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Faculty and Student Perceptions of Clinical Training Experiences in Professional Psychology

Gerardo Rodriguez-Menendez John F. Kennedy University

Jared P. Dempsey The Foundation for Recovery Initiatives,

Lubbock, Texas

Teresa Albizu R-A Pinnacle Group, Miami, Florida

Shelley Power Fielding Graduate University

Maggie Campbell Wilkerson Time2Track, LLC, Florence, South Carolina

This investigation sought to evaluate students’ perceptions of their doctoral practicum/internship training experience, with those of doctoral faculty administrators responsible for the design and implementation of clinical training programs. The participants (n � 1,219 students, n � 30 faculty administrators) completed questionnaires, administered to Time2Track members, regarding their clinical training activ- ities. The resulting sample of student respondents came from all geographic regions in the United States, 92% of whom were from accredited programs of the American Psychological Association (APA) or Canadian Psychological Association (CPA). Furthermore, 53% of the student respondents were enrolled in Ph.D. programs and 46% were enrolled in Psy.D. programs. A series of ANOVAs were conducted to evaluate the perceived effectiveness of doctoral clinical training and the experiential nature of student clinical supervision. Comparisons between Ph.D. and Psy.D. students were also conducted to investigate outcome significance of perceived preparedness for professional practice upon the completion of their doctoral studies. Further, differences were assessed between students attending APA accredited versus nonaccredited internship programs. Numerous significant differences were identified among the factors assessed in this study (e.g., students rated their training preparation significantly lower than did faculty for work with multicultural and lesbian, gay, bisexual, and transgender [LGBT] populations). Recom- mendations for enhancing clinical training relevant to competency based assessment, accreditation standards compliance, and diversity education are presented.

Keywords: clinical supervision, accreditation, competency-based assessment

Supplemental materials: http://dx.doi.org/10.1037/tep0000137.supp

This article was published Online First January 16, 2017. GERARDO RODRIGUEZ-MENENDEZ received his degree in Clinical Psy-

chology, with a concentration in Clinical Neuropsychology, from Albizu University in Miami, Florida. He is the dean of the College of Psychology at John F. Kennedy University, an affiliate of the National University System, and co-president of the R - A Pinnacle Group in Miami, Florida. His research and professional interests include clinical neuropsychology, pediatric psychology, multicultural competencies, competency-based as- sessment, and leadership development.

JARED P. DEMPSEY received his degree in Clinical Psychology at Texas Tech University. He is currently the Chief Scientist at the Foundation for Recovery Initiatives and Vice President of NLW Partners, LLC in Lub- bock, Texas. His research interests include psychophysiology, neuroimag- ing, and addiction recovery.

TERESA ALBIZU received her degree in Higher Education Leadership from Nova Southeastern University. She is the co- president of the R - A Pinnacle Group, a management and educational consulting firm. Her research interests include multicultural competencies, minority student persistence in higher education, leadership development, and communica- tions skills and effectiveness.

SHELLEY POWER received her degree in Clinical Psychology from Field- ing Graduate University. She is currently a Drug Abuse Program Coordi-

nator with the Federal Bureau of Prisons, Federal Correctional Complex, Oakdale, Louisiana. Her research interests include research interests in- clude impulsive-trait personality as a predictive factor for police selection, substance abuse, and addictive processes.

MAGGIE CAMPBELL WILKERSON received her degree in Psychology from Wake Forest University. She is the president of Time2Track, a software company specializing in experiential training management for educational institutions. Her research and professional interests focus on digital technolo- gies.

Gerardo Rodriguez-Menendez and Teresa Albizu are the copresidents and cofounders of the R-A Pinnacle Group, a business and educational consulting firm established in Miami, Florida. Gerardo Rodriguez-Menendez, Jared P. Dempsey, and Teresa Albizu have served as consultants for Time2Track, LLC. Maggie Campbell Wilkerson is president and owner of Time2Track. No form of remuneration was provided to the authors for their work in the current study. The present investigation received approval from the Institutional Re- view Board of Texas Tech University.

CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Gerardo Rodriguez-Menendez, College of Psychology, John F. Kennedy University, 100 Ellinwood Way, Pleasant Hill, CA 94523. E-mail: grodriguezmenendez@ jfku.edu

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http://dx.doi.org/10.1037/tep0000137.supp

mailto:[email protected]

http://dx.doi.org/10.1037/tep0000137

The origin of clinical supervision in psychotherapy is directly linked to the origin of psychotherapy over a century ago (Bernard, 2006; Milne, Aylott, Fitzpatrick, & Ellis, 2008). Robiner and Schofield (1990) reported that supervision is among the top five professional activities in which psychologists engage. Therefore, supervision is a vital part of a training psychologist’s growth and developmental experience. Clinical psychologists are expected to be competent and proficient in treating mental health needs. Re- gardless of their training background, the same standard of care is expected by mental health care providers collectively. Given the wide variation of experiential training across doctoral programs, and the lack of published scientific data on clinical training effec- tiveness, the extent to which these goals are being met in health service psychology is unclear. In this review, we will discuss topics of relevance to the current study and the practice of clinical supervision as related to: (a) relevant accreditation, licensing, and credentialing standards; and (b) implications for competency- based assessment and education.

