Navigating Internship as a Research-Oriented Clinical Psychology Student

Navigating Internship as a Research-Oriented Clinical Psychology

Student

Andrew D. Peckham and Jessica Hamilton

Match Day has come and gone, and between July and September of 2017, more than 3,500 students will begin the challenging and exciting experience of beginning their clinical internships. Internship entails a number of challenges, including learning new clinical skills, developing new relationships with mentors, colleagues, and training directors, and for many, relocation to a new region of the country. For research-oriented clinical psychology students, the transition to internship comes with the added challenge of maintaining research productivity while simultaneously undergoing full-time clinical training.

Fortunately, there are many internship sites that provide research-friendly opportunities such as dedicated time to work on scholarly projects, mentorship from research-oriented clinical psychologists, and opportunities for new research collaborations during the internship year. The match process allows research-oriented students to identify and apply to sites that openly allow for such opportunities alongside clinical training, and there are a number of resources (such as the APPIC website and individual program brochures) that allow students to select sites that will maximize their research potential. Yet, even interns at “research-friendly” internship sites often struggle to find the right balance between internship training responsibilities and their ongoing academic pursuits.

In the article below, we provide the results of a series of interviews with current and former research-oriented interns from a number of internship programs located in the Northeast and Midwest. While this is by no means a representative sample of all research-oriented psychology interns, the perspectives they offer represent some common themes and pieces of advice that we hope will be helpful for new interns to hear.

1. How would you recommend interns balance their clinical, research, and personal/life responsibilities?

Intern: Set small research-related goals for yourself that you think will be manageable given your intern schedule. If possible, ask around and choose the rotations that are less demanding if you have a particularly stressful research-related deadline or project you'd like to be working on. However, I would say to keep in mind that this is a demanding clinical year, and you will likely not be able to be as productive as you would like! Also--a huge thing I would recommend if possible is to have your dissertation defended. If possible, try to submit for publication as many of the ongoing projects from graduation school prior to going on internship. It becomes hard to balance old projects with new projects, especially with the limited time!

Intern: I found it important to carve out specific times or activities that I enjoy for each week. For example, putting a fun community activity on my calendar for the weekend to make sure I got out of the house, rather than just lounging in PJs all day feeling guilty about research work! It was also important to me to leave as much of my work “at work” as I could, even if that meant staying a little later to finish up rather than bringing work home with me. 

Intern: This is an exciting and challenging year. Regardless of how much research you want to do (or have done in the past), remember that it is a clinical year even at the most research-oriented sites. I definitely expected to have more research time on internship than I do. However, that is not because of the grueling clinical hours, but rather prioritization of my personal life in a very busy year! It was really important to me to explore my new city, build solid friendships with my fellow interns and postdocs, and maintain my connections with family and friends living farther away. I would say that flexibility is key—and that you should focus on what is important to you and accept that it will change based on the time of year, deadlines, and whatever life throws at you. The biggest thing for me is to remember that this year is a unique balancing act and it does not necessarily reflect anything more than that!

2. What have you learned about yourself from internship? 

Intern: I had some unique clinical experiences prior to internship, but the ability to try working with new types of presenting difficulties, in different settings, and with different therapy modalities has made me really appreciate clinical work! I found that I really enjoy working with clients in intensive outpatient programs, for example. On the flip side, I’ve also learned that I have a very hard time saying no, especially when I’m being asked to do things by multiple different people in different domains (clinical work, research, administrative), so that has been a challenge.

Intern: The internship year confirmed and intensified my desire for a research career, which has been helpful in clarifying my training goals for post-doctoral training and beyond. In addition, my internship provided many opportunities to work with diverse and varied clinical populations, which further opened my eyes to what I do and do not enjoy about clinical work as well as new populations I might be interested in conducting research with in the future.

Intern: I have learned that I know way more than I thought I did prior to coming on internship! I have also learned to be more reliant on and confident in my own decision-making skills. In graduate school I had a really supportive mentor who I would run most decisions by. I still have her guidance, but have had to learn to make more decisions on my own. It's unsettling but with practice and time I'm learning to navigate this better.

Intern: I have learned that it really is possible to balance clinical and research responsibilities in the same career. So often in graduate school, it seemed like clinical work and research were completely different parts of my life, but I’ve learned from internship that it is possible to have both of these roles fully complement each other.

3. How have your own expectations shifted over the course of the year, in terms of your expectations about how much research you expect to get done during internship?

