Training and licensing of clinical psychologists
Encyclopedia
The training and licensing of clinical psychologists
Clinical psychology
Clinical psychology is an integration of science, theory and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically-based distress or dysfunction and to promote subjective well-being and personal development...

ranges from 4 year undergraduate degree plus a 4 to 6 year doctorate program. Most programs in the U.S. are PhD
Scientist-Practitioner Model of Clinical Psychology
The scientist–practitioner model, also called the Boulder model, is a training model for graduate programs that focuses on creating a foundation of research and scientific practice. It was developed primarily to train clinical psychologist members of American Psychological Association but has been...

 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
Doctorate
A doctorate is an academic degree or professional degree that in most countries refers to a class of degrees which qualify the holder to teach in a specific field, A doctorate is an academic degree or professional degree that in most countries refers to a class of degrees which qualify the holder...

 with both clinical and research components. This is a three-year full-time salaried program sponsored by the National Health Service
National Health Service
The National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...

 (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

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
Scientist-Practitioner Model of Clinical Psychology
The scientist–practitioner model, also called the Boulder model, is a training model for graduate programs that focuses on creating a foundation of research and scientific practice. It was developed primarily to train clinical psychologist members of American Psychological Association but has been...

 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). Both models envision practising Clinical Psychology in a research-based, scientifically valid manner, and are accredited by the American Psychological Association
American Psychological Association
The American Psychological Association is the largest scientific and professional organization of psychologists in the United States. It is the world's largest association of psychologists with around 154,000 members including scientists, educators, clinicians, consultants and students. The APA...

 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.

Human Sexuality: 2

Child Abuse: 2

Domestic Violence: 2

Aging: 2

Ethics & Law: 3

Psychological Testing: 3

Psychopharmacology: 3
| valign="top" bgcolor="#FFFFFF" style="border-right:1px solid #E9E9E9;"|
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
| valign="top" bgcolor="#FFFFFF" |
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. 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
Licensed Professional Counselor
Licensed professional counselor is a licensure for mental health professionals. The exact title varies by state, but the other most frequently used title is licensed mental health counselor . Several U.S. states, including Illinois, Maine, and Tennessee, have implemented a two-tier system whereby...

 (LPC), Marriage and Family Therapist (MFT) or other similar license.

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
National Health Service
The National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...

 (NHS). These clinical psychology doctoral degrees are accredited by the British Psychological Society
British Psychological Society
The British Psychological Society is a representative body for psychologists and psychology in the United Kingdom. The BPS is also a Registered Charity and, along with advantages, this also imposes certain constraints on what the society can and cannot do...

 and the Health Professions Council (HPC
Health Professions Council
The Health Professions Council is a statutory regulator of 210,000 health professionals from 15 professions in the United Kingdom. It was set up in 2003 under the National Health Service Reform and Health Care Professions Act 2002, to replace the Council for Professions Supplementary to Medicine ....

). 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. 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, 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, include:
  • Specific disorders
    Mental illness
    A mental disorder or mental illness is a psychological or behavioral pattern generally associated with subjective distress or disability that occurs in an individual, and which is not a part of normal development or culture. Such a disorder may consist of a combination of affective, behavioural,...

     (e.g. trauma
    Psychological trauma
    Psychological trauma is a type of damage to the psyche that occurs as a result of a traumatic event...

    , addiction
    Substance dependence
    The section about substance dependence in the Diagnostic and Statistical Manual of Mental Disorders does not use the word addiction at all. It explains:...

    , eating
    Eating disorder
    Eating disorders refer to a group of conditions defined by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual's physical and mental health. Bulimia nervosa, anorexia nervosa, and binge eating disorder are the most common specific...

    , sleep
    Sleep disorder
    A sleep disorder, or somnipathy, is a medical disorder of the sleep patterns of a person or animal. Some sleep disorders are serious enough to interfere with normal physical, mental and emotional functioning...

    , sex
    Sexual dysfunction
    Sexual dysfunction or sexual malfunction refers to a difficulty experienced by an individual or a couple during any stage of a normal sexual activity, including desire, arousal or orgasm....

    , depression
    Clinical depression
    Major depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities...

