Doctorate in Clinical Psychology – PsyD and PhD Programs

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What Is Clinical Psychology? – What Psychologists Do in Clinical Settings

As a rule, it’s the severity of the illnesses being diagnosed and treated that differentiates clinical psychology from counseling psychology, with the most potentially debilitating and self-destructive of those falling squarely in the wheelhouse of clinical psychologists.

In many cases, clinical psychologists don’t work in conventional in-patient clinical settings at all, but instead operate private out-patient practices where they diagnose, counsel and prescribe treatment plans for private clients. With psychopharmacological training, some states even allow them to prescribe psychiatric medicine, which is a level of prescriptive authority typically reserved for psychiatrists.

Clinical psychologists are also employed on the payrolls of larger healthcare systems and with government organizations in settings as diverse as state psychiatric hospitals and correctional facilities. There are also frequently clinical psychologists on staff in long-term care settings, helping veterans and other patients adjust to struggles with illness, injury and recovery in cases where mental health problems arise from physical trauma and new limitations.

Clinical psychologists may specialize in certain types of treatment, like behavioral analysis or cognitive behavioral therapy, and in particular kinds of illnesses and disorders, from developmental disorders like autism to severe mental health illnesses like schizophrenia and clinical depression.

The goal is always to diagnose the issues and then create goals and a plan of action to help people heal from mental and emotional distress and simply feel better. Working with patients across the spectrum of mental health disorders, there’s always something new to discover and overcome in clinical practice.

The clinical psychology community stayed busy through the COVID-19 pandemic, counseling and treating people through what was effectively an epidemic of its own, but one of depression and anxiety that all too often gave way to self-destructive behavior and suicidal thoughts. Many expect that the psychological fallout of the global pandemic will be felt for years to come, and that clinical psychologists will continue to be a source of healing and solace.

Along the way, they had to adapt to new ways of delivering their services. Connecting with clients through Zoom wasn’t something that most of them learned in college. But the care, concern, and professionalism they showed through extreme changes are part of what makes them so valuable. The APA pushed for expanded governmental allowances on telehealth early on, and thousands of clinical psychologists stepped up to take their practices online and serve patients remotely as they sheltered at home.

Clinical psychology is a field where you often have to think outside the box. Noted Norwegian psychologist Magne Raundalen, though, tells a story of how he took that concept to the next level with a shockingly unorthodox approach.

Working with an 11-year-old cancer patient in a hospital who was suffering from depression, Raundalen fell into a daily game where he would engage in a mock showdown with the boy, with finger guns drawn and ready for the play gunfight every time he came into the boy’s room. The boy loved it and the game became the highlight of his day. Over time, this game become more and more intense, with Raundalen bursting through the door and diving for cover on the floor behind the boy’s bed.

As time went on, though, the boy became more despondent, angry and depressed, refusing the life-saving surgery that he was scheduled to undergo. Raundalen upped the ante, buying an actual air pistol – not a toy – and allowing the boy to target shoot in his room.

If that wasn’t enough, Raundalen agreed to the boy’s other outlandish wishes, which included allowing him to defiantly fly an enemy flag from his hospital window as an independence day parade marched by, much to the shock and dismay of parade-goers.

Something more was happening here than just indulging the whims of a rambunctious youngster; Raundalen was treating the boy’s depression that stemmed from feelings of helplessness by giving him a sense of empowerment.

In the end, not only would the boy go willingly into surgery and go on to survive and thrive, Raundelan would get to meet his former patient’s family twenty years later and recount the events surrounding his unorthodox treatment.

It’s not an ordinary situation for a clinical psychologist, but it demonstrates something that is ordinary in the job: a willingness to find the path it takes to break through to any individual patient. It’s not always obvious; it’s not always out of a textbook. But doctorate-prepared clinical psychologists have the right kind of skills to make connections and treat patients no matter the obstacles.

Everything You Need to Know Before Selecting a Doctorate in Clinical Psychology

You know you want to go all the way in your career as a clinical psychologist, but you need to get some questions answered first – are you going to go with a PhD of PsyD? … does an online program make the most sense? … and what role does the American Psychological Association play at this level?

What is the Difference Between a PhD and a PsyD in Clinical Psychology?

The PsyD is almost entirely aimed at preparing you for practice as a clinical psychologist. The coursework and practicum hours will almost all be put together to support a career in patient diagnosis and treatment, with a focus on the most practical approaches to delivering psychological services to patients in need.

