HELP! Thinking of dropping out

[Psychlover]

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I'm extremely upset about the situation below and would greatly appreciate any advice.

I am about to be a 2nd year in a "partially funded" Ph.D. program. I was originally told that 2nd year is fully funded with a stipend at interview day. Then I was told last semester that that was an exaggeration (or perhaps they just said "funded") and second year is about half funded. Then due to the economy, our department funding was cut, and TAships etc. were to be worth less, and there would be fewer. I was not worried, however, bc I did the best in my stats class, very well in all my other classes, and was all but promised a stats TA position. However, they ended up using FAFSA info to assign funding positions, and I ended up getting no funding for this year, due to my now unemployed husband's finacial info on my fafsa. I did my best to advocate for us and explained our current financial situation beforehand, but all my classmates (unmarried, but almost all of whom admittedly have parental/outside finacial support) received better funding than I did.

I've been having serious second thoughts about whether or not I want to continue. I will have to take out over 20 thousand for this year alone. I have also been disappointed in my program in many respects, especially in regards to "supportiveness" and research opportunities.

Before I applied to grad school, I was seriously considering going back to school for psychiatric nurse practitioning. If I started next year, it would still be about the same amount of time in school, and I'd make about the same amount of money. However, if I got into the state-school program I was looking into, the loan debt would be much lower. I'm aware that no one can help me with the issue of how much i'd enjoy these two career options, but how am I supposed to know if I like doing therapy before I even start? Sure, I imagine I will like it, but I also love the sciences, being active, and helping people in other ways as well.

Any and all advice is greatly appreciated!! Best of luck to everything else getting through these rough financial times.

 

[deleted176373]

Psych nurses do very well... I wouldn't be quick to discard that as a possible path, and yes, I would be very upset if I were you too... interesting question is would they "find" the money if you were to quit. After all, they do have an investment in you too.

Mark

 

[Ollie123]

I would be incredibly pissed off if that happened to me.

Whether or not psych is the best option for you isn't something we can answer. It certainly doesn't sound like this school is a good fit. If you want a hybrid, maybe ask about a leave of absence for a year since they weren't able to fund you and it sounds like your financial situation is rather tight. They might magically unearth some funding, or they might say nope, pay up or get out.

I don't believe people should pay a lot even for a good psych PhD, when the norm is to pay nothing (or near-nothing anyways). I certainly wouldn't pay 20k for a program I wasn't happy with to begin with because they didn't give me the funding they described. Remember, it might be a hurdle to overcome for admissions, but leaving this program doesn't automatically bar you from going into psychology.

 

[deleted176373]

Actually, an interesting tactic would be to "take time off" until they have funding again... LOL. That's not quitting the program but it's certainly drawing a line.

"I understand that these are difficult times, in light of that, I'm gonna take the next year off and come back when you have funding for me as you promised."

I am sure that this would not sit well with them, but I would find a way to hold their feet to the fire. It's a shame you didn't get something in writing regarding the promise of funding...

Mark

 

[JockNerd]

"I understand that these are difficult times, in light of that, I'm gonna take the next year off and come back when you have funding for me as you promised."

I would actually do this. 🙂 I wouldn't take that kind of bs.

I also agree with Ollie; I wouldn't pay 20k to get a PhD in psych from Yale, much less some program I didn't like. If the OP's goal is clinical work, an NP degree sounds like a great route to that. It would be better if the OP could have gotten the a masters from the program first, though.

 

[strad48]

The school is a business. What they want from you is that you direct money into their coffers. No matter if the source of the money is your pocket, parents, loans, research grants (which assumes an available labor pool) or the offset from cheap labor. Their gamble is that when school-generated aid doesn't make it through to you, you will fuss, but ultimately find other money because you won't want to forfeit the time and money you have already invested. Also, if you take a year's leave, or dis-enroll, what happens to your vacated slot? Would they be able to recoup the income loss by enrolling an additional first year? If the answer is no, they probably don't want you to walk away. (Just realize that it's not about you, personally!) Since you have options, and especially since you have an interesting alternate that wouldn't cost more in terms of time or money, you are in a pretty strong negotiating position.

 

[LM02]

This happened to my husband, albeit in a different discipline, and he pushed on. In hindsight, he absolutely should have taken a "leave of absence" for that year and pursued a job - even if it was simply at Starbucks. Instead, he racked up a good deal of debt that we are still recovering from. It hasn't ruined our lives or anything, but I hate having that hang over our heads and we do often say, "what if..." Even several years later.

