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Clinical Psychology (PSY401)

LESSON 07

MODELS OF TRAINING IN CLINICAL PSYCHOLOGY

BACKGROUND TO THE PhD TRAINING MODEL: THE BOULDER CONFERENCE

As doctoral training in clinical psychology expanded during and following the Second World War, there

was a need to regulate and monitor the type of training that students received in such programs. The

American Psychological Association took the initiative to establish accreditation criteria that included

course curricula, research training, qualifying examinations, and clinical training (APA Committee on

Training in Clinical Psychology, 1947). Carl Rogers, the president of APA, appointed David Shakow to

formulate a model for training in clinical psychology. Shakow recommended that training in clinical

psychology should produce professionals who are well equipped to conduct research, assessment, and

psychotherapy. This training should be accomplished in four years of study at the doctoral (PhD) level,

including course work in psychology, psychological research, and supervised clinical practicum

experiences in assessment and psychotherapy. The curriculum should include courses in research

methods, core areas of psychology (e.g., biology, sociology), the psychodynamics of behavior,

diagnostic (assessment) methods, and methods of psychotherapy.

Shakow proposed that the third year of training should consist of a year-long full-time internship in a

clinical setting followed by a final year of training that is devoted to doctoral dissertation research. The

report also recommended that master's-level training in clinical psychology should be discontinued and

that the professional field should be identified only at the doctoral level.

Spurred by Shakow's report, a land mark event in the development of clinical psychology as a

profession occurred with the conference on training in clinical psychology in Boulder, Colorado in

1949. The outcome of this meeting, often called the Boulder Conference, was the formulation of a

"scientist-practitioner" model of training for clinical psychologists. The recommendation of this

meeting was that students in clinical psychology should be trained as psychologists first and

practitioners second. That is, clinical psychologists were defined as individuals who are trained and

skilled in both the science of psychology and the application of psychological knowledge. This two-

pronged approach, still referred to as the Boulder model, has set the standards for training in clinical

psychology for over 50 years.

1. THE SCIENTIST-PRACTITIONER (PhD) TRAINING MODEL

The scientist-practitioner model of training is represented in PhD clinical psychology programs. This

model of training was first formally articulated in a report commissioned by the APA and chaired by

David Shakow in 1947 and subsequently at a conference in Boulder, Colorado. It is typically referred to

as the Boulder Model of training in clinical psychology. Students are required to develop skills both as

psychological researchers and as practicing psychologists. Although the balance of these two types of

training activities is rarely exactly 50-50 in any single program, all Boulder Model programs share a

commitment to a relative balance of training in the science and the application of clinical psychology.

These programs are housed mostly in university-based departments of psychology that are also

committed to educating undergraduates in psychology and to the graduate training of students in other

areas of psychology (e.g., learning, developmental, cognitive, social). Students complete course work in

basic areas of psychology and also participate in specialized seminars on topics in clinical psychology.

Students are required to carry out at least two pieces of original research: a master's thesis or its

equivalent and a second research project that constitutes their doctoral dissertation.

This research is usually on a topic relevant to clinical psychology and often involves applied research on

the nature, measurement, etiology, prevention, or treatment of some form of psychopathology or health-

related problem. In addition, students must complete a specific number of hours of training in clinical

Clinical Psychology (PSY401)

practice (typically psychological assessment and psychotherapy) during their years in graduate school,

followed by a full-year, 40-hours-per-week internship in an applied setting under the supervision of

licensed clinical psychologists.

Programs that have achieved accreditation by the APA must comply with a set of guidelines regarding

the types of courses and research and clinical training experiences that are required of students for

completion of the degree. A typical Boulder Model program requires four years of work at a university

(course work, research, clinical practica) followed by an internship in the fifth year.

THE RATIONALE FOR THE SCIENTIST- PRACTITIONER MODEL

The rationale for the balance of training in research and practice is that, regardless of the specific career

they pursue, clinical psychologists will need to draw on both sets of skills. For clinical psychologists

who are actively involved in research, it is essential to be able to draw on experience working with

people who have clinical significant problems. This experience keeps researchers in touch with the

issues and problems that are faced by such people. Without this contact with people who are suffering

from psychological problems, it is too easy for researchers to select research questions and problems

because they are the ones that are most easily answered, are the most fashionable in the field, or are best

suited for the methodologies that are available.