A PhD program takes a more theoretical and investigative approach. It’s designed more to prepare graduates for a career in research or academics with a focus on psychological theory, experimental design, and research techniques with less emphasis on direct psychological assessment and treatment.

In practice, there’s no bright line between a PhD in psychology and a PsyD, and both check all the boxes for becoming licensed by state boards as a full authority psychologist in clinical practice. There are many professors and researchers who hold a PsyD, and a lot of practicing clinical psychologists who have a PhD under their belt.So the difference isn’t so much about putting you on a specific career track, but instead has more to do with the perspective from which it teaches psychology and psychological methods.

Both PhDs and PsyDs revolve around a highly involved independent research project that comes together in a final dissertation. PsyD programs more commonly offer the option of writing and presenting a thesis in lieu of actually defending a dissertation before a committee, which is something that’s standard in a PhD. This can result in PhD programs going a year or two longer and costing slightly more than a PsyD.

An Online PsyD or PhD Program in Clinical Psychology Could Be Your Best Bet

In a post-pandemic world, it can seem like everything has moved online, and doctoral programs in psychology are no exception. But with PsyD programs in particular, remote learning presents a few challenges.

With a strong hands-on focus on clinical practice, not every step of a PsyD program can be completed online, of course. Even programs promoted as being online would more accurately be described as hybrid options, with plenty of online classes, but also a significant amount of in-person attendance requirements for projects, labs and clinical hours.

But schools that offer online PsyD options can give you a lot of flexibility in terms of how and when you get through your coursework. Anyone sinking five to seven years into a doctorate probably also has other obligations in life. Whether that’s a job or family commitments, asynchronous online courses can let you catch up with your studies on a lunch break, at the laundromat, or at the kitchen table at night after the kids go to bed… whatever works to fit into your busy schedule. That kind of flexibility can improve your odds of getting the most out of these demanding programs.

APA-Accreditation is a Must When Selecting Clinical Psychology Doctoral Degrees

Basic institutional accreditation is something that just about every American college you have ever heard of already holds. It’s what makes universities here respected worldwide—high standards and credentials that employers and students can count on.

But when you get into a professional field like psychology, you need to go beyond that basic university-level accreditation. State licensing boards and healthcare employers alike require that candidates graduate from doctoral programs that have passed a stronger test: program-specific specialty accreditation from the American Psychological Association.

The APA maintains a dedicated Commission on Accreditation that puts schools through their paces. With extensive policy and curriculum reviews, frequent on-site evaluations, and interviews with key academic and administrative staff, they get to the bottom of how well equipped a school is to provide a doctoral-level education.

The commission has members drawn from a wide range of backgrounds, from academics, to practicing psychologists, to healthcare providers, to regular citizens. A professionally diverse committee like this helps ensure a broad perspective in their analysis.

That analysis includes looking at key elements of the program, like:

Resources available to students
Professional values and ethics
Instructor qualifications and selection processes
Grading and appeals processes
Other administrative standards
Internship selection
Recruiting and student evaluation

Put it all together and you have a degree that really delivers everything expected in the field today. And it’s not just one and done, either. The APA comes back periodically to re-evaluate each school. Standards aren’t allowed to slide.

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How to Get Into a Doctoral Program in Clinical Psychology

You’ll find most PhD and PsyD programs offering both post-baccalaureate and post-master’s entry points, so your four-year degree is typically all you need to be a candidate for a doctoral program.

There are a lot of people interested in getting into the field of clinical psychology, far more than are actually cut out for the work or that even have what it takes to get through a doctoral program. This is a fact that makes doctoral programs competitive, with schools setting a high bar for entry.

To start, you’re going to have to be a star pupil in your undergraduate or master’s studies. Most doctoral programs are interested in applicants who hold at least a 3.0 GPA in their bachelor’s or master’s program.

The specifics of that program will be important, too. Your best bet is a bachelor’s degree in psychology. But even if you didn’t specialize at that level, you might still need certain related classes before you will be accepted into a doctoral program, courses like:

General and abnormal psychology
Statistics
Personality theories
Tests and measurement
Physiology

Admissions committees want to see more than just transcripts, though. You’ll have to provide a number of letters of recommendation from former instructors or supervisors. You’ll almost always have to write an essay outlining why you feel you are a good candidate for the program. In some cases, you might even need a current instructor to vouch for you.