Now if the program simply isn't for you, that's a bigger issue. It is hard, but not unheard of, to reapply and go somewhere else that is a better fit. The NP is also a great option, if it is something that really appeals to you! Good luck sorting it all out.

 

[WestIndiPsych]

Psychlover,

$20,000 more in debt is not change. It's good that you can see yourself in psychiatric nursing.. many people who have such issues end up feeling stuck because they don't see what else to do. Im not saying to leave, that is your choice and determines on how passionate you are about a psych PhD career vs. NP. By the way, Im with the others in that NP would be a great career option especially since that interests you!

Hope you make a sound decision.

 

[ela]

Man, commiseration setting in as Spring term looms.

My situation, details-lite:

Finished my masters in August. Began Counseling Psych PhD in August - to do so, moved (6hrs) away from my wife. Who has a great job, and who still lives in the house we own together.

Program is funded, but not great...tuition covered and a small stipend. Expect it to remain so. Expect to take 2.5 more years to finish coursework, then move again for Internship.

What has me worried is even after completing all of this, away from my wife, we will have to move AGAIN post internship - for an entry level psychologist job in a rapidly (if not declining) changing health-care climate. Meanwhile her career will continue on, and the smart thing (financially) to do will be to follow her trajectory.

THIS combined with the fact that my interests in psych lie more in clinical work than research/academia, has me seriously reconsidering continuing down the phd path. I did my masters prac at a UCC and really would like to do more of that; surveying the national jobs for UCC seems like PhD is required 90% of the time.

Today; slinging coffee and reading/writing in my off time is sounding more appealing than continuing the slog.

👎

 

[Therapist4Chnge]

You may not have to move again for post-doc, as there are many "informal" options to collect enough hours to be licensed. I'm not sure if you are pursuing a speciality area fo training, but as long as you aren't going for neuro, rehab, or forensic...you probably have a lot of flexibility following your internship year.

 

[PerhapsMaybeOk]

Psychlover,

$20,000 more in debt is not change..

it is if you invested in apple circa 2000. Anyway, I jest. Sounds like this situation is just bad luck. How about a grant?

 

[edieb]

Nurse Practitioner's make MUCH more money than a psychologist, have MUCH more job stability and are much more in demand. The equation looks like this:

Always fighting for a job, very little respect, poor job stability, endless years of training for very little reward, internship imbalance - Psychology

Employers begging you to work for them, respected, limitless stability, brief training, whether you get your degree or not is largely up to you - Nurse Pract

 

[Psychadelic2012]

Nurse Practitioner's make MUCH more money than a psychologist, have MUCH more job stability and are much more in demand. The equation looks like this:

Always fighting for a job, very little respect, poor job stability, endless years of training for very little reward, internship imbalance - Psychology

Employers begging you to work for them, respected, limitless stability, brief training, whether you get your degree or not is largely up to you - Nurse Pract

Exaggerations a plenty. No mention of options for self-employment/private practice, the difference in working/training environments (medical vs. office), etc.? A nurse is a nurse--some people aren't fit for that, trust me. It would be a HUGE downside to many people, for good reason.

 

[edieb]

No exaggerations, only facts.. Nurse Practitioners are independent providers in many states (and the number is growing yearly). Thus, they can work in their own practices in an office setting. Nurse practitioners are far more in demand than a PhD could ever hope to be and make much more money in the private sector (check out insurance rate reimbursements) and the public sector.

Just googled Psych NP Salaries which are around $100K and trending upward; the average psychologist salary is around 55-60 and trending downward

 

[Psychadelic2012]

No exaggerations, only facts..

Always fighting for a job, very little respect, poor job stability, endless years of training for very little reward, internship imbalance - Psychology

Employers begging you to work for them, respected, limitless stability, brief training, whether you get your degree or not is largely up to you - Nurse Pract

Always fighting for a job - Prove it. Always?? Always??
Endless years of training - Really? It is endless? It never ends?
Very little reward - Opinion, not fact.

Employers begging you to work for them - Prove it. Begging you??
Limitless stability - Again, limitless??

News Flash: Some people want to be trained as therapists and/or diagnosticians. When do you see a nurse practitioner in private practice as a therapist or doing testing? I've never seen it, although I admit to naivete that it may exist somewhere. Regardless, if you want to be a therapist/diagnostician, and you pursue nursing, you'll spend your training and days in the medical field with stethoscopes and needles. Not exactly something everyone wants to endure.

