Emily Voelkel, PhD, felt her doctoral coursework at the University of Houston gave her solid clinical interviewing skills. But her practicum experience at a Houston hospital threw curve balls that her textbooks and classes hadn't covered. Although she understood the clients' symptoms, she had no experience in building a rapport with and gaining the trust of a client she probably wouldn't see again. Parts of the experience seemed overwhelming to her. "You have to manage a lot of things in a specific amount of time," Voelkel says.
Of course, giving psychology students a taste of real-world psychology practice is exactly why practicums were created.
"Practicums are the first step in becoming a psychologist," says Nabil El-Ghoroury, PhD, APAGS associate executive director. "The goal of training is to prepare you to become independent."
Still, the experience can be daunting, so it's helpful to know in advance how you can prepare yourself.
Building experience
The timing of your practicum has a lot to do with how well prepared you will be. In a 2014 study published in Training and Education in Professional Psychology , Robert Hatcher, PhD, Erica Wise, PhD, and Catherine Grus, PhD, found that about one-third of clinical and counseling psychology programs started practicum training during the first year and about two-thirds in the second year. Among school psychology programs, about half began practicum during the first year.
How do programs determine when students are ready for practicum? Some use standard evaluation systems. The APA Benchmark Competencies for Professional Psychology, for example, rates students on dozens of core competencies, such as assessment and intervention skills, understanding evidence-based practices, and knowledge of ethical standards. The National Council of Schools of Professional Psychology (PDF, 148KB) also has a detailed list of competencies in which students should become proficient before practicum (see box).
Other graduate programs devise their own checklist of competencies, especially if they focus on a specialty area, such as forensic psychology. Meanwhile, small graduate programs often do not do formal evaluations. "Maybe they only have five students, so they just ask how everyone is doing" during a year-end faculty discussion, says Hatcher, who is on the graduate psychology faculty and is director of the Wellness Center at the Graduate Center of City University of New York.
All told, about 2.5 percent of students each year are held back from starting practicum because their assessment or intervention skills are insufficient, according to the Training and Education in Professional Psychology study. In those cases, students may take additional courses or complete skills training, says Wise, a clinical professor of psychology and director of the doctoral program psychology training clinic at the University of North Carolina at Chapel Hill.
Taking the right courses
Years ago, there wasn't a direct alignment between the courses psychology students took and their practicum. But these days, psychology graduate programs work to integrate the content of required courses so that there's a match with the experience students are expected to gain through practicum training, says Wise. "So, for example, someone teaching a psychological assessment course would be sure to teach the kinds of tests and measures students will be using in the clinic and at external practicum sites," she explains. In addition, integrated course work and practicum training should help students attain the needed practice competencies so they're ready to apply for internship.
That means students need to keep their practicum in mind as they schedule their requirements. So, find out as soon as you can which competencies you will have to master to start the practicum experience. It varies from program to program, so ask the faculty if you're unsure, says Grus. "You don't want to get to the point in time when you think you should move on but your professors say you aren't ready," she cautions.
Voelkel found that training in clinical interviewing, diagnostics and abnormal psychology helped prepare her for her practicum. Todd Avellar, a fifth-year doctoral student at the University of California, Santa Barbara, says his courses in psychology theory were useful for his practicum at the university's Hosford Clinic. "It gave me a basic framework to use when working with clients and with supervisors."
During the practicum
To get the most from their practicum, students should have a goal in mind, says El-Ghoroury. Students who have specific objectives — such as wanting to do five neuropsych batteries or to see patients with post-traumatic stress disorder — need to let their supervisors know.
It's also important to be open to supervisors' feedback, whether it's in person or watching cringe-worthy videos of yourself. "I hated watching video," says Avellar. "But then it became so helpful because I got an idea of how I presented myself to my clients." He was able to scrutinize his word choices, gestures, and whether he came across as reserved or more open toward clients.
If you feel that supervision is lacking, broach the subject. "You don't want to make waves, but it's reasonable to ask gently for the things you need," says doctoral candidate Jennifer Doran. If you want to review videotapes with a supervisor but taping isn't being done, ask for it, says Hatcher. "As much as you can, try to get feedback on what you're doing," he says.
Doran also encourages other students to get diverse clinical experience during practicum. Hers has included working with a seriously mentally ill inpatient population, clients at a community mental health center, students at a university counseling center, and first responders from 9/11 with post-traumatic stress disorder. You may even want to get training with populations that you don't plan on seeing in the future. For example, working with inpatient depressed adults may be helpful to someone interested in child clinical psychology because in the future you might work with mothers with depression.
It's also important to recognize that you will make mistakes in your practicum. "You're in training, you're going to make a mistake and wish you had done something different," El-Ghoroury adds. "This is the best time to make those mistakes because you're getting support and supervision. You can learn from your errors and develop better skills as a result."