What does someone have to do to be a clinical psychologist?

Unless you know someone who has been through the gauntlet-like process of becoming a clinical psychologist, chances are you only have a general idea of what it means. It can be helpful for potential clients to know what goes into it and how "clinical psychologist" is different from counselor or social worker. Knowing these differences is an important part of being an informed consumer when it comes to therapy. Today I'll get us started then focus in on the Clinical Psychologist category. 

Categories of "therapists" or "counselors"-- master's level (Licensed Professional Counselor, Marriage and Family Therapist, Licensed Clinical Social Worker, etc) and doctoral level (Clinical Psychologist). "What about psychiatrists?" you say. They're MD's; they prescribed medication and get significantly less therapy training. 

Master's level clinicians have received a set amount of training and, once licensed, have completed a set number of hours of clinical training. Generally their therapy services cost a smidge less and are easier to find. Doctoral level clinicians have a bit more schooling and have better odds of being either informed about or engaged in research.  Being "up on the research" can make a difference in the same way you would want a surgeon up to date on the latest and most effective techniques rather than the same one he's been doing for thirty years. 

I'll talk more about master's level clinicians and how to find the right therapist for you in future posts, but for now I want to focus on that doctorate level side and what goes into that. 

Step 1: Getting into grad school.

There are two types of programs people (or cats) can do: PhD (doctorate of philosophy in clinical or counseling psychology) and PsyD (doctorate of psychology). Generally the difference is the level of time spent learning about or doing research. PhD's generally have a greater emphasis on learning how to do research and learning how to interpret other's research. PsyD's generally have a greater emphasis on training in clinical skills. So the balance of time between learning research and clinical skills is general even in a PhD and more heavy on the clinical side in a PsyD. Having a therapist who understands research can indicate that they are more likely to know which treatments have shown through repeated testing to be effective at helping people. 

Clinical psychology PhD programs are harder to get into than med school. The quality of programs varies. There are for-profit and online programs that are not accredited by the American Psychological Association (APA); these don't generally provide good training-- run away from these. Be sure to look for someone who went through an accredited program because this means their training met high standards of training and education. These programs are not big money makers for universities generally, so they aren't everywhere and programs generally take only 3-9 students per year. Many people end up moving far and wide to get into these PhD programs and make great sacrifices over the course of their 4-7 year training. 

2. Surviving grad school.

In addition to classes, every program has a qualifying exam of some kind. It is typically some demonstration of knowing a lot of information generally and/or some info on an area of specialty. That's in addition to classes, doing research in a lab (usually), and doing clinical practicum (learning how to do therapy - usually a couple years of this in different contexts).

You might happen upon one of these trainees when looking for affordable counseling. Many departments offer therapy through training clinics. They'll having basic skills and will be supervised by a licensed psychologist. For clients with relatively straight forward, short-term issues this is a great option.

Oh yeah, and they do a dissertation. It's terrible, but I don't want to talk about it. It's terrible.

3. Predoctoral internship.

The final year of grad school is an internship. Currently it is absurd and very competitive. Most people again pick up and move at least out of state, if not halfway across the country. It's a computer match system where students and sites (again, hopefully APA-accredited programs-- places like medical schools, hospitals, community mental health centers, prisons, etc), interview and rank each other. By now if the student isn't completely broke or deep in dept, that happens with traveling all over for interviews. The internship is almost always a year of working as a therapist full-time. Again, another chance to get cheap therapy!

4. Postdoctoral residency and licensure hoops.

Here things start varying widely from state to state. Every state has a Board of Psychology that can provide specific guidance for your state. Currently a postdoc residency (another full-time year of mostly clinical work) is necessary either for licensure as a psychologist in most states or to be competitive for professor-y jobs. Postdocs are less competitive than internships, but it's another hoop often involving moving across state lines. Then there is the big monster test, the EPPP (no, I don't know what it stands for, don't ask). It covers ALL of psychology. All of it. In Texas, there's also the jurisprudence exam (law and ethics) and an oral exam, where you have to go to Austin and sit in front of and handful of intimating experts and talk about what you would do with some hypothetical clients. And you pay, lots and lots of money actually, to take these tests. 

5. Licensed. Finally.

And then when school, internship, postdoc, and licensure tests are passed, then you have a clinical psychologist! Ta da! It's a uniquely harrowing combination of education and training that people only do if they're just crazy enough...

Nobody becomes a psychologist by accident.