December 17, 2011

Internship Q&A with Two Directors of Clinical Training

Dear Fellow-Students,

         Below is a list of the internship questions submitted by people on this Listserv. Following each question is a response from Dr. Heimberg (RH) and Dr. Graham (SG), two clinical psychology professors who have experience working as directors of clinical training at their universities. If you have any follow-up questions please let me know and I will compile the questions and get responses for you. Also, feel free to comment on this Listserv what you think about the questions and answers and how your own experience relates or doesn’t.

 Best Wishes,

--Phil, Becca, and Frank

Question 1. How do the internship guidelines, hours expectations, number of sites we should apply to, etc. vary between Canada and the US? Are there other differences between internships in Canada versus the US that we should be aware of?

RH: I do not have specific familiarity with this question.  It is a bit unusual for our students to apply to Canadian internship sites, mostly for personal geographic reasons, although I have encouraged a number of students to apply to specific programs of which I have personal knowledge.  When that has happened, and the student is not himself or herself Canadian, there are some rules favoring Canadian applicants (or at least this was the case the last time one of our students applied), and our students’ record of success at Canadian schools has been mixed at best.  Regardless of that, there is nothing that I am aware of that would keep me from recommending good Canadian internship sites to American students, at my university or any other.

SG: The best place to find information about number of sites to apply to and how that affects success in the match is the APPIC match statistics website. On that site, there is comprehensive multi-year data for both US and Canadian students.

In terms of number of sites to apply to, Greg Keilin (who manages the APPIC emails lists and compiles statistics and many other things!) regularly send out information prior to the match regarding relative success rates as a function of number of sites applied to which students have applied. It seems historically that 8-10 was the norm and there did not seem to be an incremental benefit to applying to more. That being said, I would encourage students to register early for the match email lists and consider the data presented.

In terms of hours, most students from our program have over 1000 hours in total (that includes direct and indirect hours). A number of years ago the CCPPP (Canadian Council of Professional Programs in Psychology) considered the issue of hour “inflation”. This group sought to develop a consensus statement indicating that number of hours were but one aspect of the candidate (I am looking to see if this statement was finalized as it is not on their website).

 Question 2. There have been discussions about whether the predoctoral internship should be pre- or post-doctoral. What do you view as the benefits/risks associated with making the internship post-doctoral? Do you believe that a change in this direction is going to happen any time soon?

RH: The primary drives for this, as I am able to divine them, come from students who want to have their degrees granted sooner and from insurance companies’ not-infrequent position that they will not reimburse for services provided by sub-doctoral providers.  I do not know whether anything like this will happen, but there is nothing imminent that has made its way downstream to the faculty involved in clinical psychology programs of which I am aware.  This discussion has been going on in some form or another for more than 10 years, and all things being equal it may go on for another 10.  There is some uncertainty, however, because the poor state of the economy may have the effect of driving internship sites toward this option.  Without regard to those issues, I am in favor of the internship being a part of the predoctoral curriculum.  Having it as part of the requirements for the degree should act to protect the student/intern from liability or at least limit the amount of exposure (still a good idea to have your own malpractice insurance).  It should also help to maintain the internship sites’ focus on training rather than on viewing interns as a ready source of relatively cheap labor.  Of course, these are items that vary from internship to internship currently, and they are important for intern applicants to assess.

SG: I think there are a number of risks to making the internship postdoctoral. One is that training programs could no longer require students to attend accredited internships—i.e., once students have graduated, they could chose to go whenever they want (or can get a placement). Another risk is that it takes the onus off the doctoral training programs to be become advocates for their students, for the creation and sustainability of high-quality placements, and for policy-level initiatives that address the supply/demand inbalance. 

In Canada, I don’t believe there is any movement afoot to the move the internship to the postdoctoral level.

 Question 3. What is a reasonable number of clinical hours to acquire during graduate school in order to be competitive when applying for internships - especially for someone who is primarily interested in research? At times, we receive conflicting information from students who have recently navigated the internship match versus faculty at research-oriented graduate programs.