Relevant Accreditation, Licensing, and Credentialing Standards

APA’s Commission on Accreditation (CoA) assesses quality of clinical training experiences via aggregate student performance on proximal competency-based outcomes which partially rely on su- pervisor evaluations of student performance. Of importance for successful licensure, the practicum experience guidelines for li- censure of the Association of State and Provincial Psychology Boards (2015) mandate that at least 50% of the total hours of supervised experience accrued shall be in service-related activities (i.e., treatment/intervention, assessment, interviews, report-writing, case presentations, etc.) and that at least 25% of the supervised professional experience shall be devoted to face-to-face client contact. Thus, while it is of importance to monitor the quality of student clinical practicum and internship experiences, it is un- doubtedly important to also monitor the quantity and types of clinical practicum/internship work being conducted. Despite the fact that accrediting and licensing bodies establish such standards to ensure the protection of the public, little guidance is provided to programs in relation to how to satisfy and document the compli- ance with the respective standards. Moreover, there is a question as to the fidelity of the data received by CoA in making their determinations given the reliance clinical supervisors may place on student self-reports regarding their clinical interventions. Specifi- cally, are clinical supervisors evaluating student effectiveness, or something else (e.g., perceived quality of the supervisor/supervisee relationship, ability of student to engage in case conceptualization, level of trust between supervisor/supervisee, etc.)? Notwithstand- ing, accreditation bodies and programs continue to rely on super- visor evaluations of students’ clinical practicum/internship perfor- mance as primary proximal outcome data.

Implications of Competency-Based Assessment and Education

Much has been written on competency-based assessment, how- ever, a thorough discussion is beyond the scope of the present study. The reader is referred to a seminal work on competency- based assessment (APA Task Force on the Assessment of Com-

petence in Professional Psychology, 2006). Notwithstanding, it is important to discuss several salient matters of competency based assessment as they pertain to the present study. Falender and Shafranske (2007) note:

Competence is central among the constellation of principles and values that inform psychology as a profession. . . . Competency-based education is defined as an approach that explicitly identifies the knowledge, skills, and values that are assembled to form a clinical competency and develops learning strategies and evaluation proce- dures to meet criterion-reference competency standards in keeping with evidence-based practices and requirements of the local clinical setting. (pp. 232–233)

Therefore, evaluation of the supervisee is an essential role of the supervisor and one that may not come naturally to psychology supervisors. While the supervisor’s evaluative process is supposed to function as a gateway ensuring competency in the field, the supervisor’s evaluation has not traditionally been a true competency- based assessment, of the type that is standard for other health care professions, such as nursing, medicine, and dentistry (APA Task Force, 2006).

The Rodolfa et al. (2005) cube model consisting of the three orthogonal dimensions of seven (7) foundational competencies, eight (8) functional competencies, and stages of professional de- velopment is the sine qua non of competency-based assessment in psychology. Given the duty of accreditation, licensure and certi- fication agencies to protect the public welfare, congruence be- tween these sectors is a natural outgrowth of ensuring that practi- tioners acquire the required competencies for practice (APA Task Force, 2006). Like it or not, competency-based education and assessment are here to stay for the foreseeable future. The stars are definitely aligned between accreditation and credentialing bodies, so much so, that the clinical competencies routinely assessed by the Commission on Accreditation, the Association of State and Provincial Psychology Boards, and the American Board of Clinical Psychology are identical to those of the Rodolfa cube model (American Board of Clinical Psychology, 2013; APA Commission on Accreditation, 2015; Association of State and Provincial Psy- chology Boards, n.d.; Fouad et al., 2009). Notwithstanding, the validity of competency-based assessment hinges on a supervisor’s evaluation being based on observable and measurable competen- cies as demonstrated by the supervisee, and hence requires at minimum, some direct observation of a supervisee’s performance.

