Clinical Psychology Graduate Research Articles

Clinical Trainee Perspectives on the Implementation of Trauma-Focused Training.

Despite the high prevalence of trauma exposure in the United States and calls for the implementation of trauma-focused psychotherapy training, scant opportunities exist for such training in graduate clinical psychology programs. This study aimed to guide the implementation of trauma-focused psychotherapy training in graduate curricula by examining clinical trainees' perspectives on their current training and desired features for trauma-specific learning environments. The absence of research that centers trainee voices is notable; therefore, this study specifically focuses on trainee perspectives on implementation. The New Haven competencies, developed by the American Psychological Association to support efforts to improve trauma-specific training, were used as a framework to guide the development of a mixed-methods survey. Current doctoral students (N=18) in one clinical psychology program completed the survey. Trainees overwhelmingly perceived the competencies to be relevant to their psychological assessment and therapy training and to their professional goals but noted a general lack of available trauma-specific training. Nearly all trainees believed that trauma-specific training should be required and expressed varied opinions regarding how requirements should be structured. Important features of a safe and supportive learning environment were reported to include coconstructed norms, choice and flexibility for participation, and integrated wellness practices. Further, instructors' trauma awareness, cultural humility, and responsiveness to students' experiences were emphasized by trainees as important. Effective implementation of trauma-specific psychotherapy training should be guided by ongoing dialogue between trainees and training stakeholders.

Fostering telecompetence: A descriptive evaluation of clinical psychology predoctoral internship and postdoctoral fellowship implementation of telehealth education.

Telehealth education within clinical psychology predoctoral internships and postdoctoral fellowships has become a frequent recommendation designed to prepare future providers with evidence-informed telehealth skills that can be applied to rural populations. Unfortunately, the availability of telehealth training among internships and fellowships, as well as areas for growth, remains unclear. Thus, the current study evaluated graduate clinical psychology internship and fellowship integration of telehealth training components before and after the onset of COVID-19. Individuals representing 74 internships and 29 fellowships completed author-created REDCap-hosted demographic and telehealth training surveys. Before COVID-19, 2 internships and 4 fellowships reported implementing telehealth education, with a majority of materials for both types of programs being optional educational targets and generally encompassing 0-15 hours of student education. After the onset of COVID-19, 72 internships and 27 fellowships indicated implementing telehealth education, with a majority indicating materials as mandatory and encompassing between 0 and 50+ hours. Despite increases, 73.6% of internship programs and 62.1% of fellowship programs noted a desire for their students to receive additional telehealth education in the future. Integrated educational foci are discussed. The current study demonstrated positive trends in the development of telehealth education among internships and fellowships. Nevertheless, some programs can likely benefit from additional integration of telehealth components, as well as more formal programming built around field-supported competencies and models. While work is required to further clarify field offerings, the current study provided a preliminary evaluation of internship and fellowship telehealth educational offerings.

Trainee perceptions of multicultural climate and supervision in neuropsychology

ABSTRACT Introduction Mentor relationships are important in developing and supporting professional self-efficacy among psychology trainees. Additionally, the rapid diversification of the United States calls for the preparation of clinical neuropsychology trainees to work within a multicultural context. The present study aimed to assess neuropsychology trainees’ perceptions of multicultural climate and supervision and if these perceptions differ based on trainee demographics. We also sought to identify aversive experiences of trainees, program strengths or weaknesses, and how programs support trainees. Method Participants were 310 neuropsychology trainees (Mean age = 30.27, SD = 5.67) from clinical psychology graduate (n = 136), pre-doctoral internship (n = 38), and post-doctoral (n = 71) programs across the United States and Canada who completed a survey assessing perceptions to multicultural climate and supervision. 64.5% self-identified as women, 60.3% as heterosexual, and 46.1% as non-Hispanic White. 34.5% of trainees reported at least one American Disabilities Act (ADA) recognized disability. Results Though satisfied with general supervision, trainees reported overall dissatisfaction with multicultural supervision. Satisfaction with multicultural supervision did not differ by demographics. Trainees also reported various aversive experiences with supervisors, clients, and research participants that negatively impacted their training. These experiences were at times due to an aspect of the trainee’s multicultural identity, with Black and Hispanic trainees being more likely to report an aversive experience. Trainees reported ways in which they felt unsupported by their programs. Conclusions Important areas of growth for programs are discussed. Issues raised by neuropsychology trainees overlap to some degree with the experiences of trainees in other fields. Recommendations of approaches that have been successfully adopted in other fields to improve trainee satisfaction are provided. Early identification of needs that go above and beyond clinical training will allow programs to respond promptly, improve trainee satisfaction, and potentially improve the retention of trainees from diverse backgrounds.

