Where do you think the field is moving?

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gsberlin84

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First time posting.
Curious to see where people think the field of clinical psychology is moving in a general sense.
I'm freaked by two factors:
1) Graduate school competitiveness is creating an insulated environment. Eight students out of 400 applicants gaining admission to a program is absurd. There's a point where harsh competition ceases to produce good clinicians; the admission model for graduate training (PhD) is producing a farm for PIs to pick neurotic students willing to work for free in nothing more than a statistical crap-shoot.
2) Valuable research is being driven by hard science. Increasingly, the world of clinical is becoming dependent on neuroscience and psychiatry. In funding and outcome measures, we look towards pharma, fMRI, animal models and drug discovery. Psychologists can use neuro measures as correlates for behavior, but psychiatrists can fill the role of researcher and clinician more effectively.

Maybe I should maintain hope that the PhD in clinical psychology is a viable option for students nowadays, but its quickly looking like a dinosaur struggling to escape from tar.
 
I'm not a psychologist (I'm a social worker) but I have often wondered the same thing, although I didn't know to put it in those terms.

From my perspective, it seems like the PhD in Clinical Psychology could easily be "phased out" in terms of employment prospects by the other things you mentioned. There are other degree/license combinations that work better for therapy and others that work better for research.
 
I'm not a psychologist (I'm a social worker) but I have often wondered the same thing, although I didn't know to put it in those terms.

From my perspective, it seems like the PhD in Clinical Psychology could easily be "phased out" in terms of employment prospects by the other things you mentioned. There are other degree/license combinations that work better for therapy and others that work better for research.

Note, of course, that the world's #1 employer of psychologists, the VA, is apparently under marching orders from Congress to begin phasing out psychologists for therapist positions.
 
I'm not a psychologist (I'm a social worker) but I have often wondered the same thing, although I didn't know to put it in those terms.

From my perspective, it seems like the PhD in Clinical Psychology could easily be "phased out" in terms of employment prospects by the other things you mentioned. There are other degree/license combinations that work better for therapy and others that work better for research.

A lot of people believe that Masters-level therapists do not have adequate training for therapy. And what degrees work better for research? I can't really imagine what other type of degree would fit my research.
 
][/I]A lot of people believe that Masters-level therapists do not have adequate training for therapy. And what degrees work better for research? I can't really imagine what other type of degree would fit my research.

Is there any evidence to back this up? I'm curious, because I, too, am inclined to believe that PhD level psychologists should provide superior therapy. I'm wondering if they have done any studies to compare masters level therapy providers w/PhD level providers?
 
Is there any evidence to back this up? I'm curious, because I, too, am inclined to believe that PhD level psychologists should provide superior therapy. I'm wondering if they have done any studies to compare masters level therapy providers w/PhD level providers?

As far as I know, the research thus far doesn't support the existence of a substantive difference. Then again, I don't know if anything has actually delineated degree type of provider, or was even more specific and looked at length/depth of training. Plus, at least as best I can remember, outcome measures might potentially leave something to be desired.
 
Note, of course, that the world's #1 employer of psychologists, the VA, is apparently under marching orders from Congress to begin phasing out psychologists for therapist positions.

What is the source for this?
 
2) Valuable research is being driven by hard science. Increasingly, the world of clinical is becoming dependent on neuroscience and psychiatry. In funding and outcome measures, we look towards pharma, fMRI, animal models and drug discovery. Psychologists can use neuro measures as correlates for behavior, but psychiatrists can fill the role of researcher and clinician more effectively.

I don't think that is necessarily true, neuroscience research in psychology is a lot more than behavioural correlates. I just started my PhD research this May and am doing molecular neuroscience in a clinical program and the research we do in my lab is certainly not as flowery as you make it sound. Going to med school doesn't necessarily make you a better clinician or scientist than someone with a PhD.
 
Is there any evidence to back this up? I'm curious, because I, too, am inclined to believe that PhD level psychologists should provide superior therapy. I'm wondering if they have done any studies to compare masters level therapy providers w/PhD level providers?