RH: This is such a difficult issue.  I was Director of Clinical Training at my university (Temple U.) for many years, and I cannot tell you how many times I was asked this question.  It comes up again almost every year in advising my own students.  In conversations with APPIC personnel and Directors of Training at various internship sites, it has always been very difficult to get an answer, but here is what I tell my students.  Getting a number of hours is important because a large part of clinical skill is developed simply by repetition, and the more hours, the more repetition.  However, collecting large number of hours is not so wise and not so important as having a diversity of experiences of high quality.  I have personally known of students whose total hour count was in the 500 range who got good internships, presumably because they had good diversity of experience and because they had many other positive aspects of their application package.  One of the things that I have seen in our students’ experience in the last few years is that research-oriented internships are placing less emphasis on hours and more emphasis on the student’s number of publications and whether or not the student has applied for (and whether they received) a grant such as a National Research Service Award (F31) from the National Institutes of Health.  This suggests balance in your portfolio is more important that setting records with the number of hours you accumulate.  This is also important for your career beyond internship.  If you are interested in a research career, then you need to consider whether the devotion of extra time to the accumulation of hours is keeping you from developing the kind of CV or attaining the range of research experiences that will serve you better down the line.

SG: There is no easy answer to that question. So much depends on the type of hours as well as the other qualifications of the candidate.  Here are some results from the APPIC 2010 match (as reported in the APPIC November newsletter):

Doctoral Intervention: Median = 539 n = 2013
Doctoral Assessment: Median = 152 n = 2008
Doctoral Supervision: Median = 306 n = 1994

In considering these numbers, consider the following quote from the newsletter: “APPIC recommends that applicants interpret these numbers cautiously. Applicants should NOT assume that the numbers of practicum hours reported are nec­essary to successfully obtain an internship, as many Training Directors have told us that they consider these raw numbers to be one of the less important aspects of an application”(p. 7).

 Question 4. What factors do you believe are most important to consider when deciding the number of sites to which we should apply?

RH: The data from APPIC seem to suggest that there are diminishing returns in applying to more than 15 sites, and in fact, APPIC has recently reconfigured its pricing structure so that it will cost you more per site to apply to a higher number.  Beyond that, the question of how many sites to apply to is largely one of fit.  To the extent that you have carefully selected your sites so that they are a strong match to your interests and your profile should be of interest to the site, there is less need to apply to a larger number.  On the other side, there is some wisdom in not going too low because there is a certain amount of random variance in the matching decision at any site (or small set of sites) and it is best that your matching outcome not be determined by the size of the error term!

SG: Match between the site and your training interests
       Consider a broad geographical area (if possible)—i.e., don’t limit yourself to one city

Question 5. For someone who is more research oriented, what can we expect to gain from the internship experience? What should we be paying attention to during our internship year that will help us grow as scientists?

RH: If your research interests are not directed toward clinical topics, the answer may be “not much.” However, I will assume that your interests are more clinical in nature.  First of all, there are many very good research-oriented sites (or at least sites that have a meaningful research component), and if you are a research-oriented student or at least an empirically-oriented one (and this is, after all, SSCP!), there should be plenty of opportunity for you to either have time set aside for you to work on your dissertation if it is not done in advance of internship (strive for that, it will make a huge difference in the quality of your internship experience and in the success you will find in job or postdoc search), to take part in research projects initiated by faculty at the site, to initiate your own original research projects, and/or to conduct some of your clinical work in controlled case study format, all of which may be associated with publication opportunities as well.  Another thing you might look for in selecting internship sites is whether or not there are local post doc opportunities that are of interest to you.

SG: Even for those who do not plan to engage in clinical practice in their career, internship provides valuable insights and training experiences, from the opportunity to consolidate your clinical skills, having contact with a wide group of professional with differing backgrounds and experiences, to understanding the workings of a multidisciplinary setting, to scanning the environment for research needs (i.e., into knowledge translation, evidence-based treatments etc..).

I think the answer to the second question really depends on the sites. Ideally, those who are more research –oriented will attend sites that share that orientation and that will offer the opportunity to become involved in research at the site. 

Question 6. How should we prepare for the monetary cost of applying for internship (e.g., how much money should we set aside)? What are your thoughts about the monetary cost imposed on students in the form of application fees, travel costs, and costs associated with relocating?

RH: Save money.  It will be expensive.  APPIC compiles data on how much it costs students each year, and you should be able to consult their webpage or get this information through the Director of Clinical Training at your program, so I won’t try to go into those specifics.  Having this information available should allow you to set up a savings plan, if you need to do so in order to accommodate these expenses.  It is expensive, no doubt about that, but many of you have had your last several years of tuition paid and a stipend provided.  Whereas I doubt this has made you rich, these funds provided for you may well have made it possible for you to be at the point of worrying about these costs!  You can sometimes contain travel costs by working it out with internship sites so that you can interview at locations near each other at more or less the same time, but that is dependent on the flexibility of scheduling of the internship sites.  The only other way I know to limit this is to limit the sites you apply to based on geography, and if you are not limited by other factors such as the job or school of a significant other, I strongly suggest you let your training needs, rather than cost, dictate this decision.