Accreditation, education, and credentialing standards have be- come increasingly stringent in protecting the public welfare. Yet, even with improved competency-based models and closer accred- itation oversight, the question of whether clinical psychology students are receiving effective clinical training from their respec- tive doctoral programs arises. Doctoral administrators provide what they believe is the proper curricular coursework to train prospective psychologists. However, do programs lack sufficient outcome data of student clinical training experiences to determine whether this assumption is valid? The present authors propose that external training and supervision is not systematically investigated to ensure mental health care providers are receiving both quantity and quality training collectively. Demonstration and observation of clinical skills in establishing therapeutic rapport, assessment and intervention methods are of key importance in the formation and development of clinical competencies. While program administra-

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2 RODRIGUEZ-MENENDEZ ET AL.

tors may assume external practicum training is effective, it is important to empirically evaluate this assumption to ensure quality training for future mental health professionals, continuity of care for patients, and effectively address health care disparities.

The current investigation assessed practicum experiences from both the doctoral students’ perspective as well as the administra- tors’ reported perception of the training their students receive throughout their practicum and/or internship placement. Data were collected through a survey created for this investigation which assessed both the doctoral students’ and the program faculty ad- ministrators’ perception of the external training experience. Given the limited data-driven research on this topic, no specific hypoth- eses were made. Rather, an exploratory investigation was con- ducted. Our intent was to examine the perceived discrepancies in amount and quality of clinical training as reported by faculty members and students. While no formal a priori hypotheses were made, it was expected that faculty would provide a more optimistic opinion of training in comparison to students. This was in part based on a long-standing line of research in selective perception bias (Dearborn & Simon, 1958). This theory suggests that execu- tives frequently place more emphasis on information related to the activities and goals of the institution. That is, faculty may unin- tentionally skew their opinions based on the goals of the training program, departing from the actual experience occurring. Lastly, we also sought to explore the differences between Ph.D./Psy.D. and accredited/nonaccredited training programs. We held no ex- pectations regarding the results of the latter analyses. Rather, our intention was to provide the preliminary data necessary for future hypothesis driven investigations.

Method

Participants

Participants included psychology graduate students and univer- sity faculty administrators with active Time2Track memberships. For both student and faculty participants, only those within a clinical, counseling, school, or combined program leading to a Ph.D./Psy.D./Ed.D. degree were included for the present analyses. A total of 1,458 students initiated response to the survey, with 1,219 meeting criteria, and reporting being female (81.21%, n � 990) and White non-Hispanic (78.10%, n � 952). Students were represented at all levels of matriculation ranging from prepracti- cum (5%, n � 57) to graduate (8%, n � 98), with a majority of student respondents engaged in practicum (51%, n � 628). For faculty, a total of 74 individuals initiated the survey, with 30 doctoral faculty members meeting criteria. The majority of faculty respondents were female (80%, n � 24) and White non-Hispanic (80%, n � 24). Fifty-three percent (n � 17) of faculty reported having been working with their present training program for over 7 years. As a group they reported holding diverse roles such as core faculty, director of clinical training, program director/chair, and director of practicum/internship placement. Further, the ma- jority of students (91.5%, n � 1,115) and faculty (83.3%, n � 25) reported that they were from an APA/CPA accredited program (see Table 1 for additional statistical information on participant program-type and demographics).

Survey

The survey was developed by two coauthors (Rodriguez- Menendez and Albizu) in 2003. It was further refined by two independent teams of doctoral faculty of APA accredited clinical psychology programs at two universities. It was subsequently field

Table 1 Program, Region, and Demographics

Program type/Demographics Student Faculty

White (non-Hispanic) % 75% 80% N 909 24

Hispanic % 6% �3.3% N 78 1

Black (non-Hispanic) % 6% 10% N 68 3

Native American % �.4% 0% N 5 0

Asian American % 7% �3.3% N 83 1

Other % 6% �3.3% N 76 1

Ph.D. % 53% 40% N 650 12

Psy.D. % 46% 57% N 565 17

Ed.D. % .3% 3% N 4 1

Clinical % 84% 67% N 1,019 20

Counseling % 9% 13% N 110 4

School % 5% 10% N 58 3

Combined % 3% 10% N 32 3

North Central % 21% 13% N 258 4

Northeast % 31% 33% N 373 10

Northwest % 12% 13% N 146 4

South Central % 7% 7% N 89 2

Southeast % 15% 27% N 186 8

Southwest % 14% 7% N 167 2

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3PERCEPTIONS OF CLINICAL TRAINING EXPERIENCES

tested at both universities with a group of Psy.D. students (n � 198) and a group of Ph.D. students (n � 236). The directors of research of both programs participated on the faculty teams. The survey was then further refined by the current authors to make a mirror version for administration to faculty. The survey was ad- ministered to Time2Track users for a 1 week period between May 27, 2014 and June 3, 2014. Time2Track is a web-based software system that was designed to capture detailed information for a student or trainee’s clinical training experiences, which can con- tain 25 or more different data points. All clinical training activities entered by students are verified by their respective clinical super- visors to ensure data integrity. Time2Track is used by students and trainees in all 50 states, totaling nearly 14,000 individuals per year. Since 2003, over 25,000 individuals have used Time2Track to log their clinical training experiences, which exceed 30 million hours.

