APA vs PCSAS

By Sally McGregor, COPAGS President

An accreditation divide is brewing that has the potential to shake up doctoral programs in clinical psychology

Until recently, I always understood American Psychological Association (APA) accreditation process by the Commission on Accreditation (CoA) to be the gold standard in American psychology. My current graduate program recently underwent two major reaccreditation processes. One involved the PsyD (Doctor of Psychology) program, and the second sought re-accreditation for our affiliated internship consortium. My classmates and I are not only part of one of the first PsyD programs in clinical psychology, but also one that prides itself on being one of the first to secure APA accreditation. Accreditation matters a great deal in terms of quality control, easing licensure, and securing employment. I consider myself fortunate to be part of a program willing to jump through the numerous hoops involved in ensuring our APA accreditation remains. However, a younger accrediting body, Psychological Clinical Science Accreditation System (PCSAS) has set out to change the game a bit.

While over 400 programs adhere to APA standards, PCSAS is gaining momentum. PCSAS accredits clinical psychology PhD programs which adhere to a clinical-science training model. This model considers itself to be a modern extension of the well-known scientist-practitioner (Boulder) model, and regards clear scientific evidence to be paramount in the field of psychology. The accreditation body emerged out of a growing concern that scientific standards for psychology are not sufficiently rigorous under APA, which impedes the effectiveness of service providers. PCSAS is not some small, rogue, competing organization to APA. It counts the likes of Harvard, Duke, Emory, Vanderbilt, UC Berkeley, and Northwestern Universities among its 39 PCSAS accredited programs in clinical psychology.

Although it is growing, it is probable that PCSAS will not directly impact my life. The PsyD program I belong to adheres to the practitioner-scholar model which, as the name suggests, emphasizes the practical application of scholarly knowledge. Simply put, this model is aimed at training therapists and assessors rather than researchers and academics. I doubt my program is at risk of shifting to a new accreditation system in the foreseeable future, because producing research is not the highest priority of a PsyD education. However, I am interested in understanding the growth of PCSAS because it will certainly impact psychologists at large.

I anticipate a growing divide will occur in the field between clinicians who prefer a medical model in which treatment is standardized and efficient, and those who worry that overly manualized treatment dismisses the value of relational and psychodynamic approaches to healing. It is easy to see how in a world increasingly centered around integrated care, many psychologists will find utility in PCSAS’s approach. In the other camp will be psychologists (many PsyDs, I imagine) who argue that the therapy most appropriate for producing reliable research is not always the therapy most conducive to creating long lasting and meaningful change in patients’ lives. The continued debate between APA and PCSAS promises to be interesting for clinical psychology students to watch unfold.

***This brief blog post offers far from an exhaustive description of PCSAS. If you are interested in learning more about the new kid on the psychology accreditation block, you can find them here. à https://www.pcsas.org/

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Survivor’s Guide to Internship Applications

By Neilou Heidari, COPAGS Diversity Chair

As we quickly approach the 2019-2020 predoctoral internship application period, I thought I might share a few tips I learned during my own journey this year.

  1. Purchase and use the APAGS Workbook.* It clearly walks you through every step of the process with helpful samples and suggestions. Some feel the book is geared toward Ph.D. students because of the research emphasis, so that is something to keep in mind.

 

  1. Start early: Everyone operates differently. Perhaps you are someone who thrives on under pressure. But this process is a marathon, not a sprint. From counting hours, filling out the application, writing essays, purchasing a suit, to requesting letters of recommendation – allow yourself enough time to get everything done. At the end of the day, it’s not just about completion. You want to feel confident in the work you produce as you want to set yourself apart from other applicants.

 

  1. Work with a buddy: This process is largely self-directed and can feel isolating at times, so a buddy really helps hold you accountable and makes the process more tolerable. Meet weekly, set deadlines for yourselves, and edit each other’s work. I also highly recommend planning something fun afterwards to unwind. Shout out to Sally McGregor, our COPAGS chair, for being my accountabilibuddy!

 

  1. Self-care: It is SO important to take care of your mental, emotional, and physical needs throughout this process. It’s not uncommon to experience imposter syndrome, compare yourself with others, and/or question yourself at every step of the way. What fills your cup? Be intentional about scheduling these activities.

