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MALEY, J., & QUARTEMBER, R. (Psychological methods and their contribution to neuropsycho- pharmacology). Zeitachrift fur klinische Psychologie und Psychotherapie, 1973, 81, 312-316.

MEIER, M. J. Some challenges for clinical neuropsychology. In R. M. Reitan and L. A. Davison (Eds.), Clinical neuropsychology: Current status and applications. Washington: Winston, 1974.

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Prediction of specific brain damage location and process by the neuropsycho- logical factor approach. Journal of Clinical Psychology, 1976, 39, 651-654.

Neuropsychology, a clinical approach. New York: Churchill Livingstone, 1978.

Journal of Clinical Psychology, October, 1980, Vol. 36, N O . Q.

SWIERCINSKY, D. P.

WALSH, K. W.

GRADUATE TRAINING I N CLINICAL PSYCHOLOGY: A VIEW FROM THE CONSUMER’

STEVEN WALFISK~, KEITX KAUFMAN AND BILL N. KINDER

Vn&ersity of South Fbrida

Recent graduates from APA-approved doctoral programs in clinical ps chology were asked to rate the adequacy of their training in a variety of s h l arew (N = 316). For the most part, respondents were relatively satisfied with their training and were most satisfied with traditional skills in therapy and assessment. Comparisons of males and females, practitioners and academi- cians, and traditional clinical vs. community-oriented pro rams resulted in few significant differences. In light of other recent findings, &e present results suggest that satisfaction with training and satisfaction with profeeeional work role are not the same. Implications of these results and suggestions for future research are discussed.

Several significant issues related to the training of clinical psychologists have been raised in the past few years. The relevancy cf training to specific employment responsibilities and psychologists’ subsequent satisfaction with their training and their professional roles have been discussed and evaluated by several investi- gators. The emerging data (both anecdotal and empirical) suggest differing con- clusions. A report on graduates from the University of Nebraska (University of Nebraska, Note 1) suggested that these psychologists generally were satisfied with the quality of their graduate preparation. On the other hand, Lovitt (1974) implies that clinical psychologists often are unprepared in several areas when they finally graduate to the “real world.”

Two recent surveys indicate some incongruence between psychologists’ satis- faction with their graduate training and their satisfaction with psychology as a profession. Garfield and Kurtz (1976) reported that 77% of the psychologists surveyed indicated “some degree of satisfaction” with their graduate training. However, Kelly, Goldberg, Fiske, and Kilkowski (1978) found that almost one- half of the clinical psychologists whom they surveyed would not make the same career choice if they could live their lives again.

Several factors may be related to these somewhat contradictory findings. Reports thus far typically have evaluated satisfaction of older, more experienced clinicians. The results of Kelly et al. (1978) are based on a survey of clinicians

‘The authors wish to thank Juanita Williams, David Stenmark, and James Anker for their helpful comments on an earlier draft of this a er and to Earl Taublee for sup lying unpublished materials. Funds for this survey were provifef by the Department of Psychokgy, University of South Florida.

‘Requests for reprints or copies of the survey instrument should be sent to Steven Wdfish, Department of Psychology, University of South Florida, Tampa, Florida 33620.

Graduate Training in Clinical Psychology 1041

who were entering graduate school in 1947 or 1948. Likewise, over two-thirds of the respondents in the Garfield and Kurte (1976) survey had at least 10 years of postdoctoral experience, the mean age of their sample being 46.8 years. These two samples are biased toward older and more experienced clinicians; thus one apparent need is for an evaluation of educational satisfaction of recent Ph.D.s in clinical psychology.

A second factor concerns the specific questions asked of respondents in thepe various surveys. Typically, respondents have been asked to rate overall job satis- faction, overall satisfaction with graduate training, or whether they again would choose psychology as a profession if they could live their lives over. Such global questions do not allow for an evaluation of graduate training in the variety of specific areas in which clinicians reasonably may be expected to perform after graduation. There have been evaluations of some rather specific aspects of training, such as assessment (Ritzler & DelGaudio, 1976; Shemberg & Keeley, 1970), psycho- physiology (Feuerstein & Schwarte, 19771, interships (Stout, Holmes, & Rothstein, 1977; Weiss, 1975), and training in community psychology (Jacob, 1971; Meyer & Gerrard, 1977; Zolik, Sirbu, & Hopkinson, 1976). However, these studies are difficult to compare because sampling procedures and questionnaire techniques varied widely. The present study attempted to assess satisfaction in a variety of specialized skills areas.

