PhD/PsyD accelerated curriculum

[psych.meout]

Funny. When I am more sarcastic in my posts, trying to bring a little humour, you address the points seriously and want answers. When I make a totally serious post, with no jokes, and with valid points and things to think about, then I'm trolling.

When were you ever funny?

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[barryggg]

When were you ever funny?

You'll be a perfect candidate for a Phd program.

It will be like earning a Phd in clairvoyance. Lot of school, and lots of crap!

 

[PsychPhDone]

This conversation has seriously devolved, which is why I've been avoiding commenting. I can't find the reply now, but somebody else made a statement to benefit others earlier in their career who may be listening -- kudos to that commenter. For the sake of those folks who are considering this career path, just wanted to add my two cents, as well; I will not be engaging in argument on this thread beyond sharing my experience:

I am not the subject of the intended argument because I am one of those people who went for the PhD because I wanted to primarily conduct research but also some clinical work and teaching; I am the intended target of clinical science programs. I do some research in the area of clinical training but can't comment too much because it'll blow my cover. The short version: it's hard to do retrospective research on outcomes of PhD vs. masters because of how cases are allocated in naturalistic clinical settings (i.e., the more complex cases are usually given to those with more training), but there is an emerging literature on the role of education, training, and expertise on clinical outcomes. Furthermore, yes, medications are the most common treatment, but that doesn't mean we should just delegate the complex cases to psychiatrists for med management only. I feel sorry for those of you who haven't worked as part of a well-oiled interdisciplinary team. I feel valued in my work setting and regularly make a difference in patient outcomes (both physical and mental health) based on subjective patient and provider report as well as more objective outcomes, such as adherence to a life-saving medical regimen. Everyone on our team has a role and care improves because of where we overlap as well as where our training diverges.

I believe that masters-level practitioners have a place (an important place!) in mental health and can do a lot of stuff. I don't really see a point in creating some type of new credential for masters-levels psychologist or "clinical only PhD psychologist" because we already have several types of masters-level clinical practitioners. I recognize that this differs depending on jurisdiction, but if we're talking about the US, there are already many good options for masters-level training. If someone is only interested in clinical work, unless it's assessment, I usually steer them towards those options anyway. I am appreciative of the high level of training I have. I work in a setting in which complex cases are the norm, and I practice at the "top of my license" (caveat: not licensed yet, but you know what I mean). I am not just delivering interventions; I have the skill to evaluate the success of my clinical work based on real data. I develop new interventions and get to test them out using science. I know the pitfalls and limitations of research because I have done my own research, and I can interpret published articles better because I can read between the lines and ask the right questions. I have very strong training in assessment and diagnosis and have been able to consult on cases in such a way that has greatly changed the treatment trajectory. I train psychology trainees and medical residents, which effects the care of many patients in healthcare systems. Are the masters-level people I work with (LCSWs to be precise) not as good? No! They're great at delivering the care they deliver. But I offer something different. Even I were to abandon research and teaching at this point, I think my clinical skill is different than what masters-level programs offer. I admit I'm likely biased. Sounds like some in this thread just don't practice in a high-acuity, complex setting, which is totally fine. But there are settings in which having years of predoc training are beneficial.

About halfway through internship I thought I was totally over being a trainee and wanted to be let loose into practice, as least clinically. I was so over being a student. I'm deep into postdoc now and am so very grateful for my supervisors -- there is too much more to learn. Even if I had completed more clinical hours in my training, I'm not sure I would have become competent any faster. I am glad I got 6 years of training in grad school with exposure to different setting, patients, and supervisors along the way. I think there is a place for PhD level programs in training solid practitioners. And I think there is a place for masters-level practitioners. It's called an MSW or MFT or LPC.

The greatest impediment to practitioners, IMO, is not knowing what you don't know. That totally went whoosh over some heads in here (also props to whomever made that realization earlier). My extended time in training helped me become more aware of my limits. The practitioners that drive me absolutely bonkers are the ones who don't realize their limitations and gaps in knowledge. That should be a bigger part of training, from undergrad to fellowship, and I think everyone's in agreement about that.

If you have any questions about my experiences as you figure out your own career, you are welcome to send a private message my way and I'm happy to go into more detail.

 

[NeuroTrope]

This guy is a clear troll and not worth arguing with. That said, students and trainees might be reading this thread so I want to describe some of my recent work as a neuropsychologist. In the last couple months I:

Identified absence seizures in a college student who was seeking academic accommodations. Referred to neurology for diagnostic confirmation, put on appropriate medications to combat a lifelong history of working memory and processing speed deficits.