The survey consisted of a questionnaire with questions adjusted to match the roles and responsibilities of the respondent, that is, student or faculty. There were slight variations in number of questions to ascertain certain role information, resulting in a total of 71 items for students and 65 for faculty (see online Appendix 1–2 for full measures). This survey assessed various factors asso- ciated with training experience, perception of training quality, and supervision experiences. Specifically, the questionnaire covered four major sections: demographics, general overview of training, practicum experience, and internship experience. Other than de- mographic items, questions included two different 5-point Likert scale, agreement and amount. The agreement Likert scale was 1 � strongly disagree, 2 � disagree, 3 � neutral, 4 � agree, and 5 � strongly agree. The amount Likert scale was 1 � never, 2 � once or twice, 3 � three to five times, 4 � six to ten times, and 5 � more than 10 times. Questions were identical but phrased for the type of respondent. For example, students would respond to the agreement Likert scale for “My program has adequately prepared me to work with diverse multicultural clinical populations.” The faculty ques- tion for this item would be “My program adequately prepares students to work with diverse multicultural clinical populations.” Respondents were allowed to decline responding to any question, at any time, thus leading to variations in sample size by analysis. Student versus faculty analyses were conducted for the three clinical training domains. Ph.D. versus Psy.D. comparisons were conducted for the three major domains and included only students, as decades of research has been published comparing the two models in terms of performance on the Examination for Profes- sional Practice in Psychology, but not in terms of perceptions of clinical training. For internship training experiences only, an ad- ditional analytic set was performed, assessing differences between APA accredited and nonaccredited internship sites. Further, for internship training, only students who reported that they were on, or completed internship, were included in analyses (n � 216). See supplementary materials (i.e., the complete surveys used, response options, and a frequencies table).

Results

General Overview of Training

Several analyses of variance (ANOVA) tests were conducted to compare differences between Ph.D. students, Psy.D. students, and faculty. Omnibus significance was followed by Tukey post hoc

contrasts. The results showed omnibus differences for multicul- tural populations, F(2, 1226) � 11.75, p � .001, �2 � .019; LGBT populations, F(2, 1233) � 16.62, p � .001, �2 � .026; assessment with multicultural populations, F(2, 1231) � 9.44, p � .001, �2 � .015; and structured and systematic training of empirical treat- ments, F(2, 1231) � 5.69, p � .01, �2 � .009. Post hoc analyses showed that for all significant comparisons other than LGBT populations, Ph.D. students had significantly lower rating in com- parison to faculty and Psy.D. students. For LGBT populations, all groups significantly differed from other groups with faculty ratings being the highest, followed by Psy.D. and then Ph.D. students (see Table 2 for additional statistical information).

Practicum Training

For practicum training, only those students who reported being in practicum or further along in their training were included. Several one-way ANOVAs were conducted for practicum ques- tions with follow-up Tukey contrasts. Omnibus results showed significant differences for supervision by two-way mirror, F(2, 1180) � 27.49, p � .001, �2 � .045; and video, F(2, 1181) � 58.20, p � .001, �2 � .090; as well as supervisor observing intake, F(2, 1179) � 7.79, p � .001, �2 � .013; therapy, F(2, 1181) � 7.80, p � .001, �2 � .013; and assessment, F(2, 1175) � 10.93, p � .001, �2 � .018: In general, the majority of significant results showed that Ph.D. students reported significantly higher levels of supervised experiential training in comparison to Psy.D. students. Further, Psy.D. students tended to report significantly lower rat- ings in comparison to Faculty estimates. (See Table 3 for addi- tional statistical information).

Internship Training

For internship, only students who were on internship or com- pleted internship were included in the analyses. Several one-way analyses were conducted with Tukey contrasts. Differences were identified in supervision by two-way mirror, F(2, 236) � 8.81, p � .001, �2 � .070; video, F(2, 236) � 6.40, p � .01, �2 � .051; and audio, F(2, 236) � 5.83, p � .01, �2 � .047. Differences were also identified for the supervisor observing students during intake, F(2, 236) � 4.51, p � .05, �2 � .037; therapy, F(2, 236) � 3.85, p � .05, �2 � .032; and assessment, F(2, 236) � 5.43, p � .01, �2 � .044. Lastly, differences were identified for observing the super- visor conduct therapy, F(2, 233) � 3.85, p � .05, �2 � .032; and assessment, F(2, 233) � 4.14, p � .05, �2 � .034. Post hoc contrasts did not identify any significant differences between Ph.D. and Psy.D. students. The majority of differences were from faculty having higher values in comparison to Ph.D. and/or Psy.D. students (see Table 4 for additional statistical information).

