Megargee's Guide to Obtaining a Psychology Internship

Edwin Megargee, Edwin I. Megargee

• Publisher: Routledge
• Year: 2012
• Print ISBN:
  9781138462823
• eBook ISBN:
  9781135896751
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Megargee's Guide gives students essential information about the internship selection process, including updated material on the computer selection process that was implemented by the Association of Psychology Postdoctoral and Internship Centers (APPIC). Also included is a discussion of new standardized set of application forms that have been adopted by most internship sites; the disparities between internship supply and demand; and the rules governing internship selection. It also provides practical information such as a four-step process for preparing a resume and tips for preparing for interviews.

1

CHAPTER

A Short Course on Predoctoral Internships

This chapter provides you with the background information you need to understand what predoctoral internships in professional psychology are, what they are supposed to accomplish, and how the rules governing internship selection evolved over the years.

Trends in Graduate Education in Clinical Psychology

The American Psychological Association (APA) has accredited doctoral training programs in professional psychology for over 50 years. Ever since the Boulder Conference of 1949, a year-long predoctoral internship, ideally in an APA-accredited program, has been an essential requirement for doctoral degrees in clinical, counseling, and school psychology.

What constitutes an internship? APA, the Association of Psychology Postdoctoral and Internship Centers (APPIC), the American Association of State Psychology Boards (which coordinates licensing), and the National Register of Health Service Providers in Psychology have collaborated on a uniform operational definition of what goes into a satisfactory predoctoral internship training program. These criteria, which are reprinted in the front of the annual APPIC Directory (Hall & Hsu, 2000), stipulate that a psychology internship is an organized program of training that goes beyond supervised clinical experience or on-the-job training. Each internship must have a clearly designated, licensed, doctoral-level director who is on site at least 20 hours weekly and who is responsible for the quality and integrity of the program, as well as at least two full-time, licensed, doctoral-level supervisors (one of whom may also be the director) who provide each intern with at least 2 hours of direct individual supervision each week. An internship must have at least two full-time interns who must work at least 1,500 hours over a 9- to 24-month period, at least 25% of which must be in direct face-to-face service with clients. In addition, at least 2 hours weekly must be spent in didactic training such as case conferences, grand rounds, seminars, and the like. The nature and goals and the quantity and quality of the work expected of the interns, who may also be called residents or fellows, must be written and made available in a brochure.

The 1987 National Conference on Internship Training stated:

The purpose of the internship is to provide a systematic program of supervised, applied psychological training which extends and is consistent with the prior research, didactic, and applied experience of graduate education and training. Internship training will provide for the integration of scientific, professional, and ethical knowledge, attitudes, and basic skills to professional practice. The internship continues to provide for the professional socialization and development of professional identity. The person who completes the internship training is an individual who has demonstrated the capability to function autonomously and responsibly as a practicing psychologist. (Belar et al., 1987, p. 4)

Predoctoral psychology internships are available in a wide variety of settings. In the United States, the most numerous are university counseling centers (110 sites, 19%), community mental health centers (72 sites, 13%), Veterans Administration (VA) medical centers and clinics (69 sites, 13%), medical schools, (69 sites, 13%), state hospitals (52 sites; 10%), children’s facilities (47 sites, 9%), consortia (37 sites, 7%), the psychiatric units of general hospitals (25 sites, 5%), private psychiatric hospitals (24 sites, 5%), correctional facilities (14 sites, 3%), and military internships (9 sites, 2%) (Hall & Hsu, 1999). A few internships can also be found at school districts, health maintenance organizations (HMOs), rehabilitation hospitals, facilities for the developmentally disabled, and pastoral counseling centers.

Although graduating from an APA-accredited degree program is not required for state licensure, for inclusion in the National Register, or for obtaining a diploma issued by the American Board of Examiners in Professional Psychology (ABPP), APA accreditation criteria have become the “gold standard” by which training programs are judged. If your degree is not from an APA-accredited program, you will continually need to convince various credentialing bodies that your program equaled or exceeded APA standards.

The Origins of Psychology Internships

For the first half of the 20th century, APA had no involvement in professional training. Prior to World War II, APA was a learned society whose primary concerns were promoting and publishing scientific research (Resnick, 1997). In the early years, APA’s membership requirements included a Ph.D., an academic teaching position, and a record of published scientific research (Brems, Thevenin, & Routh, 1991). Indeed, in those days there were no formal training programs in applied psychology. Future practitioners earned university degrees in scientific psychology and obtained whatever professional training they could from mentors, reading, or trial and error (Peterson, 1991).

As it did in so many other areas of American life, World War II fostered drastic changes in graduate education in professional psychology. The war created an acute need for mental health personnel to assist the military in screening and classifying troops upon induction into the service and, later, in treating GIs suffering from war-induced traumas. As the war drew to a close, the federal government recognized the need to provide mental health services to the 16 million veterans who were returning to civilian life. Funds for training clinical psychologists were made available through the VA and the National Institute for Mental Health (NIMH; Peterson, 1991).

