PsyD Programs George Stricker The first edition of this volume (Freedheim, 1992) contained chapters on the doctor of psychology degree (Peterson, 1992) and the professional school movement (Stricker & Cummings, 1992). That configuration was necessary and appropriate to the time, as many professional schools offered the doctor of philosophy (PhD) degree rather than the doctor of psychology (PsyD) degree. However, at the present time the two approaches have converged. The National Council of Schools and Programs in Professional Psychology, the organization that represents professional schools, has 62 member schools (accreditation by the American Psychological Association [APA] is required for membership) and 20 additional associate member or observer schools. The great majority of these offer the PsyD degree, although several offer both degrees. If one looks at the list of APA-accredited programs in clinical psychology, approximately one quarter are PsyD programs, and because of the large size of PsyD classes, these programs graduate about one half of all doctorates in clinical psychology each year (Norcross, Kohout, & Wicherski, 2005). Clearly, the PsyD degree, once a subject of great controversy, is here to stay. This conclusion represents something of a palinode for both authors of the original chapters. The late Donald Peterson, whose contributions led to the establishment of the PsyD degree, became a critic of the movement toward the award of the PsyD degree (Peterson, 2003) and suggested several actions to be taken to correct what he saw as an erosion of standards. In contrast, I was an initial critic of the PsyD degree (Stricker, 1975) but am now a happy faculty member in a program that awards the PsyD and have changed my initial position. The reasons for Peterson s discontent and my shifting allegiance are elaborated in a later section of this chapter. However, it is clear that times have changed. HISTORY OF THE PsyD Before going into detail, it probably would be helpful to briefly indicate what the PsyD represents. Programs in practice areas of clinical psychology typically culminated in the PhD degree (a few offered the EdD), emphasizing research and not giving as much attention to practice. Nonetheless, the majority of graduates of these PhD programs then went into practice careers. The PsyD was developed in an attempt to redress the balance, emphasizing practice without neglecting research. 630 GEORGE STRICKER
Peterson (1992) provided an extensive history of the PsyD degree, from which I will quote at length, dating the first suggestion back to 1925 (Crane, 1925). According to Peterson, Crane proposed a 4-year graduate curriculum with heavy emphasis on psychology and those aspects of medicine most clearly pertinent to the study and treatment of psychological problems. He suggested that the Doctor of Psychology degree be awarded upon completion of the program. (p. 830) Luminaries such as Freud and Menninger are also seen as having recognized the potential contribution of psychologists to clinical practice, but their suggestions were unheeded because professional psychology was small in size, indefinite in function, uncertain as to usefulness, and unclear about its own identity. Then, and for the two decades to follow, the discipline was too weak to be taken seriously as a profession (Peterson, 1992, p. 832). A marked change in the role of psychology was brought about by World War II. The need to provide services to returning veterans led to a need for additional personnel for Veterans Administration (VA) hospitals (see Chapter 16f). To help the VA to select appropriately trained psychologists, APA was asked to accredit training programs. This, in turn, led to a need for a training model for clinical psychology, and a conference was convened for this purpose. The resulting conference led to the development of the Boulder model (Raimy, 1950), which remains the single most important development in psychological training (see Chapter 17, this volume). Since that time, every training program in each practice area of psychology either claims to follow that model or a model that was developed in response to it. The Boulder model, also known as the scientist practitioner model, emphasized the need to train students in both science and practice, recognizing that there would be variations in the interests of students and the emphases of different programs. The valued balance between science and practice remains an excellent one in theory, but in implementation it has fallen far short of the intention of the conferees (Stricker, 2000b). In the decade that followed the Boulder conference, almost every program that developed followed a science-first approach, even though students usually intended to follow a practice-oriented career path. As Peterson (1992) noted, the students, once admitted, either had to maintain the pretense, reveal their aims and incur the disfavor of their professors, or withdraw from training altogether (p. 833). Surveys conducted at that time showed that most graduates were not becoming productive scientists and felt ill prepared for the careers they chose in practice. Peterson concluded that the scientist practitioner model was TRAINING SYSTEMS AND SITES 631
