Training and licensing of clinical psychologists

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The training and licensing of clinical psychologists ranges from 4 year undergraduate degree plus a 4 to 6 year doctorate program. Most programs in the U.S. are PhD programs that have a strong focus on research and are typically housed in universities. There are fewer programs resulting in a PsyD (doctor of psychology), many of which are in private schools and have a greater focus on treatment. There are more students enrolled in PsyD programs overall so that both degrees are about 50/50 in terms of number of students. In the U.K., those training to be clinical psychologists have to complete a Doctorate in Clinical Psychology (D.Clin.Psych.), which is a practitioner doctorate with both clinical and research components. This is a three-year full-time salaried program sponsored by the National Health Service (NHS) and based in universities and the NHS.

In the U.S., Canada and the U.K the practice of clinical psychology requires a license. Although every state is somewhat different in terms of requirements and licenses, there are three common elements—a degree from an approved educational program, a minimum amount of supervised clinical experience, and passing an examination. Most states also require a certain number of continuing education credits per year in order to renew a license, which can be obtained though various means, such as taking audited classes and attending workshops.

Doctoral level training

The University of Pennsylvania was the first to offer formal education in clinical psychology.

There is stiff competition to gain acceptance into clinical psychology doctoral programs (acceptance rates of 2-5% are not uncommon). Clinical psychologists in the U.S. undergo many years of graduate training—usually 5 to 7 years post-Bachelors—in order to gain demonstrable competence and experience. Licensure as a psychologist takes an additional 1 to 2 years post PhD/PsyD (licensure requires 3,000 hours of supervised training), depending on the state (see below under licensure). Today, in America, about half of all clinical psychology graduate students are being trained in PhD programs—a model that emphasizes research and is usually housed in universities—with the other half in PsyD programs, which has more focus on practice (similar to professional degrees for medicine and law).^[1] Both models envision practising Clinical Psychology in a research-based, scientifically valid manner, and are accredited by the American Psychological Association^[2] and many other English-speaking psychological societies. APA accreditation is very important for U.S. clinical psychology programs and may affect employment prospects and licensure after one graduates (http://www.apa.org/support/education/accreditation/importance.aspx#answer).

Mean debt related to doctoral education in clinical psychology currently exceeds $80,000, according to the 2011 appic match survey, and 44% of graduates accrue over $100,000 in debt (http://www.appic.org/match/5_2_2_match_about_statistics.html). There is currently a significant internship crisis affecting U.S. clinical psychology programs for the past 10 years (see under clinical psychology; http://en.wikipedia.org/wiki/Clinical_psychology).

Doctorate (PhD and PsyD) programs usually involve some variation on the following 5 to 7 year, 90-120 unit curriculum:

• Bases of behavior—biological, cognitive-affective, and cultural-social
• Individual differences—personality, lifespan development, psychopathology
• History and systems—development of psychological theories, practices, and scientific knowledge
• Clinical practice—diagnostics, psychological assessment, psychotherapeutic interventions, psychopharmacology, ethical and legal issues
• Coursework in Statistics and Research Design
• Clinical experience
  • Practicum—usually three or four years of working with clients under supervision in a clinical setting. Most practicum placements begin in either the first or second year of doctoral training
  • Doctoral Internship—usually an intensive one or two year placement in a clinical setting
• Dissertation—PhD programs usually require original quantitative empirical research, while PsyD dissertations involve original quantitative or qualitative research, theoretical scholarship, program evaluation or development, critical literature analysis, or clinical application and analysis. The dissertation typically takes 2-3 years to complete.
• Specialized electives—many programs offer sets of elective courses for specializations, such as health, child, family, community, or neuropsychology
• Personal psychotherapy—many programs require students to undertake a certain number of hours of personal psychotherapy (with a non-faculty therapist) although in recent years this requirement has become less frequent.
• Comprehensive Exams and/or Master's Thesis: A thesis can involve original data collection and is distinct from a dissertation

Masters level training in the U.S.