METHOD Subjects

Survey packets were mailed to the chairpersons of the 100 APA-approved doctoral programs in clinical psychology as identified in the December, 1976, issue of the American Psychologist (APA, 1976). Each packet contained seven surveys along with a cover letter and a sample survey. Each of the seven surveys (sealed in a pre-stamped envelope) also included a pre-stamped and addressed return envelope. Packets were mailed during September of 1977. In order to insure confidentiality, the chairpersons were requested to address and forward the surveys to graduates of their respective programs who were receiving a Ph.D. or Psy. D. during 1976. Additional surveys were available upon request for those programs with more than the seven initially allotted. Follow-up letters were sent to those programs whose graduates did not respond by March of 1978.

Initially, 700 surveys were mailed to the 100 programs. Sixty-six additional surveys, mailed upon request, bring the total t o 766. All surveys returned by June 1, 1978, were included for analysis in our sample. Of the 100 programs contacted, respondents from 62 returned surveys. Assuming this to represent the programs that actually forwarded the surveys, 434 surveys reached the appropriate respon- dents. A total of 316 surveys were returned, which yielded a return rate of ap- proximately 73%. Twenty-eight of these were unusable due to inadequate demo- graphic information or because they were largely incomplete. Thus, the final sample included the surveys of 288 recent graduates.

The Survey A questionnaire was constructed to measure respondents’ satisfaction with

their graduate training in 22 skill areas. These areas were identified by the authors as being skills that clir,ical psychologists reasonably might be called upon to use in a variety of possible employment settings. Respondents indicated how satisfied they were “with the way in which your graduate training contributed t o the develop- ment of your skills” in each of the 22 areas. Each area was rated on a 6-point scale that ranged from “Very satisfied” (1) t o “Very dissatisfied” (6). Using the same 6-point scale, respondents then were asked t o rate their satisfaction with five additional variables : Overall graduate training, number of possible practicum settings, ethical preparation, exposure to appropriate role models, and relevance of training to present employment setting and demands.

1042 Journal of Clinical Psychdogy, October, 1980, Vol. 36, No. 4.

RESULTS The mean age of the respondents was 30.78 years, and the majority had begun

their graduate training in 1969 or 1970. There were 203 males and 85 females. The primary emphasis of respondent’s current employment included clinical practitioner ( N = 148, 510/0), academic/research ( N = 57, 2070), administration ( N = 13, 5%)) and other (most commonly some combination of practitioner and administration) ( N = 72, 25%).

Table 1 presents the data from the total sample and comparisons of sex dif- ferences in the various skill areas. Respondents generally were satisfied with their graduate training and were most satisfied (X ratings <2.49) with training in the areas of individual therapy with adults, behavior modification, projective testing, and research. On the other hand, respondents felt less satisfied (x ratings >3.50) in the areas of program evaluation, vocational guidance, and pharmacology. Re- spondents were most dissatisfied with their training in grant writing (x = 4.35) and budget preparation (x = 4.61). The only significant sex differences were

TABLE 1 MEAN SKILL AREA RATINQS FOR MALES, FEMALES, AND TOTAL SAMPLE

Total Females Males ( N = 288) ( N = 85) ( N = 203)

Skill area x SD x SD x SD Individual psychotherapy

Group psychotherapy Vocational guidance Behavior modification Program evaluation Projective testing Objective personality testing Intellectual assessment Diagnosing neurological deficits Teaching Training paraprofessionals Clinical supervision Community consultation Research Research supervision Grant writing Budget preparation Pharmacology Psychotherapy with children Family therapy Marital therapy Sex therapy Overall graduate training Practicum available Ethical preparation Role models Relevance to present position

w/adults 2.18 3.13 3.80 2.15 3.50 2.26 2.34 1.89 3.38 2.87 2.97 2.77 2.86 1.96 2.73 4.35 4.61 3.95 2.72 2.83 2.88 3.39 2.11 2.04 1.93 2.5G 2.11