But, then again, if all you care about is making a large salary (and not the kind of work you do), then you're right--be a NP.🙄

 

[erg923]

Always fighting for a job - Prove it. Always?? Always??
Endless years of training - Really? It is endless? It never ends?
Very little reward - Opinion, not fact.

Employers begging you to work for them - Prove it. Begging you??
Limitless stability - Again, limitless??
.🙄

We are not doing CBT here, pal. No need to point to the distortions, as I am sure we are all sharp enough to know what Edieb meant. Some of it was opnion and will vary, but there is no denying that compared to clinical psychs....psych nurse practioner's training is more streamlined, more in demand, and more actively recruited/in need in the healtcare system.

 

[cara susanna]

Well, that is a good point about the training being entirely different. I don't want to be a psychiatric NP because I don't want that kind of training. SDN a lot of time acts like we all have a physician complex. I find it insulting because I chose this path for other reasons, ones that med school or NP/PA school can't fulfill.

 

[wigflip]

I'm extremely upset about the situation below and would greatly appreciate any advice.

I am about to be a 2nd year in a "partially funded" Ph.D. program. I was originally told that 2nd year is fully funded with a stipend at interview day. Then I was told last semester that that was an exaggeration (or perhaps they just said "funded") and second year is about half funded. Then due to the economy, our department funding was cut, and TAships etc. were to be worth less, and there would be fewer. I was not worried, however, bc I did the best in my stats class, very well in all my other classes, and was all but promised a stats TA position. However, they ended up using FAFSA info to assign funding positions, and I ended up getting no funding for this year, due to my now unemployed husband's finacial info on my fafsa. I did my best to advocate for us and explained our current financial situation beforehand, but all my classmates (unmarried, but almost all of whom admittedly have parental/outside finacial support) received better funding than I did.

I've been having serious second thoughts about whether or not I want to continue. I will have to take out over 20 thousand for this year alone. I have also been disappointed in my program in many respects, especially in regards to "supportiveness" and research opportunities.

The above sounds terribly familiar (though I'm in another discipline presently). I really feel for you (and ela, and others in similar boat). Some of our department's TAships have been cut and/or converted to "readerships" which pay much less and don't confer tuition remission. Little in the way of supportiveness and research opportunities. Kids with parental stipends and less research productivity get funded. Depending on the outcome of an upcoming regents meeting, our tuition could go up 80+%. If I stay, it could end up costing me well over $50,000 to finish a doctorate which would probably enable me to do little more than adjunct.

I'd suggest talking to Graduate Division--people's suggestion for taking a leave is a good one, but if your school is like mine, it's not an available option for anything other than dire, non-economic circumstances (death in the family, serious health problems--or research out of state). It used to be that you could take time off for other reasons, but not any more. 🙁

Good luck no matter what you decide. It's a tough time to be in school right now.

 

[Psychadelic2012]

Well, that is a good point about the training being entirely different. I don't want to be a psychiatric NP because I don't want that kind of training. SDN a lot of time acts like we all have a physician complex. I find it insulting because I chose this path for other reasons, ones that med school or NP/PA school can't fulfill.

Thank you.

 

[futureapppsy2]

Nurse Practitioner's make MUCH more money than a psychologist, have MUCH more job stability and are much more in demand. The equation looks like this:

Always fighting for a job, very little respect, poor job stability, endless years of training for very little reward, internship imbalance - Psychology

Employers begging you to work for them, respected, limitless stability, brief training, whether you get your degree or not is largely up to you - Nurse Pract

Plus, Psych NPs don't have to live in a shack in the woods. 😉

Although this field definitely has many serious issues--and I think many grad students go in blind to them--I agree with cara that the training a psychology PhD program offers is different than any other mental health field. IMO, for example, this is why I think research training in psychology grad school is so important--we aren't just training to be therapists or assessors but to be therapists and assessors who can understand, evaluate, and produce research that can advance the field, clinically and otherwise. I think programs that de-emphasize research training to the point where it is more or less non-existent are really missing a large part of what doctoral-level professional psychology training is meant to be, IMO--a field based in empirically validated practice that is constantly being refined through research. YMMV. I think FSPS in particular have the unfortunate tendency to attract a lot of students who are "scared" of research and "just want to help people," and while I have nothing against people who want to become clinicians, I think anyone who is doctoral-level psychologist should have a solid understanding and competencies in both research (including research production) and clinical work, regardless of whether their degree is a PhD or PsyD.