An educational program of this magnitude created an urgent need for agreed-upon models for graduate training in clinical psychology and for standards that could be used to evaluate the adequacy of training programs and the competency of their graduates. The VA and NIMH asked APA and the American Association for Applied Psychology (AAAP), a professional organization for practitioners, to develop models and standards for graduate training in clinical psychology and to identify university programs that met these criteria. During the 1940s, joint task forces of APA and AAAP met to consider schemes for training and accreditation (Laughlin & Worley, 1991).

In 1945, AAAP merged with APA. The new APA by-laws stipulated that the goals of the organization were to advance psychology as a profession as well as a science and to promote human welfare. Publications and an academic appointment were no longer required for membership, making it easier for practitioners to join.

A new APA Committee on Training in Clinical Psychology headed by David Shakow proposed a model that combined university-based academic training with a year-long clinical internship. The internship would involve supervised, direct clinical experience in inpatient settings combined with indirect experience, such as case conferences, and with administrative experience in which the interns familiarized themselves with the facilities where they worked by participating in staff meetings, main taining patient records, and preparing reports. Students were expected to go on internship in their 3rd year of graduate training, after which they would return to their academic settings for their 4th and final year, during which they could integrate their academic and clinical experiences, ideally by conducting a dissertation on a clinical topic (Davies, 1987; Laughlin & Worley, 1991). This model assumed that relatively little direct clinical training would take place in the university setting. It further recommended that APA establish an accreditation program with on-site visits occurring every 5 years (Brems et al., 1991). These recommendations were adopted at an NIMH-funded conference on graduate clinical training held at Boulder, Colorado in 1949. Thus was born the “scientist-professional” or “Boulder model” of clinical training.

Early Patterns of Clinical Education

Devised largely by academicians, the original Boulder model emphasized the scientific end of the scientist-professional continuum. University faculty members expected Boulder model Ph.D.s to become research producers, not just research consumers. They considered those graduates who went on to do clinical research in academic and medical school settings as successes, but regarded those who never published and went into full-time practice as “hand holders” who had wasted their mentors’ time (Peterson, 1991).

During the years when clinical training grants and VA stipends were readily available, graduate education in clinical psychology was controlled by the ADCTs and university faculties. Traditional academic departments were able to retain their scientific values while reaping important practical rewards. By enrolling large numbers of graduate students in clinical psychology, and by winning large clinical training grants, academic departments of psychology were able to generate increased numbers of faculty positions and obtain more space from their universities.

As is so often the case in the internship game, when one player prospers, others become dissatisfied. While the academic departments were, as the late Red Barber would have said, “sitting in the catbird seat,” many internship training centers felt as if they were at the bottom of the bird cage. It appeared to them that the universities promoted research training at the expense of preparation for internship. As Peterson (1991, p. 423) noted, “Situated as they were in academic departments, controlled as they were by researchers, the Boulder-style programs all too often neglected training for practice.” Summarizing the results of a survey of Internship Training Directors (ITDs), Shemberg and Leventhal (1981, p. 639) reported, “Consistent with previous data, considerable dissatisfaction exists among directors relative to university preparation in clinical skills. Interns are seen by many as not well-prepared in assessment or psycho therapeutic activities.” In one brief year, the internship center was expected to provide the bulk of the student’s clinical training. One ITD and his colleagues warned the academic programs, “In your attempts to mold a scientist-practitioner, beware of over emphasizing the scientist at the expense of the practitioner” (Stedman et al., 1981, p. 419).

Changing Patterns in Clinical Education

Most university-based training programs have since moved closer to the middle of the scientist-professional continuum. Few graduate students today have to pass foreign language examinations, as my classmates and I did (French, German, Russian—pick two), and today’s clinical curriculum provides students with much more clinical instruction and practicum experience than the early Boulder-model programs afforded.

Today’s students also differ from those of the 1950s. In those days, graduate students in clinical psychology were typically young men supported by government-financed fellowships, unburdened by student loans, and unfettered by family obligations. It was no great hardship for them to leave their graduate programs for a year and later return to their universities to complete their academic requirements. After the United States Public Health Services (USPHS) fellowship program and clinical training grants were phased out during the Nixon and Ford administrations, it became necessary for most clinical graduate students to earn their stipends in practicum settings, thereby extending the amount of time required to complete a degree. Older students in general, and women in particular, are more likely to have family obligations that make it difficult for them to relocate for a year. As a result, today’s students typically complete most, if not all, of their academic requirements before leaving for internship and do not return to their universities.

As a result of the decrease in government-supported clinical training, most internships must now support their interns with agency funds. Many rely heavily on fees generated by the interns and their supervisors to underwrite the cost of training. Indeed, the internship training program may be expected to show a profit (Brickley, 1998; Greenberg, Cradock, Godbole, & Temkin, 1998). In today’s marketplace, a 2nd-year student who has received little or no clinical training would find it difficult if not impossible to compete successfully for a fully funded APA-approved internship. Internships now demand a higher level of clinical preparation than the original Boulder model envisioned.