I agree with the above poster that thus far research has not suggested that PhD's are more effective therapists than master's level clinicians.

That said, I'm not sure it actually matters. Unfortunately, when positions are created and hiring decisions are made, the question isn't always "Who will do the BEST job?" but rather, "Who will do an adequate job for the least amount of money?" Sad but true.

I have been looking at job postings for clinical positions in my large city. The positions seem to be largely for social workers, psychiatrists, and psychiatric nurse practitioners. One of my psychologist friends was able to get a job by applying to postings for master's level clinicians (of course he had to accept master's level compensation.)

Dr. E
 
I disagree that psychiatrists would make better researchers. The MD/PhD types can have an excellent setup, but most plain MD psychiatrists don't have adequate training to facilitate research studies. They may have unique access to pharma funding, but that's about the only advantage I can see.

I would be worried if i was a therapist. Part of my decision to go into academia and focus on assessment in clinical work was to keep my skills in areas that are more unique to psychologists.(to make me competitive). Of course, there is some encroachment even in neuropsychology that people are concerned about, but I don't think it is as systemic as the encroachment on therapy.

JeyRo, how new is that VA information?
 
2) Valuable research is being driven by hard science. Increasingly, the world of clinical is becoming dependent on neuroscience and psychiatry. In funding and outcome measures, we look towards pharma, fMRI, animal models and drug discovery. Psychologists can use neuro measures as correlates for behavior, but psychiatrists can fill the role of researcher and clinician more effectively.

Its a big, big, big mistake to assume that psychologists are not doing this type of work. We are, in abundance. I'd also put my research/science training as far beyond that of 9/10 med school graduates (not counting MD/PhD) ...they are completely different degrees. Certainly a motivated MD can learn stats, but their training is not set up for this. The field is undoubtedly changing, and those who refuse to adapt will certainly be left behind. However, psychology is a broad field, and a scientific one. Those who embrace change will move forward, those who cling to the past will wither and die out.

All that said, there are actually a LOT of problems with some of these lines of work that are starting to get more and more attention. For example, while fMRI is popular and "cool", a lot of the work (even in solid journals) is absolute garbage. I won't go into details here, but it certainly has developed quite the bad reputation among many groups of scientists. That's also not to say it can't be done well - just that one needs to be careful not to get caught up in the hype.
 
Those who embrace change will move forward, those who cling to the past will wither and die out.

Literally 🙄? I just envisioned a large group of psychologists actually withering and dying.

That's also not to say it can't be done well - just that one needs to be careful not to get caught up in the hype.

Agreed, fMRI can be totally bogus. Dead fish study. But I do know lots of psychologists involved in neuroimaging research.

Interdisciplinary is the operative phrase here - get good at what makes you unique and then fill that role within a team framework if you want to have a clinical job and be successful. Unless you are going to get your own R01 grants to run studies as the boss, someone else is going to be the boss.
 
I am in science because I love evidence and data, but let's not hobble ourselves when it comes to presentation/marketing and act like a lack of data that Ph.Ds provide superior treatment outcomes means we aren't better qualified professionals who can command higher compensation. We need to be in sales for a sec, push our strengths and stop being mopey. The world of employment and compensation is as much about intangibles and perception as it is about credentials/evidence. It matters if people respect the Ph.D. "brand" more, it matters if we can push the benefits of assessment and our other unique strengths. It matters if we can push the idea that we have better training in and provide more evidence based treatment with less 'supportive counseling'.

Many people don't like to hear this but it also matters that we push into psychiatrist and psych NP's turf if we are getting pushed from the LPC end. Even if you believe we "can't" acquire the training to fully manage psychotropics, do you think we can't gain the training to perform the 10 minute med check that a psych nurse does? The one where anything out of the ordinary is punted up to the psychiatrist?
 
Many people don't like to hear this but it also matters that we push into psychiatrist and psych NP's turf if we are getting pushed from the LPC end. Even if you believe we "can't" acquire the training to fully manage psychotropics, do you think we can't gain the training to perform the 10 minute med check that a psych nurse does? The one where anything out of the ordinary is punted up to the psychiatrist?

