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Some psychology graduate and training programs fail to provide students with basic skills needed to lead group therapy sessions and work with managed care, according to two recent studies.

Psychologists Howard Markus, PhD, and Deborah King, PhD, document the deficits in group therapy training in a survey of 177 training programs in April's Professional Psychology: Research and Practice (Vol. 34, No. 2).

"More and more, group therapy is being established as a very effective treatment modality," says Markus, a staff psychologist at Unity Health Systems in Rochester, N.Y., and former associate training director in psychology at the University of Rochester Medical Center (URMC). "When psychologists are called to lead these groups without adequate training, it raises a big concern." King is an associate professor and director of training in psychology at URMC.

Markus and King found that slightly more than half of the training programs offered a didactic seminar in group therapy, and a quarter offered experiential group therapy for interns. Many programs did not give interns the opportunity to lead groups, and those that did provided exposure to only one group, often of only one theoretical orientation, Markus notes.

Good supervision and group therapy training are inconsistently available, Markus says. Graduate programs and predoctoral clinical psychology internships often do not provide enough depth or breadth in group therapy training, Markus adds.

Not everyone will be a group therapist, he acknowledges, but training in the area is still important so that students have a solid background they can build on during internship.

He encourages students whose programs do not offer such training to ask for it in didactic instruction, practicum and internship. He also urges students to participate in an experiential process, training group or group therapy, and to look for opportunities to lead groups and receive supervision.

Equally important for students is experience working with managed care, yet not all programs offer that kind of training either, says Jeffrey Daniels, PhD, an Indiana University assistant professor in counseling psychology. Daniels, with Luis Alva and Sandra Olivares, conducted a survey of 117 chairs from clinical and counseling psychology and social work programs to evaluate training relating to managed care. The results were published in Professional Psychology: Research and Practice (Vol. 33, No. 6).

Nearly 60 percent of the programs surveyed offered some training in managed care, but more than 40 percent offered none, according to the study.

Programs were most likely to offer training on ethics and diversity issues concerning managed care, but were least likely to offer training on basic health-care marketing strategies and finances. Only 18 percent of clinical programs and 16 percent of counseling programs offered basic financial training, according to the survey.

"A lot of students are coming out with a master's or doctorate in clinical psychology and working in settings that require basic knowledge of managed care," Daniels says. "But if they are not getting that during training, they are initially at a loss."

Daniels advises students to read books and journal articles on managed care and to choose a practicum or internship site that offers experience dealing with managed care.

-M. DITTMANN