Boosted by the growth of professional psychology schools, the number of PsyD and PhD students training to become clinical psychologists has increased in the past few decades.
But the number of internships, a year's worth of work putting the skills learned at practica sites and the classroom to use, has not kept pace, creating a bottleneck.
Simply put, there are more doctoral psychology students then there are internships offered through the Association of Psychology Postdoctoral and Internship Center (APPIC) process that matches interns with open slots, says Steve McCutcheon, PhD, APPIC Board of Directors chair.
Last year, for example, 3,479 students initially registered to be matched with 2,779 total positions, McCutcheon says. PsyD students were more likely to go unmatched than PhD students.
One solution to the problem has come from schools of professional psychology building their own networks of internships.
With schools providing the administrative oversight, some smaller community mental health centers and other nonprofits that couldn't organize and fund an APA-accredited internship on their own are banding together to offer internship slots to PsyD students.
Students benefit by getting a chance to put their training to practical use, and clients who are part of underserved populations benefit too, with access to therapy that might not otherwise be available.
"We view it as a very positive step by professional schools to take on the responsibility of ensuring their students have internships that are high quality and are funded," he says.
To make internships available, professional schools are using a variety of approaches. Some work to create internships that are only available to their students but give them the option of applying to other internships through APPIC. Others make the internships available through an application process open to all PsyD doctoral students nationally and internationally. Others create a specific internship track for a school's students, building a local network of internship opportunities in a specific region.
GSPP: helping the underserved
At the University of Denver's Graduate School of Professional Psychology (GSPP), school officials created an exclusively-affiliated consortium to allow PsyD students to stay in the Denver area for their internships if they chose, says Jenny Cornish, PhD, GSPP associate professor and director of clinical training and the internship consortium. She currently works with eight sites providing 13 internship positions to GSPP students.
The school has approximately 35 students ready for internship every year. Before the school's Psychology Internship Consortium was organized in 2001, students sometimes ran into problems getting internships that fit their life circumstances, Cornish says.
Some older students, married students and those with children couldn't swing the financial cost and familial disruption caused by taking an internship far away, she says.
"In town, there often weren't enough possibilities for our students," Cornish says.
The new arrangement gives the school's PsyD students the option of applying for a local internship through GSPP or of entering the APPIC Match process, she says.
The consortium internship sites include the Mental Health Center of Denver, the largest mental health center in the region, and the Rape Assistance and Awareness Program (RAAP), a program for sexual assault survivors run by a nonprofit.
As director, Cornish oversees supervision and training, the administrative process of matching applicants with with internships, seminars for the interns and helps mediate any intern-supervisor problems that arise.
Each internship site provides a yearly stipend, currently pegged at $18,500, and also contributes money for professional development and administrative costs for the overall program. Many of the programs hosting interns serve underserved populations, she says.
"They're definitely able to serve a lot of people in Denver who wouldn't get that help otherwise," Cornish says.
GSPP internship participant RAAP is Colorado's largest rape crisis center, say psychologists Sheri Vanino, PsyD, and Donna Peters, PsyD, co-directors of counseling services at the center.
The center sees about 275 clients a year for trauma counseling, handles 2,500 calls a year on its sexual assault hotline and runs educational programs for schools, hospitals and police departments.
The center's psychology intern handles a caseload of 10 to 12 clients a week for outpatient trauma treatment and runs group therapy sessions for survivors of sexual assault. Interns can also teach awareness programs in schools and learn the grant-writing process by seeking grants from government agencies and philanthropic foundations.
Billed on a sliding-fee scale, clients usually pay between $1 and $10 for a session. Many of the center's clients don't have health insurance and wouldn't have access to a therapist if it wasn't for its services, Vanino says.
Peters says the program would not have been able to organize an internship without GSPP.
"To apply to APA and be accredited, I don't think we'd be able to do that on our own," Peters says. "The time and money would just be too much."
CSPP: pooling resources
Deane Rabe, PsyD, associate vice president of academic affairs at the Chicago School of Professional Psychology, says his school is working with practica sites in the Chicago area to create a consortium of internship sites that will pool site resources to support the larger program.
So far, the effort is in early discussions, and has not yet created any internship slots.
While there are plenty of places where students can learn assessment and therapy skills as part of a practicum experience, the smaller sites often lack the resources to support an internship program, let alone get APA accreditation, Rabe says.
"I'm becoming convinced there are more then enough opportunities to support students....It's a funding problem at this level of training," he says.
Rabe, who has studied the internship supply issue for a National Council of Schools and Programs in Professional Psychology self-study task force, says that a 2005 council survey revealed that 33 professional psychology schools have either developed, or helped develop, internship programs or positions in the previous 10 years.
APA's Education Directorate is supporting such efforts to create additional internships, says Catherine Grus, PhD, APA's assistant executive director for professional education and training. The association is working with the Council of Chairs of Training Councils to understand trends in the numbers of students seeking internships compared with the number of positions available, Grus says.
APA also is working to advocate for funds for psychology internship training through such programs as the federal Graduate Psychology Education program, which awards funds through a competitive process to APA-accredited internships serving underserved populations, she says.
While the difference between the number of students seeking internships and the number of slots available is certainly troubling, it is important that the focus remains on developing high quality education and training programs, such as those that have been accredited by APA, Grus says.
Wright State, Widener: different models
In another effort, Wright State University's School of Professional Psychology has set up a network of internships at local Ohio community mental health clinics and hospitals.
The school wanted to give students an opportunity to apply for a local internship, says Leon VandeCreek, PhD, a professor in the program. Unlike the GSPP program, the application process to Wright State's internships is open to students nationally and internationally, meaning the school's PsyD students compete with outside students for the slots.
"Some students are pretty geographically bound by spouses, partners and family," VandeCreek says.
Interns serve two rotations: an internal rotation at the school's counseling center and the Duke E. Ellis Human Development Institute, a psychological services center in a low-income neighborhood in Dayton, and an external rotation at a community mental health center or hospital. In a typical year, one or two of the school's students are selected for the seven internship slots, says Victor McCarley, PsyD, an associate professor who also serves as internship director.
Two of the internship slots are at the Brief Therapy Center at the South Community Mental Health Center in Kettering, a facility run by a nonprofit that focuses on treating the chronically and persistently mentally ill.
The Brief Therapy Center sees about 200 people a year, says Wright State professor J. Scott Fraser, PhD.
A typical client receives 10 sessions of treatment from interns, who help a client resolve a particular crisis or pattern of trouble threatening their long-term stability.
Interns also oversee practica students who run a "mindfulness-based" stress-reduction group for clients suffering from anxiety, chronic pain and depression, he says.
At another professional school, Widener University's Institute for Graduate Clinical Psychology, PsyD students take part in an "exclusively affiliated" internship, split into two years during their fourth and fifth years of study, says Linda Knauss, PhD, an associate professor and director of psychology internship training at the Chester, Pa.-based school.
During those two years, PsyD students work at an internship site three days a week and meet two days a week in the classroom, using the classes as a form of case consultation for the clients they're seeing at their internships, Knauss says.
Currently, Widener has 41 different sites hosting internships in Pennsylvania, New Jersey and Delaware, says Knauss, adding that most of those sites also serve underserved populations. By participating in the partnership, a variety of sites that couldn't devote the time or funding to organizing an internship are able to host one, she says.
With Widener's approach, PsyD students know they've got an internship slot, won't face the hassles and expense of traveling long distances for interviews, and don't have to move for the yearlong training experience.
"When they walk in, they're guaranteed an APA internship if they successfully complete the program. There's no need to travel very far for interviews, and no delays in graduation," she says.