Similarly, it is essential for clinical psychologists who are primarily involved in clinical practice to have

a solid foundation in psychological research. Without training in research methods, practicing clinicians

will be unable to stay informed of the latest developments in research concerned with psychopathology,

assessment, or treatment. Clinicians need to be trained in research so that they can be educated

consumers of the research advances that will emerge during the course of their career.

CRITICISM OF SCIENTIST- PRACTITIONER MODEL

Most recently, this training model came under attack by clinicians as being unrealistic in its emphasis on

research in the training of clinical psychologists. The majority of clinical psychologists who are in

clinical practice do not engage in research activities either due to the lack of time or lack of interest. In

either way, their time spent in research training seems meaningless.

The critics also charge this model as being unresponding to the needs of the students who aspire only to

clinical practice. For example, Drabman (1985) describes students who arrive at their internship site

without an adequate knowledge of how to administer, score, and interpret psychological tests. These

students also sometimes show a surprising lack of experience with clinical populations. Although well

versed in the technicalities of research, they have little skill in the practical application of their

knowledge.

Nevertheless a majority of clinical programs still subscribe to the scientist-practitioner model in varying

degrees. It is this model that differentiates clinical psychologists from the rest of the mental health pack.

BACKGROUND TO PSY.D TRAINING MODEL: THE VAIL CONFERENCE

The wisdom of trying to train clinical psychologists to be both competent scientists and practitioners

was questioned vigorously in the years following the Boulder Conference. In a series of conferences and

papers, some clinical psychologists argued for the need of an alternative approach to training, one that

placed greater emphasis on clinical training and less emphasis on scientific training. An alternative

approach emerged in 1968 when Donald Peterson presented the model for the first professionally

oriented clinical psychology training program at the University of Illinois. His efforts culminated in

another training conference, this time held in Vail, Colorado, in 1973.

At this meeting there was, as expected, a reaffirmation of support for the Boulder model as one

approach to the training of clinical psychologists. But a second approach, a professional model of

Clinical Psychology (PSY401)

training, also emerged from the Vail Conference with significant support. The professional model

validated the importance of knowledge of psychological research but deemphasized the importance of

training in research skills for clinical psychologists.

Training programs could now receive accreditation from the APA by following either the scientist-

practitioner model or the new professional model. During this time period the number of programs

offering the Psy.D (doctor of psychology) degree grew rapidly, and most of the programs that offered

this degree developed in freestanding professional schools of psychology; schools that were independent

of universities.

This development of university-independent professional schools contributed further to the widening

gap between practicing clinical psychologists and psychologists involved in basic research. Professional

schools were not designed to train students in research in basic areas of psychology, and their faculties

did not include researchers in these core areas. The number of clinical psychology training programs has

grown rapidly in recent years, due primarily to the increase in the number of Psy.D programs.

Due to its emphasis on clinical practice, the Psy.D program is also referred to as the "Practitioner-

oriented Model of Training".

2. Psy.D TRAINING MODEL

Programs that grant a Psy.D degree in clinical psychology to their graduates differ from PhD programs

in the balance of training devoted to research and clinical practice. Although some Psy.D programs are

based in universities, most exist in separate freestanding professional schools devoted solely to the

training of professional psychologists. In these programs, relatively little emphasis is given to clinical

research and relatively more training is devoted to skills in psychological assessment and intervention.

Although students in these programs may conduct original clinical research for their dissertation, Psy.D

programs allow students an alternative to complete this requirement through other means, such as a

review of the literature on a topic relevant to clinical psychology or a detailed case study.

The first of these programs was developed at the University of Illinois in 1968. Psy.D programs are not

substantially different from PhD programs during the first two years of training. The real divergence

begins with the third year. At that point, increasing experience in therapeutic practice and assessment

becomes the rule. The fourth year continues the clinical emphasis with a series of internship

assignments. More recently, Psy.D programs have moved toward compressing formal course work into

the first year and expanding clinical experience by requiring such things as five-year practices.

THE RATIONALE BEHIND PRACTITIONER-ORIENTED (Psy.D) MODEL OF TRAINING

The rationale behind practitioner-oriented models of training is twofold. First, there is a large body of

knowledge and skills that a student needs to learn to become a competent clinician, and competence in

the skills needed for clinical practice requires more time than can be devoted to them in a program that

emphasizes both research and practice.

