Addressing the internship crisis

While it is agreed, as Dr. Vasquez stated in her March “President’s Column,” it is not a simple matter to solve the internship crisis, there are some simple solutions for certain parts of the problem. Dr. Greg Keilin, match coordinator for the Association of Psychology Postdoctoral and Internship Centers, wrote a heartfelt editorial to us training directors after the Phase-II portion of the match process had ended. One message was that unplaced students feel that their chosen profession has let them down, because of this lack of positions available. Secondly, he stated we should not feel helpless, but should contact our professional organizations and let our voices be heard. I am doing so with this letter, yet my recommendation puts the onus back on the APPIC leadership as follows: APPIC should refuse to place students from programs who do not have affiliated programs that provide for the same number of internships that they place, or APPIC will only place as many students from a program equal to the number of internship positions that program has created or can claim they support with no other graduate program laying claim to those same positions.

One would hope that state and provincial licensing boards, institutions, state and provincial professional organizations and APA/CPA would be on board with solutions of this nature. For example, APA could refuse to accredit programs that did not demonstrate this proviso. Nonetheless, APPIC is uniquely positioned to implement such a policy. Such a solution would motivate graduate programs to be instrumental in creating internship positions. This way, regardless of APA accreditation, students would know entering a program that they are in a program that creates internship positions; therefore, there are positions available for them upon completion of their program. A student could still fail to be placed based on quality, but not availability.

Finally, there is no excuse for the current imbalance. It is both unethical and immoral that we as a profession have allowed this to go on since 1994 when the first two years of a small imbalance began, and since 1996 when it began spiraling out of control. 

Joseph H. McCoy, PhD
Lone Star Psychology Residency Consortium

The real problem with internship is the power it unnecessarily wields. I’m troubled many potential employers won’t consider candidates without an APA-accredited internship. This profession requires lifelong learning, yet many site directors are blacklisting candidates without APA-accredited internships.

Despite whatever future learning might occur, the implication is that no amount of training or experience will ever be enough. Internship has created a caste system. If more slots are to be created, why do all training opportunities have to be limited to internship? Take the power away and the crisis ends. Therefore, any psychologist working and receiving supervision from a licensed psychologist for one year at such a placement would have an APA-accredited training experience. This would limit discriminating hiring practices and ease the imbalance problem associated with internship, since more opportunities would be available post-internship.

This solution would also be attractive to the APA-accredited sites. Accreditation is expensive. Although more money is spent on that slot for accreditation, the position could be used to hire a fully licensed psychologist for less money, since this extra slot would be a training opportunity. Another example would involve potential employees being more willing to relocate to rural regions, which traditionally have difficulty filling vacancies, if these sites have an APA-accredited slot. Finally, with more sites seeking accreditation, APA would also prosper. This solution is beneficial to all parties involved.

Daniel Wade, PsyD
Florence, Mass.

The April Monitor’s articles on psychology internships largely adopted the perspective that internships are undersupplied and that the solutions are to grow them and have doctoral programs be more accountable for matching. Relatively little attention is given to the perspective that doctoral students are oversupplied.

A body of research suggests that this “crisis” is not restricted to internships. The programs producing the most graduates are accepting nearly half of their applicants, producing graduates who perform worse on the EPPP, and graduating students with substantially higher educational debt. It is clear that the crisis is occurring in a context much broader than an internship shortage.

When the articles addressed the oversupply perspective, it was noted that complaints about programs producing too many students are difficult to address because APA has no authority to regulate enrollment. But APA has no authority to enact many of the other solutions proffered (e.g., increasing internship positions and funding). The inability or, more likely, the lack of resolve to force programs to better manage the number of students is not a compelling reason to sidestep the issue of oversupply. The psychologists who constitute the programs producing large numbers of graduates have an obligation to their students, their colleagues and the field to tackle this issue. APA has an obligation to determinedly pursue these solutions as well.

