Wednesday, March 13, 2013

Recommended undergraduate curriculum for aspiring clinical psychologists, Part 1

The following was originally published (2011) in Psychogram, the quarterly professional publication of the Virginia Academy of Clinical Psychologists (VACP).

Because I am a licensed clinical psychologist in private practice as well as an assistant professor at a liberal arts college, my students often ask me, “How can I get to do what you do? How can I become a clinical psychologist?” Often, what they seek is mere advice on getting into grad school (e.g., When should I start studying for the GRE? Which is more impressive to admission committees:  two undergraduate poster presentations or an internship at a summer camp for autistic children?). Rather than become overly concerned with such noisome – even bureaucratic – details, I prefer to sketch for these aspirants an educational program that outlines, perhaps, what an ideal clinical psychologist should have learned during his or her undergraduate studies. My suggestions are idiosyncratic and based on undergraduate courses that I have found most useful in my career thus far, and on what I wish I had learned as an undergrad so that I didn’t have to teach it to myself during the course of my doctoral and postdoctoral training.         

It is refreshing to recall that at the Boulder Conference in 1947, the American Psychological Association’s Committee on Training in Clinical Psychology recommended that undergraduates take a mere 20 hours of psychology as preparation for graduate training in clinical psychology. How is it then that so many undergraduate programs require 30 hours or more of psychology from their majors? Are we overdoing it? More to the point, does requiring an excessive number of psychology courses deprive our majors of the broad-based liberal arts and science education they really need to perform at the highest levels of our profession? (The truly subversive question is: Would a student preparing for graduate study in clinical psychology be better off majoring in some discipline other than psychology?)

In retrospect, the undergraduate psychology courses that were most meaningful to me were research methods, independent research, theories of personality, psychological testing, introduction to counseling, and abnormal psychology. My theories of personality course was a year-long affair in which we actually read and discussed Freud, Skinner, and the other greats. In contrast to that enriching experience, the developmental psychology course I had as an undergrad was essentially a parenting course, and not the protracted exploration of gene-environment interaction that it should have been. I am certain that I took other psychology courses; it was my major, after all. But if one must refer to one’s transcript to see if you took a particular undergraduate course, it more likely than not that it was unnecessary, or even, dare I say, a waste of time.

By far, the most important experience of my undergraduate education was a nine-month internship with an afterschool program for problem children. I worked side-by-side with a psychologist, a psychiatrist, a social worker, and two doctoral students. I got an inside view of the profession that I was considering entering and a chance to begin my apprenticeship under master practitioners. Get into the field! Do the work! Escort twenty state hospital patients on a field trip to the zoo! Break up a scissors-fight between two 4th graders with ADHD and Oppositional Defiant Disorder! Listen to a battered woman explain why she can’t leave her husband. Hold the hand of a young man dying of AIDS. You will either learn quickly that you are not made for this work, or you will realize that you could never be happy doing anything else.

One controversial and rarely heeded recommendation I make to undergraduates interested in doctoral training in clinical psychology is to fulfill the minimum academic requirements for admission to medical school. Those minimum requirements generally include: 1) one year of general biology (with lab); 2) one year of physics (with lab); 3) one year of chemistry (with lab); 4) one year of organic chemistry (with lab); and, 5) one year of calculus. “But I want to go to grad school in psychology, not med school!” students protest. True enough, but doctoral students often train in medical settings, sometimes alongside med students, and are frequently supervised by psychiatrists. We need to be able to speak the local language, and the grammar of that language is the basic science education outlined above. This science education will become increasingly important as psychology grows more integrated with primary health care and psychologists collaborate more regularly with physicians.

I recall with horror sitting in a hospital conference room packed with psychiatrists as one of my psychologist colleagues raised her hand during a presentation on the etiology of depression and asked the speaker, “What’s an allele?” She was an accomplished psychotherapist and an ambitious researcher, but the last “hard science” course she took was probably in 11th grade. Because the mission of clinical psychologists is to “study, diagnose, and treat mental disorders” it is our duty to be intimately familiar with all aspects of mental health, including biological research and pharmacological treatments. Prescriptive authority for clinical psychologists will never arrive unless a large number of us possess the basic science knowledge necessary to complete the appropriate postdoctoral training. Completing these med school prerequisites also keeps students’ options open. Some may eventually decide to apply to med school (or to the increasing popular programs for physician assistants, nurse practitioners, or occupational therapists).

I recommend the following courses from the Biology curriculum, most of which are four-credit, semester-long laboratory courses: Anatomy, Physiology, Genetics, Animal Behavior, Developmental Biology, and Organic Evolution. For fun, one might wish to add courses in Nutrition, Biostatistics, Microbiology, and Epidemiology. Aspiring clinical psychologists should take courses in neuroscience, whether they are offered by the psychology department or the biology department. In effect, I suggest fulfilling the requirements for a minor in Biology.

In addition to the traditional courses in probability and statistics, my recommendation is to take as much math as one can manage. If your college offers a minor in Statistics, pursue it. The example of the great clinical psychologist Paul Meehl is instructive: he attributed his significant contributions to our field in part to his “23 credits of college algebra, analytic geometry, differential and integral calculus, and probability theory.” I suspect that this is the recommendation least likely to be taken to heart.  As Meehl noted, “most humans are happier to take the easy way, which never means mathematics.” In addition to the math courses, I recommend a course in Logic (and the excellent text by Harry Gensler).
Part 2 of this article will be posted tomorrow.

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