Nov-20-2009

The 411 on Clinical Psychologists: Here’s the Truth

You may have seen articles in Newsweek and the Washington Post that claimed clinical psychologists were not properly trained to understand and use current research to help them treat patients. This blog previously tried to refute and clarify some of the claims made in the Newsweek article. But you may still be wondering if you can trust that psychologists are up to speed on current research and are giving people the best care.

As a clinical psychologist who has been practicing for the past 23 years, let me shed some light on these provocative and misleading articles.

Like my colleagues, I rely on research daily to help make decisions on the best way to help clients. Yesterday, for example, I saw a patient suffering from depression. I used the current research available to help instruct this patient on ways to monitor her negative “self talk,” the critical harsh thoughts she had about herself, and to suggest alternative ways she could think about herself. I also gave her a reference book and homework to help reinforce these concepts.

So let’s talk a little about what it takes to make a clinical psychologist.

Clinical psychologists receive extensive training and education in psychological science and theory, clinical diagnoses, psychological assessment and specialized training in evidence-based treatments.

It all begins with a bachelor’s degree. Here are the rest of the steps to becoming a licensed practicing psychologist. My path to becoming a clinical psychologist is fairly typical of most psychologists, so I’ll use it as an example.

  • Graduate school! It takes the average clinical psychologists six to seven years of full-time study beyond the bachelor’s degree to complete their training. I studied, for example, at the University of Illinois in Chicago, a program accredited by the American Psychological Association, where I took years of coursework in statistics, normal and abnormal psychology, child psychology, psychological testing, psychotherapy techniques and behavioral medicine. I also had several clinical placements at child and adult outpatient clinics, a state hospital and a university outpatient clinic.
  • Research training and experience while in graduate school! At the University of Illinois at Chicago, for example, my research training focused on the study of attachment between mother and child. I worked in a laboratory setting observing hundreds of moms and one-year-old babies playing together. I watched to see what happened when the mother left the room for a few minutes and then returned to be reunited with the baby. Attachment is thought to relate to later ability to form close interpersonal relationships in adulthood. I completed an original master’s thesis and doctoral dissertation in this area as well and presented this information at local and national conferences.
  • Internship training! To finish your graduate training, you must complete an approved one year full-time clinical internship (followed by either a year of full-time clinically supervised experience or a one year clinical fellowship.) I did my clinical internship in Chicago at Michael Reese Hospital followed by a year of full-time clinical work and supervision at the hospital working with high risk adolescents who were struggling with severe depression. Following all of this clinical training you are almost finished.
  • Doctorate! Graduation means you now have a doctorate. People could start calling me Dr. Nancy, but that didn’t mean I could yet practice on my own. I needed more training to get a license.

Phew! That’s a lot. But you’re not done yet.

  • FINALLY! You can take the exam for your license, and once you pass it, you can practice psychology and call yourself a psychologist. So, for me this journey took a total of six-and-a-half years of full-time training and work experiences!

But, wait, there’s still more!

  • Continuing education! To keep that license to practice, we need yearly continuing education credits. I have taken courses in such areas as “Newest research findings on the success of treating depression in adolescents” or “Ethical dilemmas of working with older adults.”

Our training is very important, of course. But in my opinion, what really makes a clinical psychologist is the ability to combine training with clinical experience and judgment. I know the research on clinical depression, for example, but I also know that humans are incredibly complex and that their individual differences, their family situation, their past history are all important and need to be considered in devising a treatment plan and in devising any psychological treatment.

Years of research show that psychological treatment works! Most patients who are treated show improvement. Successful treatment is based on three factors:

  • using the most appropriate evidence-based treatment
  • clinical expertise of the psychologist
  • the patients’ values

So how can you be sure you’ll find the right clinical psychologist for you? A great place to start is asking trusted friends, family members or your primary care physician for a referral. You can also check your state psychological association for a local referral. Trusted online resources and directories, such as the APA locator are often also useful.

Make sure you select a licensed provider, and don’t be afraid to interview prospective psychologists about their clinical expertise and training, especially with regard to your specific area of concern.

Before selecting a psychologist, ask about their approach to treatment, their attitudes toward things such as missed sessions, telephone contact, fees and accepted insurance. A good “chemistry” between psychologist and patient, as well as a collaborative working relationship is essential to successful treatment.

Be active: Ask questions about your treatment plan, help set the goals for treatment and ask your provider for a timeline. If your situation does not improve within a reasonable amount of time, talk to your provider and discuss additional methods of treatment.

Selecting the right psychologist can be stressful and confusing. But don’t be scared away from seeking help. A psychologist can help you when you can’t do it yourself.

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6 Responses to “The 411 on Clinical Psychologists: Here’s the Truth”

  1. Warren H. Phillips, Ph.D.   December 20, 2009 at 1:16 pm

    I’m pleased to see Dr. Molitor’s post about the training that licensed Psychologists receive. I, too, received my Ph.D. at the University of Illinois at Chicago and am quite familiar with Dr. Molitor’s discussion of the multiple training activities that we experience as part of our training. I am also a Senior Lecturer and clinical supervisor in the Psychology Dept. at Iowa State University and, thus, am part of the training of psychology graduate students on a regular basis.

    I, wholeheartedly, agree with Mr. Young’s statement that he wishes that the discussion of differences in training would occur primarily among mental health professionals. However, as my grandmother would say, “that ship has sailed” with the publication of the articles in Newsweek, the Washington Times, and on NPR a couple of weeks ago.

    It is now critically important for us all, as psychologists from every field, whether it be clinical psychology, counseling psychology, school psychology, etc. to ensure that the public knows that psychologists are well trained mental health professionals with several years of training in research and practice.

