Clinical Psychology Training Programs Research Articles

Reported positive and negative outcomes associated with a self-practice/self-reflection cognitive-behavioural therapy exercise for CBT trainees

Objective: The aim of the current study was to identify outcomes of a self-practice/self-reflection (SP/SR) exercise for trainee clinical psychologists. Method: Thirty-two trainees enrolled in their first year of a UK university doctoral clinical psychology training programme completed an online questionnaire following an eight-week exercise. Results: Findings indicated an endorsement of many previously reported benefits of exercise participation, but also the identification of negative outcomes. Thematic analysis of qualitative data revealed that outcomes could be grouped into two main thematic domains (individual task outcomes and task organization issues) along with several subordinate themes. Conclusion: SP/SR is a useful tool in the development of trainee CBT therapist competences. There has been limited previous recognition of potential negative outcomes from this type of exercise. However, these can provide additional impetus for therapist skill development.

Training the scientist–practitioner in the twenty-first century: A risk–benefit analysis

The scientist–practitioner (S–P) model plays a central role in the professional ideology guiding most graduate training programs in clinical and counseling psychology. Unfortunately, the ideals of the S–P model are rarely fulfilled. It may be helpful to examine the relevant issues from a risk–benefit analysis. Common benefits of the S–P model include the satisfaction that practitioners derive from helping clients in distress, improvements to graduate teaching, refinements to psychological research, and the positive influence when faculty members serve as effective role models for the next generation of psychologists. Potential risks of the S–P model occur when faculty members take time away from other university chores, especially if it would reduce the likelihood of tenure and promotion. However, the biggest risk lies in the potential damage to the field of psychology, created when psychologists lose sight of important issues in the field. Graduate training programs are encouraged to maximize the benefits while minimizing the risks, thereby continuing to promote the ideals of the S–P model.

Extending training in multicultural competencies to include individuals identifying as lesbian, gay, and bisexual: Key choice points for clinical psychology training programs.

Traditional models of multicultural training for professional psychology have focused primarily on racial and ethnic minorities and have not included competencies focused on individuals identifying as lesbian, gay, and bisexual (LGB), despite documented evidence of health disparities for sexual minorities. Ways to adapt models based on Sue's (1992) 3 × 3 competencies (attitudes and beliefs, knowledge, and skills across the dimensions of awareness of one's own cultural influences and biases, understanding the client perspective, and appropriate interventions for an individual client) for LGB health are described. This includes the addition of an action/advocacy dimension. Six key choice points for clinical psychology training programs adding LGB competency to a multicultural competency training component are outlined. Potential challenges and solutions for expanding multicultural training are discussed.

Integrating LGBT competencies into the multicultural curriculum of graduate psychology training programs: Expounding and expanding upon Hope and Chappell's choice points: Commentary on “Extending training in multicultural competencies to include individuals identifying as lesbian, gay, and bisexual: Key choice points for clinical psychology training programs”.

In this volume, Hope and Chappell outline a number of “choice points” that they presume psychology training programs will universally face as they build competency in working with sexual minority (lesbian, gay, and bisexual [LGB]) clients into their multicultural training curricula. From our vantage points as the director of clinical training (DCT) and the training clinic director from a doctoral program in clinical psychology, we concur with their suggestions and believe that they can serve as a guide for doctoral programs implementing LGB and transgender (LGBT)-specific training. In the commentary that follows, we elaborate upon these choice points, share our experiences within our own program, discuss some predictable challenges and questions faced by programs when implementing such an inclusive curriculum, and propose a solution that supports integration of LGBT competencies into all training programs, while acknowledging the difficulties inherent in this endeavor.

Scientist–practitioner training at the internship and postdoctoral level: Reflections over three decades.