    , anxiety
    Anxiety
    Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...

    , or phobia
    Phobia
    A phobia is a type of anxiety disorder, usually defined as a persistent fear of an object or situation in which the sufferer commits to great lengths in avoiding, typically disproportional to the actual danger posed, often being recognized as irrational...

    s)
  • Neuropsychological disorders
    Clinical neuropsychology
    Clinical neuropsychology is a sub-field of psychology concerned with the cognitive function of individuals with neurological and psychiatric disorders. Neuropsychological assessment examines cognitive function in the broadest sense, including the behavioural, emotional, social and functional status...

  • Child and adolescent
    Child psychopathology
    Child psychopathology is the manifestation of psychological disorders in children and adolescents. Oppositional defiant disorder, attention-deficit hyperactivity disorder, and pervasive developmental disorder are examples of child psychopathology...

  • Family
    Family therapy
    Family therapy, also referred to as couple and family therapy, family systems therapy, and family counseling, is a branch of psychotherapy that works with families and couples in intimate relationships to nurture change and development. It tends to view change in terms of the systems of...

     and relationship counseling
    Relationship counseling
    Relationship counseling is the process of counseling the parties of a relationship in an effort to recognize and to better manage or reconcile troublesome differences and repeating patterns of distress...

  • Health
    Health psychology
    Health psychology is concerned with understanding how biological, psychological, environmental, and cultural factors are involved in physical health and illness. Health psychologists work alongside other medical professionals in clinical settings, work on behavior change in public health promotion,...

  • Sport
    Sport psychology
    Sport psychology is an interdisciplinary science that draws on knowledge from the fields of kinesiology and psychology. It involves the study of how psychological factors affect performance and how participation in sport and exercise affect psychological and physical factors...

  • Forensic
    Forensic psychology
    Forensic psychology is the intersection between psychology and the criminal justice system. It involves understanding criminal law in the relevant jurisdictions in order to be able to interact appropriately with judges, attorneys and other legal professionals...

  • Organization and business
    Industrial and organizational psychology
    Industrial and organizational psychology is the scientific study of employees, workplaces, and organizations. Industrial and organizational psychologists contribute to an organization's success by improving the performance and well-being of its people...

  • School
    Educational psychology
    Educational psychology is the study of how humans learn in educational settings, the effectiveness of educational interventions, the psychology of teaching, and the social psychology of schools as organizations. Educational psychology is concerned with how students learn and develop, often focusing...


Licensure

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 http://www.bbs.ca.gov/lic-req2.htm and http://www.bbs.ca.gov/pdf/publications/mft_faq.pdf for examples), there are three common elements:
  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. 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.
  • 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.
  • Licensed Professional Counselor (LPC). Similar to the MFT, the LPC license
    Licensed Professional Counselor
    Licensed professional counselor is a licensure for mental health professionals. The exact title varies by state, but the other most frequently used title is licensed mental health counselor . Several U.S. states, including Illinois, Maine, and Tennessee, have implemented a two-tier system whereby...

     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.
  • 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. 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
    Substance abuse
    A substance-related disorder is an umbrella term used to describe several different conditions associated with several different substances .A substance related disorder is a condition in which an individual uses or abuses a...

    , developmental disabilities, and mental illness
    Mental illness
    A mental disorder or mental illness is a psychological or behavioral pattern generally associated with subjective distress or disability that occurs in an individual, and which is not a part of normal development or culture. Such a disorder may consist of a combination of affective, behavioural,...

    . This profession draws on the evidence base of applied behavior analysis
    Applied Behavior Analysis
    Applied behavior analysis is a science that involves using modern behavioral learning theory to modify behaviors. Behavior analysts reject the use of hypothetical constructs and focus on the observable relationship of behavior to the environment...

     and the philosophy of behaviorism
    Behaviorism
    Behaviorism , also called the learning perspective , is a philosophy of psychology based on the proposition that all things that organisms do—including acting, thinking, and feeling—can and should be regarded as behaviors, and that psychological disorders are best treated by altering behavior...

    . 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 http://www.bacb.com. The model licensing act for behavior analysts can be found at the Association for Behavior Analysis International's website.

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.
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