Advocacy Learning by Doing: Human Trafficking Course for Graduate Clinical Psychology Students

ABSTRACT The scientist-practitioner-advocate model encourages informed engagement with social justice issues. Human trafficking stands out as such an issue, where psychological science and practice make a difference on multiple levels, including prevention and raising awareness. This article discusses a human trafficking graduate course in psychology as an example of learning by doing, featuring an activity with high school students based on interactive rotation. Emphasis on diversity among high school students paves the way for solidarity and appreciation for interdependence, which go hand in hand with multicultural competency also reflected in humility. Psychologists-in-training draw parallels between rapport in clinical practice and advocacy settings, recognizing the importance of allowing sufficient time for preparation and subsequent reflection. This helps students consider personal values and belief systems, and their compatibility with raising human trafficking awareness. As a result of teaching a course on this topic and conducting the learning by doing activity, three action steps are proposed to train scientists-practitioners-advocates: Research, Rotate, and Reflect.

Competency‐based training and assessment in Australian postgraduate clinical psychology education

BackgroundCompetency‐based training and assessment is considered the best practice internationally in postgraduate clinical psychology education. In Australia, there are still some ways to go as programmes begin to integrate competency‐based pedagogical models into clinical training and assessment. Further understanding of the strengths and challenges of these models will be useful to educators interested in developing a competency‐based approach.MethodsA structured literature review was carried out using the databases PsychInfo, PubMed, and PsychArticles. Keywords were: competency, and “training” or “assessment” or “model” or “clinical” or “psychology” or “medicine” or “allied health.” Articles had to be written in the English language and published in peer‐reviewed journals. Relevant book chapters and web references from professional accreditation bodies were also assessed for inclusion. A total of 54 references were utilised in the review.ResultsThe review supports the relevance of competency‐based learning and teaching. It draws on seminal benchmarking work from the international literature and considers the strengths and limitations of competency‐based approaches to clinical health training and assessment. The review provides support for the ongoing progression towards competency‐based training models in Australian postgraduate clinical psychology.ConclusionsCompetency‐based training and assessment methods offer educators sophisticated mechanisms for ensuring that clinical psychology graduates are prepared to meet the demands of professional practice and public accountability. Further efforts at integrating competency‐based training models into Australian postgraduate curriculum, and associated research into the outcomes, are necessary to ensure a pedagogical culture of best practice in this country.

Supplemental Material for Exploring Therapeutic Alliance Training in Clinical and Counseling Psychology Graduate Programs

Supplemental Material for Exploring Therapeutic Alliance Training in Clinical and Counseling Psychology Graduate Programs