I think I am in the minority on this forum regarding RxP, but I really don't think it is a viable lobby for us. Look at how much money was wasted already at lobbying efforts. We could have been funding more outcome research or lobbying to protect our title and make our specialty less confusing to the public. While some feel that RxP is paramount, I don't think it represents the interests of a large number of psychologists out there.
 
I think I am in the minority on this forum regarding RxP, but I really don't think it is a viable lobby for us. Look at how much money was wasted already at lobbying efforts. We could have been funding more outcome research or lobbying to protect our title and make our specialty less confusing to the public. While some feel that RxP is paramount, I don't think it represents the interests of a large number of psychologists out there.

To me, its just a question of what that effort is likely to get us.

We can continue to pump money into RxP, make it easy for psychologists to gain these privileges, etc. Of course, as implied above it is quite likely that LCSWs will then follow in our footsteps, etc. Of course, I'd have less of a problem with it if I didn't feel like APA was ignoring everything else and putting all its time/money towards RxP.

As you indicate above, I think we should be pushing for things that make us LESS like other providers, not more like them. Its always been very unclear to me how creating a slew of psychologist/nurses (essentially what RxP is) will solve all the problems with the profession. If we can do things that others can't, we can place ourselves in demand. While I don't doubt that RxP will have some short-term benefits, in the long-run I think its more likely to drive down the salaries of prescribers than significantly boost the salary of psychologists.
 
To me, its just a question of what that effort is likely to get us.

We can continue to pump money into RxP, make it easy for psychologists to gain these privileges, etc. Of course, as implied above it is quite likely that LCSWs will then follow in our footsteps, etc. Of course, I'd have less of a problem with it if I didn't feel like APA was ignoring everything else and putting all its time/money towards RxP.

As you indicate above, I think we should be pushing for things that make us LESS like other providers, not more like them. Its always been very unclear to me how creating a slew of psychologist/nurses (essentially what RxP is) will solve all the problems with the profession. If we can do things that others can't, we can place ourselves in demand. While I don't doubt that RxP will have some short-term benefits, in the long-run I think its more likely to drive down the salaries of prescribers than significantly boost the salary of psychologists.

Incorporating medications, to me, is one plank. It won't solve the problem, it will help so it is worth pursuing. What are all the areas that we should expand into that make us less like other providers? And I mean things we don't already do.

I notice that people think our field is threatened with extinction, they are probably right that there is cause for serious concern. And in the face of that a large proportion of psychologists think that medication management should be the third rail? I don't think it should be pursued to the exclusion of everything else, but ignoring it seems mind boggling. The universe of what people get paid to do in mental health is pretty finite. If we only look at long-term building we risk becoming a marginalized profession before we get to these far away solutions.
 
What are all the areas that we should expand into that make us less like other providers?

It's not an area of expansion perse, but perhaps we could put more effort into correcting the (apparently abundant) assumption that MDs are more qualified to do research. Research and evidence based practice are really the unique domains of the PhD. The fact that people don't know this is a problem.
 
Incorporating medications, to me, is one plank. It won't solve the problem, it will help so it is worth pursuing. What are all the areas that we should expand into that make us less like other providers? And I mean things we don't already do.

I notice that people think our field is threatened with extinction, they are probably right that there is cause for serious concern. And in the face of that a large proportion of psychologists think that medication management should be the third rail? I don't think it should be pursued to the exclusion of everything else, but ignoring it seems mind boggling. The universe of what people get paid to do in mental health is pretty finite. If we only look at long-term building we risk becoming a marginalized profession before we get to these far away solutions.

I think a national effort to influence state law regarding how training/licensure operates would do a lot for our profession. If psychology trainees could get a provisional license (which doesn't seem far fetched if you've had a few practicums) where they still need supervision, but can bill on internship and postdoc, we'd help our training model substantially.

I am not on that train because I think we need to open up more slots for Argosy students. I hold this perspective because it seems ridiculous to me that one needs a minimum of 6 years of training as a PhD before you can be licensed and bill.