Sample Curriculum for MA in Clinical Psychology in the U.S.
State Required	School Required	Electives
Chemical Dependency: 3 Human Sexuality: 2 Child Abuse: 2 Domestic Violence: 2 Aging: 2 Ethics & Law: 3 Psychological Testing: 3 Psychopharmacology: 3	Process and Psychotherapy: 4 Personality Theory: 6 Cross-Cultural: 3 Comparative Theories: 6 Psychology and Society: 2 Systems Theory & Family: 5 Assessing and Planning: 3 Brief Therapy: 2 Group and Couples Treatment: 6 Applied Therapeutic Techniques: 9 Developmental Psych and pathology: 9	Gay and Lesbian Issues: 2 ADHD: 1 Crisis Intervention: 2 Cognitive/Behavioral: 2 Existential Psychology: 2 Clinical Intervention with Adolescents: 2 Narratives of Women's Lives: 2

Where subject is required by both the state and the school, it is shown under the school's required column. Similar courses have been lumped together, for example "Group Treatment Techniques" and "Couples Counseling" were combined, their units added together and called "Group and Couples Treatment"—just to keep the table of manageable size.

There are a number of U.S. schools offering accredited programs in clinical psychology resulting in a Masters degree. Such programs can range from 48 to 84 units, most often taking 2 to 3 years to complete post-Bachelors. Training usually emphasizes theory and treatment over research, quite often with a focus on school or couples and family counseling. Similar to doctoral programs, Masters-level students usually must fulfill time in a clinical practicum under supervision and undergo a minimum amount of personal psychotherapy.^[3] While many graduates from Masters-level training go on to doctoral programs, a large number also go directly into practice—often as a Licensed Professional Counselor (LPC), Marriage and Family Therapist (MFT) or other similar license.^[4]

Other related licenses open to Masters-level graduates in the U.S. include: Marriage and Family Therapist (MFT), Licensed Professional Counselor (LPC), and Licensed Psychological Associate. (LPA).

Training in the U.K.

In the U.K., clinical psychologists undertake a Doctorate in Clinical Psychology (D.Clin.Psych., Clin.Psy.D. or similar), which is a doctorate with both clinical and research components. This is a three-year full-time salaried program, provided by 30 centres across the UK, sponsored by the National Health Service (NHS). These clinical psychology doctoral degrees are accredited by the British Psychological Society and the Health Professions Council (HPC). Entry into these programs is highly competitive, and requires at least a three-year undergraduate degree in psychology, plus some form of experience, usually in either the NHS as an Assistant Psychologist or in academia as a Research Assistant.^[5] More information about the path to training in the UK can be found at the central clearing house for clinical psychology training applications, and at www.ClinPsy.org.uk where questions can also be answered on the forum, which is run by qualified UK clinical psychologists.

In the U.K. there are currently protected 'psychologist' titles. These are: • Practitioner psychologist • Registered psychologist • Clinical psychologist • Counselling psychologist • Educational psychologist • Forensic psychologist • Health psychologist • Occupational psychologist • Sport and exercise psychologist.

The public can check whether a psychologist is registered on the Health Professions Council website (http://www.hpc-uk.org), which would prove they are genuine. It is compulsory for a psychologist to register with the Health Professions Council in order to practice using one of the protected titles in the United Kingdom. The terms 'clinical psychologist' and 'counselling psychologist' cannot be used legally by any member of the public for any purpose, unless that person is registered with the Health Professions Council.

Clinical Psychologists are required to be licensed in the U.K. in order to practice. It is a requirement to be a member of the Health Professions Council in order to practice.