A CV outlining your experience to date is also required. Many programs want to see some volunteer hours in psychological services, or some other indication you’ve been getting to know the field on your own.

A few programs may also look at standardized test scores such as the GRE, but there is rarely a pass or fail grade. Instead, each factor is considered as a part of the bigger picture of your ability, desire, and determination.

From Curriculum to Dissertation – What To Expect From a Clinical Psychology Doctoral Program

Psychology doctorates built around the field of clinical psychology will include a core curriculum lines up closely with what licensing boards and healthcare organizations expect of a psychologist. Most programs have a set foundation of core coursework that will cover areas such as:

Foundations of Psychology – Classes in these fundamental knowledge areas cover the broad history of psychology and neuroanatomy. You’ll learn about diversity and cross-cultural psychology, development across the lifespan, and society. You’ll also study the diverse branches of modern psychology, everything from behaviorism to somatic psychology. Every aspect, physical and mental, that affects human cognition and behavior will be studied.

Assessment Competencies – You’ll spend a lot of time as a clinical psychologist just trying to figure out what is going on with your patients. So it stands to reason you’ll get a lot of coursework in how to do that. These classes will teach you about cognitive and personality assessment techniques and interpretations, as well as integrative assessment… figuring out how the whole person comes together from the many factors that affect psychological well-being. You’ll also get at least the basics of conducting forensic psychological assessments, and some elementary neuropsych practices. This coursework also includes everyone’s favorite, abnormal psychology.

Ethics and Standards – Ethics and professional conduct are always a huge factor when you’re dealing with treating mental health issues. Expect to spend a lot of time in classes that handle the core philosophies of ethics and their practical applications. You’ll also be trained in the APA Ethics Code and learn about legal obligations and boundaries in clinical psychology.

Clinical Practice Skills – This is the meat of your PsyD education—learning how to actually treat patients in the real world. You’ll learn about case conceptualization, differential diagnosis, treatment plans, and progress measurement. You will be taught how to write clear reports and work with other providers as part of cross-disciplinary care teams working with patients with complex issues. Commonly, you’ll have specialized classes in this area highlighting different approaches to juvenile, child, and adult treatment.

Intervention Skills – Related to your clinical practice training, you’ll get specialized instruction in various types of clinical psychology interventions. These range from formalized concepts like cognitive-behavioral therapy to more general studies of family dynamics and group-based interventions. You’ll probably also take classes on substance abuse disorders and complex treatments required for physical and mental dependencies.

Research – Experimental design, statistics, and best practices in investigation are a more prominent part of PhD programs than PsyD degrees, but all clinical psychology doctoral students have some exposure to these elements of the field.

Practicum – Finally, you’ll get the opportunity to put all your skills into play through direct practical experience treating patients. You will go through carefully supervised clinical rotations that put you in the room with clients in real-world conditions, making assessments, developing treatment plans, and taking your first steps at genuinely making a difference in their lives. You’ll go back to class with your conclusions and efforts to review and improve them along the way, honing your skill before graduation.

Each school is unique in how they cover these areas, however. Some schools may have a fixed program schedule that you will step through along with every other student on the track. Others will allow you to select from among a variety of courses that might fulfill each area from a slightly different perspective. For instance, in interventions, you might have the option of taking classes that focus on adults or on children and adolescents.

Most PsyD programs also offer a variety of concentrations that build on these core courses with unique classwork to launch your career in a psychological specialty. Again, this is an area where every school is different, so it’s worth looking at the specific concentrations on offer.

How Your Dissertation Forms the Core of Your PsyD and PhD Experience

The centerpiece of every doctoral degree is your dissertation, or doctoral project. A dissertation is an original piece of work on a specific topic of interest to you in the field of clinical psychology. It can take a year or more to write and amount to 50 pages or more of carefully crafted analysis. It will usually involve unique research and experimentation along with careful study of existing literature on the topic.

A doctoral project offers similar intensity but less writing, with a more hands-on, practical application as the focus. Not all schools offer these, however.

The dissertation process is designed for you to demonstrate your ability to bring together everything you learn in the course of your doctorate studies. You will have to present and defend your work to an experienced committee of professors and professionals. In the end, they want to see your thought process at work. You will need to put together a memorable and innovative piece of work in order to pass.