designed to meet the dual purposes of scientific inquiry and professional service. In trying to reach both aims, it evidently accomplished neither. As scientists, the Boulder style PhDs were unproductive. As professionals, they were incompetent (p. 834). An exception to this trend was at Adelphi University, the only accredited clinical program explicitly intended to train practitioners, culminating in the award of the PhD degree. Another training model seemed called for, and another committee, the Clark committee, was convened. Their report (APA, 1967) concluded that the PhD programs then in effect for educating scientist practitioners were neither preparing scientists for contributory research nor professionals for effective practice. They recommended creation of a two-track educational system. Students interested predominantly in research would be prepared to do research and receive the PhD degree. Students interested predominantly in practice would be prepared for professional service and receive the PsyD degree. Students interested in combining careers of research and practice would complete both courses of study and receive both degrees. (Peterson, 1992, p. 834) The report led to a great deal of discussion but little action because most programs continued with business as usual. One exception was at the University of Illinois, where active consideration was given to developing a PsyD program. A conference was then convened in Chicago (Hoch, Ross, & Winder, 1966) to discuss the Clark report (APA, 1967), and it produced rather ambivalent results. Peterson (1992) noted that there was some support for the report, but the majority, however, 57%, were merely willing to extend recognition to the idea that explicit professional training programs might be attempted in some university departments, and that the results of those efforts should provide a basis for evaluating the programs at a later time. (p. 835) The University of Illinois then voted to go ahead with a PsyD program and, in 1968, under the direction of Peterson, admitted students. The program received provisional APA accreditation in 1972 and became a template for many professional schools that then developed. At the same time, other professional schools were being developed, most noteworthy of which is the California School of Professional Psychology, but these led to the PhD degree. As a side note, the program at Illinois has been discontinued, and the California School of Professional Psychology programs are now known as Alliant University and award PsyD and PhD degrees. The APA response to the growing interest in and need for professional programs was to convene one more conference, this time in Vail, Colorado (Korman, 1976). Peterson (1992) cited the most important of the Vail resolutions: 632 GEORGE STRICKER
First, the development of psychological science has sufficiently matured to justify creation of explicit professional programs, in addition to programs for training scientists and scientist-professionals. Second, we recommend that completion of doctoral level training in explicitly professional programs be designated by award of the Doctor of Psychology degree and that completion of doctoral level training in programs designed to train scientists or scientist-professionals be designated by award of the Doctor of Philosophy degree....where primary emphasis in training and function is upon direct delivery of professional services and the evaluation and improvement of those services, the Doctor of Psychology degree is appropriate. Where primary emphasis is upon the development of new knowledge in psychology, the PhD degree is appropriate (Korman, 1974, p. 443). (Peterson, 1992, p. 838) The Vail conference gave an official imprimatur to professional schools, the PsyD degree, and the practitioner model of training as an alternative to the scientist practitioner model. This was followed by an explosion of new programs in many settings, including research universities (e.g., Rutgers), small colleges (e.g., Florida Institute of Technology), and free-standing programs (e.g., Argosy University). Most of the newly developed programs preferred the PsyD degree, perhaps because it is less expensive to develop (there is no need for extensive laboratories), attracts more students, and can manage larger classes. Peterson (1992) detailed several of the local fights that took place, at the level of both the university and state boards of education, but that now seems to be an event of the past. Several studies have demonstrated that initial worries about public stigmatization, licensure uncertainty, and employment difficulty have not materialized at least not any more than encountered by PhD recipients (Norcross, Castle, Sayette, & Mayne, 2004). Today, the APA accredits 63 PsyD programs in clinical psychology, three in counseling psychology, six in school psychology, and three in combined professional scientific psychology ( Accredited Internship and Postdoctoral Programs, 2007). Another 20 or so are not (yet) accredited by APA, mostly because they are relatively new programs. The PsyD has attained acceptance and is increasingly familiar to the public and within the discipline. Nonetheless, active criticism persists, and it is to this that I turn next. CRITIQUES OF PsyD PROGRAMS There have been two approaches to criticizing PsyD programs. The first of these consists of articles in peer-reviewed journals, and these usually are thoughtful and measured, even if critical. I review several exemplars of this TRAINING SYSTEMS AND SITES 633