Of course, this only works if we have appropriate boarding proedures for specialties and regulate how we market ourselves (e.g., I'm a neropsychologist, I'm a health psychologist, I am a geropsychologist...). At present, Joe Schmo Psy.D. (or PhD) can finish internship and call themselves whatever they want. That's wrong and it obviously isn't covered enough in the ethics code or regulated enough by state law. To me, pursuing regulations in these areas will protect our profession and prevent the untrained quacks from giving us a bad reputation.

Edit: I wanted to add that my main point is "quality control." If we can operationalize ourselves and our specialties better, and have the power to regulate them, I think we are in better shape to define ourselves to other providers and the public.
 
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It's not an area of expansion perse, but perhaps we could put more effort into correcting the (apparently abundant) assumption that MDs are more qualified to do research. Research and evidence based practice are really the unique domains of the PhD. The fact that people don't know this is a problem.

I totally agree with that and I think we can simultaneously look to get paid to do things we don't currently do. I don't see an external area more obvious than meds.
 
Well, as I said I would have much less of a problem with it if we weren't pushing so freakin hard. For one, I think if the obscene amount of money put towards RxP so the people who want to be nurses too (which is fine!) but for some reason don't want to go to nursing school was instead spent on campaigning for better reimbursement for behavioral treatments, it seems entirely possible we WOULDN'T be in quite as bad a position right now.

You are right that some of what I am getting at isn't "new" its just a question of focus. And I do agree that we need to be thinking both short-term and long-term. However, there are vast untapped markets we have only recently started delving into (e.g. health psychology and primary care) where we can play a more unique role. To my knowledge, there is no other healthcare field where people receive even a fraction of the training in stats. Why are we not focusing on building up our supervisory roles and program evaluation/development? Our administrative capacity? Why not further expand our assessment into different areas? There are an absolute ton of settings that would benefit from someone who actually had psychometrics training. These are just some things off the top of my head. I'm not anti-RxP in principle, I just think we've gone about it in an incredibly misguided and wasteful manner and have ignored the multitude of alternatives.
 
You are right that some of what I am getting at isn't "new" its just a question of focus. And I do agree that we need to be thinking both short-term and long-term. However, there are vast untapped markets we have only recently started delving into (e.g. health psychology and primary care) where we can play a more unique role. To my knowledge, there is no other healthcare field where people receive even a fraction of the training in stats. Why are we not focusing on building up our supervisory roles and program evaluation/development? Our administrative capacity? Why not further expand our assessment into different areas? There are an absolute ton of settings that would benefit from someone who actually had psychometrics training.

Totally on the same page with you here. I literally started nodding as I read your post.

Edit: I'd add that I think some psychologists are too "perseverative" about their roles at times. I actually lobbied to do some program evaluation work at my postdoc AMC and was never taken seriously by my supervisor. I think demonstrating these types of skills within interdisciplinary contexts is very important.
 
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I think the points above are well taken about finding places where psychologists can have a unique contribution.

I think one part of the difficulty is that graduate school does not adequately prepare us for the real world of psychology (be it practice, program evaluation, administration, non-academic research settings). Of course, I can only speak directly about my program, but other colleagues have echoed these concerns as well. Our program faculty expected us to turn into professors. There was support and guidance for this career path. But certainly not every psychologist can or should become a professor. There was very little guidance or preparation for anything else.

As an example, I'm willing to bet that even in more practitioner-oriented programs that there aren't any classes on how to manage the business aspects of a practice.

Graduate training programs play a key part in protecting and expanding the role of psychologists. Unfortunately the people running these programs seem to have very little experience with the real world!

Dr. E
 
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I think a national effort to influence state law regarding how training/licensure operates would do a lot for our profession. If psychology trainees could get a provisional license (which doesn't seem far fetched if you've had a few practicums) where they still need supervision, but can bill on internship and postdoc, we'd help our training model substantially.

I totally agree. The inability of interns and post-docs to bill for services is a major disincentive to prospective employers.