Clinical psychology training for research-oriented scientist–practitioners tends to have a gap in research training during the predoctoral internship year. In 1982, the Clinical Psychology Training Program (CPTP) at the University of California, San Francisco (UCSF) began a 2-year clinical and clinical research training program combining an American Psychology Association (APA)-accredited internship and a postdoctoral fellowship. The goal of the program is to prepare graduates for leadership roles as principal investigators who are licensed clinicians able to function as independent practitioners. This article conveys the philosophy behind the program, its structure, and the results of the program over the last 31 years. The CPTP accepted 142 trainees, of whom 46 (32%) were minorities and 78 (55%) were women. CPTP fellows have published over 250 articles, chapters, and books with their mentors and have contributed to submitting research grants with them. The vast majority continued research and academic activities after graduation. The most recent self-study for APA accreditation reported that of 43 trainees admitted in the 10 years between 1999 and 2008, 41 (95%) went on to academic positions, research, or clinical positions in academic settings or research positions in other settings; 1 obtained a clinical position; and 1 provided no information. The program serves as a model for clinical psychology nationally, allowing for uninterrupted clinical research training during the internship and postdoctoral years, nurturing clinical psychologists committed to clinical research careers, and contributing substantially to the clinical research productivity of the host department.

Mindfulness-based interventions for trainee clinical psychologists: An invitation for profession leadership in self-care

This paper reflects on the concept of self-care, personal experiences of self-care as incorporated into a clinical psychology training programme and explores the potential usefulness of the application of mindfulness-based approaches to this area.

A neuroscience perspective on incidental imaging findings and diagnostic and therapeutic silos.

Traditionally, psychiatry and clinical psychology have understood behavior as separate from brain function and have avoided referring neurobehavioral patients, particularly those carrying a Diagnostic Statistical Manual (DSM) diagnosis, for additional studies such as neuroimaging. Current psychiatric training programs continue to permit this dichotomous misunderstanding by neglecting neuroscience courses that elucidate the relationship between behavior and brain function. Psychiatrists and psychologists have learned to interpret and manage behavior without a clear picture of brain physiology and function (1). Moreover, with the exception of some neuropsychologists, most psychologists and psychiatrists neglect standard neurological exams and only consider behavioral symptoms. When it concerns neurobehavioral disorders, psychiatric and psychological standards of practice disregard objective imaging for assessing brain function and primarily reserve this technique for research. This omission confirms a meager understanding of brain physiology and function and their influences on behavior. Therefore, psychological and psychiatric theories have become stuck in unsubstantiated data. For example, the DSM defines disorders purely from observational data. To be fair, those diagnostic theories evolved during an era that lacked the necessary technology for objective brain evaluation, yet despite neuro-imaging and neuro-scientific advances, clinical psychology and psychiatry training programs still disregard introducing neuroscience to their students trained to be clinicians. Consequently, this omission has caused competition and isolation between clinical specialties and the development of practical and intellectual silos. Didactic programs that ignore neuroscience perspectives hinder clinical mental health students by denying them a holistic view of the patient. This incomplete picture begins the process of pseudo-specialization, a process that has little to do with developing optimal person centered therapeutics for the patient. In an ideal world, all behavioral fields would pursue a common neuroscientific language and education that permits seamless understanding of biology, behavior, sociology, and pathology.

Mindfulness as a way of addressing the deficits in clinical psychology training programmes: A review

Research suggests that there is a lack of focus on developing trainees’ intrapersonal skills or adequately fostering self-care. Mindfulness training may help address the gaps in training programmes. Quantitative and qualitative studies involving mindfulness training for postgraduate trainees were reviewed. There is a need to explore different designs of mindfulness training groups to ascertain what would be feasible and effective, given the trainees’ existing time constraints. Furthermore, the current understanding is limited due to the difficulties defining and operationalising mindfulness. Qualitative research would help to explore what mindfulness training means to trainees and how it impacts on their lives.

Values and goals in clinical psychology training programs: Are practice and science at odds?

Values and goals in clinical psychology training programs: Are practice and science at odds?

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.