 

[Psychadelic2012]

Plus, Psych NPs don't have to live in a shack in the woods. 😉

Although this field definitely has many serious issues--and I think many grad students go in blind to them--I agree with cara that the training a psychology PhD program offers is different than any other mental health field. IMO, for example, this is why I think research training in psychology grad school is so important--we aren't just training to be therapists or assessors but to be therapists and assessors who can understand, evaluate, and produce research that can advance the field, clinically and otherwise. I think programs that de-emphasize research training to the point where it is more or less non-existent are really missing a large part of what doctoral-level professional psychology training is meant to be, IMO--a field based in empirically validated practice that is constantly being refined through research. YMMV. I think FSPS in particular have the unfortunate tendency to attract a lot of students who are "scared" of research and "just want to help people," and while I have nothing against people who want to become clinicians, I think anyone who is doctoral-level psychologist should have a solid understanding and competencies in both research (including research production) and clinical work, regardless of whether their degree is a PhD or PsyD.

Yeah, and how often do you hear of advance practice nursing training involving research? Totally different model of care--totally.

 

[audchik]

I can certainly see how these barriers can make you wonder if it's really worth it. Clearly we all love psychology here, but do you love it *that* much? Since there are many other priorities in life, this can be a hard question to answer. I'm struggling with that question myself and can only imagine how frustrating it can be to be halfway through your training only to realize that it's getting even more difficult.

 

[Therapist4Chnge]

I can certainly see how these barriers can make you wonder if it's really worth it. Clearly we all love psychology here, but do you love it *that* much? Since there are many other priorities in life, this can be a hard question to answer. I'm struggling with that question myself and can only imagine how frustrating it can be to be halfway through your training only to realize that it's getting even more difficult.

I think the challenge is the subjectiveness of "worth it". Financially it is almost never "worth it" if the alternative is another halfway decent white collar job in finance, IT, accounting, business, etc. Between wage loss/differences during the entirety of training (at least 6 years) and any debt acrued, it is actually quite hard to break even in the first 10+ years. Just be thankful you aren't me, I left a $100k+ career path to go into debt and be a psych/research minion for 8 years. Suze Orman would karate chop me if she ever caught wind of my negative net financial decision....but I think I will be a happier person in this career, so that has to count for something.

 

[Pragma]

I can certainly see how these barriers can make you wonder if it's really worth it. Clearly we all love psychology here, but do you love it *that* much? Since there are many other priorities in life, this can be a hard question to answer. I'm struggling with that question myself and can only imagine how frustrating it can be to be halfway through your training only to realize that it's getting even more difficult.

Good point. I finished my training and still wish there was more that I had known going in. I think it is easier for some students to gain access to important pieces of information before going to graduate school now. When I applied at a very young age, I didn't even know all of the right questions to ask.

I get frustrated with people who are overly dogmatic about some training issues and fail to back it up with a serious effort towards addressing economic concerns. I also get frustrated with more senior folks in the field who clearly avoided the issue because of either a) petty in-fighting in the field or between subsections of psychology, or b) they clearly benefitted from earlier, more advantageous billing practices and took advantage of it to get rich without producing much research to justify a lot of interventions that are out there.

Some people have just got their head in the clouds, yet our field is run by a culture of people who do not encourage people to ask questions about practical field matters or challenge their authority.

 

[Pragma]

I think the challenge is the subjectiveness of "worth it". Financially it is almost never "worth it" if the alternative is another halfway decent white collar job in finance, IT, accounting, business, etc. Between wage loss/differences during the entirety of training (at least 6 years) and any debt acrued, it is actually quite hard to break even in the first 10+ years. Just be thankful you aren't me, I left a $100k+ career path to go into debt and be a psych/research minion for 8 years. Suze Orman would karate chop me if she ever caught wind of my negative net financial decision....but I think I will be a happier person in this career, so there is always that.

Good visual

 

[edieb]

Psychiatric Nurse Practitioners ARE getting trained to do CBT. Matter of fact, in the V.A. where I work, the NP next door just got trained to do cognitive processing therapy for PTSD. Furthermore, the local medical school where I interviewed is hiring NPs, not psychologists, to conduct CBT-I for its insomnia center. As far as psychological testing, reimbursement rates have for this service have been in freefall for a long time...