 

  1. Prepare, don’t ‘wing it’: Practice, practice, practice interview questions. Take it a step further and stimulate the actual process by asking a peer, adviser, or whomever to grill you with questions. It’s impossible to prepare for every question that may come your way, but practicing will help you manage your nerves, speak concisely/coherently, and allows for feedback on your performance.

 

  1. Trust the process: As the Internship Director at DU’s Graduate School of Professional Psychology likes to say, “It’s all about the fit.” It can be tempting to tell internship sites what you think they want to hear. But presenting yourself authentically will increase the likelihood of you landing somewhere you’re really happy with.

 

On behalf of myself and the rest of COPAGS, best of luck with internship applications! Whatever the outcome, please remember that Match does not define you. This is just one of many hurdles in your life and career. And once your make it to the other side, I promise it will be a distant memory… 🙂

 

*Internships in Psychology: The APAGS Workbook for Writing Successful Applications and Finding the Right Fit by Carol Williams-Nickelson PsyD, Mitchell Prinstein PhD, W. Greg Keilin PhD

Therapeutic Courage

By Carly Knauf, COPAGS Advocacy Chair

As I prepare to move for my doctoral internship, I have been taking time to reflect on my experiences from grad school. My past three years have been filled with lectures, quizzes, tests, assessments, friendships, laughter and, oh yes, tears. As I think back on all the lessons learned, there are a few that stand out more than others. One of those lessons, was on therapeutic courage which was a term introduced to me by Dr. John McNeill. Dr. McNeill explained that therapeutic courage means having the courage to notice, bring up, and ask the “hard stuff” with clients. It means showing up to being present in the room and aware of what is happening in those moments with your client(s) so you can notice, acknowledge, validate, expose, and sit with clients’ interpersonal vulnerable behaviors aka the “hard stuff”.

Dr. McNeill’s lectures helped me realize how much I was avoiding in the therapy room with my clients due to my own fears and insecurities. It was a really hard day… I mean a day of great growth, when I realized my lack of self-awareness was negatively impacting the progress of my clients. At that point in my life, I had never truly examined my own values or understood how much of my life had been about control. Trying to control unwanted experiences through experiential avoidance. I was doing this with my own clients, I probably still am at times, if I am being honest, and it is a goal I continue to work on. With clients, it can be brutally hard to sit through the uncomfortable silence or have the courage to ask those hard questions. But it is the hard questions and silences that can be so critical in the therapeutic process for growth and change. In the past, and even up until recently, I have struggled to bring up the hard topics with my clients. I was afraid I would offend them, hurt them, or make them not want to come back. So instead, I would sit there and ask the safe and easy questions. That wasn’t helping my clients. I needed to do the work to understand what was keeping me from being courageous in the room with my clients.

Through that work, I realized that I was not doing my job as a therapist when I wasn’t present, attending to, or asking the hard questions. For much of my time in grad school I felt like an imposter and I was so self-conscious knowing supervisors would be reviewing my tapes that at times I was not present in the room to notice what my clients were bringing or hiding. I became a prisoner to my own self-doubt and insecurities, and that was negatively impacting the work I was able to do with my clients. Understanding myself and working through my insecurities lead to growth and therapeutic courage. Graduate school has taught me many things, including that our journey and development as therapists will be ongoing and never-ending. I look forward to continuing this journey with (therapeutic) courage.

PSA- Psychology, Schedules, and Activism

By Carly Knauf, COPAGS Advocacy Chair

Today’s graduate students’ lives are jam-packed with classes, clients, conferences, consultations, and much more. As psychologists in training, many of us are also working on incorporating social justice practices into our professional identities. This can be quite difficult as it often feels there is barely enough time to brush our teeth, let alone add another potentially stressful activity such as advocacy and activism. For myself, activism is a foundation of which I strive to build my professional and personal identity from. For some, activism is a nuisance, for some, it’s still on their to-do list, and others can’t imagine activism and advocacy being separate from their daily lives. So, what does activism and advocacy look like for you? You may be in an early stage of identifying broad issues and social injustices, you might be listening and gathering an understanding on said occurrences, you may be leading a charge on Washington with a heart on fire, or you might be so overwhelmed with the current demands of school, field placements, and personal life that you haven’t even gotten out of bed yet. Regardless of your current progress I encourage you to get to know the name Elaine Welteroth.