Learning on the front line: can personal development during problem-based learning facilitate professional development in trainee clinical psychologists?

Problem-based learning (PBL) is a form of self-directed learning that has been employed for over 30 years within a variety of disciplines and professional training programmes. This paper focuses on the acquisition of skills and knowledge gained through experiential learning components of the academic programme, namely Problem-Based Learning, of a Clinical Psychology training programme. This paper explores the learning experiences of a PBL group on this programme, reflecting on the impact of an experience early on in their group formation (presenting a personal in-vivo version of their PBL experience and subsequent negative evaluation). These narratives were written after their 3rd PBL exercise (the latter two were formally evaluated). This paper then goes on to consider how they then managed PBL including factors that may have helped or hindered their ability to learn and work together effectively. We conclude with what we may learn for the benefit of other learning contexts.

Hidden gems among clinical psychology training programs.

As a result of CoA-mandated program disclosure being initiated in 2006, there are now sufficient data available to allow for analyses that compare clinical psychology programs on a range of variables, including student outcomes. This standardized data, in concert with other sources of publically available data (i.e., APPIC and ASPPB), allow for programs to be compared empirically in new ways. Using SEM, in this Study 80.6% of the variance in clinical psychology training programs’ outcomes (i.e., internship match and licensure exam performances) was accounted for by predoctoral characteristics (measured by GPA and GRE scores). Analyses then identified programs that produced exceptionally better outcomes than expected, given their predoctoral characteristics. The identified top programs were next compared on a range of department level training-relevant variables to similar programs, but whose outcomes were equal to or worse than expected. Findings are discussed and future directions for research and policy are suggested.

DCP Pre-Qualification Group Column Giving trainees a voice: Reviewing the accreditation standards for clinical psychology training programmes

As highlighted earlier in this edition, the accreditation standards for clinical psychology doctorate programmes are currently being reviewed. The Pre-Qualification Group felt that it was imperative to give a voice to trainee clinical psychologists to comment on their experiences of training, with the hope of influencing the revised standards. This article discusses how the PQG managed this process and aims to encourage trainees to continue to provide feedback on the new standards, which are open to consultation.

White clinical psychology trainees' views on racial equity within programme selection in South Africa

The issue of diversity in both physical and epistemological access to programmes in higher education is an important concern worldwide. In South Africa, as elsewhere, access to professional clinical psychology training programmes is extremely competitive, and there is an important imperative to diversify the student profile. Perspectives of black students on access to clinical psychology training in South Africa have been extensively studied, but the views of white students are minimally documented. We interviewed four white professional clinical psychology trainees on their views about the role race plays in selection for professional training. Four major themes arose from the participants' responses: uncertainty versus transparency; internal shame versus external blame; race versus socio-economic status and language and relevance versus irrelevance. Participants expressed discomfort with selection procedures, and though there are several limitations to this study, such as the small sample size, the need to open the door to discussions on the frightening topic of race is essential for a socially responsible approach to future equity, diversity and representativeness in professional training in higher education in South Africa.

A Guide for Starting a Specialty Training Clinic: An Alcohol Treatment Program as an Example.

Since the Boulder conference more than 50 years ago, clinical psychology has been moving towards empirically based techniques and methods. Considerable research has been conducted and a multitude of studies have documented support for empirically supported treatments (ESTs). However, the literature on implementing ESTs in real-world settings is relatively limited. The absence of practical guidance poses a particular problem for students in clinical psychology training programs that emphasize training and competency in ESTs. This article describes the development of an alcohol specialty clinic within a clinical psychology training program from the first conceptualizations to establishment of a referral base and provision of services. At each step, integration of science and clinical practice is discussed. Future directions and suggestions for developing training clinics are provided.

Perceptions of climate in clinical psychology doctoral programs: Development and initial validation of the Graduate Program Climate Scale.