The Rise of Professional Schools

The Korean war exacerbated the VA’s need for mental health practitioners, and the deinstitutionalization of the mentally ill and the prolifera tion of community-based mental health centers in the 1960s increased the demand for clinical psychologists—personnel needs that were not being met by the traditional programs. For example, even though the California State Psychological Association had urged the state’s universities to expand their clinical training programs, the entire University of California system turned out less than 20 Ph.D.s in clinical psychology annually (Peterson, 1991).

Although there was a market for practitioners, the decrease in federal support of graduate education in clinical psychology led many universities to reduce the number of graduate students they accepted. Although they welcomed large numbers of undergraduate psychology majors and adopted undergraduate curricula that would prepare these majors for graduate school, only a fraction of those graduating with bachelors degrees in psychology were admitted into their doctoral training programs (Strieker, 1997). University-based scientist-professional training typically followed the scientific tradition in which faculty mentors worked closely with a limited number of graduate students on their research teams. There was insufficient room in their laboratories for all the students seeking graduate education in psychology, especially those whose primary interests were in practice rather than research.

In response to these pressures, various alternatives to the Boulder model were considered in a series of APA-sponsored training conferences at Miami Beach (1958), Princeton (1962), Chicago (1965), Vail (1973), and Salt Lake City (1987). In the 1960s, Psy.D. programs and free-standing schools of professional psychology were initiated. By 1982, there were 44 such practitioner programs in the United States with almost 5,000 students enrolled (Brems et al., 1991).

Unlike traditional academic departments, free-standing professional schools typically rely on the fees paid by students to support their programs. It is to their financial advantage to have large classes. In the past, the traditional academic departments had served as the gatekeepers to professional psychology. My entering class at Berkeley had 25 students, but only 3 of us eventually obtained our doctorates in clinical psychology. With the proliferation of independent professional training programs, the gatekeeping function has now shifted to the internships and the postdoctoral programs. Since 1996, there have been substantially more applicants for predoctoral and postdoctoral positions than there are slots available (Constantine, Keilin, Litwinowicz, & Romanus, 1997; Keilin, 2000; Keilin, Thorne, Rodolfa, Constantine, & Kaslow, 2000; Oehlert & Lopez, 1998).

Impact of Managed Care

Like the other mental health agencies, most internships have been operating under financial constraints in recent years (Constantine & Gloria, 1996). Whereas universities and professional schools are in the business of providing education, training is only an ancillary activity at most internship sites. In an era of reduced budgets and “downsizing,” some centers are tempted to lower their costs by cutting back or eliminating internship training. In this era of managed health care (MHC), internships, like other mental health providers, have had increasing difficulty billing for the services performed by interns and postdoctoral fellows (Brown, 1996; Constantine & Gloria, 1998). As part of their quality assurance programs, many third-party providers will only pay for services performed by licensed health care providers. If an unlicensed technician carries out a procedure, the licensed provider often must be in the room directly supervising the activity for it to be reimbursable. Reviewing a videotape of a procedure is not sufficient.

This model does not work well for psychologists. Unlike X-ray technicians, nurses, and physicians’ assistants, most psychology trainees do not have any sort of license, even though they typically have a master’s degree or the equivalent, and it is obviously impractical for an intern’s licensed supervisor to be physically present throughout the administration of a lengthy test battery or psychotherapy session. In settings where rules such as this apply, the range of clients that an intern may see can be severely limited if the facility wishes to be reimbursed for the intern’s services.

Possible solutions to this dilemma are being discussed (Brown, 1996). Since MHC systems are accustomed to reimbursing for services performed by medical interns or residents, one proposal is that students should defend their dissertations and be awarded their degrees before going on internship. This would present a major change, since APA has always insisted that a predoctoral internship is a prerequisite for the doctoral degree in clinical psychology. Still, as we have seen, when money talks, educational programs listen. Another suggestion is to create some sort of limited master’s-level license that would permit third-party reimbursements for selected procedures. This would have to be done on a state-by-state basis, and indeed, some states already have master’s level-licenses. These discussions are continuing, and their outcome may significantly influence the nature of psychology internships.

Constantine and Gl...

Table of contents

• Cover
• Halftitle
• Title
• Copyright
• Contents
• Acknowledgments and Dedication
• Preface
• 1 A Short Course on Predoctoral Internships
• 2 Applying for Internship: An Overview
• 3 Establishing Your Priorities
• 4 Where to Apply? Compiling Your Application List
• 5 Preparing Your Resume or CV
• 6 Preparing Your Internship Applications
• 7 Traveling to Internships: How to Survive and Stay Solvent
• 8 The Site Visit and Interview
• 9 The Endgame
• 10 Dealing With Adversity
• Appendix 1: Useful Web Sites for Internship Applicants
• Appendix 2: Availability of Internship Positions by Region and State
• Appendix 3: A Sample Curriculum Vitae
• Appendix 4: Questions Interviewers Ask Intern Applicants
• Appendix 5: Questions Applicants Can Ask Interviewers
• References
• Index