Professional practice

Clinical psychologists can offer a range of professional services,^[6] including:

• Provide psychological treatment (psychotherapy)
• Administer and interpret psychological assessment and testing
• Conduct psychological research
• Teaching
• Development of prevention programs
• Consultation (especially with schools and businesses)
• Program administration
• Provide expert testimony (forensics)

In practice, clinical psychologists may work with individuals, couples, families, or groups in a variety of settings, including private practices, hospitals, mental health organizations, schools, businesses, and non-profit agencies. Most clinical psychologists who engage in research and teaching do so within a college or university setting. Clinical psychologists may also choose to specialize in a particular field—common areas of specialization, some of which can earn board certification,^[7] include:

• Specific disorders (e.g. trauma, addiction, eating, sleep, sex, depression, anxiety, or phobias)
• Neuropsychological disorders
• Child and adolescent
• Family and relationship counseling
• Health
• Sport
• Forensic
• Organization and business
• School

Licensure

Comparison of mental health professionals in USA
Occupation	Degree	Common Licenses	Prescription Privilege	Ave. 2004 Income (USD)
Clinical Psychologist	PhD/PsyD	Psychologist	Mostly no	$75,000
Counseling Psychologist (Doctorate)	PhD	MFT/LPC	No	$65,000
Counseling Psychologist (Master's)	MA/MS/MC	MFT/LPC/LPA	No	$49,000
School Psychologist	PhD, EdD	Psychologist	No	$78,000
Psychiatrist	MD/DO	Psychiatrist	Yes	$145,600
Clinical Social Worker	PhD/MSW	LCSW	No	$36,170
Psychiatric Nurse	PhD/MSN/BSN	APRN/PMHN	No	$53,450
Psychiatric and mental health Nurse Practitioner	DNP/MSN	MHNP	Yes (Varies by state)	$75,711
Expressive/Art Therapist	MA	ATR	No	$45,000

Sources: ^{[8][9][10][11][12][13]}

The practice of clinical psychology requires a license in the United States, Canada, the United Kingdom, and many other countries. Although each of the U.S. states is somewhat different in terms of requirements and licenses (see [2] and [3] for examples), there are three common elements:^[14]

1. Graduation from an accredited school with the appropriate degree
2. Completion of supervised clinical experience
3. Passing a written examination and, in some states, an oral examination

All U.S. state and Canada province licensing boards are members of the Association of State and Provincial Psychology Boards (ASPPB) which created and maintains the Examination for Professional Practice in Psychology (EPPP). Many states require other examinations in addition to the EPPP, such as a jurisprudence (i.e. mental health law) examination and/or an oral examination.^[14] Most states also require a certain number of continuing education credits per year in order to renew a license, which can be obtained though various means, such as taking audited classes and attending approved workshops.

There are professions whose scope of practice overlaps with the practice of psychology (particularly with respect to providing psychotherapy) and for which a license is required.

• Psychologist. To practice with the title of Psychologist, in almost all cases a Doctorate degree is required (a PhD or PsyD in the U.S.). Normally, after the degree, the practitioner must fulfill a certain number of supervised postdoctoral hours ranging from 1,500-3,000 (usually taking 1 to 2 years), and passing the EPPP and any other provincial exams.^[15]
• Marriage and Family Therapist (MFT). An MFT license requires a Doctorate or Masters degree. In addition, it usually involves 2 years of post-degree clinical experience under supervision, and licensure requires passing a written exam, commonly the National Examination for Marriage and Family Therapists which is maintained by the American Association for Marriage and Family Therapy. In addition, most states require an oral exam. MFTs, as the title implies, work mostly with families and couples, addressing a wide range of common psychological problems.^[16]
• Licensed Professional Counselor (LPC). Similar to the MFT, the LPC license requires a Masters or Doctorate degree, a minimum number of hours of supervised clinical experience in a pre-doc practicum, and the passing of the National Counselor Exam. Similar licenses are the Licensed Mental Health Counselor (LMHC), Licensed Clinical Professional Counselor (LCPC), and Clinical Counselor in Mental Health (CCMH). In some states, after passing the exam, a temporary LPC license is awarded and the clinician may begin the normal 3000-hour supervised internship leading to the full license allowing for the practice as a counselor or psychotherapist, usually under the supervision of a licensed psychologist.^[17]
• Licensed Psychological Associate. (LPA) About twenty-six states offer a Masters-only license, a common one being the LPA, which allows for the therapist to either practice independently or (more commonly) under the supervision of a licensed psychologist, depending on the state.^[4] Common requirements are 2 to 4 years of post-Masters supervised clinical experience and passing a Psychological Associates Examination. Other titles for this level of licensing include Psychological Technician (Alabama), Psychological Assistant (California), Licensed Clinical Psychotherapist (Kansas), Licensed Psychological Practitioner (Minnesota), Licensed Behavioral Practitioner (Oklahoma), Licensed Psychological Associate (North Carolina)or Psychological Examiner (Tennessee).