approach in this section. The second source of criticism hails from the ongoing tension between scientists and practitioners within APA. From the founding of the organization, the APA presidency was occupied by a series of distinguished researchers and academicians. However, in 1977, Theodore Blau, a well-known practitioner, was elected to that office, followed over the next decade by Nicholas Cummings, who was instrumental in beginning the California School of Professional Psychology, and Max Siegel, also a noted practitioner. Not coincidentally, the American Psychological Society (APS), now known as the Association for Psychological Science, was founded in 1988. The mission of APS is to dedicated to the advancement of scientific psychology and its representation at the national and international level (Association for Psychological Science, n.d., para. 1). Although this is a worthy goal, the subtext is that APA, now dominated by practitioners, was not doing a very good job with science. The criticism of professional education from this source is not covered because it belongs primarily in the realm of politics. One early criticism of the then newly developing PsyD degree, as mentioned earlier, was my own (Stricker, 1975). At the time, as now, I was a strong supporter of professional education, but I believed that there was a need to disentangle the value of professional education from the need for a new degree. I took exception to many of the points that Peterson (1968) raised in his presentation of the PsyD program at Illinois. The most critical point concerned the doctoral dissertation. Peterson thought that the research demands of a PhD program could not be altered in a practitioner program. I contended that the final paper required of PsyD students was comparable in scholarship to that of a doctoral dissertation, although the requirement for empirical research had to be altered to allow papers more in line with clinical concerns. The PhD is not a research degree but one that rewards scholarship, and the final papers in the better professional programs met any reasonable standard of scholarship. However, I recognized that many universities would not allow this to happen, and clinical training resulting in a PsyD would then occur in a second-class program within the university. I still believe that students who produce excellent final papers deserve the PhD, but I also recognize that it is unlikely that many universities will grant such a degree for that effort. With several notable exceptions, most PsyD programs exist in settings other than major universities, and so the programs become the centerpiece of the academic institution rather than a minor offering as they would be in a research setting. Many of the other problems cited by Peterson (1968), such as the differentiation of goals of training and the valuing of clinical practice, follow from this difficulty and could have been overcome if the large universities had been willing to do so. They were not, and thus the need for an alternative degree increased. 634 GEORGE STRICKER
I summarized my concerns by stating, There is no denying that the PhD is the highest and most prestigious academic degree that is awarded, that it is well accepted by the general public, and that a strange-sounding degree will raise inevitable and undeserved suspicion in our era of rampant quackery in the mental health field. Before we accept the creation of a new degree, we must demand evidence that it will lead to benefits unattainable within the well-accepted and well-understood contemporary framework. (Stricker, 1975, p. 1065) Time has proven me wrong. Major universities, with few exceptions, have not turned to professional training, and the PsyD is often the only doctoral degree available in the settings in which it is offered. The undeserved suspicion may have occurred earlier, but at this time, most internship directors, employers, and the general public either recognize the value of the PsyD or at least do not make distinctions according to degree. I still believe that a well-done dissertation is deserving of a PhD, and a poorly done project is not deserving of any doctoral degree, but I also am convinced that practicality will not allow for this solution. Accordingly, I am glad that the PsyD has become an appropriate vehicle to allow for professional training to occur. Recently, an empirically based criticism of professional school graduates (almost always now PsyD recipients) was published and widely circulated (Templer, Stroup, Mancuso, & Tangen, 2008). It is the most recent of a series of studies by the same senior author, who compared the scores of professional school graduates with those of graduates of more traditional PhD programs on the Examination for Professional Practice in Psychology (EPPP), which is a part of the licensing examination for psychologists in every jurisdiction