Here is a link to a cbt training program (and there are many) to train NPs to practice cbt

http://npao.org/wp-content/uploads/2011/07/Medical-CBT-Certificate-Program.pdf
Very scary for us

 

[cara susanna]

Hiring NPs over psychologists to do CBT? Well, that's infuriating and depressing.

 

[LHDMMD]

If I'm remembering correctly, at my old job there was an entry level research assistant who was trained in CBT for a research study.

 

[erg923]

"Medical CBTassumes that interventions must be applied within normal medical appointments—which generally means 10-15minutes—and that the number of those appointments will often be fewer than ideal. It sensibly integrates lifestyle and psychological interventions. It assumes a minimal background training in psychology and is blissfully free of "psychobabble".​

You have got to be ****ting me!!!!​

 

[Psychadelic2012]

"Medical CBTassumes that interventions must be applied within normal medical appointments—which generally means 10-15minutes—and that the number of those appointments will often be fewer than ideal. It sensibly integrates lifestyle and psychological interventions. It assumes a minimal background training in psychology and is blissfully free of “psychobabble”.​

You have got to be ****ting me!!!!​

+1

Also, we have things like: "Certification requires the completion of four six-hour workshop modules, and a 75% grade on a multiple choice examination."

That's less than a one semester class, with a grade of "C". How is this comparable? Really, this just seems like medication management, according to the flyer. CBT can be used as an adjunct therapy to medical care for medical conditions, sure. It's not like they're specializing in doing therapy for mental illness. They are coming from a medical model--and this focus on short sessions just validates that. How frustrating.

 

[Pragma]

If I'm remembering correctly, at my old job there was an entry level research assistant who was trained in CBT for a research study.

Psychologists haven't set themselves up to argue against it, because of what you say.

Not only are bachelor's level (and less educated, in some cases) folks actually trained to do the "grunt" work (time-consuming but sometimes representing the actual assessment/intervention) in research studies by psychologists, but most clinical testing practices these days employ psychometricians.

I think it is fair for opponents of psychologists having exclusive testing rights to point out that our job can't be that tough if we only spend 5 minutes with a patient and write up our report while a bachelor's level person does all of the actual work.

 

[cara susanna]

But it's not difficult to administer tests, you really COULD train a monkey to do it. Interpreting them is difficult.

However, as someone currently working as a psychometrist, I think there is an advantage to knowing about the theory and statistics behind the test even when you're administering it. Also, my job would super easy if all I had to do was administer tests.

 

[Pragma]

But it's not difficult to administer tests, you really COULD train a monkey to do it. Interpreting them is difficult.

However, as someone currently working as a psychometrist, I think there is an advantage to knowing about the theory and statistics behind the test even when you're administering it. Also, my job would super easy if all I had to do was administer tests.

Well yes, a lot of people do not interpret the tests very well, and it does require training. But lots of psychologists are lazy and don't really interpret them well either, regardless of training.

It isn't a knock on psychometricians. To me, it reflects how some psychologists have physician syndrome and want to operate under the same kind of model of farming out the grunt work, while at the same time providing competing professions with justification for their ability to do testing as well. What's to stop them from taking a testing sequence in their respective programs if it becomes a moneymaker for their profession?

 

[Therapist4Chnge]

At the end of the day it comes down to lobbying...and most mid-level organizations (marriage & family therapist, counselors, social workers, etc) have been more effective at expanding their scope of practice, with NO CHANGE IN THEIR TRAINING. In contrast, the APA has failed to adequately protect the field against this encroachment. They have fought effective for some things, but not for the most important areas that threaten the long-term viability of the field. They want to play nice with mid-level providers, even if the mid-level organizations have been very blatant about their intent to encroach on our areas of treatment by expanding their scope of practice. We are now seeing the impact of the non-action.

NPs are not adequately trained to provide therapy...supportive or otherwise. What was described about is NOT what anyone would consider CBT therapy, and I have yet to see actual research that supports their version of the intervention. This is reason #1,304 why I got away from therapy-based work. Between falling reimbursement rates and encroachment from mid-levels, I don't see how a full-time psychotherapy practice can survive even 3-5 years from now.

 

[Pragma]

NPs are not adequately trained to provide therapy...supportive or otherwise. What was described about is NOT what anyone would consider CBT therapy, and I have yet to see actual research that supports their version of the intervention. This is reason #1,304 why I got away from therapy-based work. Between falling reimbursement rates and encroachment from mid-levels, I don't see how a full-time psychotherapy practice can survive even 3-5 years from now.