Second, because most clinical psychologists do not go on to conduct research, they need relatively less

training in research. Proponents of this model contend that it is no longer possible to acquire the

necessary foundation of both clinical and research skills in the span of four to five years of doctoral

training.

EVALUATION OF Psy.D MODEL OF TRAINING

Psy.D programs have gained an increasing foothold in the profession. Researchers such as Peterson,

Eaton, Levine and Snepp (1982) hold that Psy.D practitioners are more satisfied with their graduate

training and careers than are clinicians trained in traditional programs. They encounter few problems in

Clinical Psychology (PSY401)

becoming licensed and report that the Psy.D degree is an advantage in competing for clinical positions.

However, finding academic jobs is difficult for them. Further, when resources and incentives in the

workplace permit, PhD graduates engage in scholarly activities more often than do Psy.D graduates.

3. PROFESSIONAL SCHOOLS

Although the Psy.D model represents a clear break with tradition, an even more radical innovation is the

development of professional schools. Many of these schools have no affiliation with universities; they

are autonomous, with their own financial and organizational framework. Often referred to as "free-

standing" schools, these schools mostly offer the Psy.D degree. Most schools emphasize clinical

functions and generally have little or no research orientation in the traditional sense. Faculty are chiefly

clinical in orientation and therefore are said to provide better role models for students. The first such

free-standing school was the California School of Professional Psychology. It was founded by the

California State Psychological Association and offers several mental health degrees.

The proportion of doctorates in clinical psychology awarded by professional schools has increased

dramatically: by 1993, almost half (1,107 out of 2,220, or 49.9 %) of the doctorates in clinical

psychology were awarded by professional schools. These programs tend to admit far more students than

traditional, university-based scientist-practitioner programs.

EVALUATION OF FREE-STANDING SCHOOLS

Whether such schools ultimately will survive is still uncertain. One of their greatest problems is stability

of funding. Many such institutions must depend on tuition as their chief source of funds, which does not

generate enough money to make them financially secure. They often depend heavily on part-time

faculty whose major employment is elsewhere. As one consequence, it is sometimes difficult for

students to have the frequent and sustained contact with their professors that is so vital to a satisfactory

educational experience.

Although some professional schools are fully accredited by the APA, they are the exception rather than

the rule. This is a major handicap that such schools will have to overcome if their graduates are to find

professional acceptance everywhere. Recent conferences on training suggest that both PhD and Psy.D

programs are secure. However, they continue to recommend that all doctorate programs be at or

affiliated with regionally accredited universities.

4. CLINICAL SCIENTIST MODEL

Over the past decade, empirically oriented clinical psychologists have become increasingly concerned

that clinical psychology, as currently practiced, is not well grounded in science. According to this view,

many of the methods that practitioners employ in their treatment have not been demonstrated to be

effective in controlled clinical studies. In some cases, empirical studies of these techniques have not

been completed; in other cases, research that has been completed does not support continued use of

these techniques. Similarly, the use of assessment techniques that have not been shown to be reliable

and valid and to lead to positive treatment outcome has been called into action.

THE "CALL TO ACTION" FOR CLINICAL SCIENTISTS

The "call to action" for clinical scientists appeared in 1991, in the "Manifesto for a Science of Clinical

Psychology" (McFall, 1991). In this document, McFall argued:

1. "Scientific clinical psychology is the only legitimate and acceptable form of clinical psychology"

2. "Psychological services should not be administered to the public (except under strict experimental

control) until they have satisfied these four minimal criteria:

Clinical Psychology (PSY401)

a. The exact nature of the service must be describe clearly.

b. The claimed benefits of the service must be stated explicitly.

c. These claimed benefits must be validated scientifically.

d. Possible negative side effects that out-weigh any benefits must be ruled out empirically".

3. "The primary and overriding objective of doctoral training programs in clinical psychology must be

to produce the most competent clinical scientist possible".

Like-minded clinical psychologists were urged to help build a "science" of clinical psychology by

integrating scientific principles into their own clinical work, differentiating between scientifically valid

techniques and pseudoscientific ones, and focusing graduate training on methods that produce "clinical

scientists" - individuals that "think and function as scientists in every respect and setting in their

professional lives".