    Unfortunately, the articles that have been published have implied and, in some, outright stated that psychologists are not paying attention to the research on effective practice and are using highly alternative (e.g., dolphin-assisted therapy) methods of therapy as a matter of general practice. This kind of misinformation is not only inaccurate and misleading but, of course, can serve to undermine the public’s confidence in mental health services and willingness to seek those services when needed. In a country where a large proportion of people who need mental health services are already not utilizing them, it is time that practicing psychologists let the public know that we are highly trained professionals providing effective services for a variety of mental health conditions! The public needs to know that they can reach out and we will be there with effective help to provide.

    I encourage all of us to share information about the training and effectiveness of psychologists and our psychological interventions with our local communities.

    Have a great Holiday everyone!

    Warren Phillips

  2. Scott Young   November 20, 2009 at 6:46 pm

    Dr. Molitor,

    I applaud your efforts to respond to recent criticisms of psychology practice from our colleagues in APS and the medical profession. As a doctoral candidate in an empirically and research-grounded counseling psychology program, I wanted to share a few thoughts I had on this issue.

    While I whole-heartedly agree that practicing psychologists have a responsibility to make use of treatments supported by available research, I would remind us that “empirically-supported treatments” in the classic sense is but one way to use research-informed treatment. While Division 12’s lists of the known “empirically-supported treatments” for a given disorder are useful, other tracks have been also proposed to “empirically support” either common factors (cf., Norcross, 2002) or principles to evaluate the strength of research on given treatments for specific local populations (cf., Wampold, Lichtenberg, & Waehler, 2002).

    Thus, I would humbly submit that “using the most appropriate evidence-based treatment” is likely a source of contention among many professionals, not because they disagree about the value of research-informed treatment, but rather because they disagree about the manner in which treatments are to be empirically-evaluated. Thus, I feel it necessary to suggest that our colleagues in APS may be taking a position on “empirically-supported treatments”, which only a portion of professional’s share. To some, any therapy with a measurably-strong therapeutic alliance and a bonafide treatment approach is “empirically-supported” whether or not it appears on Division 12’s list.

    I would also comment on the sentiment expressed by Dr. Giurleo, that discussion of our differences is needed for growth as a profession. It is my hope that my comments might be seen as part of such a discussion; however, I must confess to a frustration with “discussing” our differences in a public forum targeted at the general population rather than psychologist. I fear that the criticisms expressed recently in the media will harm the very clients the authors purport to protect, by making them doubt the effectiveness of their practicing psychologist and treatment. Thus, I would close by echoing the statements made by Drs. Agazzi and Molitor that most licensed school, counseling, and clinical psychologists are both well-versed in research and well-suited to help clients change! We as a profession would do well to remember that and to make certain our clients do as well.

    Scott Young – Iowa State University.

  3. Susan Giurleo, PhD   November 20, 2009 at 3:29 pm

    It seems the point of the articles is that not all training for psychologists is created equal. I see the outcome of this daily in my collaboration with colleagues. The rigor of the training must be standardized or we leave the profession open to this criticism. As someone trained in a research driven program (Univ Illinois-Champaign-Urbana) I utilize research findings daily in my clinical work. It pains me to see this strain on the profession, but I also know that growth only comes when we discuss our differences.

  4. Dr. Nancy Molitor   November 20, 2009 at 3:19 pm

    Dr. Agazzi,

    Thanks for your clarifying comment! I focused on the term “clinical psychologist” because that was the term used in the Post and Newsweek articles and wanted to be consistent . But of course, you are correct, a psychologist who is licenced to practice in their state can come from a variety of programs such as school and counseling psychology , as well as clinicial.

    Nancy Molitor

  5. Heather Agazzi   November 20, 2009 at 1:45 pm

    I just wanted to add that all licensed psychologists with the PhD degree who provide therapeutic services go through similar training, not just folks who achieve PhDs in clinical psychology programs. There is a lot of misinformation about this issue. I have a PhD in school psychology and work as a licensed psychologist in the field of pediatric psychology. I completed all of the above training, did the supervised internship, earned the PhD (including dissertation, thesis, qualifying exams which are all about conducting and reviewing research), did another year of supervision and sat for all of the tests before being given a license to pracitce!!!. I too am perfectly trained in utilizing the literature to inform evidence-based practice in my daily practices. Most psychologists have more training and understanding of research than our other allied health professional peers!!

  6. Janelle Wohltmann   November 20, 2009 at 12:59 pm

    Hi Dr. Molitor,

    Thanks for the thoughtful article about how to select the right psychologist and the training some psychologists receive. It sounds like you went to an excellent school that trained you extremely well since you participated in important classwork, clinical training, and research.

    My take on the articles from the Washington Post and Newsweek, which you mention as the basis for this post, is that not every psychologist receives the excellent training that you did, and yet they can still become licensed psychologists! In fact, according to the aforementioned articles, there is evidence showing that many clinical psychologists do not, as you do, consult research when treating their patients. This seems very dangerous! You make a great point when you say, “Years of research show that psychological treatment works!” In fact, under that point you list the first important factor of a successful treatment as “using the most appropriate evidence-based treatment.” As a future clinical psychologist, I think it is extremely important that we as a field keep that as our top priority. We need to ensure that all clinical psychologist are well trained in research, so that they will always use research along with their clinical judgments to, as you suggest, successfully treat patients.

    -Janelle Wohltmann
    Clinical psychology graduate student
    University of Arizona
    Student member, APA
    Student member, SSCP