Doctor of Psychology

The Doctor of Psychology (Psy.D.) degree is a professional doctorate earned through one of two established training models for Clinical Psychology. The Psy.D. degree is an applied clinical doctorate on the same level as (in alphabetical order) Au.D. (Doctor of Audiology), D.D.S./DMD (Doctor of Dental Surgery/Dental Medicine), D.O. (Doctor of Osteopathic Medicine), D.P.M. (Doctor of Podiatric Medicine), DPT (Doctor of Physical Therapy), D.S.W. (Doctor of Social Work), D.V.M. (Doctor of Veterinary Medicine), M.D. (Doctor of Medicine), O.D. (Doctor of Optometry), Pharm.D. (Doctor of Pharmacy), and other applied clinical doctoral degrees. In the United States, the other doctorate-level degree in Clinical Psychology is the Ph.D. An individual who earns a Psy.D. or Ph.D. in clinical psychology or counseling psychology from an accredited program may become licensed to diagnose and treat mental disorders, conduct psychological testing and complete psychological evaluations, and provide psychotherapy.

The degree is usually abbreviated as PsyD in the United States. In the United Kingdom and Ireland it is often abbreviated as DClinPsy or ClinPsyD. In Australia it is often abbreviated as DPsych or DPsych (Clinical).

Training
Psy.D. coursework and practica are designed to produce a professional who is a practitioner first, and a scientist second. A solid understanding of scientific method and behavioral science is required of both Psy.D.'s and Ph.D.'s alike; however Psy.D. programs focus particularly on applying this knowledge to direct clinical intervention in the diagnosis and treatment of various mental illnesses, brain injuries, and other clinical impairments in which psychological approaches can be of use. Most Psy.D. programs take 4–7 years to complete, and require extensive training in assessment, diagnosis, and psychotherapy, in addition to research methods, theoretical training, neuroscience, and other specialized training in behavioral and social sciences. Psy.D. and Ph.D. candidates alike must participate in supervised part-time practicum placements in various clinical settings during their training, followed by an accredited full-time supervised clinical internship.

Unlike many other professional doctoral degrees, completion of the Psy.D. usually requires submission of a (usually quantitative) doctoral dissertation, or a clinical doctoral project. The Psy.D. dissertation is similar to the dissertation required in a psychology Ph.D. program, however the Psy.D. dissertation almost always focuses on clinical/applied topics.

After a person obtains a Psy.D. or Ph.D. in psychology, most states require a year of post-doctoral clinical work (similar to a medical residency) to sit for state and national boards to become a licensed psychologist. Only one state, Washington, has removed the one year post doctoral experience in place of requiring two years of supervised experience, both of which can be completed prior to graduation. The argument for this change has been that there are few positions available for recent graduates and providing the training before graduation facilitates early career psychologists. In February 2006 the American Psychological Association Council of Representatives adopted a statement recommending that this change also be made to the licensing requirements of other states.

This training is different from the training required to become a psychiatrist. While psychologists are professionals who train exclusively in behavior and mental health, psychiatrists are Medical Physician & Surgeons holding a Doctor of Medicine (M.D.) degree, or Osteopathic Medicine Physicians & Surgeons holding a Doctor of Osteopathy (D.O.) degree, who specialize in behavioral health after receiving general medical training. Both psychologists and psychiatrists are able to diagnose mental disorders and provide psychotherapy. However, psychiatrists are able to offer pharmacotherapy (medication) as an additional tool for treatment, while psychologists in most states do not prescribe. Another difference is that most psychiatrists do not receive training in psychological testing to the same extent as psychologists. Professionals from both fields often work side-by-side to develop comprehensive treatment plans that meet the individual needs of their patients. Psychologists often refer patients to psychiatrists for medication evaluations, and likewise, psychiatrists frequently refer patients to psychologists for testing or psychotherapy.

The American Psychological Association (APA) accredits both Psy.D. and Ph.D. programs. Most managed care organizations and the majority of licensing boards require licensed psychologists to have completed training in accredited programs and complete internships at accredited sites. Aspiring psychologists should be certain to check the accreditation status of schools before applying, and patients/clients should be encouraged to determine whether their clinician was trained at a fully accredited program.

Background
The practitioner-scholar model and the associated Psy.D. degree were recognized by the Vail Conference on models of training in clinical psychology. Practitioners and academics at this conference argued that the field of psychology had grown to a degree that warranted training persons explicitly in clinical psychology. While both the Ph.D. and Psy.D. models of training include basic science and a practical skills component, there are clear differences in relative emphases on the role of research versus clinical activity, with Ph.D. programs emphasizing research and Psy.D. programs putting greater emphasis on clinical applications and interventions. Graduates of both training models are eligible for licensure in all states (licensing exams and renewal requirements are the same for both degrees).