OUTCOME OF THE "MANIFESTO FOR A SCIENCE OF CLINICAL PSYCHOLOGY"

This document has proved to be quite provocative. One outgrowth of this model of training is the newly

formed Academy of Psychological Clinical Science. The academy consists of graduate programs that

are committed to training in empirical methods of research and the integration of this training with

clinical training. The academy is affiliated with the American Psychological Society (APS). As of 1999,

it included 43 member programs.

The primary goals of the academy are:

1. To foster the training of students for careers in clinical science research. Who skillfully will produce

and apply scientific knowledge.

2. To advance the full range of clinical science research and theory and their integration with other

relevant sciences.

3. To foster the development of and access resources and opportunities for training, research, funding,

and careers in clinical science.

4. To foster the broad application of clinical science to human problems in responsible and innovative

ways.

5. To foster the timely dissemination of clinical science to policy-making groups, psychologist and other

scientist, practitioners and consumers.

EVALUATION OF THE CLINICAL SCIENTIST MODEL

Essentially, a network of graduate programs that adhere to the clinical science model has developed.

These programs share ideas, resources, and training innovations. Further, they collaborate on projects

aimed at increasing grant funding from governmental agencies, addressing state licensing requirements

for the practice of psychology, and increasing the visibility of clinical science programs in

undergraduate education. The ultimate success and influence of this new model of training remains to be

seen.

5. COMBINED PROFESSIONAL-SCIENTIFIC TRAINING PROGRAMS

A final alternative training model involves a combined specialty in counseling clinical, and school

psychology. As outlined by Beutler and Fisher (1994), this training model assumes that

(1) These specialties share a number of core areas of knowledge.

Clinical Psychology (PSY401)

(2) The actual practices of psychologists to graduate from each of these specialties are quite similar. The

curriculum in these combined training programs focuses on core areas within psychology and exposes

students to each sub specialty of counseling, clinical and school psychology.

EVALUATION OF COMBINED PROFESSIONAL-SCIENTIFIC TRAINING PROGRAMS

The combined training model emphasizes breadth rather than depth of psychological knowledge.

However, this feature can also be seen as a potential weakness of the model. Graduates from this type of

training program may not develop a specific sub-specialty or area of expertise by the end of their

doctoral training. Further this model of training appears to be better suited for the future practitioners

than for the future academician or clinical scientist. By the end of 1998 there were nine APA-accredited

programs in combined professional-scientific psychology-one of which offers a Psy.D degree.

CONCLUSION

In many ways, the changes in graduate training over the past 30 years have mirrored the market place

for clinical psychologists. Starting in the mid-1960s, a shift occurred from university-based academic

jobs to jobs in private practice. Not surprisingly, complaints about the limitation of the scientist-

practitioners model of training surfaced soon thereafter. These complaints focused by primarily on the

perceived inadequacy of the Boulder model of training for future practitioners according to the critics

training in clinical skills was deficient and faculty members were oblivious to the training needs of

future practitioners.

Out of the Vail Training Conference in 1973 came an explicit endorsement of alternative training

models to meet the needs of the future practitioners. Clearly, these alternative training programs are

becoming increasingly influential.

However, several recent trends may affect the viability and success of the various training models. First,

some believe that there may be an over supply of practice-oriented psychologists. If true, this may

ultimately affect the number of students entering and finishing graduate program in clinical psychology.

In recent years, there have been many more applicants for internship position than slots available. If the

internship and job market tighten, the programs that primarily train practitioners (professional schools,

schools awarding the Psy.D degree) will likely feel the brunt of this effect. This will be especially true

for professional schools whose economic viability is heavily dependent on tuition fees and large

numbers of students.

Second, the managed health care revolution will likely affect the demand for clinical psychologist in the

future as well as curriculum in training programs. More emphasis will be placed on course work

involving empirically supported brief psychological interventions and focal assessment. Training

programs that do not employ faculty with expertise in these areas may produce graduates without the

requisite skills to compete in the market place.

Finally, several authors have noted that there may be an undersupply of academic and research-oriented

clinical psychologists. If true, scientist-practitioner and clinical scientist programs may be in a better

position to meet this need.

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