Intern: I think overall my expectations haven't shifted much. In fact I may have had more time than expected to do research. But it takes flexibility - using a couple hours here or there rather than expecting to have half a day. 

Intern: Although the internship program I attended is primarily clinical, there was an emphasis on and time dedicated to research. At the beginning of internship, all interns were required to set research goals for the year, which helped set my expectations for the year. Overall, my expectations were met or exceeded in terms of how much research I expected to get done during internship. 

Intern: Manage your expectations about how much research you can get done during internship! While it is certainly possible to stay productive, there is no way around the fact that you will have fewer hours in the day to work on research. This is a fact that deserves some radical acceptance at first, followed by strategic planning. Once I accepted that there is less time for me to devote to research than I would like, I found that it was easier to pick a few specific projects to focus on.

4. What advice would you give to new interns about settling into a new place, institution, and/or position?

Intern: I think I have a few pieces of advice: 1) Give yourself some time to settle in! If you can move to your internship site’s city before the start of internship, do it. It’s stressful to start a new full-time position regardless, but it’s more stressful when your whole apartment is in boxes and you don’t know how to get to the grocery store! 2) Ask for clarification (from all supervisors - research, clinical, training directors) about expectations up front. It’s much easier to have those conversations when you’re starting a new rotation or working with a new mentor than it is to address miscommunications later on. 3) Don’t sign up for too many projects, patients, etc. right away - it’s easy to feel like a kid in a candy store with a lot of new opportunities in front of you, but it’s much easier to add something a month in than it is to stop doing something you’ve already agreed to. 4) Recognize that you’re new, and that just because things have always been done a certain way in your previous experiences doesn’t mean that will necessarily fly at the new place. Also remember that people may have very different opinions than you (about certain theoretical orientations, for example), especially if you’re starting at an institution or in a city that’s very different from the one where you did your training. Acknowledge the experience and expertise of those around you!

Intern: Enjoy and explore! I found that my internship mentors have been much more likely to encourage me to spend my free time pursuing activities that bring me pleasure and adventure. This exploration led me to feel much more enmeshed in the larger community of my city than I felt in graduate school. 

Intern: Try to find those supportive people, whether it be friends, family, or mentors, especially if you are moving somewhere new. For me, building a supportive network has been the most significant piece of adjusting to a new place, job, home, and people.

Intern: Embrace your cohort! I found that my strongest supports this year came from having a close-knit group of fellow interns who were going through the same challenges that I was. Even though internship doesn’t leave much time for socializing, take advantage of lunch breaks, downtime, and happy hours to get to know your co-interns.

5. What advice would you have for navigating different research mentors (including current and past advisors)?

Intern: I think it’s helpful to have a conversation with your graduate advisor before you go on internship about what their expectations are for you (and what your expectations are for them) during the internship year. Do they want you to write up your dissertation into a manuscript? Do they want you to be Skype-meeting with them weekly? Do you want to be meeting with them a lot when maybe they would prefer to be in less frequent contact? Will you have any responsibilities to your old lab? I think that, if you’ve had that conversation before internship starts, you’re in a better position to set up reasonable expectations with your internship research mentor. I also think that my earlier advice (don’t sign up for too much too early) applies here - it’s better to set limited, reasonable goals for yourself with your internship research mentor and then be pleasantly surprised by being able to take on more later than it is to say you can do 5 projects but only deliver on 2!

Intern: Broadening your research network is both amazing and challenging. Specifying your training goals to your mentorship team is essential as well as making explicit the role you see each mentor playing in achieving those goals. Putting things in writing always helps.

Intern: Your new mentor will undoubtedly be different from your grad school mentor, who you have now known for 5-6 years, at least. So, it takes some time to adjust to a new mentor's style and personality. If a meeting doesn't quite go how you wanted it to, take some time to reflect on how your learned interactional style in these meetings might contribute to any miscommunications. Problem solve about how you might structure the interaction or approach your mentor differently so that you can have a more productive and clear meeting. That being said, from the outset make sure to ask around about the mentor's style and personality prior to making any commitments--it is stressful to have a difficult mentor, especially during internship!

Intern: Don't over-extend yourself. It's good to make some new connections, and keep the old ones in good shape, but don't promise too much too soon. It's easy to get excited and agree to lots of different projects, but you have to protect your time and be realistic. Most mentors understand that. Importantly, just be honest about your time up front. 

