value of couples therapy training

[rlw23]

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My (phd clin psy) program is starting up a couples clinic next year. We're allowed to "specialize" in behavioral activation, exposure therapy, or couples therapy in addition to generalist training. I'm interested in health psychology and working in VAs or medical centers after I graduate.

Does anyone have any insight into how valuable or not valuable training in couples therapy would be considering my career goals?

My sense is that couples therapy is not as valued.

 

[G Costanza]

My little knowledge of the VA system would suggest that couple and family counseling experience would be valuable in that setting. From what I understand they recently began hiring more MFTs.

 

[AcronymAllergy]

I'd imagine that with that interest area and with the VA in mind, behavioral activation and exposure therapy experience will probably end up being used more frequently than couples therapy skills. All could of course come in handy, but I'd probably prioritize the other two areas (and/or gaining experience with brief, evidence-based interventions) over couples work. The VA has been hiring some MFTs and seems to be trying to do more family/couples-related work, but I still don't see a whole lot of it relative to the continued growth of PTSD clinical teams and primary care mental health. That, and even with the experience, there's still a possibility that they'd just refer to an MFT for that, and would prefer the psychologist to work more in exposure or prime care techniques.

That's just my take, though. Others more heavily involved in the health psych/bmed world can feel free to correct me if I'm wrong.

 

[Rorshocked]

My two cents is that you're lucky to have an opportunity to actually gain experience in couples therapy while in grad school. (I took a course on it, but was never able to put those skills into practice.) Plus, if you train in a VA for practicum or internship, you will likely have plenty of chances to do exposure therapy. But, if your program is offering specialization in Prolonged Exposure in particular, I'm sure VAs would look favorably on that. However, they also want to know there's still something they can offer you on internship and, a lot of times, that is primarily training in trauma-focused treatment.

Also, it is true, in my experience, that couples therapy is being saved for master's-level professionals in VAs (i.e., LCSW, MFT), but that could just be because doctoral-level psychologists haven't received that training or aren't as interested. My specialty is also health psychology and I think couples work can be very valuable in this population because of caregiving stress and other reasons.

 

[WisNeuro]

The VA is indeed incorporating more couples therapy options. But it seems to me that the majority of those cases are going to MFT's at the moment.

 

[HomeworkHelper]

Rlw23, I'm not sure how the "specialization" part of your program goes, but can you get more than one of the experiences you mentioned? If so, I would suggest exposure therapy first (because its big in the VA), and then couples therapy if that's what you're interested in. What does the generalist training consist of? That might be helpful to know in weighing your options.

 

[erg923]

Uh, how does one specialize in "behavioral activation?!" Can you also specialize in cognitive restructuring and activity scheduling? Its like specializing in session 4 and 5 of a 12 session protocol. I dont understand....

Whatever the case, if your interest is in health psych and working in the VA, then snatching up chances to do protocol based therapies like PE, CBT, CBT-I, and brief health behavior intervention will give you the best bang for the buck. Breath of training is always going to be important, but a lack of couples therapy certainly wont hurt you in the VA internship and job market. I currently head a PC-MHI clinic at a VA CBOC and my brief parle into couples therapy my first year of grad school was nowhere in the equation during my interview.

 

[thewesternsky]

@erg923 - Agreed, for the most part. It seems like an odd specialization. That said, I've definitely seen BA used as a stand-alone 6-8 week treatment for depression. (Christine Padesky advocates for this approach, especially for severe depression, in some of her recent CBT workshops).

 

[erg923]

@erg923 - Agreed, for the most part. It seems like an odd specialization. That said, I've definitely seen BA used as a stand-alone 6-8 week treatment for depression. (Christine Padesky advocates for this approach, especially for severe depression, in some of her recent CBT workshops).

I am aware that BA can be standalone, especially if there is alot of vegetative sx and the episode is acute and/or very circumstantial.

Nevertheless, its way way too specialized for a grad school "specialization. " And, to be frank, it aint that hard. BA is BA. Learning to run it with less than cooperative patients is an acquired clinical skill of course...one that comes with experience and utilizing a plethora of another clinical skills/competency. There should be no specializations at the grad school level that encourage, or increase the chances of, "if all you have is a hammer then everything is a nail."
At that level, it should be all about breadth of skill application within some broader circumscribed areas (e.g., health psychology/health behavior change).

 

[thewesternsky]

We're on the same page, then.

 

[joetro]

IBCT is being rolled out at many VAs, and a ton of relatively new couples/family therapy post-docs are starting to crop up at many VAs, beyond the ones like San Diego where they have already been established.