances usually aren't one of them. At least not in salary from the institution anyways.

That said, I really have no idea what the future holds there. The landscape is shifting, partnerships with industry and community are evolving. No better example than what just happened with Insel - that would have been an unheard of move 20 years ago but I don't think anyone batted an eye when the press release came out.

I agree that innovation in our field has been limited of late. I love ACT and mindfulness, bit these were not exactly mind-blowing breakthroughs when you look at treatment effect sizes. I think any major innovations are likely to come from partnering with tech (like everything else these days), but few psychologists are tech savvy.

Eh, I think in a lot of cases tech can be a bit overblown--so many apps that claim things, so little research on them, for example. Apps and internet programs can be awesome, but we need to test them well before claiming that they're good or effective psychological interventions, and app developers often don't.

 

[Ollie123]

Eh, I think in a lot of cases tech can be a bit overblown--so many apps that claim things, so little research on them, for example. Apps and internet programs can be awesome, but we need to test them well before claiming that they're good or effective psychological interventions, and app developers often don't.

Oh the things I was referring to is certainly not what is out there right now. What is out there right now is the opposite of innovation...its crap. Complete and utter crap. There is very little decent research on any of it. Condensing CBT into soundbites you can scroll through in an app is not innovation. Having cutesy figures read you those soundbites is not innovation. All of this can potentially be of some value, but its not a leap forward by any stretch of the imagination.

I'm more talking about ways we can harness mobile sensors for diagnosis/adaptive intervention. Better integration of mobile technology and even desktop-based technology with EMR systems. Computer-assisted diagnostics for us and non-mental-health providers. Stuff that is largely pipe dreams right now (I have several fantasy softwares/devices I pretend that one day I will have the time/resources/expertise to develop - anyone out there with strong backgrounds in both computer programming and bayesian statistics?), but if it happens it could actually be a leap forward.

 

[MJPsych]

I just wanted to say that I agree with the various opinions on integrated care being the future. I work in integrated care and currently everyone is jumping on that ship. The amount of SSRI's prescribed in primary care is insane, I think it's something like 90%, and at least half of all primary care patients have a behavioral health issue (whether that be a traditional mental health issue like depression or a behavioral plan for managing their diabetes). These are people that will never make it into a specialty mental health practitioners office. It's worth it to be informed about PCMH. Because of these trends, I speculate that board certification will become more of a requirement in the future. When I view jobs in many medical settings they are requiring an ABPP or obtaining one within 2 years.

 

[Therapist4Chnge]

We are well poised as a field to be the facilitators of change, both at the research and clinical/health care levels, because of our flexibility and breadth of training. We need to do a better job as a field of selling that flexibility (and thus increasing its value), rather than continue to focus on being "treatment" providers (when treatment means therapy).

100% agree. We have a unique skill set that fits well in leadership (with some additional mentorship). We need to stop clinging to therapy jobs and embrace the critical thinking skills, analytical skills, and emotional intelligence needed to be major players in organizations in and outside of healthcare.

 

[Justanothergrad]

100% agree. We have a unique skill set that fits well in leadership (with some additional mentorship). We need to stop clinging to therapy jobs and embrace the critical thinking skills, analytical skills, and emotional intelligence needed to be major players in organizations in and outside of healthcare.

Agreed, and in conjunction - there is a push towards MA level providers because of the cost to see one/have one as an agency member. However, the other side of that is that I'm not convinced giving up positions that we are qualified to work is a good practice either. It leads to a shrinking bank of jobs since there are far less admin jobs than therapist jobs in the world.

 

[Sanman]

What it the future? Partly sunny with a 50% chance of rain?

I agree with most of what is said here. As for who longs for the 45 min standard psychotherapy structure? I do as I mostly work in what is mostly integrated care and don't a breather from the fast pace. However, I feel this model is best utilized in a cash only part-time manner. It is a luxury rather than a reality for the majority of people and the expectation should be such. It is also an evening and/or weekend gig if you are concerned about filling slots with the greatest ease and using your time wisely.

The upcoming changes in the winds of healthcare is good for us if we position ourselves properly. Fee for service sucks for us as out codes are time based in a system that rewards procedure based healthcare. However, as the pendulum swings towards quality measures, we offer a lower cost (as compared to physicians) way of ensuring that compliance goals are met, patients adjust well to changes, and preventative care is more successful. I have been doing this inadvertently since internship from the day I joined the oncology residents for rounds and the Oncology attending said, Mr. ABC, here is the bad news, here is the medical plan, and here is Dr. Sanman to process that with you. The model works and provides a concrete, time limited need that is really missing in the role that psychologists play in healthcare today very often.