SG: It’s hard to say how much money to set aside as it depends on how far you have to travel and by what means you will be travelling.

My thoughts are that the monetary cost imposed on students is high. I think it is beneficial for both students and sites to have in-person visits, however, this does increase the cost significantly. It is also costly to relocate for a one-year period. I think our national bodies need to devote some discussion to this issue.

Question 7. Does internship placement influence job prospects for a post-doc and/or faculty position following internship? That is, are certain internships more preferable if you are seeking a career in academia? Alternatively, are there certain types of internships that should be avoided if one is planning for a research-oriented career?

RH: I get this particular question a lot, and the answer, I think, is yes and no.  One way in which internship placement may have effect on postdoc prospects is when those postdoc positions are at the internship facility, and there are several sites that have sizable postdoctoral training programs as well.  To some extent, an internship that will give you research opportunities may be best for those headed toward academic positions – but only to an extent.  If you have been productive as a researcher in your pre-internship years, you can get an internship that is more clinically focused without truly hurting your job or postdoc prospects.  If not, then the internship may be more important in that regard.  One way in which you may “suffer” at a clinical/no research internship is that the letters of recommendation that you get from your internship supervisors may be less relevant, and you may have to rely more on the faculty from your home program.

SG: When we review the dossiers of candidates for faculty positions in Clinical Psychology, we do look at where they have done their internship. Of course, our first concern is whether their internship was at an accredited site. But the location of the internship is really only one part of the dossier.

Question 8. What tips do you have for internship interviews? Some people say that it is important to be very prepared with answers to questions that are typically asked during interviews whereas others say it is better to be more spontaneous and relaxed. What is your opinion about this? What do you feel are the main preparations that should be made prior to interviewing?

RH: I believe that it is important to have thought about the questions that are likely to be asked and to have answers prepared for at least some of them.  For instance, it might be useful to think about a case that you could talk about, how you conceptualized the client’s concerns, and how you conducted treatment.  Depending on the internship, it might also be useful to think about how you might conceptualize and treat the client if you were working from one or more different theoretical orientations.  At Temple, our students who have gone through the internship process have compiled a list of questions that they have been asked on their interviews and this is circulated to students entering the application process each year.  We also hold more-or-less biweekly meetings with these students during the application and interview time to discuss such issues as they arise.  So you might guess that my position is that it is best to be prepared, and that is right.  However, it is also important to be yourself and let your (I’m sure) charming personality have a chance to show itself.  One thing to keep in mind is that, if you have been invited to interview, you have already passed the credentials test.  The interview is more about how well you fit interpersonally and how well you fit the profile of the student the internship is looking for – this latter should mirror the idea that the internship should fit the profile of what you are looking for as well.  One last piece of advice is to plan your travel so that you are rested and to get a good night’s sleep!

SG: People vary greatly in their ability to “think on their feet”. I think being prepared is always best—that being said, applicants should not be over-rehearsed but rather should have given some thought and consideration to the kinds of questions that will likely be asked. In addition, you  should be prepared for a whole array of questions. CCPPP does have a guide to potential interview questions etc.. (

Question 9. Is it appropriate to ask, when interviewing for an internship, if a post-doc position may be available at the end of the internship? Also, is it a good idea to apply primarily to places offering post-doc positions (compared to those that do not) if that is the next step in our career? How much should this factor influence decisions about where to apply and how to rank sites?

RH: Yes, it is perfectly fine to ask that question, and it may be something that the internship sites are interested in knowing (that you have an interest in this).  Is it a good idea to apply to these places?  Yes, if the postdocs fit the kind of experience you want; no, if they don’t.  These matters should have some weight in the decision making process, but it is most important to ask whether the training during the internship is what you want.

SG: It depends, of course, on your plans and career goals. I think voicing an interest in a postdoctoral position, particularly if one exists at that site, is positive. I think I have less to offer for this question as fewer internship sites in Canada offer postdocs.

Question 10. If you could provide just one key piece of advice about the internship process in general, what would it be?

RH: Remember that you are being interviewed by everyone you talk to and you are always on; also remember that you are (or should be) interviewing the site to see if it is someplace you want to go.  If it is not, do not rank it.  Oops.  I think that was more than one.  Oh well.  Best regards to all.

SG: We all know this is very anxiety-provoking and time-consuming. I would suggest approaching it in stages, allowing sufficient time for each stage, seeking out relevant information and support from colleagues and faculty, and employing all those great anxiety-management techniques!

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