Accredited versus nonaccredited sites. Several one-way analyses were also conducted for students at accredited or nonac- credited internship sites. Consistent with analyses above, only those students who were currently on or had completed internship were included. No significant differences were identified for the internship questions (see Table 4 for additional statistical informa- tion).

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4 RODRIGUEZ-MENENDEZ ET AL.

Discussion

The present study sought to assess various factors associated with student clinical training experiences, perception of training quality, and experiential supervision activities. The obtained re- sults comparing faculty versus student perceptions of clinical training are consistent with the selective perception bias hypoth- esis (Dearborn & Simon, 1958). Specifically, program faculty may be making decisions and forming an understanding of situations based on their own perceptions of the student experience, regard- less of whether the information is accurate. Program faculty ad- ministrators must guard against solely focusing on outcomes sup- porting the attainment of program goals, while ignoring outcomes indicative of potential deficits. It may therefore behoove program faculty to engage in more rigorous oversight of their curricular delivery in key areas, and particularly, in clinical supervision. Otherwise it follows that program administrators and faculty may focus on those aspects of curricular delivery in clinical supervision which confirm the perceived views about the effectiveness of their curriculum, while ignoring aspects of their model which discon- firm their operational hypotheses.

Given the limited faculty sample in the present study, more meaningful comparisons may be obtained from the intergroup differences of the students. Significant differences were obtained between Ph.D. and Psy.D. students, with Psy.D. students perceiv- ing having received more training with multicultural and LGBT populations, and in the area of multicultural assessment. Addition- ally, Psy.D. students reported having received greater training in the area of empirically supported treatments, as compared to their Ph.D. counterparts. Notwithstanding, Ph.D. students reported

greater experiential clinical training activities in practicum, as reflected by supervisor observations with two-way mirror, video, and while conducting assessments. Moreover, Ph.D. respondents also reported greater perceived experiences with supervisor obser- vations of intakes and psychotherapy. However, on measures of experiential training during internship, no significant differences were obtained between Psy.D. and Ph.D. students.

A finding of particular importance in this study was that students reported far less experiential supervision of student performance occurring during internship than during practicum training. This latter finding supports the need for APA’s IR C-31(c), which mandates that programs must more closely monitor the training received by students during their internship training. This requirement is all the more necessary, given that students frequently attend internship sites which are not phys- ically accessible to program faculty due to geographic distance. However, in relation to supervisor led experiential activities during internship at APA accredited versus non-APA accredited sites, the present findings do not support the superiority of APA accredited internship training. The present results also indicate that direct supervisor observation and experiential training are particularly needed during internship training as this is the formative stage for “readiness for practice,” and a crucial step in a student’s summative development for professional practice. Moreover, another notable finding in the present study was that in the cohort of respondents who were on or had completed internship, 45% reported they had not obtained an appropriate orientation regarding the process of obtaining a residency/ postdoctoral fellowship.

Table 2 General Training Outcomes

Group Classification M SD F N p†

Multicultural populations Ph.D.a��,b�� 4.03 .92 11.75 642 �.001 Psy.D.b�� 4.25 .82 — 557 — Facultya�� 4.47 .57 — 30 —

LGBT population Ph.D.a��,b�� 3.43 1.07 16.62 645 �.001 Psy.D.a�,b�� 3.71 1.03 — 561 — Facultya�,b�� 4.20 .61 — 30 —

Assessment with multicultural populations Ph.D.a�,b�� 4.01 .92 9.45 644 �.001 Psy.D.b�� 4.21 .83 — 560 — Facultya� 4.37 .67 — 30 —

Curriculum/training effective with increase in complexity Ph.D. 4.16 .85 2.12 647 .120 Psy.D. 4.24 .80 — 561 — Faculty 4.33 .71 — 30 —

Sufficient training in theories/concepts Ph.D. 4.21 .85 2.91 644 .055 Psy.D. 4.29 .78 — 559 — Faculty 4.50 .68 — 30 —

Proper training for supported treatments Ph.D. 4.22 .91 2.22 629 .109 Psy.D. 4.11 .91 — 554 — Faculty 4.13 .68 — 30 —

Structured training of empirical treatments Ph.D.a�,b�� 3.87 1.03 5.69 644 �.01 Psy.D.b�� 4.03 .94 — 560 — Facultya� 4.27 .78 — 30 —

Structured and systematic training in assessment Ph.D. 4.30 .81 1.52 646 .220 Psy.D. 4.31 .83 — 561 — Faculty 4.57 .57 — 30 —

Note. LGBT � lesbian, gay, bisexual, and transgender. Within question groups, matching superscripts reflect significant differences. † p values represent the omnibus alpha. � p � .05. �� p � .01. �� p � .001.