• Licensed Behavior analysts are licensed in five states to provide services for clients with substance abuse, developmental disabilities, and mental illness. This profession draws on the evidence base of applied behavior analysis and the philosophy of behaviorism. Behavior analysts have at least a master's degree in behavior analysis or in a mental health related discipline as well as at least five core courses in applied behavior analysis. Many behavior analysts have a doctorate. Most programs have a formalized internship program and several programs are offered online. Most pracitioners have passed he examnination offered by the behavior analysis certification board [4]. The model licensing act for behavior analysts can be found at the Association for Behavior Analysis International's website.

Main article: Professional practice of behavior analysis

In the U.K. registration as a clinical psychologist with the Health Professions Council (HPC) is necessary. The HPC is the statutory regulator for practitioner psychologists in the U.K. In the U.K. the following titles are restricted by law "registered psychologist" and "practitioner psychologist"; in addition the specialist title "clinical psychologist" is also restricted by law. The title of "Assistant Psychologist" is used by a psychology graduate under the supervision of a qualified clinical psychologist, and the title "Trainee Clinical Psychologist" is used during the three-year doctoral program.

References

1. ^ Norcross, J. & Castle, P. (2002). Appreciating the PsyD: The Facts. Eye on Psi Chi, 7(1), 22-26.
2. ^ APA. (2005). Guidelines and Principles for Accreditation of Programs in Professional Psychology: Quick Reference Guide to Doctoral Programs.
3. ^ Antioch University. (2006). Master of Arts in Psychology Program Options & Requirements.
4. ^ ^{a b} Northamerican Association of Masters in Psychology. (2004). Licensure Information.
5. ^ Cheshire, K. & Pilgrim, D. (2004). A short introduction to clinical psychology. London ; Thousand Oaks, CA : Sage Publications. ISBN 076194768X
6. ^ Compas, Bruce & Gotlib, Ian. (2002). Introduction to Clinical Psychology. New York, NY : McGraw-Hill Higher Education. ISBN 0070124914
7. ^ American Board of Professional Psychology, Specialty Certification in Professional Psychology
8. ^ APA. (2003). Salaries in Psychology 2003: Report of the 2003 APA Salary Survey
9. ^ NIH: Office of Science Education. (2006). Lifeworks: Psychiatrist
10. ^ U.S. Department of Labor: Bureau of Labor Statistics. (2004). Occupational Outlook Handbook: Social Workers
11. ^ U.S. Department of Labor: Bureau of Labor Statistics. (2004). Occupational Outlook Handbook: Registered Nurses
12. ^ NIH: Office of Science Education. (2006). [1] Advance News Magazines.(2005).
13. ^ "Lifeworks: Art Therapist". http://science.education.nih.gov/LifeWorks.nsf/Alphabetical+List/Art+Therapist. Retrieved 2007-02-17. 
14. ^ ^{a b} "Association of State and Provincial Psychology Boards". http://www.asppb.org/. Retrieved 2007-02-17. 
15. ^ Kerewsky, Shoshana. (2000). Some US states also require additional requirements, such as an oral exam and extra coursework Beyond Internship: Helpful Resources for Obtaining Licensure.
16. ^ American Association for Marriage and Family Therapy, Frequently Asked Questions on Marriage and Family Therapists
17. ^ "National Board for Certified Counselors". http://www.nbcc.org/. Retrieved 2007-02-17.