Recently, I attended a conference at the University of Denver which highlighted unity, empathy, and inclusion of community. The Keynote speaker was Elaine Welteroth, former editor-in-chief of Teen Vogue, she spoke about her journey and what it has meant to her, to be an activist. Welteroth said, “Your authenticity is your activism, when you’re in spaces that weren’t made for you.” She highlighted her experience and understanding that at times being an advocate and participating in activism is showing up in places that historically have not made space for you. Welteroth was asked to repeat her statement as the room recognized how powerful and accurate it was. At times, it may feel like we are not doing enough if we are not showing up with colorful posters, an expert understanding of the issue, and a plan to fix everything. I believe Welteroth highlighted the important of activism by showing up as our authentic selves for all we represent. Showing up seems to be the first step towards activism. While the rest of the journey will be different for all of us, we must start by showing up. Showing up for ourselves, our clients, our communities and each other.

Do Less, Be More: A slightly cliché, but true, story of doing graduate school all wrong.

By Wendell Robinson, CPA Student Member

In July 2018, I got engaged. Amidst the excitement and reveling in the love I felt, I had a realization that stopped me in my tracks—I was too tired, too burnt out, and to overworked to enjoy the moment. When my fiancé and I were starting to plan the wedding date, I asked him if we could put the wedding off for two years because I didn’t think I had time in my graduate school schedule to show up for a wedding, much less plan one. He took a deep sigh, one look at me and said, “Are you going to put your life on hold forever? If it isn’t graduate school, it will be your career. When will we come first? When will you come first?”

 

His comment came at the end of a week where I turned in another report late, rushed into another, okay multiple, counseling sessions without thorough preparation, and wasn’t able to take my dog to the vet for a paw injury he had. As cliché as it sounds, when he said that, things fell into focus. I was averaging 30 direct client hours a week, plus at least 7 supervision hours, and clocking countless more with documentation, report writing, school assignments, being a TA and being in class. All great things for my resume, right?

 

For me, everything I was doing was tied to my desire to be “good-enough.” A good enough student. A good enough clinician-in-training.  If I could just do it all then maybe my imposter syndrome would melt away. Maybe looking good on paper would translate to being good. Turns out, I could not have been more wrong.

 

It is not my proudest moment, by any means, but it was the moment when things started to change. I had been so busy being insecure in my roles—as a supervisee, a student-therapist, a graduate school student, that I had stretched myself too thin. Sure, on paper I looked great but looking past the paper, at the actual work I was doing and the person I was being, was a grim sight. I was doing too much, and I was doing most of it poorly. I realized then that I had to cut back, say no, and slow down. I needed to be present.

 

A recent supervisor had been encouraging me to “show up” in the room with my clients. Frustrated at the feedback, I floundered to implement this in the room. I AM showing up, I would think angrily to myself. I watched and re-watched clips of myself in therapy and began to notice how not present I actually was. I watched myself try too hard to get things “right.” In essence, I was far from showing up, I was hiding out. Hiding behind theory, insecurity, and a desire to be a “good” therapist.

 

One day I was hiking with my dogs and took time to watch my yellow lab, Diamond. She had her nose to the ground, as she usually does, when she caught the scent of a rabbit several feet in front of her. She lifted her head, saw the rabbit, and chased. She didn’t catch the rabbit, but she put all of her effort into catching it in that moment. Diamond hadn’t been thinking about catching the rabbit before and probably wouldn’t think about it again after, but she poured herself into catching it in that moment. I thought to myself: that is what “showing up” really looked like. It wasn’t about planning, having the answers, or worrying about the future. Diamond showed me it is about being present for the chase. Being present enough to notice the smells, sights and sounds and only then can you pursue the chase wholly.

 

So, I’ve started emulating Diamond. I cut back my schedule so that I could take in the sights and smells, so that I could be present. I’ve been working to not “do” so much but to “be” more. It’s an uncomfortable place for me to be and I’ve noticed my mind trying to hook me with thoughts of not being good enough. Just yesterday I had the thought—what if this slowed-down schedule costs me the internship I want? What if I am missing out on an opportunity that will make me look like a better applicant?