Conducted dementia evaluations for adults seeking DBS surgery, informed the risks of surgery for individuals with mild cognitive impairment.

Identified chronic cognitive impairment and areas of preservation of a bilateral cerebellar stroke victim.

Was the first to diagnose a somataform disorder in a patient who has been bounced around by various doctors for several years.

Conducted a bilingual evaluation (granted this is a niche area for me) for a young boy with a severe TBI and identified areas of strengths that can guide treatment planning.

"Cured" dementia in a patient that was misdiagnosed by a GP due to language/cultural barriers (this one was a year or so back).

As a one-year out professional, I find my work stimulating, valuable, and challenging. This is a fantastic field to be in.

 

[barryggg]

This guy is a clear troll and not worth arguing with. That said, students and trainees might be reading this thread so I want to describe some of my recent work as a neuropsychologist. In the last couple months I:

Identified absence seizures in a college student who was seeking academic accommodations. Referred to neurology for diagnostic confirmation, put on appropriate medications to combat a lifelong history of working memory and processing speed deficits.

Conducted dementia evaluations for adults seeking DBS surgery, informed the risks of surgery for individuals with mild cognitive impairment.

Identified chronic cognitive impairment and areas of preservation of a bilateral cerebellar stroke victim.

Was the first to diagnose a somataform disorder in a patient who has been bounced around by various doctors for several years.

Conducted a bilingual evaluation (granted this is a niche area for me) for a young boy with a severe TBI and identified areas of strengths that can guide treatment planning.

"Cured" dementia in a patient that was misdiagnosed by a GP due to language/cultural barriers (this one was a year or so back).

As a one-year out professional, I find my work stimulating, valuable, and challenging. This is a fantastic field to be in.

I'm actually laughing uncontrollably at this list. I guess you find it stimulating and challenging to tell people obvious stuff that they probably already knew. Ohhh you figured out areas of strength for someone with severe TBI...that's unbelievable! It's not a difficult task. I do it all the time.

Furthermore, you should not be giving people advice about risks of surgery. That is something that the real doctors already do..and it's a laughable service to offer and say "boy that was stimulating and challenging!"

 

[psych.meout]

I'm actually laughing uncontrollably at this list. I guess you find it stimulating and challenging to tell people obvious stuff that they probably already knew. Ohhh you figured out areas of strength for someone with severe TBI...that's unbelievable! It's not a difficult task. I do it all the time.

Furthermore, you should not be giving people advice about risks of surgery. That is something that the real doctors already do..and it's a laughable service to offer and say "boy that was stimulating and challenging!"

This is some sort of meta-troll, demonstrating everything that is wrong with scope of practice creep and providers practicing outside of their expertise while being overconfident and not understanding the nuance and complexity of the field. Andy Kaufman would be proud.

 

[NeuroTrope]

This is some sort of meta-troll, demonstrating everything that is wrong with scope of practice creep and providers practicing outside of their expertise while being overconfident and not understanding the nuance and complexity of the field. Andy Kaufman would be proud.

I really hope s/he is a troll at this point. The alternative...

 

[barryggg]

This is some sort of meta-troll, demonstrating everything that is wrong with scope of practice creep and providers practicing outside of their expertise while being overconfident and not understanding the nuance and complexity of the field. Andy Kaufman would be proud.

Think of what you're really saying..even though you refuse to address it directly.

You still need to address directly why advanced western nations (no dumber than Americans) refuse to understand this nuance you speak of? These nations have the CAPABILITY to make these changes.

Indirectly, you're suggesting two things. 1. These nations are putting their public at risk, and 2. you're suggesting that there is no way that they can competently train people with just an Undergrad or Masters.

You want a big part of the reason why they do things differently?

These nations understand that a lot of individual psychology comes down to how a society is set up, (norms, stigma, how it advantages and disadvantages some people over others in terms of economics/socially, etc) and they also understand that a lot of the mental health issues can be solved if people have access and if there is good coordination among different mental health providers. They also understand the importance of deinstitutionalization. So they work on this stuff...especially Nordic nations. And they are the happiest people in the world.

In fact, where you see the most mental illness is NA, (and especially US) and it is largely because 'experts' and institutions have way too much dominance over people. This is not a problem of providers not having enough expertise, it's a much larger problem, and one of those problems are experts themselves. The focus is on diagnosing people that have totally
normal reactions to their environment (aside from very serious mental disorder), and we do this because the focus is to label the person (because the expert is more concerned applying labels than helping..often these labels are a negative for the person.) In short, find me a poor person, and I'll find you a mental problem. This is WHAT WE ARE DOING.