Chaos Theory and Group Psychotherapy 15 Years Later

Chaos Theory and Group Psychotherapy 15 Years Later Virginia Brabender1 issn 0362-4021 © 2016 Eastern Group Psychotherapy Society group, Vol. 40, No. 1, Spring 2016 9 1 Professor, Widener University. Correspondence should be addressed to Virginia Brabender, PhD, Institute for Graduate Clinical Psychology, Widener University, One University Place, Chester, PA 19013-5792. E-mail: vmbrabender@gmail.com. 2 I urge the reader to visit or revisit that article, as well as Brabender (1997), to obtain some basics on chaos/complexity theory. In 2000, I wrote an article, “Chaos, Group Psychotherapy, and the Future of Uncertainty and Uniqueness,” for GROUP (Brabender, 2000), in which I forecasted the rise of chaos theory (Prigogine & Stengers, 1984) as a conceptual framework through which we could better understand group phenomena and which would serve as a platform for the formulation of effective interventions.2 Chaos theory examines the dynamics of nonlinear, adaptive systems—systems in which the effects need not be related in linear fashion to the cause, systems that are altered by their interaction with the environment. Whereas chaos theory looks at systems at the edge of disorder, complexity theory, the overarching frame, accounts for the transitions between order and chaos (Arrow, 2005). Chaos/complexity theory seemed a natural fit for understanding the psychotherapy group, and I was convinced that it would be a driver of theory and research into the new millennium for four specific reasons that I believe continue to have relevance to group psychotherapy. First, across the sciences, chaos theory was illuminating phenomena that had not been easily or as neatly explained, and that illumination continues. Chaos/ complexity theory has been used to understand phenomena as diverse as the human aging process (Kyriazis, 2003), individuals’ career trajectories (e.g., Pryor, Amundson , & Bright, 2008), and disaster response management (Koehler, Kress, & Miller, 2014). As different as these areas are from psychotherapy groups, all of them share with the psychotherapy group features that chaos/complexity theory showcases. 10 brabender Psychotherapy groups, like these other systems, are irreversible in that they all entail the presence of feedback loops wherein past experiences feed into and shape the present. Psychotherapy groups, like other systems that have lent themselves to chaos/ complexity analyses, are dissipative in that an ongoing exchange of information with the environment exists. All of these complex adaptive systems are characterized by the previously mentioned feature of nonlinearity. For example, the same stimulus, the therapist’s manifest inattention, in one moment of the group may elicit members’ worry and, in another, their outrage. Finally, the psychotherapy group is similar to other groups examined through the lens of chaos/complexity theory in that they are all self-organizing. Psychotherapy groups can be on the brink of chaos in one segment of the life of the group only to achieve, sometimes quite rapidly, coherence in its organization. For example, a group that seems fragmented, with a variety of issues holding sway, might move into a subgrouping structure that provides a container for members to explore different positions related to dependency. Hence many of the important features of the psychotherapy group are the very features examined by chaos/complexity theory, features that have been successfully explored in other domains of application. Second, chaos theory has an obvious compatibility with one of the dominant theoretical frameworks in understanding psychotherapy groups: general systems theory. For example, chaos/complexity theory’s notion that from disorder comes reorganization (or order; Freeman, 2014) is integral to general systems theory. However , whereas general systems theory focuses on systems moving toward equilibrium, chaos/complexity theory had and still has the promise of adding something beyond what general systems theory could provide in that the former studies systems that are far from equilibrium or at the edge of chaos, with chaos being a state of unpredictability and apparent randomness. Chaotic systems are only apparently random because they operate within circumscribed parameters. It is precisely in their position at the edge of chaos that systems have the greatest potential to reorganize. Chaos/ complexity theory also shares with general systems theory the notion that embedded systems within a hierarchy exhibit a similarity across levels of the system. General systems theory refers to structural and dynamic features that repeat...

Clinical and Counseling Psychology Graduate Students’ Expectations for Future Work With Older Adults

In a study that sampled clinical and counseling graduate students in four countries, we examined ways in which students who do not plan to specialize in work with older adults anticipate future work with this population. Participants (n = 431) completed an online survey of geropsychology training opportunities and the Pikes Peak Geropsychology Knowledge and Skill Assessment Tool. Counseling psychology students and those pursuing a PsyD or Master’s degree were more likely to anticipate future work with older adults than clinical psychology students and those pursuing a PhD, though clinical psychology students tended to have more training opportunities in geropsychology. Content analysis was used to examine open-ended responses about expectations for future work with older adults. Themes varied by country, degree, and specialty.

English

This study targeted clinical psychologists engaged in student counseling in Japan and investigated their level of clinical and psychological knowledge about sexual orientation. This study also assessed the relationship between sexuality education and self-learning experiences and knowledge. A questionnaire which included 13 items assessing basic and clinical knowledge about sexuality, experiences regarding education on homosexuality, experiences of self-learning, and experiences with sexual minorities, was anonymously administered to 484 student counselors trained as clinical psychologists. The total number of valid responses was 321 (66.3%). About 80% of the participants correctly answered the items under the category “basic knowledge about homosexuality,” although their clinical knowledge and knowledge regarding differences in sexual orientation and gender identity were limited. 277 had attended graduate school and the proportion of participants who had received education on homosexuality during graduate clinical psychology training was 14.8%. Education on homosexuality received during graduate clinical psychology training and that received via self-learning had little associations with the level of knowledge about sexuality. These results suggest that the level of clinical knowledge of Japanese student counselors was insufficient for appropriate clinical practice. Issues surrounding sexuality education and clinical psychologist training, as well as the limitations of this study, are discussed.   Key words: knowledge about sexual orientation, counselor education, student counselor.

To treat or not to treat: should psychologists treat tobacco use disorder?