Fortunately, your professors will guide you throughout the process. You’ll often go through a number of revisions to hone the paper into something that is worthy of publication. And many schools have their students present at colloquia to professionals in the field. It’s your big opportunity to make your first real contribution to clinical psychology. You will want to make the most of it.

What Will it Cost to Get a Doctorate in Clinical Psychology?

The cost of college has been skyrocketing in America in recent years, so don’t expect your PsyD to come cheap. According to a CNBC report from 2018, college costs had jumped by 25 percent over the course of a decade.

That trend is even steeper when it comes to the cost of a psychology doctorate. The APA conducted a study in 2016 that looked into tuition rates nationwide in PhD and PsyD programs and found that in-state tuition rates had jumped by 50 percent between 2009 and 2015.

The annual rates they found at the time were already hefty, but differed between public and private schools:

Public in-state university – $11,000 per year
Public out-of-state university – $24,000 per year
Private university – $34,000 per year

You will find that costs have increased since then, but that the trend remains. The National Center for Education Statistics has more recent data on the yearly cost of doctoral programs nationally, and puts the current numbers at:

Public in-state university – $12,171
Private university – $25,929

Again, those are general numbers… psychology programs specifically are likely to be higher in every case. And that makes the total cost, on the low end, more than $73,000 for six years at a public school, and more than $155,000 at a private school.

That explains why the APA found that some 90 percent of PsyD graduates had at least some student debt by the time they graduated. That makes getting a job with a good paycheck a priority.

Becoming Licensed as a Clinical Psychologist

Before you get that job, you’ll need to go through one important event: earning your license as a clinical psychologist.

Each state maintains its own standards and process for earning that license. Having a degree from an APA-accredited school is always one part of it. So is a healthy amount of field experience… most states require a field internship and one or two years of professional experience.

You’ll also have to pass the Examination for Professional Practice in Psychology (EPPP), a two-part exam that covers foundational knowledge and skills in the field. Developed by the Association of State and Provincial Psychology Boards, the EPPP includes multiple question formats including:

Multiple choice/multiple response
Scenario-based questions
Point and click questions
Drag and drop questions

There are eight domains covered by the knowledge test:

Biological bases of behavior – 10%
Cognitive-affective bases of behavior – 13%
Social and multicultural bases of behavior – 11%
Growth and lifespan development – 12%
Assessment and diagnosis – 16%
Treatment, intervention, and supervision – 15%
Research methods and statistics – 7%
Legal, ethical, and professional issues – 16%

The skills test goes into six additional subjects:

Scientific orientation – 6%
Assessment and intervention – 33%
Relational competence – 16%
Professionalism – 11%
Ethical practice – 17%
Collaboration, consultation, and supervision – 17%

You won’t be eligible to sign up for the exam until your application has been approved by your state board. It’s a tough test and most candidates take advantage of the ASPP practice exams or third-party test preparation.

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Job Outlook and Salary Expectations for Graduates With a Doctorate in Clinical Psychology

With your license in hand, you will find plenty of those jobs out there. Clinical psychology professionals are in high demand across a wide range of public and private healthcare industries. The Bureau of Labor Statistics (BLS) forecasts that those positions will be increasing at about the average rate between 2019 and 2029, a three percent growth rate.

BLS breaks down the ranks of psychologists into several different categories. Clinical psychologists are grouped with counseling and school psychologists, which are much lower paying roles in general. But a little sleuthing helps tease out the median pay for those psychologists working in establishments other than schools. For 2019, that came to $100,300 per year. Those in the top ten percent of the profession, with the education and the experience to back them up, could earn more than $132,070.

For more specific data, there’s an APA study conducted in 2016 that offers a breakdown by specialty area. They showed clinical psychologists earning an average of $107,183, which suggests that today’s number would be somewhat higher.

You can also expect differences in salaries based on your location. Big city clinical psychologists, particularly those on the coasts, will tend to out-earn their more rural compatriots:

Pacific – $93,322
Mountain – $73,645
West South Central – $97,195
East South Central – $69,782
South Atlantic – $82,631
West North Central – $103,652
East North Central – $77,288
Middle Atlantic – $144,970
New England – $98,011

Of course, you will need to think about your cost of living and education, which can affect your take-home pay regardless of the top-line number.

But work in clinical psychology is both exciting and satisfying. Your paycheck isn’t the only kind of compensation you’ll take home. Instead, you will have success stories to look back on, hopefully some as memorable as what Magne Raundalen experienced.

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