In my last column, I put forth a few ideas about how we could re-envision the doctoral curriculum. I started by outlining what I saw as fundamental requirements for the student embarking on doctoral level education in health service psychology. My premise remains that we can and must make doctoral level health service psychology education more approachable, affordable and efficient. As I’ve argued, we are in part responsible for the mental health crisis now afflicting us, because while we worked diligently to destigmatize mental disorders and their treatment, we did not anticipate the consequences of our success. I’ve recently heard people argue that “we can’t train our way out of this.” I couldn’t disagree more strongly. We CAN and MUST train our way out of this, but I admit we cannot if we use the antiquated, arts and sciences-based models that define graduate education today. If we as a profession are going to thrive, this leaves us with one option only: A wholesale modernization of the doctoral curriculum. If we commit to this, we can indeed ‘train our way out of it’, because we’ll produce more doctoral level health service psychologists who can enter the workforce and make a true difference. It will take time, and it isn’t a short-term solution. But it we adopt it we will position psychology well for the next century.
Recall that our objective is to preserve the basic knowledge and competencies of the profession but to teach them in an integrated, clinically oriented fashion. Rather than teaching in stand-alone, monolithic, three or five unit courses, we will take the essential aspects of theory and knowledge and contextualize it in a clinically pertinent way. Let’s start with the example of biological bases of behavior. It’s a great example because it represents an area of evolving and often speculative knowledge. Now when I took bio bases almost 40 years ago we spent some time in neuroanatomy and neurophysiology (sheep’s brains were on the menu). We learned about central and peripheral nervous systems, sympathetic and parasympathetic branches, axonal structure and functioning, intra and intercellular signaling, and other (to me) fascinating aspects of vertebrate nervous systems. What we did not learn, in those pre fMRI days, was functional neuroanatomy, nor did we touch on neuropathology to a significant extent. Should these areas be conserved in the doctoral curriculum? I would strongly argue yes, but they should be taught rather than in a siloed course but in an integrated course that teaches human neurodevelopment, pathophysiology (particularly in neurodegenerative diseases) and what we think we know about biological bases of mental disorders (still not much). Thus we see a course that is intimately linked to coursework in developmental bases of behavior, psychopathology, and cognitive-affective bases of behavior. It goes without saying that psychopharmacology should be integrated into this sequence. Many graduate students do seek coursework in psychopharmacology, but it is almost always an elective, not a core element of the doctoral curriculum. This is a shame, because knowledge of psychopharmacology is the lingua franca of modern mental health treatment. We don’t have to argue about the overall efficacy of psychotropics here (though it should be well covered in any course, along with strategies for combined treatments), but the subject matter should be a fundament of education of the health service psychologist.
As you may recall in my last column I proposed a trimester system that would provide essentially year-round education. Such a structure would be in keeping with models used to train other doctoral level health care professions. It will compress the doctoral curriculum and should reduce attendant costs, allowing students to attain the doctorate more quickly and at lower cost. I suggested that in the first trimester we teach three intensive courses: The Doctor-Patient Relationship, The Therapeutic Relationship, and Foundations of Health Service Psychology. Let’s now expand on these three courses in our second trimester of the academic sequence.
Let’s call our first class in the second trimester Foundations of Health Service Psychology II: The Adolescent and Young Adult. In this course we will integrate principles of developmental psychology, much as we focused on pediatric populations in the first trimester. We’ll look at developmental trajectories in adolescence, and we will examine psychometrics of standardized evaluation of adolescents. Social and cognitive-affective bases of behavior can be addressed via addressing maturational milestones, as well as the developmental consequences of ethnic, socioeconomic, or sexual minority status. We will address psychological processes of maturation and autonomy, physiological processes of maturation, including the developing brain, and discuss behavioral and pharmacological interventions for common mental disorders affecting adolescence. The ethics of informed consent and assent would be most appropriate to be addressed here, along with the dilemmas that accompany problems of parental disharmony, divorce, and problems of abuse or neglect. Our applied clinical experience will involve direct patient assessment and intervention, ideally as a member of a multidisciplinary treatment team.
Another class that we can teach in this trimester would be titled something like Research Skills for Health Service Psychologists. In this course we could cover ethics and principles of behavioral and psychological research. Applied statistical methods would be covered in this course, and this would fit nicely with psychometric principles being taught simultaneous in the Foundations course outlined above.
The third course in this rather intensive trimester might focus on a continuation of skills development in therapeutic and behavioral interventions. Here, continued instruction in techniques of psychotherapy, psychotherapeutic outcome, and analysis of the psychotherapeutic literature might be featured, all with an emphasis on adolescence, so that the ethical, practical, and research foundations of the profession are integrated seamlessly with the student’s deepening experience in the clinical realm.
Ambitious? Absolutely. But consider the advantages to this model over those of a second semester graduate student in current graduate models. The graduate student of today in the second semester of their first year might be taking a course in social or cognitive bases of behavior, perhaps a course in inferential statistics, a course in psychometrics or test construction, and perhaps a course in personality theory or psychopathology. Which model do you think is liable to produce a competent, well-rounded health service psychologist? Which model do you think might produce clinicians interested in working with child or adolescent populations, which are continually short-changed in terms of service provision?
In my over 40 years of experience in the profession, I have heard many things called a ‘crisis’. In retrospect, few actually were. Colleagues, the need to reform our educational curriculum is a true crisis. I believe that the future of psychology as a health service profession rests on our ability to undertake this challenge. There are many models, and we could discuss the merits of these ad infinitum. I realize that many people will not agree with the model I propose, and it certainly needs considerable refinement. Whether you want to build on it or tear it down and propose something entirely different is immaterial. What matters is that we engage, and the sooner we can start the better off our profession will be.
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