 

Although the thoughts are present, I am not letting them hook me into behaviors that were not working. I could add another thing to my schedule, but I probably wouldn’t learn much from it because it would be too much. I may miss out on an opportunity by saying no to something, but I am gaining opportunities to truly learn, immerse myself in my training, and my relationships. Over the last several months I have begun to truly become the graduate student and clinician in training that I have wanted to be.

 

I’ve stopped worrying about how I look on paper and started focusing on who I am right now. I work every day to show up—with my supervisors, with my clients, my peers, my friends, my partner. I work to be present and like Diamond, to enjoy the chase.

Perpetual Pupil Problems

By Sally McGregor, MC, LPCC

COPAGS Chair

I have spent the bulk of my life enrolled in school.  Granted, there were some hiccups along the way. I transferred universities, studied internationally, and there was a brief period in which I took classes only part time and worked 2-3 jobs just to get by. But mostly, I have been a full-time student, and only a part-time working and functioning human, forever.

While I forge through weeks of classes and clients, and weekends filled with homework assignments and other projects, I often neglect to pause and realize that I am lucky to be so busy. It is a privilege to have access to higher education, as there are numerous barriers to entry and legitimate reasons people are unable to complete their degrees (i.e. financial hardship, institutional racism, family obligations, cultural expectations, etc.) I am quite fortunate that each time I faced serious barriers to completing my programs – undergraduate, masters, and doctorate (pending!) – I was awarded the benefit of the doubt, and found that someone else supported my dreams and pushed me not to give up. This blog post intends to support my fellow graduate students in psychology with the particular schedule-related oddities that come along with being a perpetual student.

Academic life is made up of clearly defined beginnings and endings. For the most part, every academic year, semester, and quarter I finish my work, and shift into something entirely new. In undergrad this meant I took brand new classes every semester. My masters program added clinical work, and pretty soon each year I was working at a new practicum placement. In my doctoral program, our academic year is split into quarters rather than semesters, which means every 10 weeks I have a completely different course load. This is all coupled, of course, with ever shifting clinical work. One year I worked in a jail every week, and the next, a university counseling center. Some days I attend class from 8am to 8pm, and some days I commute across town to see clients in various specialty clinics. I often wonder if other graduate students in psychology can relate to enjoying the perpetual change, and the stimulation that is this constant newness of things. Some people prefer the stable, reliable schedule that characterizes the majority of the workforce. I love learning novel ideas, meeting new people, and exploring different environments and systems. I think I will miss the pace of change that is inherent in schooling in general, but especially prominent in graduate, clinical training.

My main coping skill for surviving graduate school has been a steadfast focus on the future. If I am taking a difficult class, I often remind myself that it will be behind me forever in less than 10 weeks. I cannot count the number of times I have declared to myself and to other students, “In (insert time frame) this (insert stressor) will be over!” I suspect other students use the same strategy as well. While this is not a totally problematic method for getting through difficult experiences, it will not necessarily translate well to long-term employment. I risk setting myself up to be constantly looking forward to Friday, to vacation, to a promotion, or to some future career move. It is important to remember that the pace of academic life is unique and is bound to eventually slow down. I aim to be more present, and to develop more tolerance for discomfort in the difficult times. I hope other graduate students also find small ways to enjoy each step in this arduous, but thrilling journey toward graduation day!

Taking A Break

By Leigh Kunkle, COPAGS Communications Chair

It sometimes is almost shocking to me how much my graduate training shows up outside of clinical settings. I feel it especially during the holidays when visiting family and childhood friends. While I am technically “off the clock”, being thoughtful, attuned and empathic in my interactions certainly does not go away. This is, all in all, a great thing. I feel grateful for clinical training that have emphasized integrating effective interpersonal skills in all situations. It is also exhausting at times, especially when the individuals with whom I am engaging are not making similar efforts.

In these more trying moments, I wonder what it means for a mental health professional/psychologist to “take a break”. Sure, I’m not writing notes or doing therapy, but am certainly employing skills vital to my professional success much more frequently than my peers who work in others fields. Again, I feel this is beneficial, even if it does require a great deal of mental energy at times. This is due, in part, to the fact that I believe social consciousness is an important aspect of practicing in clinical psychology and something one cannot just “turn off”. In other words, with an increase passion for addressing complex social issues in clinical work comes the same desire to address them in conversations with friends and family. And if I am going to “go there” with my loved ones (who invariably will not agree 100% with what I have to say), I better bring my handy dandy clinical skills along to help me out.