Take this one study by Berkeley.

"
For this latest study, 612 young men and women rated their social status, propensity toward manic, depressive or anxious symptoms, drive to achieve power, comfort with leadership and degree of pride, among other measures.

In one study, they were gauged for two distinct kinds of pride: “authentic pride,” which is based on specific achievements and is related to positive social behaviors and healthy self-esteem; and “hubristic pride,” which is defined as being overconfident and is correlated with aggression, hostility and poor interpersonal skills.

And in a test for tendencies toward hypomania, a manic mood disorder, participants ranked how strongly they agreed or disagreed with such statements as “I often have moods where I feel so energetic and optimistic that I feel I could outperform almost anyone at anything,” or “I would rather be an ordinary success in life than a spectacular failure.”

Overall, the results showed a strong correlation between the highs and lows of perceived power and mood disorders.

“This is the first study to assess the dominance behavioral system across psychopathologies,” Johnson said. “The findings present more evidence that it is important to consider dominance in understanding vulnerability to psychological symptoms.”"

 

[erg923]

Think of what you're really saying..even though you refuse to address it directly.

You still need to address directly why advanced western nations (no dumber than Americans) refuse to understand this nuance you speak of? These nations have the CAPABILITY to make these changes.

Indirectly, you're suggesting two things. 1. These nations are putting their public at risk, and 2. you're suggesting that there is no way that they can competently train people with just an Undergrad or Masters.

You want a big part of the reason why they do things differently?

These nations understand that a lot of individual psychology comes down to how a society is set up, (norms, stigma, how it advantages and disadvantages some people over others in terms of economics/socially, etc) and they also understand that a lot of the mental health issues can be solved if people have access and if there is good coordination among different mental health providers. They also understand the importance of deinstitutionalization. So they work on this stuff...especially Nordic nations. And they are the happiest people in the world.

In fact, where you see the most mental illness is NA, (and especially US) and it is largely because 'experts' and institutions have way too much dominance over people. This is not a problem of providers not having enough expertise, it's a much larger problem, and one of those problems are experts themselves. The focus is on diagnosing people that have totally
normal reactions to their environment (aside from very serious mental disorder), and we do this because the focus is to label the person (because the expert
is more concerned applying labels than helping..often these labels are a negative
for the person.) In short, find me a poor person, and I'll find you a mental problem.

Take this one study by Berkeley.

Oh, I see what this is about now.

 

[psych.meout]

Think of what you're really saying..even though you refuse to address it directly.

You still need to address directly why advanced western nations (no dumber than Americans) refuse to understand this nuance you speak of? These nations have the CAPABILITY to make these changes.

Indirectly, you're suggesting two things. 1. These nations are putting their public at risk, and 2. you're suggesting that there is no way that they can competently train people with just an Undergrad or Masters.

Nope. That's not what I wrote at all. I was specifically talking about you being obtuse and making certain specific claims that fly in the face of psychological science and EBTs.

What I have consistently said is that the specific things you are talking about are examples of scope of practice creep and other problems we experience in the US, while also stating that we can't yet make direct comparisons of providers between different countries, because there isn't enough data or research.

You want a big part of the reason why they do things differently?

These nations understand that a lot of individual psychology comes down to how a society is set up, (norms, stigma, how it advantages and disadvantages some people over others in terms of economics/socially, etc) and they also understand that a lot of the mental health issues can be solved if people have access and if there is good coordination among different mental health providers. They also understand the importance of deinstitutionalization. So they work on this stuff...especially Nordic nations. And they are the happiest people in the world.

And Americans don't understand the importance of access to care, deinstitutionalization (you know, the thing we did in the 1980s), and other psychosocial variables?

In fact, where you see the most mental illness is NA, (and especially US) and it is largely because 'experts' and institutions have way too much dominance over people. This is not a problem of providers not having enough expertise, it's a much larger problem, and one of those problems are experts themselves. The focus is on diagnosing people that have totally
normal reactions to their environment (aside from very serious mental disorder), and we do this because the focus is to label the person (because the expert is more concerned applying labels than helping..often these labels are a negative for the person.) In short, find me a poor person, and I'll find you a mental problem. This is WHAT WE ARE DOING.

You're going need to support each of these wild claims that:
1. where you see the most mental illness is NA, (and especially US)
2. mental illness is largely because 'experts' and institutions have way too much dominance over people
3. The focus (of providers) is on diagnosing people that have totally normal reactions to their environment
4. That #3 is because the focus is to label the person
5. the expert is more concerned applying labels than helping..
6. often these labels are a negative for the person
7. "find me a poor person, and I'll find you a mental problem"
8. "WHAT WE ARE DOING" is pathologizing poverty

Take this one study by Berkeley.