In 1973, the American Psychological Association, at its Conference on Levels and Patterns of Professional Training in Psychology (The Vail Conference), endorsed the Doctor of Psychology degree (Psy.D.). This supported applied training that would respond to a healthcare industry demand for psychologists who could function in a variety of practitioner roles. Ph.D. programs, usually quite small, were not producing enough professional psychologists to satisfy the needs of the growing field of mental health care.

Before this period, professional training for psychologists followed "The Boulder Model" (est. 1948) in which a psychologist earned a Ph.D. for competence both as a scientist and as a professional. The Boulder Model's ability to prepare its graduates for academic and research positions was unquestioned for years by the psychology establishment, by and large, but there was a growing interest in a degree that was self-identifying, as well as growing evidence that Ph.D. graduates in clinical psychology nearly always chose to be practitioners. The Vail Conference recognized that opportunities for psychological practice were now both diverse and complex and required training that focused on applications of psychology toward practice. It was decided that it was time to develop applied programs that awarded an applied doctorate, the Doctor of Psychology (Psy.D.) degree. The Ph.D. and the Psy.D. then stood as two different degree-designations for professional psychologists and provided more choices in training programs.

Each degree has its criticisms. The Ph.D. in professional psychology is criticized for taking too long to complete (typically 6–7 years). The length of the program, which may be twice as long as medical school, makes it extremely difficult to complete. Some even suggest that the high GRE score requirements and rigorous structure of the program are biased against minority candidates. Still others argue that the research emphasis in Ph.D. programs does not adequately prepare such candidates for actual practice.

The Psy.D. has been criticized by some for taking too many students. As demand for qualified psychologists grows however, the academic demands placed upon students are growing (see "Accreditation" above), gradually forcing programs to become more selective with regard to who can be admitted. In addition, Psy.D. programs typically require students to pay to attend just as medical, dental, and other professional schools would, while Ph.D. programs, typically university based, provide an assistantship package, a feature common among other academic and research oriented programs who obtain grants for research activities, which may then be used to fund training for students who double as research assistants on a particular project.

Ph.D.'s, with their heavier training emphasis on research, are often considered more likely candidates for academic positions in teaching and research institutions, whereas Psy.D.'s have gained favor in many clinical settings. Essentially however, a doctoral-level psychologist is licensed and qualified to perform the same functions whether she or he has a Psy.D. or a Ph.D.

Practice
Upon graduation, students are expected to understand psychology at a psychological-service-provider level, use their clinical skills as practitioners, use scientific findings for clinical practice, and conduct independent research.

One benefit of the Psy.D. is that by having a separately distinguishing degree, e.g., Doctor of Psychology, psychologists have a direct designation as clinicians. While the Doctor of Education (Ed.D.) was once considered fully adequate for psychologists seeking an applied orientation, it was felt that a self-identifying degree fostered the perception of psychology as a clinical science rather than a primarily educational, social, or behavioral science discipline. The Psy.D., then, was created to support the growing field of clinical psychology, which had reached well beyond its origins in educational testing and talk therapy.

This type of clear designation is standard practice for applied degrees (e.g., Doctor of Medicine, Doctor of Optometry). Arguments against a specialty degree include complaints about its applied nature, which some persons (primarily Ph.D.-trained psychologists) feel places it "below" research-emphasizing degrees such as the Ph.D. But such an argument spawns much debate; medical degrees such as the M.D. and D.O. for instance, are in fact specialized, practice-oriented, scientist/professional degrees that have long since proven indispensable.

Historically, psychology was often housed in schools of education. After being widely recognized as a science (behavioral science), especially in recent years as it has increased its emphasis on the study of evidence-based practices, it has migrated from the confines of such schools. With the broadening of health care concerns to include matters of perception, attitude, and behavior, professional psychology has increasingly been incorporated into the medical realm of health professionals. For example, clinical psychologists are often trained in psychoeducation and cognitive-behavioral restructuring which can help noncompliant patients adhere to their treatment regimens (taking medications, etc.) Health psychologists work with physicians and patients to address health concerns like pain management, coping with long-term illnesses, and help patients manage diseases resulting from habits like smoking and overeating that can be corrected with changes in behavior. Likewise, clinical neuropsychologists use numerous assessment techniques to determine the impact of various brain illnesses and injuries on a patient's behavior, making targeted recommendations for treatment and rehabilitation. These specializations within the field of professional psychology are based firmly in a blend of biology, physiology and behavioral science, and while they are far removed from the stereotypical "couch therapy" portrayed in the media, they have proven themselves to be of great value in the provision of health care across many settings.