This is where I think the argument blows up a bit. Why not? I mean, as a PhD-trained clinical psychologist, I have an idea why, but you also don't need to have a PhD to do therapy.

In fact, you don't even really need a post-bachelor's degree at all in some states.

Without some agreed-upon standard of training with consistent legal merit, programs like this will pop up everywhere. We can say "That's not CBT" and complain condescendingly, but we don't walk the walk and operationalize things all that well.

Another issue: Training for these skills is not equal across graduate programs WITHIN psychology. I don't think I got very good CBT training, but never really cared since I never wanted to be a therapist and don't plan to do CBT. Everyone points to practicing within the realm of competence as the ethical thing to do, but you certainly know that psychologists will take a workshop (or not do any extra training) and think they are now "competent."

So, I think the "I know it when I see it" attitude that psychologists who have had training have towards these mid-level providers obviously makes sense, but it isn't useful. If we can't quantify what consitutes competence to practice a particular intervention (AND regulate it) within our own field, then how do we expect to have a compelling argument against NPs or other providers? Just because "we were first" to inherit psychotherapy from the psychiatrists?

I am sure us saying that you have to complete an APA-accredited competency exam in a particular intervention in order to provide that intervention within the APA ethics code would create a huge uproar among providers. That is because, despite all of our training in evidence-based work, there is an "art" to psychology and psychologists like their freedom to practice and alter interventions as they see fit. As a result of that attitude though, we get other professions saying "why not us?"

Hmmm....maybe I should stop ranting 😳

 

[Therapist4Chnge]

This is where I think the argument blows up a bit. Why not? I mean, as a PhD-trained clinical psychologist, I have an idea why, but you also don't need to have a PhD to do therapy.

In fact, you don't even really need a post-bachelor's degree at all in some states.

Without some agreed-upon standard of training with consistent legal merit, programs like this will pop up everywhere. We can say "That's not CBT" and complain condescendingly, but we don't walk the walk and operationalize things all that well.

...but we do. There is a real effort to implement and use EBTs whenever possible. The EBTs I have trained in all have manuals, a senior level clinician leading the training, tape review, on-going feedback & supervision, etc.

They are getting...a few workshop classes and MAYBE some type of exam, but many just offer the training in a weekend format.

Those are a little different, no?

 

[Pragma]

...but we do. There is a real effort to implement and use EBTs whenever possible. The EBTs I have trained in all have manuals, a senior level clinician leading the training, tape review, on-going feedback & supervision, etc.

They are getting...a few workshop classes and MAYBE some type of exam, but many just offer the training in a weekend format.

Those are a little different, no?

I agree that there are great EBTs out there with great training programs. But is that a standard set by the field in order to say you do CBT?

No. Many psychologists don't get that kind of specified training. They learn principles and do their own thing.

I wish things were more standardized in order for psychologists to claim expertise. Then it would be easier to argue with nonpsychologists.

 

[Psychadelic2012]

And you all aren't even talking about supervision--it's not just a lecture topic in school, it's real and useful and (dare I say) necessary for good treatment. Does the medical model even talk about such a concept?

 

[AnnoyedByFreud]

Nurse Practitioner's make MUCH more money than a psychologist, have MUCH more job stability and are much more in demand. The equation looks like this:

Always fighting for a job, very little respect, poor job stability, endless years of training for very little reward, internship imbalance - Psychology

Employers begging you to work for them, respected, limitless stability, brief training, whether you get your degree or not is largely up to you - Nurse Pract

This seems to be true in my neck of the woods as well (Pacific Northwest). It's one of the reasons why I decided not to pursue a PhD anymore but switch to psych NP. I applied to 6 direct entry programs (accepted to one so far, with interviews at 3 others) and really can't believe that so many people don't consider this route.

Also, while its true that some programs offer crappy therapy training, they're not all like that. I applied to top programs and many offer complete lifespan training (kids-adults, families, etc.) for med management and therapy. I can choose to specialize in DBT, CBT, addictions treatment, etc. if I want to. It's pretty flexible and they let you choose your practicum sites (which they set up) based on your interests. This isn't to say that psych NPs receive comparable therapy training to clinical psychologists (of course not!) I just wanted to clarify that there are good programs which train their students in EBTs. I plan on pursuing extra training/certification in EBTs (likely either CBT or DBT) after graduation.