1.14 2.20 1.32 3.06 1.37 3.77 1.17 2.10 I .35 3.46 1.21 2.29 1.23 2.30 .97 1.90 1.53 3.39 1.34 2.84 1.28 2.94 1.27 2.78 1.32 2.87 1.09 1.97 1.35 2.67 1.31 4.33 1.13 4.55 1.40 3.82 1.33 2.83 I .29 2.89 1.30 2.90 1.45 3.43 1.00 2.12 1.17 2.03 1.09 1.98 1.28 2.57 1.01 2.14

1.21 2.12 1.29 3.31 1.35 3.92 1.18 2.25 1.32 3.62 1.23 2.19 1.20 2.46 .91 1.81 1.52 3.40 1.36 2.96 1.25 3.07 1.23 2.77 1.33 2.87 1-10 1.92 1.37 2.87 1.30 4.44 1.14 4.75 1.30 4.29 1.36 2.49 1.29 2.71 1.28 2.85 1.38 3.34 1.00 2.11 1.18 2.08 1.09 1.81 1.29 2.55 1.01 2.08

.96 1.39 1.40 1.15 1.39 1.19 1.31 1.04 1.57 1.30 1.36 1.35 1.32 1.07 1.36 1.33 1.12 1.56* 1.24* 1.29 1.36 1.65 .98 1.17 1.05 1.29 1.02

* p <.05, two-tailed t-test, males vs. females.

Graduate Training in CZinicaZ Psychology 1043

that females were more satisfied than males with their training in pharmacology and less satisfied than males with their training in psychotherapy wit,h children.

Table 2 presents the comparisons of respondents in applied settings (practi- tioners) vs. those in academic/research positions. Again, few significant differences emerged. Respondents in academic/research positions were less satisfied with their training in group psychotherapy. Practitioners were less satisfied with training in program evaluation and research supervision, and with the overall relevance of their training to their present positions.

Those clinical psychology departments identified as offering a major emphasis in community psychology (Meyer & Gerrard, 1977) were compared with p!ogrems that offered the more traditional clinical degree. The only significant difference was that respondents from clinical/community programs were more satisfied with their training in community consultation than their counterparts from tra-

TABLE 2 MEAN SICILL AREA RATINQS FOR CLINICAL

PRACTITIONERS AND ACADEMICUN~RESEARCHERS

Practioners Academic/Research ( N = 148) ( N = 57)

Skill area x i3D s S D

Individual psychotherapy with adults Group psychotherapy vocational guidance Behavior modification Program evaluation Projective testing Objective personality testing Intellectual assessment Diagnosing neurological deficits Teaching Training paraprofessionals Clinical supervision Community consultation Research Research supervision Grant writing Budget preparation Pharmacology Psychotherapy with children Family therapy Marital therapy Sex therapy Overall graduate training Practicum available Ethical preparation Role models Relevance to present position

2.10 2.95 3.81 2.18 3.61 2.34 2.41 1.91 3.54 3.00 3.08 2.78 2.89 2.01 2.91 4.43 4.62 4.04 2.71 2.83 2.93 3.43 2.20 2.00 1.83 2.60 2.21

1.11 1.36 1.32 1.22 1.34 1.30 1.22 1.00 1.58 1.36 1.33 1.30 1.25 1.01 1.31 1.35 1.20 1.42 1.34 1.34 1.35 1.41 1.10 1.16 1.00 1.32 1.04

2.40 3.49 3.78 2.19 3.17 2.21 2.10 1.89 3.22 2.80 2.70 2.63 3.14 1.73 2.39 4.19 4.46 3.81 2.69 2.82 2.89 3.25 2.00 2.10 2.15 2.70 1.80

1.16 1.24.' 1.50 1.30 1.33. 1.10 1.26 .97 1.48 1.42 1.26 1.31 1.49 .91 1.18'. 2.12 1.05 1.32 1.33 1.32 1.24 1.59

* 94 1.24 1.29 1.28 .91**

*p <.05. **p <.01.