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5PERCEPTIONS OF CLINICAL TRAINING EXPERIENCES

A most striking finding is the limited amount of time that students report being observed while conducting clinical interven- tions, and the limited opportunities students have to observe a licensed practitioner modeling core competencies required for clinical practice (see online Appendix 3). For example, the fol- lowing percentages of students in this study reported having never been observed via: a two-way mirror (67.5%), using video (31%), or audio tape (41.6%). Fifty percent of students report never having been observed conducting psychotherapy. Moreover, the following percentages of students report never having seen a licensed practitioner conduct: an intake (34.5%), psychotherapy (49.1%), or administer an assessment instrument (38.2%). The fact that 92% of the student survey respondents are from APA accred- ited programs is all the more concerning.

The current findings regarding supervisory practice in clinical psychology lead us back to a prior question: Just what do evalu- ations of student clinical performance measure? It appears that in a sizable number of cases it is not clinical competencies that are being measured, but some other phenomena (i.e., student likability, perceived quality of the relationship between the supervisor and supervisee, etc.). Consequently, the present findings suggest that in a substantive number of cases, clinical evaluations of students are not measuring the “quality” of demonstrated clinical skills, and this may constitute a threat to the validity of APA accreditation. An additional threat is that if programs are not requiring that their students be observed and provided experiential training activities during their clinical practicum training (and more so during in- ternship), then how can they ensure that training is sequential,

cumulative and graded in complexity? The present findings there- fore support the revised Standards of Accreditation (APA, 2015) requiring direct or video observation of students engaged in clin- ical activities to ensure that at minimum, students are properly evaluated for core competencies in health service psychology. Whereas the SoA requires that clinical supervision evaluations incorporate direct observation, and the APA (2014) and ASPPB supervision guidelines (ASPPB, 2015) cite supervisee observation as an element of effective supervision and supervisory compe- tence, none of the documents refer to the importance of supervisors modeling core clinical competencies.

In the present study, 31% of students and 62% of internship students/graduates reported never having been observed during their practicum and/or internship training, respectively. A question therefore arises as to whether the findings are generalizable across education in clinical psychology. For many programs, we ac- knowledge that these results may not be germane to their particular setting or curriculum, as students are being directly observed and provided with rich experiential training experiences. However, if there is a gap in the clinical training of a substantive proportion of students in clinical psychology, is it not of importance to us all?

Subsequent to the present study, an additional investigation was conducted by the authors and presented at APA’s 2015 convention (Rodriguez-Menendez, Dempsey, Albizu, & Power, 2015). A thor- ough discussion of the results of this second study is not possible. In brief, it entailed an analysis of quantifiable Time2Track super aggregate clinical training data for a 2008 cohort of students (n � 489) from 20 APA accredited Psy.D. programs across the nation,

Table 3 Experiential Practicum Training Activities

Group Classification M SD F N p†

Supervised by two-way mirror Ph.D.a�� 1.99 1.42 27.48 610 �.001 Psy.D.a��,b�� 1.47 1.03 — 543 — Facultyb�� 2.30 1.21 — 30 —

Supervised by video Ph.D.a�� 3.63 1.65 58.20 611 �.001 Psy.D.a��,b�� 2.59 1.64 — 543 — Facultyb�� 3.43 1.57 — 30 —

Supervised by audio Ph.D. 2.58 1.70 1.86 608 .157 Psy.D. 2.55 1.53 — 543 — Faculty 3.14 1.43 — 29 —

Supervisor observed intake Ph.D.a�� 2.48 1.36 7.79 611 �.001 Psy.D.a��,b�� 2.23 1.27 — 541 — Facultyb�� 2.90 1.32 — 30 —

Supervisor observed therapy Ph.D.a�,b�� 2.28 1.54 7.80 611 �.001 Psy.D.a��,b�� 2.02 1.34 — 543 — Facultya�,b�� 2.83 1.44 — 30 —

Supervisor observed assessment Ph.D.a�� 2.57 1.38 10.93 608 �.001 Psy.D.a��,b�� 2.24 1.28 — 541 — Facultyb�� 2.93 1.16 — 29 —

Observe supervisor conduct intake Ph.D. 2.32 1.33 .02 607 .977 Psy.D. 2.31 1.30 — 537 — Faculty 2.33 .66 — 30 —

Observe supervisor conduct therapy Ph.D. 1.99 1.26 1.23 606 .291 Psy.D. 1.95 1.18 — 533 — Faculty 2.30 .99 — 30 —

Observe supervisor conduct assessment Ph.D. 2.28 1.31 1.63 604 .197 Psy.D. 2.15 1.28 — 539 — Faculty 2.33 .96 — 30 —

Note. Within question groups, matching superscripts reflect significant differences. † p values represent the omnibus alpha. � p � .05. �� p � .01. �� p � .001.