6. How would you have approached this year differently knowing what you know now?

Intern: I think I would have set clearer plans for myself about how to balance my own research projects with the clinical work. Even when I’ve had rotations with relatively lower clinical workloads, it’s just very mentally taxing to be working clinically all day, and then try to “switch” your brain to a more research-focused line of thought. I might have done better with research productivity if I’d set specific goals for myself on a weekly basis, with the hope of staying more on track.

Intern: I would have approached the internship year with more purpose from the very beginning. Because I was initially ambivalent regarding the value of a purely clinical year, my approach was to let experiences come to me rather than specifically seeking out certain experiences. This year has made me re-evaluate that approach and led me to be more explicit in my goals for post-doctoral training.

Intern: In retrospect, I would have given myself “permission” to take more time off from the clinic to work on research projects earlier in the year. I was surprised at the amount of vacation time and “professional” days off that my internship site allows, and once I learned how easy it was to ask for a day off to work on writing, I definitely took advantage of that opportunity. I would have approached my training director about taking time off for research earlier in the year if I had been more confident about making this request.

7. How did you decide the next steps in your career? What advice would you give for people in their internship trying to figure out the next steps? 

Intern: I was pretty sure going into internship that I wanted a career focused on research. I think if people are unsure, it's good to think - "could I do this full-time?" or "do I actually miss research?" Because for me, I missed research quite a bit, and I knew that while internship was a good training experience, it wasn't what I wanted to do for my career. I also relied significantly on supervisors for career advice - I highly recommend getting multiple different opinions and perspectives. 

Intern: I decided on the next steps of my career based on balancing my long-term career goals with my personal/family goals. I recommend that future interns consider the setting, location, and fit of their next step (e.g., postdoc) as it could provide opportunities for future employment. 

Intern: So much of the internship year can be thought of as “networking” for postdoc, particularly if you are able to stay at the same institution. So don’t be afraid to set up meetings with researchers at your internship site and ask about ways to get involved with their team, even if you may not have the bandwidth to join their team right away. Go to lab meetings, go to grand rounds or other talks, and see if there are people at your internship institution that might be a good fit for your next steps. It’s also never too early to start looking into postdoc options. It’s a remarkably fast turnaround between starting internship and applying to postdoc positions, so be sure to set aside time early in the year to think about what your next steps might be.

8.  Any other advice that would you give to new interns? 

Intern: Take the clinical opportunities available to you, even if you don’t intend to pursue clinical work as a primary career! First, you might find you really like certain kinds of work, which can inform your career plans or at a minimum where you want to focus your hours for postdoctoral requirements. Second, even clinical work in populations that didn’t seem relevant to my research has helped me develop new hypotheses and new ideas that will benefit me in research in the future. Third, it’s the last chance you get to be fully focused on your own training!

Intern: Be open-minded, use cognitive reappraisal often, and have fun!

Intern: Be open to new experiences, but also remember that you can’t do it all! Prioritize what is important to you – it’s okay to politely decline an offer (clinical/research). Also, remember that this is your training, so you should not hesitate to experience it fully and make it what you want/need!

Intern: Don’t be afraid to (respectfully) rock the boat a little. At many internship sites, you are coming in for only 12 months to work with people who may have been working there for decades. Be open to learn from people who do things a little differently than your training, but also don’t be afraid to speak up if you see ways to make improvements in the way things are done. As clinical scientists, we have a lot of training in evidence-based practices, and it’s important to share that knowledge broadly.

Summary: The interviews in this column represent what many people who have completed internship understand: that despite the stress and challenges associated with this year of clinical training, it is absolutely possible to make progress on your research, to learn new clinical skills, and even to enjoy yourself all at the same time. While everyone’s experiences are different, there is also remarkable consistency across these interviews: many interns would agree that managing expectations about your ability to get research done during internship is important, but that internship includes many chances to elevate your research career. We believe that managing this dialectic is essential to staying happy, healthy, and productive during this exciting time.

Andrew Peckham is a postdoctoral fellow at the Behavioral Health Partial Hospital Clinical Research Program of McLean Hospital, and a clinical fellow at Harvard Medical School. He is a recent graduate of the McLean Hospital/Harvard Medical School internship program.

Jessica Hamilton is a predoctoral intern at Western Psychiatric Institute and Clinic in Pittsburgh, PA. Beginning September 2017, she will be a postdoctoral fellow on a T32-funded fellowship in the Department of Psychiatry at the University of Pittsburgh.