 

[AnnoyedByFreud]

Always fighting for a job - Prove it. Always?? Always??
Endless years of training - Really? It is endless? It never ends?
Very little reward - Opinion, not fact.

Employers begging you to work for them - Prove it. Begging you??
Limitless stability - Again, limitless??

News Flash: Some people want to be trained as therapists and/or diagnosticians. When do you see a nurse practitioner in private practice as a therapist or doing testing? I've never seen it, although I admit to naivete that it may exist somewhere. Regardless, if you want to be a therapist/diagnostician, and you pursue nursing, you'll spend your training and days in the medical field with stethoscopes and needles. Not exactly something everyone wants to endure.

But, then again, if all you care about is making a large salary (and not the kind of work you do), then you're right--be a NP.🙄

Maybe it's because I live in an independent practice state, but there are many psych NPs in private practice here. The psych NPs I know who have private practices are doing very well and actually have so many patients that they're turning them away. They also do assessment and diagnosis... mostly med management, and therapy when they want to.

I think one reason psych NPs are in such high demand is that people who choose medical fields (MD/DO, PA, NP, etc.) tend to shy away from mental health/psych. 3% of NPs specialize in psych. Most psych-minded people that I know tend to choose masters level (LCSW, MFT, etc.) or doctoral level training, not training in health care. This has left a wide gap and need for people interested in mental health who receive medical training. Also, I think a lot of people don't know the psych NP option exists. When I told my psych research lab what my plans were, most of the grad students weren't aware that programs like this exist.

 

[PETRAN]

Psych NP is an interesting area but IMO it is quite different from a PhD in Clinical Psych, plus i'm not sure how many people would like to see a psych NP alone without visiting a fully certified clinical psychologist or a psychiatrist.

There are areas that Psych NPs can't go, e.g. clinical neuropsych and pediatric neuropsych, clinical health psych, forensic clinical psych etc. You can do a lot of complicated assessments and some good interventions e.g. cognitive rehabilitation for cognitive decline, various behavioral interventions like applied behavioural analysis for autism, sensory stimulation for learning disabilities, various forms of state-of-the-science psychotherapies-some of which are currently researched, etc. . Then, with a PhD in clinical psych you can do research, run experiments, observations etc. these things have little in common (if any) with Psych NPs and the majority of practicing MDs. Ofcourse if you don't like psychometrics and research then PhD in psych may not be for you and a Psych NP degree could ne just fine. Just to keep in mind that this could be a bit more "difficult" (and possibly with a higher degree of burn-out) in a day-to-day practice with more direct dirty-hand work (which ofcourse is very important) and probably less intellectual/academic stimulation (nothing wrong with that just pointing it out).

 

[futureapppsy2]

But it's not difficult to administer tests, you really COULD train a monkey to do it. Interpreting them is difficult.

However, as someone currently working as a psychometrist, I think there is an advantage to knowing about the theory and statistics behind the test even when you're administering it. Also, my job would super easy if all I had to do was administer tests.

Yep--test admin can be taught to pretty much anyone of average intelligence and verbal, sensory, physical, etc, functioning, given enough practice, though actually knowing *why* you're doing a subtest may help in trickier cases. Interpretation is much stickier.

Me, I love interpretation and integration but don't care for actual test administration at all. Otoh, I know people who actually do enjoy the "routine" of administration.

 

[Pragma]

Yep--test admin can be taught to pretty much anyone of average intelligence and verbal, sensory, physical, etc, functioning, given enough practice, though actually knowing *why* you're doing a subtest may help in trickier cases. Interpretation is much stickier.

Me, I love interpretation and integration but don't care for actual test administration at all. Otoh, I know people who actually do enjoy the "routine" of administration.

Some would argue that to adequately interpret, you ought to test as well. Obviously the tech model has been around for awhile and many folks do a good job with just an interview, but I personally think that something is lost when the more seasoned folks don't always get to observe things that they maybe should. Techs can be taught some things to look for, but it isn't quite the same thing.

 

[StellaB]

At the end of the day it comes down to lobbying...and most mid-level organizations (marriage & family therapist, counselors, social workers, etc) have been more effective at expanding their scope of practice, with NO CHANGE IN THEIR TRAINING. In contrast, the APA has failed to adequately protect the field against this encroachment. They have fought effective for some things, but not for the most important areas that threaten the long-term viability of the field. They want to play nice with mid-level providers, even if the mid-level organizations have been very blatant about their intent to encroach on our areas of treatment by expanding their scope of practice. We are now seeing the impact of the non-action.