I think a lot of the issues facing psychology could be greatly helped by capping class sizes at 15-20 students per year, tops. Given that most PhD programs take 10 or fewer students a year, and top university-based PsyD programs take around 15-25, this would not cause much of an issue for solid programs (APPIC survey data indicates that about 40% of applicants came from programs with more than 20 students in their cohort). Additionally, it would really reduce pressure on the internship, post-doc, and employment markets and would definitely discourage FSPS from flooding the market. Of course, I doubt APA is likely to ever do this, but maybe if another accrediting agency takes power, they could take the long view for psychology.

In addition, I think more promotion of and advocacy around the specialized training psychologists have, as Ollie mentioned, would be great/
 
Note, of course, that the world's #1 employer of psychologists, the VA, is apparently under marching orders from Congress to begin phasing out psychologists for therapist positions.

That surprises me, but it shouldn't...
 
2) Valuable research is being driven by hard science. Increasingly, the world of clinical is becoming dependent on neuroscience and psychiatry. In funding and outcome measures, we look towards pharma, fMRI, animal models and drug discovery. Psychologists can use neuro measures as correlates for behavior, but psychiatrists can fill the role of researcher and clinician more effectively.

Maybe I should maintain hope that the PhD in clinical psychology is a viable option for students nowadays, but its quickly looking like a dinosaur struggling to escape from tar.

😱. As others noted, the vast majority of psychiatrists (or MDs for that matter) do *NOT* have the proper training to run any kind of significant research study. I'm at one of the top R01 for medical research, and most studies still have PhDs handling the heavy lifting because doing research is far more than running some stats and doing a lit review.
 
I also heard that lawyers, real estate agents, medical surgeons, civil engineers, and airline pilots will all be phased out in the next few years. Anyone else hear this?

The PhD Clinical Psychologist is not being 'phased out'. Grow up.
 
I don't think that psychologists as a whole will be phased out. However, if you come out of grad school with few useful skills, then you will suffer. When I was in grad school, my goal was to develop a set of skills that made me useful as a program director rather than a simple provider of services. While I am still building skills now, I hope that my training in geropsych, health psych, and neuropsych as well as program evaluation/development will allow me to establish myself someone that can use my doctorate to manage lower level providers in a hospital, nursing home, or hospice setting to provide the highest quality of care while maintaining a sound bottom line. The health behavior coordinator positions being added to many VA hospitals would be a great fit for me and I think that those positions have more security and require skills more unique to a psychologist than any other position.

I think that the points about some sort of change in licensure status in the internship/post-doc year is sorely needed as well.
 
That surprises me, but it shouldn't...

Go to usajobs.gov and search for "marriage and family therapist" and you'll see some positions being advertised as we speak. Not many, but I notice at least a couple that do that distressing thing where they equate the skills of an MFT with a psychologist, such as: http://www.usajobs.gov/GetJob/ViewDetails/320960700

I imagine this trend will continue. Personally, I make sure that I'm doing a lot of things other than therapy when I'm at work. Program development, administration, research, teaching, assessment. I don't want to be considered just an overpaid MFT/LCSW/LPC when push comes to shove.
 
Go to usajobs.gov and search for "marriage and family therapist" and you'll see some positions being advertised as we speak. Not many, but I notice at least a couple that do that distressing thing where they equate the skills of an MFT with a psychologist, such as: http://www.usajobs.gov/GetJob/ViewDetails/320960700

I imagine this trend will continue. Personally, I make sure that I'm doing a lot of things other than therapy when I'm at work. Program development, administration, research, teaching, assessment. I don't want to be considered just an overpaid MFT/LCSW/LPC when push comes to shove.

IM pretty young for all of this, but is there anything at an undergrad level to prepare for this?
 
Second some of the comments above. I'm eternally baffled when psychologists identify as a "therapist". If your training prepared you to implement therapy, and nothing else, I'm sorry, but you are not a psychologist regardless of what your degree or license say. From what I can tell, these are also the people who seem to be hurting the most right now in terms of mid-level encroachment and poor pay. We all have to focus on different things in our career and it is impossible to be the best of the best at everything, but to me, the major advantage of psychology is the incredible diversity of our skillset and our ability to bring so many different things to the table...its no surprise to me that someone with "one" skill would be struggling right now.
 