Now, this is not to say that being a psychologist requires one to have frustrating conversations with their family members about sociopolitical issues. But it seems fair to me that it involve having the wherewithal to manage difficult conversations when they do arise and mitigate conflict, even in an argument with a parent that feels uncomfortably reminiscent of your high school years.

So, even though it can feel as though I’m making more explicit efforts to be understanding in the midst of disagreement, I am quickly reminded that doing so is an important part of maintaining good relationships with loved ones, and that clinical skills are meant to be transferable, not conditional. While holding the boundary between being supportive and therapizing your family members doesn’t totally feel like a break, I’ve learned to enjoy the break from writing notes and take pride in the personal growth my graduate training has afforded me.

WANTED: Mental Health (Professional) Connection

By Alex Littleton, MA- COPAGS Programming Chair

Hoping to find cool events to meet other mental health professionals, I recently googled “Denver Mental Health Networking.” To my dismay, plenty of options came up, but only for folks WITH mental health issues (not for those treating it).

Denver has done a great job at making spaces for folks with mental illness to get together and connect. We have companies such as Project Helping, which offers volunteer opportunities for folks with mental illness. We have Colorado Mental Wellness Network, which connects people in recovery from mental illness through workshops and community events. What we DON’T have is a space for mental health professionals to meaningfully connect. Yes, we have conferences. And yes, we have training events. But we don’t have a lot of informal fun.

The implication of confidentiality and client privacy can lead us to feel as if we, as professionals, must also be private. As much as we need client confidentiality, we often over-extend this privacy in a way that siloes us, both socially and professionally.

Our work feels private, so we become private.

We’re further separated by private practice work, which -unless it’s a collaborative group practice- does little to create natural opportunities to connect.

So why not create spaces for Denver mental health professionals to connect…?

This January, the Colorado Psychological Association will be hosting their first Denver Mental Health Networking Series event. We’ve been working with local community partners, including New Image Brewery, Project Helping, and GRIT Digital Health, to host a fun, FREE networking event for mental health professionals in Denver.

The event will be held on Thursday, January 24th from 6-9pm. It will feature free beer, hands-on volunteer activities, a food truck, and an interactive networking space at a local start-up in downtown Denver. The idea is to connect a mix of students, professionals, and mental health advocates in the community to share ideas, learn about resources, drink beer, and have fun!

***For information about free tickets, please email COPAGS Programming Chair, Alex Littleton, at Alex.Littleton@du.edu. *Space is limited, and tickets will be distributed on a first come, first serve basis*

Massage Therapy

By Alex Littleton- Programming Chair

During a 30-minute chair-massage that counted as VA training hours (I know, sweet deal), I got to thinking about pain relief. I’ve struggled with back pain for the better part of the last decade, and was quick to volunteer for a free treatment at a massage school down the street from the Colorado Springs VA Clinic.

As the massage therapist worked through the various knots and tension spots in my lumbar area, I felt immediate relief. As the session woefully came to an end, I remember thinking, “wow, it would feel GREAT to have this every week.” And indeed it would- massages make me feel good!

But I’ve struggled with my body long enough to know that weekly massages won’t solve my problem long term. As an astutely observant yoga teacher recently pointed out (what up Stephen!), I have a bum ankle that causes my left foot to turn too far inward when I stand or walk. This causes my knee to rotate, which in turn contributes to the misalignment of my hips. Hello back problems!

Although the pain shows up in my back, the root of the problem is structural- my back pain isn’t the problem, it’s the symptom. The root cause of the pain is further upstream (or in my case, downleg).

Being the broke grad student I am, it wouldn’t be a good investment to pay for weekly massages. Sure, it feels pretty dang good, but I’d have to continue coming back week after week to receive the healing benefits. If I really want to fix my problem, I’ll need to address this bum ankle.

As an early-career therapist, I’ve seen myself become a massage therapist for my clients. I want to help people feel less pain (which, no surprise, is often what my clients want too). After all, I joined this helping profession because I like to help.