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which was collected over a 6.5-year period. The results suggest that at minimum, 29% of students were never monitored using direct observation methods (video or in vivo). Furthermore, Har- way, Kadin, Gottlieb, Nutt, and Celano (2012) reported concerns that clinical psychology students are not being provided with sufficient training in couples and family therapy, leaving them poorly prepared to engage in the ethical practice of psychology using these modalities. A review of the data obtained in the super aggregate training report indicates that during the 1,069,306 hr of clinical training activities recorded by the group, a total of 90,229 clients (89%) were seen for individual therapy, as compared with 2,681 families (2.6%) and 871 couples (0.8%) over the 6.5-year period. Therefore, an additional question arises regarding the suf-

ficiency of broad and general training students are required to receive in APA accredited programs.

As an analogy, one could imagine similar findings being applied to other professions. For example, how would the reputation of a physician be affected if patients knew that s/he was never directly evaluated by a licensed supervisor while in medical school? Would you engage the services of such an individual? Unfortunately, the results from the present study suggest that this may well be the status of the clinical training received by a substantive proportion of students (whether Psy.D. or Ph.D.) in APA and CPA accredited psychology pro- grams today. Therefore, are we as a profession, adequately safeguarding the public welfare?

Table 4 Experiential Internship Training Activities

Group Classification M SD F N p†

Supervised by two-way mirror Ph.D.a�� 1.46 1.10 8.81 83 �.001 Psy.D.b�� 1.28 .81 — 127 — Facultya��,b�� 2.07 .80 — 29 — Accredited 1.34 .91 .00 93 .979 Nonaccredited 1.35 .96 — 118 —

Supervised by video Ph.D.a�� 2.17 1.53 6.40 83 �.01 Psy.D.b�� 1.92 1.49 — 127 — Facultya��,b�� 3.00 1.16 — 29 — Accredited 2.20 1.61 2.68 93 .103 Nonaccredited 1.86 1.40 — 118 —

Supervised by audio Ph.D.a� 1.95 1.52 5.83 83 �.01 Psy.D.b�� 1.74 1.27 — 127 — Facultya,b�� 2.69 1.17 — 29 — Accredited 2.00 1.53 2.88 93 .091 Nonaccredited 1.68 1.23 — 118 —

Supervisor observed intake Ph.D. 2.25 1.37 4.51 83 �.05 Psy.D.a�� 2.00 1.20 — 127 — Facultya�� 2.76 1.15 — 29 — Accredited 2.20 1.36 1.23 93 .268 Nonaccredited 2.01 1.20 — 118 —

Supervisor observed therapy Ph.D. 2.02 1.46 3.84 83 �.05 Psy.D.a�� 1.83 1.19 — 127 — Facultya�� 2.55 1.12 — 29 — Accredited 1.90 1.30 .00 93 .978 Nonaccredited 1.90 1.30 — 118 —

Supervisor observed assessment Ph.D.a� 2.12 1.27 5.43 83 �.01 Psy.D.b�� 1.94 1.21 — 127 — Facultya,b�� 2.76 1.02 — 29 — Accredited 2.13 1.35 1.69 93 .196 Nonaccredited 1.91 1.14 — 118 —

Observe supervisor conduct intake Ph.D. 2.13 1.28 1.92 82 .149 Psy.D. 2.06 1.28 — 126 — Faculty 2.57 .88 — 28 — Accredited 2.30 1.32 4.87 92 .028 Nonaccredited 1.91 1.22 — 117 —

Observe supervisor conduct therapy Ph.D.a�� 1.77 1.17 3.85 82 �.05 Psy.D.b� 1.87 1.19 — 126 — Facultya,b�� 2.46 1.00 — 28 — Accredited 1.84 1.15 .01 92 .921 Nonaccredited 1.82 1.21 — 117 —

Observe supervisor conduct assessment Ph.D.a� 1.87 1.06 4.14 82 �.05 Psy.D.b�� 1.84 1.20 — 126 — Facultya,b�� 2.50 .88 — 28 — Accredited 1.96 1.15 1.51 92 .221 Nonaccredited 1.76 1.14 — 117 —

Note. Within question groups, matching superscripts reflect significant differences. † p values represent the omnibus alpha. � p � .05. �� p � .01. �� p � .001.