Well, since you only quoted a section of this study without linking it, we can only go off of the supposed quote.
But let's address what is there anyways:

This is the first study to assess the dominance behavioral system across psychopathologies

So these are the results of one study which was the first to consider these "dominance" variables. When and where was it published? Was this a peer-reviewed journal? Have there been any replications of the study to verify its results? Have there been any follow-up studies?

For this latest study, 612 young men and women rated their social status, propensity toward manic, depressive or anxious symptoms, drive to achieve power, comfort with leadership and degree of pride, among other measures.

What are these measures that they used? Are these accepted measures that have been independently assessed for their validity and reliability or were they created by the authors for the purposes of the study?

As for the population, what exactly were their characteristics? Do these results have external validity for other populations, e.g. older adults and the elderly, non-Americans, etc?

Overall, the results showed a strong correlation between the highs and lows of perceived power and mood disorders.

Ok, but what is the direction of this relationship? Is it a causative one? Are there other variables mediating or moderating relationship?

“The findings present more evidence that it is important to consider dominance in understanding vulnerability to psychological symptoms.”

Your leap from this conclusion to your other claims, e.g. the ones I've enumerated here, is not at all justified.

Oh, I see what this is about now.

Yep, clearly, Americans are unaware of biopsychosocial variables and we can sidestep the entire issue we've been discussing throughout this thread, i.e. how to compare the training and expertise of providers in different countries.

 

[barryggg]

Oh, I see what this is about now.

Yeah..it's called reality.

 

[barryggg]

Yep, clearly, Americans are unaware of biopsychosocial variables and we can sidestep the entire issue we've been discussing throughout this thread, i.e. how to compare the training and expertise of providers in different countries.

No. It's not that Americans are unaware. They are very much aware. But the solutions are bad, and just makes the problem worse.

In North America, we've decided that there are 'experts' on how people think/how to live life, and we've stamped the seriousness of these people as experts by requiring a Phd standard. We've done this even though most of Psychology is about well off people labeling less well off people, people that fit norms labeling those that don't..which essentially maintains the dominance) We tell them that we can help solve their issues by essentially talking to them and we charge $200. We call that 'treatment'. We sound like psychics. We then make up tons of research (look at social psychology)..to help our cause. Or we do pointless research that proves the most obvious things. Traumatic events in childhood can be bad for people? Oh, wow really? Took you 10 years to figure that out? Stress is bad for people? Nooooo?! I thought it was amazing.

Point is, most mental health problems are largely solved through practical means, and the best way to solve them is not only through practical solutions, but to worry more about the system from top to bottom (income inequality, getting rid of stigma, more transparency, better coordination among mental health workers, etc).

That $200 that the poor person spends on us per hour could be much better spent on programs that equalize people's chances in life, and to get rid of the dominance of some people over others, or the govt over the people..and it get rid of a lot of the issues they have. This is why Nordic countries are some of the happiest people alive.

If an issue is very serious..well then this has nothing to do with any of these factors..it's mostly a biological problem that needs to be dealt with meds..but who knows there may be other solutions even for those cases.

 

[neurobain]

No. It's not that Americans are unaware. They are very much aware. But the solutions are bad, and just makes the problem worse.

In North America, we've decided that there are 'experts' on how people think/how to live life, and we've stamped the seriousness of these people as experts by requiring a Phd standard. We've done this even though most of Psychology is about well off people labeling less well off people, people that fit norms labeling those that don't..which essentially maintains the dominance) We tell them that we can help solve their issues by essentially talking to them and we charge $200. We call that 'treatment'. We sound like psychics. We then make up tons of research (look at social psychology)..to help our cause. Or we do pointless research that proves the most obvious things. Traumatic events in childhood can be bad for people? Oh, wow really? Took you 10 years to figure that out? Stress is bad for people? Nooooo?! I thought it was amazing.

Point is, most mental health problems are largely solved through practical means, and the best way to solve them is not only through practical solutions, but to worry more about the system from top to bottom (income inequality, getting rid of stigma, more transparency, better coordination among mental health workers, etc).

That $200 that the poor person spends on us per hour could be much better spent on programs that equalize people's chances in life, and to get rid of the dominance of some people over others, or the govt over the people..and it get rid of a lot of the issues they have. This is why Nordic countries are some of the happiest people alive.

If an issue is very serious..well then this has nothing to do with any of these factors..it's mostly a biological problem that needs to be dealt with meds..but who knows there may be other solutions even for those cases.