But pain relief can’t be the only goal. If the client needs to come in week after week to receive the healing benefits of my therapeutic listening skills, then I might be treating the symptom and not the problem.

For example, if I identify “depression” as the problem, I might use my listening skills, validate the client, and attune to their emotional experience. And this may have a healing effect on the client in the room.

But looking upstream, I may find that the depression is a symptom of the problem, not the problem itself.  Maladaptive behaviors, inflexible attitudes, and negative self-concepts- these all could be the bum ankles that keep the back pain coming back again and again.

I’m not suggesting that emotional validation and empathy are unimportant- they’re crucial for treatment. But for beginning therapists, it’s important to understand that by focusing solely on symptoms, you may be missing the long-term, structural, and behavioral components of distress.

It could be possible that the depression and subsequent emotional repair by the therapist is part of a reinforcement pattern that keeps the client stuck in life. This would mean that we’re passively participating in keeping a client stuck with our repeated efforts to heal them.

In the same way massages may help relieve back pain, therapeutic attunement may help relieve emotional pain. And while temporary relief may feel good (for both you and the client), it’s also important to look upstream for any bum ankles that might keep the problem coming back.

Text-a-Therapist: Psychotherapy in the Digital Age

By Sally McGregor, MC, NCC, LPCC

COPAGS Programming Chair

 

Online therapy is not just a fleeting fad, but rather a paradigm shift in our profession, and it should be treated as such. Life is increasingly automated, and numerous services and transactions exist entirely online. The same is true of psychotherapy. Some consumers are determining that it is more practical to utilize our services from the privacy and comfort of their living rooms. Rather than resist this change, perhaps we should embrace it.

Did I just call therapy patients “consumers”? Let me explain. I am extremely uncomfortable with regarding clients as consumers in the context of the actual therapy. Words are important, and we should watch how we use them. We stop doing our job the minute we begin to relate to our clients more as paying customers than as people seeking an overall more satisfying and meaningful life. However, as professionals seeking to provide a service, we also need to consider that our clients are demanding that we become more tech savvy, in some of the same ways that non-medical service providers are. On a macro level, considering our patients as consumers allows us to think about how to make psychotherapy accessible to as many people as possible. Truthfully, I also think resistance to change is futile. In any profession, if you do not adapt to the demands of a changing world, and modernize as the technology does, you are bound to be left behind. So, it is time to take this whole distance therapy phenomenon a lot more seriously.

Telepsychology is the umbrella term for any interaction with a psychologist through a website, phone, or mobile app. It can be attractive to people who otherwise may not interested or able to attend in-person appointments. For example, people who are housebound with mobility issues can find virtual therapy extremely useful. That being said, the use of technology places a pretty tangible barrier between the client and their psychologist. For relational therapies, which place an emphasis on the interpersonal, moment-to-moment process as a healing factor, I can understand the trepidation on the part of professionals. How much do we lose when the complexity of human connection is reduced to an exchange of text messages? Ideally, you would be able to use a HIPPA compliant video conferencing app to avoid sacrificing face-to-face contact, and a real-time conversation. But, even then, technology can still feel like a barrier.

On the other hand, it is interesting to consider whether treatment entirely via text message could be therapeutic. More than one of my clients (particularly my adolescent clients) spend a portion of their session with me reviewing text message exchanges they have had with their romantic interests and friends. This is clearly an opportunity for them to illuminate and process the interpersonal issues they are experiencing. I realized the amount of emotional investment they place in these forms of communication. Entire arguments are initiated and resolved via iMessages. If text messages are one of the most significant and meaningful ways in which they communicate with other people, who is to say text-therapy cannot be beneficial as well?

I do not want to end this blog post without acknowledging that there are important issues with online therapy, and that this post is a very small part of a much larger conversation. At this juncture, it can be difficult to secure insurance coverage for such services. Technology frequently fails to work correctly and concerns about confidentiality are an entirely new beast when your communication is over the internet. Most importantly, considering how you will respond to a crisis situation becomes very important when your client has never stepped foot into your office, in real life. However, for those clients who live in remote areas, or who otherwise experience barriers to attending therapy in person, we have an obligation as professionals to consider the options. When our clients have transformed how they communicate with others, why should we be so determined to sticking to our old forms of communication?