Measurement of program climate, defined as a sense of environmental safety amid respectful relationships and effective organizational systems, has been associated with a myriad of important outcomes in school and workplace settings. However, climate has received scant attention in the realm of graduate training, including training in psychology health service programs, despite related research suggesting that quality of mentor–mentee relationships and the research training environment influences student satisfaction and educational attainment. The current study presents the initial development of the Graduate Program Climate Scale, a brief 20-item assessment of climate derived from school and workplace climate measures, targeted at clinical psychology doctoral students in scientist-practitioner programs. The scale was found to be internally consistent and correlated with program satisfaction, satisfaction with evaluation and feedback procedures, and confidence in research skills. Importantly, more positive program climate also predicted outcomes related to peers with problems of professional competence, suggesting that program climate is associated with students’ faith in faculty to handle professional competence issues. Results from the current study suggest that the Graduate Program Climate Scale may be a useful tool for examining program-level characteristics and processes associated with success in clinical psychology training programs.

Evaluation of a Combined Cognitive Behavioural Therapy and Interpersonal Process Group in the Psychotherapy Training of Clinical Psychologists

It is now widely acknowledged that both content and process elements of psychotherapy play a part in client treatment outcomes. Despite this, there are pressures on Australian clinical psychology training programs to teach evidence‐based approaches in a relatively short time frame. Producing clinical psychology graduates who have an adequate level of competence in evidence‐based practice and meeting the demands of professional accreditation requirements can mean that less time is available to teach the process elements of psychotherapy.The aim of this study was to conduct a preliminary evaluation of a clinical psychology psychotherapy training program that combines an interpersonal process group with a cognitive behavioural therapy training model that incorporates self‐reflection and self‐practice. Eleven participants who participated in the training in 2008 completed the Counseling Self‐Estimate Inventory at pre‐ and post‐training. Significant improvements on the majority of the subscales of this inventory were found. A separate sample of nine trainees and clinical psychology registrars who also previously completed the program attended individual interviews in 2010 aimed at gaining their perspective regarding various aspects of the program. Self‐practice of cognitive behavioural therapy techniques was found to be important in the identification and management of trainees’ own core beliefs, and to their appreciation of how challenging this process may be for clients. The interpersonal process group was described by participants as enhancing their competency as psychotherapists. Common themes included the experience of anxiety and a high level of emotion, and understanding how this experience might be similar for clients; increased self‐awareness; and increased competence in process issues. Many participants believed the process and content components of training were equally important to their development as psychotherapists.

Clinical Psychology Students’ Experiences of a Pilot Objective Structured Clinical Examination

There is a need to improve methods used to assess students’ clinical skills in postgraduate clinical psychology training, but research into the use of new competency‐based assessments are sparse. The current study examines the potential application of the objective structured clinical examination (OSCE) to clinical psychology training. Commonly used in medical training, the OSCE requires students to demonstrate clinical skills across a number of standardised stations with trained actors playing the part of patients. A pilot OSCE was conducted with nine students from a psychology doctoral program. Participants completed a brief student feedback questionnaire and attended a focus group after the OSCE. They also completed the State–Trait Anxiety Inventory before and after the OSCE. The results showed that students viewed the OSCE as a valid, realistic, and fair assessment method. They reported high levels of anxiety during the OSCE but noted that the OSCE was a positive learning experience. These results suggest that OSCEs should be considered in clinical psychology training programs for the assessment of clinical competence. Further evaluations of the validity and reliability of the clinical psychology OSCE using a larger sample size are required. Other limitations and implications of the study are discussed.

Sleep education in clinical psychology training programs.

Sleep education in clinical psychology training programs.

Training and staff retention: National issues and findings from the South Thames (Salomons) clinical psychology training programme

This survey examined long-term employment outcomes of trainees from the Salomons, Canterbury Christ Church University Programme completing clinical psychology training. Ex-trainees had spent the great majority of their time working within the NHS; within the training commissioning area. Figures calculated compared favourable to other professions within the NHS.