Daniel T. Rogers, PhD
Jeffrey L. Helms, PsyD

Kennesaw State University

I am glad APA is finally paying attention to this outrageous situation, which I think verges on fraud. How, in good conscience, can a psychology program take money from a student when the program doesn’t guarantee the availability of an experience required for its degree? I favor the kind of internship I had at the University of Michigan in the 1960s in which the department assumed responsibility for finding internships for all its clinical students. All placements counting toward the internship had supervision by faculty members on staff or who were consultants to it, thus making a real connection between academic and practice knowledge. APA should only approve programs that assume full responsibility for placements; and all internships should be local.

Maury Lacher, PhD
Poughkeepsie, N.Y.

I am surprised that others seem to be surprised that there is now a “shortage” of spots for those seeking an internship in psychology. The April Monitor refers to the imbalance of applicants and slots as “unacceptable” and, among other things, urges existing internships to create additional slots to offset this problem. Nowhere in the issue is acknowledgment of what surely is the real issue, that there just may be too many students in graduate psychology programs. I find it naive and self-serving for APA to nudge internships into creating more slots because certain doctoral-level programs have proliferated and profited by admitting more students than the marketplace can absorb. Internships face real-world scrutiny by hospital or agency administrators as to their cost-benefit analysis, not whether they solve a “full-employment” mandate set out by those who created the problem. The solution is not necessarily to artificially create internship slots, but to remind students to only attend doctoral-level programs that can reasonably assure them that they will acquire the skills and knowledge that will make it likely they’ll be accepted into high-quality internships.

Christopher Grote, PhD

Response from APA President Melba J.T. Vasquez, PhD

Clearly there are too many students in the doctoral program pipeline as related to the number of accredited internships. That is of great concern. How this relates to work force needs, however, is unclear. We know that many people with mental and behavioral health needs remain unserved. We also know that in the area of primary care, which many consider our nation’s de facto mental health system, there are only several hundred psychologists in the nearly 8,000 federally qualified community health centers. Psychology needs a comprehensive work force analysis that considers not only supply and demand, but societal needs, the context of other professions and the kinds of psychologists needed. I am supporting such efforts as part of APA’s strategic plan.

What history tells us

The April Monitor highlights the growing popularity of positive psychology. As is often the case with such developments, it is easy to assume that we are dealing with a new field of study in psychology. One benefit of the historical record is that it allows for examination of the contributions and contexts that underlie psychological science and practice.

If we dig a little deeper, we can readily see that there have been multiple determinants and influences for what we now popularly refer to as positive psychology. For centuries philosophical and psychological treatises have advocated for the liberation of the individual from tyranny and oppression. The freedom to pursue health and happiness has a long history. In the 20th century, the genesis of positive psychology can be seen in the civil rights era. Responding to centuries of oppression and racism, African-American psychologists such as Dr. Joseph L. White offered a psychology of blacks that was strength based, emphasizing characteristics such as resilience, connectedness, openness to experience and many other tenets of modern positive psychology.

Positive psychology is a hopeful movement and one that looks to improve the human condition. Recognizing the contributions of those past and present and the context in which this important work unfolds is of benefit to us all.

David Baker, PhD
Center for the History of PsychologyThe University of Akron

Toys for vegetables

In reflecting on the April “Judicial Notebook” article, “If you want a toy, eat your broccoli,” as a psychologist and a parent of two young toddlers, I could comment on both my research and “real life” perspective. I am particularly impressed with the research opportunity at the end of the article that addressed the question of “If toys are serving as reinforcers or the food in kids’ meals itself is reinforcing?”

I was immediately motivated to “field test” this question. I took my children to a fast-food restaurant, where my 3-year-old was given a “kids’ meal” with a cute toy. She actually had no interest in eating the food, but instead was extremely motivated by the toy to the point that we had to take it away so she would eat her lunch. I then relayed this story to my husband regarding the article’s idea that the toys are such potent reinforcers that perhaps we should try this at home with healthier foods. We did, with green vegetables, something my daughter normally does not like. Well, when we told her that “if she eats her greens she would get a new coloring page,” guess what? She ate them! This is some preliminary support for the authors’ hypotheses.

Victoria Comerchero, PhD
Touro College

Please send letters to Sara Martin, Monitor editor. Letters should be no more than 250 words and may be edited.