NPs are not adequately trained to provide therapy...supportive or otherwise. What was described about is NOT what anyone would consider CBT therapy, and I have yet to see actual research that supports their version of the intervention. This is reason #1,304 why I got away from therapy-based work. Between falling reimbursement rates and encroachment from mid-levels, I don't see how a full-time psychotherapy practice can survive even 3-5 years from now.

I agree with a lot of what you're saying here, except that I don't see the mid-level practitioners being as big a threat as primary care physicians and big pharma. There is an excellent paper by NAPPP available online (http://nappp.org/White_paper.pdf) or you can find a condensed version in this month's issue of New Therapist (free online) - they really talk a lot about the encroachment of the traditional medical community on mental health, and how it results in reduced quality of care and increased costs. The spread of the ideology that mental health issues are all medically based undermines the foundation of psychology in a way that is far more damaging than the issue of mid-level practitioners offering affordable therapy.

 

[The Everglow]

the spread of the ideology that mental health issues are all medically based undermines the foundation of psychology in a way that is far more damaging than the issue of mid-level practitioners offering affordable therapy.

qft!

 

[psychgeek]

I agree with a lot of what you're saying here, except that I don't see the mid-level practitioners being as big a threat as primary care physicians and big pharma. .

There is a limit to the degree to which both groups will be able to push psychologists out of the therapy market. At the risk of being impolitic, psychologists are better at providing therapy than other clinicians, and ultimately people who can afford good therapy will pay to receive it from the best therapists available. While generalist clinics and hospitals may try to replace psychologists with masters level clinicians or rely on PCPs to provide the majority of psych services, patients who truly need psych services and can afford to pay for them without using insurance will not tolerate suboptimal psych care.

Anecdotally, the concentration of psychologists in fee-for-service practices and boutique clinics seems to have already started to happen in some of the bigger cities where therapy is traditionally highly valued (i.e. Chicago, New York, and San Francisco). Despite a strong commitment to social justice among my cohort from a Ph.D. program in Chicago, none of us were able to find jobs providing therapy or testing to underserved populations. Instead we ended up in boutique clinics serving high SES groups or academic positions (even if we would have rather worked in direct service). Of the ones who still provide direct service now, all of them either refuse to accept insurance or work for facilities that depend on insurance companies for very little of their funding. The only way they end up seeing people who can't afford to pay the fee directly is by sliding their scale. I know the same was true of the two cohorts that followed us, and I suspect it is also true of some of the more recent classes. As the general quality of psych service provided by clinics funded by insurance plummets, more and more people will be willing to pay a significant amount of money to secure more effective psych services from outside of their insurance networks, and this will increasingly become the domain of the therapists with the best credentials.

Even if it does work out for the few psychologists whose program's reputation grants them access to these jobs, it is horrifying to me that the system is evolving into one in which only the wealthy can afford mental health. Equally horrifying is the idea that new psychologists will face a sort of Hobson's choice between accepting a job where you contribute to the economically imposed health disparities that characterize our medical system or taking a job in which you provide no direct service at all.

Psych NPs are in high-demand, and they make a lot more money starting out than psychologists. However, psych NPs are paid a great deal because they are very profitable employees for hospitals and clinics-not because they are the best service providers for their patients. Their scope of practice covers most of what a psychiatrist and a psychologist can do, and one psych NP can replace two clnicians with expensive terminal degrees. That said, would anyone preferrentially see a psych NP over a psychologist and a psychiatrist? I am not sure I'd feel comfortable knowing that I was employed to provide a "good enough" substitute for optimal care to those who can't afford to make any other choice.

I don't think there is any easy choice here, but I do wonder if becoming an NP would really allow the OP to occupy the roll in society she wanted when she decided to become a psychologist.

 

[Psychadelic2012]

At the risk of being impolitic, psychologists are better at providing therapy than other clinicians

That's not what the research says. What basis do you have for making that statement?

 

[cara susanna]

That NAPPP article is fascinating and IMO makes some great points, but they make a lot of strong statements without much research support...

 

[AnnoyedByFreud]

That NAPPP article is fascinating and IMO makes some great points, but they make a lot of strong statements without much research support...

Agreed. I enjoyed reading it, but I found that they made many assertions without providing solid evidence that backs them up.