Just some thoughts after reading your last post.

1) People come to mental health professionals on their own volition, with the exclusion of individuals that are court mandated, but that is a different circumstance. They are free to come and go as they please. Behaviors outside of the norm is just one piece of the puzzle, although you are making it seem as if it is the entirety. What if a person is not in distress about his or her thoughts, emotions, or behaviors, or if they are not experiencing any form of dysfunction in their life? It would be hard to justify treatment based solely on them "not fitting the norm."

2) Therapy, when done correctly, is much more than just "talking to them." Sure, we are speaking with the patient, but this is targeted to address his or her problem(s). Ideally, treatment goals are discussed respectfully, and collaboratively. That is how I was trained at least. Nothing about that screams dominance. They can cease at any time. They can get a second opinion. They can decide to stay and modify treatment goals. Further, claiming we sound like psychics is a false equivalent. During a clinical interview, we are learning about the patient, and using this information to gain a perspective of his or her struggles. There is no mind reading or looking into the future here. Just using the information they provided to help paint a clinical picture that is then discussed with the patient. There is much more to therapy than the antiquated psychoanalysis of Freud and Jung.

3) Make up research? As in fabricate? Research in psychology and neuroscience is suffering from a replication crises, but that doesn't mean that 100% of the studies are false or inadequate. Just because something seems obvious, doesn't mean it is worth assuming. Your example of "Traumatic events in childhood can be bad for people? Oh, wow really? " is really just a straw man argument designed to invalidate clinical research. Studies tend to me much more complex and nuanced than you lead on. Exploring mediating and moderating variables, for example, in a study of childhood traumatic events could yield novel information on how to better target interventions, or why some people may be more resilient than other victims of trauma.

4) I agree that addressing large scale community issues is essential, and will likely reduce rates of mental health problems. Community psychology and community health psychology are two avenues that are addressing this. But instead of waiting for this panacea, wouldn't we be better off taking a multi-pronged approach?

5) What clinics have you worked at that poor people were charged $200? If they go to someone in private practice who does not offer a sliding scale, ethically the patient will have to be referred elsewhere. Having worked in both the poorest and richest parts of New York, I have seen a great variance in SES (i.e. homeless veterans to very rich CEO's and VIPs) for both therapy and neuropsychological assessment. All hospitals and clinics offered sliding scales depending on income level. There are also plenty of community based centers and University programs that will see people for free or close to free.

6) So if a patient goes to a therapist for $200, then that is $200 less for the communal pot to fix the community based issues? If that is the case, why don't to set up such a communal pot for collections to fix the societal issues at large? Because until someone does, then these patients will be subservient to the dominance of big government and psychologists.

7) It is difficult to compare Nordic countries and North America. Nordic countries are much more homogenous and with a much smaller population compared to the whole of North America. In just the US alone, there are significant subcultural differences between regions (i.e. south, north east, west coast, texas, etc.). It is difficult to come up with a solution that will work well in NY or Boston, and also Birmingham and Nashville, for example.

It seems like you have much disdain for the clinical and research aspects of clinical psychology. Forgive me, but why continue in this profession?

 

[psych.meout]

It seems like you have much disdain for the clinical and research aspects of clinical psychology. Forgive me, but why continue in this profession?

Because the Dunning Kruger effect exists?

 

[barryggg]

Because the Dunning Kruger effect exists?

Says someone who is pre-psychology....you follow the herd little buddy.

 

[psych.meout]

Says someone who is pre-psychology....you follow the herd little buddy.

Sorry, I forgot that you have all the answers and all these American psychologists are just fake doctors who are making things up and taking themselves too seriously.

 

[barryggg]

Sorry, I forgot that you have all the answers and all these American psychologists are just fake doctors who are making things up and taking themselves too seriously.

Reading comprehension will serve you well. I never said I had all the answers.

 

[barryggg]

It seems like you have much disdain for the clinical and research aspects of clinical psychology. Forgive me, but why continue in this profession?

Not disdain. I just feel the system doesn't have the patients in mind. And it's frustrating when people in the field don't get that. Instead, they just want to find ways to get more authority.

 

[psych.meout]

Reading comprehension will serve you well. I never said I had all the answers.

Not disdain. I just feel the system doesn't have the patients in mind. And it's frustrating when people in the field don't get that. Instead, they just want to find ways to get more authority.

Wow. Just, wow.

 

[barryggg]

Wow. Just, wow.

Where in that statement am I suggesting that I have all the answers? Are you using your psychic powers and somehow interpreting my words in your own way?