in North America. The results indicate that professional school graduates score lower on average on the EPPP than graduates of traditional PhD programs. The major problem with this conclusion, as I see it, is the overvaluing of EPPP scores as a measure of quality of the student, particularly when it comes to students pursuing a clinical career. I would prefer to see scores on clinical functioning assessed, either rather than or as well as scores on an examination that correlates highly with GREs, which are typically used as a principal selection tool for traditional programs. It is no surprise that students selected for excellence on GREs also score well on the EPPP, but it is not clear what either has to do with clinical functioning. Clinical training is multifaceted, and it is unlikely that any single test could ever capture the variability in clinical programs of equal but differing sources of excellence (Stricker, 2000a). Peterson (2003) recommended that action be taken to reduce the number of inadequate PsyD programs, a recommendation that no serious person can oppose, but one that requires the identification of such programs. He then suggested an evaluation of clinical training programs, again a recommendation TRAINING SYSTEMS AND SITES 635
that is appropriate but difficult to implement. The closest we have to such evaluation is accreditation by APA, and most of the extant PsyD programs have survived this challenge (many of the others are in an early developmental phase and may eventually become accredited). I am sympathetic to Peterson s wish for increased quality but not to his conclusion that PsyD programs fall short of the goal, because there is little evidence that they do not produce graduates who achieve excellence in the mission of their training program. All of us endorse determining quality through graduates performance as professionals (Kenkel, DeLeon, Albino, & Porter, 2003, p. 805), but nobody has suggested a viable method of doing such an assessment. Additional data-based criticisms of PsyD programs concern (a) the larger size of these programs; (b) their comparatively high acceptance rates; and (c) the paucity of financial support for students, leading to increased student debt compared with PhD clinical programs. PsyD programs are, as a rule, considerably larger than PhD programs, typically by a factor of two or three (with the size made possible by the lack of need for extensive research training or an empirical doctoral dissertation, both of which are very laborintensive activities for faculty members). There is widespread concern about the shortage of APA-accredited internship positions, and PsyD students, as a rule, are those experiencing the shortage most acutely. PsyD programs have been particularly active in creating internship consortia for their students to reduce the gap between the number of applicants and the number of internship positions. STRENGTHS OF PsyD PROGRAMS The contributions of PsyD programs are difficult to separate from their strengths. These contributions have been listed as (a) a comprehensive competence-based training model for professional psychologists (a concept that the rest of psychology has only more recently begun to consider), (b) pedagogies appropriate to training goals, (c) ways of attracting more diverse students into psychology and more diverse faculty to professional programs, (d) measures of quality control for both academic and clinical skills, (e) methods for integrating diversity training throughout the curriculum, (f) interdisciplinary training and collaboration, and (g) methods for keeping the curriculum current with societal demands. (Kenkel et al., 2003, p. 802) The emphasis on diversity is particularly noteworthy. PsyD programs have as high a proportion of minority students in the student body as traditional PhD programs, and perhaps a higher proportion of minority faculty members (Norcross et al., 2004). PsyD programs have taken the lead in 636 GEORGE STRICKER
changing the face of psychology and, in doing so, have adopted a socially responsible role consistent with the goal of making excellent services available to the public. Finally, I should note that training in PsyD programs does not ignore either research or the corpus of psychological knowledge. To do so would result in a loss of accreditation, and that has not happened. However, the approach to research has been to produce consumers of research rather than producers of research (traditional programs, despite stated intentions, have not been very successful at developing many producers of research either). Along this line, the graduate of a PsyD program will probably not be an active research scientist but should be a local clinical scientist (Stricker & Trierweiler, 1995; Trierweiler & Stricker, 1998). CONCLUSIONS Accredited PsyD programs have successfully met their stated goal: to produce competent practitioners prepared to meet public needs for psychological services. Graduates of these programs are gaining in getting internships, passing the licensure exam, and finding employment in the area for which they have been prepared. They have grown the clinical practice of psychology, filling unmet societal needs. Despite this success, they