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7PERCEPTIONS OF CLINICAL TRAINING EXPERIENCES

In conclusion, the current findings regarding student clinical training may be due in part to national health care economics, especially as it impacts the provision of psychological services. Part may also be due to university administrators who view clinical programs in psychology as “cash cows.” In such cases, tuition dollars are then redirected to other university interests at the expense of the public who may get less than competent care, not to mention the students who are getting less than the training they paid for. It is therefore the responsibility of faculty administrators to advocate for increased funding for student clinical training. In closing, throughout this study we have been impressed by several features in the research on the supervision of student clinical training which include an absence of emphasis on patient out- comes among other variables. Therefore, the authors exhort faculty and administrators to engage in a constructive dialogue to develop effective strategies to improve the quality of clinical training in their programs. To this end, the authors offer the following rec- ommendations to faculty, clinical supervisors, and faculty admin- istrators, as applicable:

1. Seek and obtain training in clinical supervision, if you haven’t already done so, and maintain competence with this important aspect of clinical practice.

2. Invest in technology to better monitor your students’ expe- riential training during clinical practicum and internship. For example, consider having your students use a clinical training activities tracking program that provides supervi- sor verified data on the types of experiential training activ- ities and the client demographics that students serve.

3. Consider reducing reliance on manual data entry by devel- oping integrated databases to assess program outcomes in real time, thereby facilitating early detection and interven- tions with factors that impact the quality of clinical training.

4. Ensure that clinical supervisors engage in regular observa- tions of your students in clinical practice. At a minimum, the observations should be in vivo, and/or recorded through a clinic’s closed circuit video or other similar technology medium.

5. As possible, have clinical supervisors model core clinical competencies through experiential activities and demon- strations for enhanced student learning (i.e., student obser- vations of clinical faculty conducting intakes, psychother- apy, assessments, and client feedback sessions).

6. Survey your students in regard to quality of clinical train- ing. In addition to surveys required for reporting official outcomes to accreditation and regulatory bodies (e.g., re- gional, APA, state agencies, etc.), consider using surveys specifically designed to detect strengths and weaknesses in the program. We find that the latter form of questionnaires are highly valuable for implementing programmatic im- provements.

7. Conduct regular focus groups with students to assess the quality of their clinical training experiences based on their self-report. This is particularly important with students in

external placements and those who have recently completed their internship experience.

8. Consider requiring your students to have a finite number of practicum hours with specific populations to ensure broader clinical training for eventual professional practice. For ex- ample, programs might require that students complete a minimum of 100 direct contact hours with children/adoles- cents, and with couples/families, as part of their clinical training experience.

9. We encourage training directors and clinical supervisors to utilize client outcome measures in evaluating student train- ing experiences and clinical competencies. Consider how to facilitate clinical supervisors migrating from a focus on their relationship with their supervisees to a focus on client outcomes.

10. Regularly encourage clinical supervisors to discuss and explore issues of diversity (i.e., multicultural, LGBT, dis- ability, etc.) with students during their clinical supervision, and compile a comprehensive list of guidelines for working with diverse groups.

11. Develop a network of experts for consulting about clinical supervisory matters, especially in those areas of practice in which you may not be fully knowledgeable about the sub- ject matter (e.g., LGBT issues, multicultural assessment, disability evaluations, etc.).

12. Encourage students to join the early enrollment credential- ing programs provided through the American Board of Professional Psychology, the National Register of Health Service Psychologists, and the Association of State and Provincial Psychology Boards.

13. Maintain contact with your interns during their internship year and beyond. Regularly provide advanced students and recent alumni with information about securing postdoctoral fellowships and residencies.

14. Clinical faculty and faculty administrators must effectively advocate for increased funding allocations for clinical su- pervision due to the higher costs in providing experiential activities and clinical observation. As appropriate, incorpo- rate funding needs through your school’s strategic planning process via objectives and action plans to obtain needed resources (i.e., supervision time funding, video equipment, etc.).

Limitations of the present study include using intact groups (as reflected by student and faculty membership with Time2Track), the small sample size of faculty respondents limit the generaliz- ability of findings, and the fact that the study doesn’t actually measure the amount of time spent by students in the various supervision activities, but rather, faculty/student perceptions about the amount of time students spend in the experiential activities. Additionally, given the lack of previous data to guide hypotheses, the present study was exploratory in nature, with no stringent alpha corrections. Further, respondents were not asked about their per-

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ceptions of the frequency of harmful supervision. It should be further noted that APA does not regard student evaluations/per- ceptions of their clinical training experiences as primary outcome data, given that students are not experts in their respective disci- plines (i.e., clinical, counseling, and school psychology). Hence, students would need to graduate to provide primary outcome distal data about the effectiveness of their program experiences. Never- theless, we believe that the results of this investigation are of value in assisting program faculty to strengthen their respective pro- grams.

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Received March 4, 2016 Revision received September 12, 2016

Accepted October 19, 2016 �

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