Monday, March 25, 2013

What I Wish I Knew Before Becoming a Doctoral Student in ClinicalPsychology: So Much More Than I Did.

As I am (hopefully) nearing the end of my graduate school training, there are many things I wish I would've know prior to starting. Getting a Ph.D. isn't as easy as it seems - and not for the reasons you may have guessed.

While much of this post is specific to my experience, it still may prove helpful. So without further ado, here's a list of what I wish I knew before going for a doctorate in clinical psychology:

1. The training isn't as hard as having the financial burden. If you're considering going for an academic degree like a Ph.D., chances are you've been pretty good at school. You can go to class, learn, and use the info you've picked up.  That being said, managing to pay the bills can become very difficult. While programs differ, doctoral students generally have to complete three externships, which are 20 hour / week training positions at clinics or hospitals outside of your program. While some externships are paid, I was only accepted to unpaid externships for my first two years. I am extremely grateful to have trained where I did, but I needed to pick up extra work on the side. It was exhausting.

2. Unpaid externships tend to offer better training than paid ones. Because I was running myself into a financial hole, I just figured I would get paid positions. Interestingly, the less competitive positions tend to be paid. Conversely, the most competitive positions tend to be unpaid.  Your supervisors at the unpaid externships are likely to take more time to really educate you rather than just quickly putting you to work. At my unpaid externships, I had about four to five hours a week of supervision, CBT classes, seminars, etc. Conversely, although I really learned a ton at my paid position from my wonderful direct supervisor, I was treated as more of a work horse by the other hospital staff.   While I did my best to have learning experiences at the paid position, much more of my day was spent doing paperwork that (much more) falls under the job description of other members of the hospital staff.  Anyhow, I thought for sure with my publication record I would be able to make a bit more money training. Wrong!  As it turned out, I wasn't offered interviews at paid positions for my first two externship years. The whole process is kind of backwards.

3. Most clinical positions don't care about research experience and publications. Again, I thought for sure that my publication record would help me get clinical jobs. In fact, I was told that I wasn't offered some paid clinical positions because I was "too research-y." People are split into two stereotypes: clinical folks and research folks. Broadly speaking, the clinician is viewed as valuing human connection above science. In turn, the scientist is viewed as valuing data that may be helpful to the masses over helping a smaller number of people via direct human interaction.  Even though I consider myself a good balance between clinical and research, my CV shows a bunch of research conference presentations and papers. It appears I was pigeon-holed.

4. The current APA-accredited internships are not the internships of your professors. Internships are the last year of your training. They are very typically completely clinical in nature (meaning you won't be doing research). It is extremely hard to get an APA-accredited internship nowadays. Something like 67% of people match to accredited sites. Because of financial problems, many internships - especially in the NYC area - were closed. While most of the great unpaid externships are worth it in the long-run, the ones I was accepted to were located in clinics, not hospitals. Getting a hospital externship puts you in a much better place for an APA-accredited internship. They may also pay. Even if you think you "know" you never want to work in hospitals, be prepared to give it a shot as part of your clinical training. Don't try to avoid it.

5. Get experience in a bunch of different type of settings. It doesn't matter if you're afraid of working on an inpatient unit. Use all of your CBT, DBT, and ACT skills. Also, it may not be a bad idea to take a self-defense course. Inpatient units aren't exactly dangerous, but they're not exactly not dangerous. I am lucky enough to have worked at places that require self-defense classes aimed at keeping yourself safe without hurting patients.  Anyhow, work on being willing to have the experience of working on an inpatient unit. And if you can find them, try emergency department experiences too.

6. It is unclear if getting an APA-accredited internship matters long-term.  It's common knowledge in psychology that you will be unable to work at a VA and are unlikely to ever be hired by a state hospital if you don't have an accredited internship.  Beyond that, no one seems to know how not having an accredited internship will impact your career.  I can say though, that if you just want to do research, it likely won't impact you at all since internships are clinical positions.

Also, because universities typically didn't offer stellar insurance policies for students with preexisting medical problems at the time and since I was 26 (the age at which you can no longer be on your parents' plan), I needed private insurance. Because unaccredited internships often don't offer health insurance, I fervently sought out an accredited internship so that I can stop paying through the nose for private insurance.

 By the way, for positions and internships at state-run hospitals, you do not get health benefits until six months after you have been employed. Because internships are one-year, you will not be provided coverage for half of the year.

7. If your program does not teach the Rorschach because it is not considered research-validated, seek outside training. While many consider the Rorschach to be outdated, many APA-accredited internships require it as part of your training. They will not accept you application without it.

8. Read the newest edition of the APA's Publication Manual before you write anything. It will save you loads of time and embarrassment if you read the newest version of the manual before writing your thesis or dissertation. The manual not only tells you how to format things correctly, but offers excellent writing tips you'll want to know.

9. Try to make your master's thesis the precursor / pilot study to your dissertation. This will save you a lot of time in doing a literature review and will make the putting together a plan for your dissertation easily. Before you finish your dissertation, you need to defend a proposal. Knowing the literature well and having piloted your study's method will make the proposal defense go much more smoothly. You'll be able to answer questions based on previous experience.

10. Even after learning all of that, I'm so happy I'm doing what I love. Did the process of going through graduate school leave me unscathed? No. Yet, I would do it all over again. If you're willing to do it, try. Even when I'm doing the paperwork of overburdened hospital staff instead of seeing patients, I'm still part of a solution to a larger problem. Every day has meaning.

And that's all for now! I'll probably continue to add to this over the coming weeks/months/years, as I tend to do with all of these posts.

Comments welcome!


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