The author presented this Presidential Address for Divison 18, Psychologists in Public Service, at the 2012 American Psychological Association Convention in Orlando, Florida. The address challenges public service psychologists to reduce the tobacco disease burden through their roles as researchers, leaders, educators, and practitioners and explains why treating tobacco use disorder is important and relevant for psychologists. The address discusses the prevalence and the resulting mortality and morbidity rates of tobacco use disorder, which call for effective evidence-based interventions that can be integrated by psychologists into other ongoing treatments. Treatment of the underserved populations, including those with serious mental illness and/or substance use disorders, presents many barriers. In addition, education and training for tobacco use disorder in undergraduate and graduate clinical psychology programs present further barriers for psychology trainees. However, progress is being made because of the numerous resources and psychology leaders who are advocates for tobacco use disorder treatment and research. Challenges for the future include increasing awareness of the importance of treatment for tobacco use disorder, finding innovative ways to increase access to comprehensive evidence-based treatment, and acknowledging that psychologists can make a difference in reducing the tobacco use disorder disease burden. Psychologists have an ethical and professional responsibility to treat tobacco use disorder.

Multicultural Grand Rounds: Competency-Based Training Model for Clinical Psychology Graduate Students

Preparing students to enter the field of psychology as competent professionals requires that multicultural practices be infused into all areas of training. This article describes how the Grand Rounds model was adapted to a graduate clinical psychology training program to foster applied learning in multicultural competence. This extension of Grand Rounds as A? student-driven program to enhance multiculturalism may help others in doctoral psychology training programs develop experiential learning opportunities to further enhance professional competence.

Using Game-Based Learning to Teach Psychopharmacology

This article reviews several approaches used to teach psychopharmacology for graduate clinical psychology students. In order to promote engagement and increase student interest, students were broken up into groups and were asked to demonstrate their understanding of the material through a variety of interactive games (i.e., game-based learning, or GBL). Games used to teach this course included Quiz Bowl, Family Feud, Rounds, Potions, Brainopoly, and Puzzles. Results indicated that most students completed the reading prior to each class, were engaged with their team members, and appeared more confident in their understanding of the material over the course of the semester. Additionally, student satisfaction surveys revealed that most students greatly enjoyed these games and reported that they were useful to advancing their understanding of the material.

Development of Clinical Psychology and Mental Health Resources in Vietnam

In this paper, we discuss development of the Vietnam National University graduate Clinical Psychology Program, which has the goal of training both Vietnamese researchers who will develop and evaluate culturally appropriate mental health treatments, as well as Vietnamese clinicians who will implement and help disseminate these evidence-based treatments. We first review the background situation in Vietnam regarding mental health, and its infrastructure and training needs, and discuss the process through which the decision was made to develop a graduate program in clinical psychology as the best approach to address these needs. We then review the development process for the program and its current status, and our focus on the schools as a site for service provision and mental health task shifting. Finally, we outline future goals and plans for the program, and discuss the various challenges that the program has faced and our attempts to resolve them.

Using the Psychodynamic Diagnostic Manual in the Training of the Competent Assessor

The Psychodynamic Diagnostic Manual (PDM;PDM Task Force, 2006) was published in 2006 and very soon after that date, the assessment faculty at the Institute for Graduate Clinical Psychology considered its incorporation into the assessment curriculum. Personality assessment has been a major emphasis of the doctoral program since its inception in 1970. Although faculty had a high level of satisfaction with students’ training in using individual techniques, they saw skills lying at the interface of assessment and psychodiagnosis (integration of test data, providing a diagnosis synopsis, formulation of treatment recommendations, and delivery of feedback) as less fully honed. Essentially, all of these activities were tied to the overarching task of case formulation. This finding is unsurprising in that the areas in need of support are at a higher level of complexity and sophistication than the areas the students had more thoroughly mastered. This article discusses how the PDM has been a valuable tool in improving the Widener assessment curriculum and how it could be a potent instrument in other doctoral programs as well. It also considers what kind of curricular adjustments enable the PDM to be used to best advantage.