1044 Journal of Clinical Psychology, October, 1980, Vol . 36, No. 4.

ditional clinical programs (Ztailed p <.05), a result that could have occurred by chance alone.

Additional two-way Anovas for sex X position (academic vs. practitioner and clinical vs. clinical/community) produced. no significant interaction effects.

DISCUSSION For the most part, respondents in the present survey appear to be relatively

satisfied with their graduate training in a variety of skill areas (Table 1). The specific areas that respondents indicated they were most satisfied with (x ratings < 2.49) fall in the general categories of traditional therapy and assessment. Ad- ditionally, their responses indicate satisfaction in a more global sense with respect t o overall graduate training, available role models, relevance to current position, etc. By themselves, these results suggest that graduate programs are doing an adequate job of training new clinical psychologists, at least from the graduates’ point of view.

On the other hand, the results of Kelly et al. (1978) indicate a substantial dissatisfaction with their profession among many clinical psychologists. Later in their careers, a substantial proportion of psychologists apparently become dissatisfied with the profession of psychology, a dissatisfaction that is so pervasive that many indicate they would not make the same career choice again (Kelly e t al., 1978). The present results do not directly address this issue. However, along with the results of Kelly et al. (1978) and of Garfield and Kurtz (1976), the present data do suggest that satisfaction with training and satisfaction with the profes- sional work role of psychology are not the same. A follow-up some years later of the respondents in the present survey may yield additional data with respect to this apparent process among clinical psychologists of becoming dissatisfied with their profession while apparently remaining satisfied with their training. A follow-up of the respondents of the Kelly et al. (1978) survey also could be undertaken to delineate specific reasons for dissatisfaction with clinical psychology as a career choice.

The comparisons of males and females are interesting because of the lack of significant differences obtained, particularly the question that assessed the respondents’ satisfaction with their role models. The need for more appropriate role models for female students has been discussed extensively in the past few years (e.g., APA, 1975; Douvan, 1976). However, the present results indicate that females are just as satisfied with their role models as their male counterparts. On a more global level, the results suggests that females and males are actually quite similar with respect to their attitudes toward training, a finding that supports similar surveys in the Southeast (Brodsky, 1974) and in internship training (Ken- worthy, Koufacos, & Sherman, 1976).

Garfield and Kurtz (1976) found that clinical practitioners were significantly less satisfied with their training than were academicians and researchers. The present results support these previous findings in that practitioners were signifi- cantly less satisfied with the overall relevance of their training to their current employment positions. Perhaps more importantly, this dissatisfaction among practitioners was reported after about only 1 year of postdoctoral experience. Apparently clinicians trained in APA-approved programs who work in applied settings quickly perceive some deficiencies in their training as they relate to the duties and responsibilities of clinical practice. Yet neither the present results nor those of Garfield and Kurtz (1976) further clarify the specifics of this dis- satisfaction to any degree. This dissatisfaction clearly has significant implications for the future training of clinical practitioners and is an area in which additional research should be an immediate concern.

When the graduates of departments that offer a major in community psy- chology were compared with graduates who had received the more traditional clinical emphasis, only one significant difference emerged-community graduates were more satisfied with their training in community consultation. If clinical/

Graduate Training in Clinical Psychology 1045

community psychology training programs are addressing issues that are somehow different from traditional clinical psychology training programs, we might expect differences with respect to some of the skill areas measured in the present survey. However, any major revisions in training such as those discussed a t the Austin Conference on Training in Community Psychology (Iscoe, Bloom, & Spielberger, 1977) of necessity will take several years to implement fully, and the respondents in the present survey graduated only 1 year after the Conference. A follow-up survey in 3 to 4 years is suggested to determine whether such differences between the two types of programs are emerging.

CONCLUSIONS Obtaining feedback from individuals who undertake graduate training in

clinical psychology is an important process. It is an opportunity to evaluate, from a consumer or student perspective, what is perceived as valuable in our training programs and what areas need to be improved. Such a process of evaluation allows those who are planning clinical training an opportunity to gain first-hand infor- mation as to the effectiveness of their training programs. With this information, modification in curriculum, practicum settings and relevant research areas can be delineated. Hopefully, the present survey provides some useful information for the planning of future training needs and goals.

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