have drawn criticism on the basis of the alleged lack of quality of some graduates, a charge that has only indirect and flawed data to support it, and the larger size of the student bodies, lower acceptance standards, and higher debt load. The question of size is only of importance if it relates to performance in the clinical setting for which the students have been prepared, and these have not been systematically attempted. The organization charged with quality control in psychological education and training is APA s Committee on Accreditation. There are two suggestions that I can make to this group about weeding out programs that are not successful, and these suggestions should be applied to PsyD and PhD programs alike: (a) Programs that are consistently unsuccessful in placing students within accredited internships should be phased out, and (b) programs that are consistently unsuccessful in placing students in employment settings for which they have been trained should be phased out. These represent operational definitions of the problem of size. If these criteria are used, I suspect that neither PsyD programs nor PhD programs will have difficulty meeting the first criterion. However, the second criterion will be far more difficult for PhD programs, as many of their graduates, who are being prepared for research or academic careers, end up in service delivery positions. TRAINING SYSTEMS AND SITES 637
The PhD scientist practitioner model and the PsyD practitioner model entail trade-offs in their mission and subsequent training. An unfortunate penchant of humans, including psychotherapists, is to demonize differences rather than embrace them. Let the evidence speak, and that evidence largely favors the simultaneous existence of two training models toward different but overlapping ends. REFERENCES Accredited internship and postdoctoral programs for training in psychology: 2007. (2007). American Psychologist, 63, 1016 1040. Anonymous. (1967). The scientific and professional aims of psychology. American Psychologist, 22, 49 76. doi:10.1037/h0024248 Association for Psychological Science. (n.d.). About APS. Retrieved from http://www.psycho logicalscience.org/about/ Crane, L. (1925). A plea for the training of professional psychologists. Journal of Abnormal and Social Psychology, 20, 228 233. doi:10.1037/h0068539 Freedheim, D. K. (1992). History of psychotherapy: A century of change. Washington, DC: American Psychological Association. doi:10.1037/10110-000 Hoch, E. L., Ross, A. O., & Winder, C. L. (1966). Professional preparation of clinical psychologists. Washington, DC: American Psychological Association. doi:10.1037/10537-000 Kenkel, M. B., DeLeon, P. H., Albino, J. E. N., & Porter, N. (2003). Challenges to professional psychology education in the 21st century: Response to Peterson. American Psychologist, 58, 801 805. doi:10.1037/0003-066x.58.10.801 Korman, M. (1974). National Conference on Levels and Patterns of Professional Training in Psychology: The major themes. American Psychologist, 29, 441 449. doi:10.1037/h0036469 Korman, M. (1976). Levels and patterns of professional training in psychology. Washington, DC: American Psychological Association. doi:10.1037/10047-000 Norcross, J. C., Castle, P. H., Sayette, M. A., & Mayne, T. J. (2004). The PsyD: Heterogeneity in practitioner training. Professional Psychology: Research and Practice, 35, 412 419. doi:10.1037/0735-7028.35.4.412 Norcross, J. C., Kohout, J. L., & Wicherski, M. (2005). Graduate study in psychology: 1971 to 2004. American Psychologist, 60, 959 975. Peterson, D. R. (1968). The Doctor of Psychology program at the University of Illinois. American Psychologist, 23, 511 516. Peterson, D. R. (1992). The Doctor of Psychology degree. In D. K. Freedheim (Ed.), History of psychotherapy: A century of change (pp. 829 849). Washington, DC: American Psychological Association. Peterson, D. R. (2003). Unintended consequences: Ventures and misadventures in the education of professional psychologists. American Psychologist, 58, 791 800. Raimy, V. (1950). Training in clinical psychology. New York, NY: Prentice-Hall. Stricker, G. (1975). On professional schools and professional degrees. American Psychologist, 30, 1062 1066. Stricker, G. (2000a). The measurement of clinical psychology training programs. Clinical Psychology: Science and Practice, 7, 361 363. Stricker, G. (2000b). The scientist practitioner model: Gandhi was right again. American Psychologist, 55, 253 254. 638 GEORGE STRICKER
Stricker, G., & Cummings, N. A. (1992). The professional school movement. In D. K. Freedheim (Ed.), History of psychotherapy: A century of change (pp. 801 828). Washington, DC: American Psychological Association. Stricker, G., & Trierweiler, S. J. (1995). The local clinical scientist: A bridge between science and practice. American Psychologist, 50, 995 1002. Templer, D. I., Stroup, K., Mancuso, L. J., & Tangen, K. (2008). Comparative decline of professional school graduates performance on the Examination for Professional Practice in Psychology. Psychological Reports, 102, 551 560. Trierweiler, S. J., & Stricker, G. (1998). The scientific practice of professional psychology. New York, NY: Plenum. TRAINING SYSTEMS AND SITES 639