Geropsychology content in clinical training programs: a comparison of Australian, Canadian and U.S. data

There is a worldwide shortage of mental health professionals trained in the provision of mental health services to older adults. This shortage in many countries is most acutely felt in the discipline of psychology. Examining training programs in clinical psychology with respect to training content may shed light on ways to increase interest among students and improve practical experiences in working with older adults. A large multinational survey of geropsychology content in university-based clinical and counselling psychology training programs was conducted in 2007 in the U.S.A., Australia, and Canada. Both clinical/counseling programs and internship/practicum placements were surveyed as to staffing, didactic content and training opportunities with respect to geropsychology. Survey response rates varied from 15% in the U.S.A. (n = 46), 70% in Australia (n = 25) to 91.5% in Canada (n = 22). The U.S.A. and Australia reported specialist concentrations in geropsychology within graduate clinical psychology training programs. More assessment and psychopathology courses in the three countries were cited as having ageing content than psychotherapy courses. Many non-specialist programs in all three countries offered course work in geropsychology, and many had staff who specialized in working clinically with an older population. Interest in expanding aging courses and placements was cited by several training sites. Recruiting staff and finding appropriate placement opportunities with older adult populations were cited as barriers to expanding geropsychology offerings. In light of our results, we conclude with a discussion of innovative means of engaging students with ageing content/populations, and suggestions for overcoming staffing and placement shortcomings.

Clinical expertise and reasoning with uncertain categories

Expert clinical psychologists, clinical psychology graduates, and nonclinical graduate students were presented with clinical and nonclinical cases in which the diagnosis or category membership of a character was uncertain; they then made feature predictions about the character. For each case, there was a diagnosis or category that was highly probable and a less likely alternative that either did (relevant condition) or did not (neutral condition) alter predictions. For clinical cases, clinical experts and graduate clinicians gave different predictions for the relevant and neutral conditions, indicating that they had considered the uncertain nature of the diagnosis in their predictions. Although they acknowledged that the diagnosis was uncertain, nonclinical students ignored the less likely diagnostic alternatives when making predictions. For the nonclinical cases, all three groups made predictions based on only the most likely category alternative. The results showed that clinical training and/or experience promote multiple-category reasoning, but that this effect is domain specific.

An exploratory study of vicarious trauma among therapist trainees.

The current study explored vicarious trauma among therapist trainees in relation to history of trauma, experience level, trauma-specific training, and defense style. Students in graduate clinical and counseling psychology training programs (N 129) completed the Trauma Symptom Inventory, Defense Style Questionnaire, and an experience questionnaire. Results indicated trauma symptoms were significantly associated with defense style, which appeared to moderate personal trauma history and experience level. Trauma-specific training was also independently related to trauma symptoms. Notably, over half the sample reported a self-sacrificing defense style, which was a risk factor for vicarious trauma. Training implications of the findings are discussed.

The Dissertation as a Component in the Training of Clinical Psychologists

The dissertation, a significant component of graduate clinical psychology training, is hardly ever completed within the stipulated two years, with the result that students graduate much later than they should. Against this background, the present investigation surveyed clinical psychologists who graduated between 5 and 10 years ago for feedback on their experiences of the dissertation. One hundred and thirty-seven subjects responded. The average time taken to complete the dissertation was almost three years, with a range between 6 months and 14 years. Almost 70 per cent of the subjects took longer than the stipulated time, and almost 30 per cent took more than one year longer. About one-third of the subjects had a negative or indifferent attitude prior to starting the work, and similar percentages of the sample felt they did not have sufficient grounding to start the dissertation or enough supervision while working on it. Almost three-quarters of the subjects felt the dissertation had minimally influenced their practice as clinical psychologists. The results are discussed within the context of the ‘scientist-practitioner’ model of training, and training issues in low-income countries.

Teaching Clinical Competence

This Commentary is written from my experience as a teacher of Emily Liu in a graduate clinical psychology course focusing on the training of psychotherapy skills. Liu took the class simultaneous to seeing the case of TC, and she utilized the class to develop her approach to the case, including conceptualization and formulation; the processing of her emotional, "countertransferential" reactions to the client; the devising of intervention strategies with the client; reflection upon the process; and writing about the case. These processes are reviewed in the context of the course and issues raised by the nature of the case material itself. A synergistic overlap is reviewed among (a) the skills taught in the course, (b) an emerging national consensus on core clinical skills developed at the 2002 Scottsdale "competency conference," and (c) the competencies required to function in Peterson's "disciplined inquiry" paradigm, which is the model underlying the structure of the case studies in this PCSP journal. It is this overlap which provided to Liu very targeted and effective preparation in graduate school for the development of her impressive case study in this journal.

The Process of Selecting Clinical and Counseling Psychology Graduate Programs: An Informed Career Decision

The Process of Selecting Clinical and Counseling Psychology Graduate Programs: An Informed Career Decision