Not directly answering your original post, my first response to the title of this thread is that it's moving to less developed nations (Note: I am not sure if this is the most PC term these days) in the world. There are significant gaps to be filled. There are many clinical, training, and research opportunities... Just saying.
 
a couple that do that distressing thing where they equate the skills of an MFT with a psychologist, such as: http://www.usajobs.gov/GetJob/ViewDetails/320960700

Well, I was hesitant at first but I'll share an anecdote. I was in Montana (near Yellowstone) a few weeks ago and was searching the local job market just for fun (I lead a boring life). I saw a job listing that advertised for a bilingual PsyD, PhD, LCSW, LMFT, or LPC (or whatever the local equivalents are called...I just remember that it was five possible degree/licenses).

In my head, it seemed like all those people would do different things, so I called them and they said that they were looking for somebody to provide "counseling and supervision" and they had to be able to do it in two languages.

I asked why there was such a broad range of degrees possible for the position, and she transferred me to somebody else.

This person described to me, quite more frankly than I expected, that the agency was trying to get the most for its money. I explained that I was in an MSW program and I had been led to believe that PhDs and LCSWs did very different things and she said, "Oh, they can do different things, but in the job market of today everybody is doing a little bit of everything. You have to be versatile to get ahead." She went on to tell me the story of how she got her Masters in Psychology and then an MBA to remain competitive.

She was very friendly but the conversation made me cringe inside, because I think she is right about a lot of areas, particularly under-served ones like Montana. Professionals are expected to do more than they're really trained for, and have to compete with degrees that can be very different.

Once I have my LCSW, I don't know how I will compete with PhDs. I don't know how they'd compete with me, for that matter. It's bananas to blueberries (I don't like apples or oranges).

It seems to me, more and more, that those who are willing to step outside their professional and ethical boundaries are the ones who will succeed in this type of work environment. It's frightening to think about.
 
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Professionals are expected to do more than they're really trained for, and have to compete with degrees that can be very different.

...

It seems to me, more and more, that those who are willing to step outside their professional and ethical boundaries are the ones who will succeed in this type of work environment. It's frightening to think about.

Well certainly in just about any job these days you have to do some things that are perhaps not in the job description. I'd say the onus is on the professional to set limits on where they would be stepping outside their area of competence. Unfortunately, I somehow doubt that many folks actually do that.

I'd say it also depends on what the task is. If it's a master's level provider suddenly trying to give IQ tests or something else beyond what their training encompasses, then yes, that's ridiculous. But you can't learn everything in graduate school either.

For example, I had some training in program evaluation, but I am by no means an expert. If I were to do a program evaluation at a hospital, there would be a component of on-the-job learning. I think communicating that to my superiors and seeking consultation as appropriate would be an effective solution, and ultimately I'd probably develop these skills further with the opportunity.
 
As far as practice goes, the future of psychology is in disability evals, supervisory positions, and forensic work IMHO. Currently, these seem to be the most solid markets.
 
First time posting.
Curious to see where people think the field of clinical psychology is moving in a general sense.
I'm freaked by two factors:
1) Graduate school competitiveness is creating an insulated environment. Eight students out of 400 applicants gaining admission to a program is absurd.

If there is only funding to train and only a demand for 8 new doctoral level psychologists per year, then accepting only 8 is not "absurd", it's responsible.
 
nahh, Psychology is where it is at for me. But thanks for not answering my question.

Well if you still definitely want to pursue a career as a psychologist, all of the threads focused on how to make yourself competitive (i.e., awesome GREs, research experience, etc) for graduate school are relevant. As it relates to the job market, anything that sets you apart from other candidates (i.e., lots of pubs, funding, experiences in great settings, unique skills) is what will give you an edge when the environment is as competitive as it is. As an undergraduate, I'd be focused on getting competitive for getting into an APA accredited doctoral program.
 
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