Oasis

I think you’ve got a couple of misunderstandings about clinical psych and psychiatry, so I feel the need to clear those up (if you already know this, skip to the last part where I actually answer your question :)

Clinical psychology and psychiatry are not basically the same. The theoretical perspective, the training, the most common job duties, the pay, and other things are quite different between the two. Let’s take this piece by piece:

Theoretical perspective. Psychiatrists are MDs. They are physicians first and foremost. They come from a medical, biological model like all other MDs. Basically like: there is a problem, it has a biological underpinning, we need to treat the biological underpinning. Psychologists are PhDs. The most supported model now is the biopsychosocial model. This is basically like: there is a problem, there are multiple interwoven and interacting underpinnings to this problem including biology, psychology, immediate environment, and systemic environment, we need to understand these underpinnings and determine which levels to intervene on to improve the problem. 

Training. MDs go to medical school, and PhDs go to grad school (I know, obvious). But these are completely different training experiences with completely different focuses. Medical school starts with the basics of medicine and human biology (anatomy, for instance). It trains students to be medical doctors first. The first four years are well rounded in knowledge base focus but with little to no hands-on treatment (I’m not counting observing, although that’s important). Then people train in treatment and specialize, and interns/residents. Psychiatry training is four years, with most but not all focusing on psychiatry, and most of the psychiatry training focusing on acute cases and medication management. Some psychiatry residences have decent training in therapy, but it’s generally a quite small part of training. Clinical psychology PhD programs are research programs with clinical training (some have more or less focus on one side than the other). Students start with psychology theory and research with focus on clinical applications. They start seeing clients early on (in most programs, 1st or 2nd year). They are trained in therapy, assessment, case conceptualization, treatment planning, administration, supervision, and lots of other components of clinical work. They complete (at minimum) a master’s thesis and a dissertation. After four or five years, they do a year-long predoctoral internship outside of their university (usually). Post docs are common to gain hours, get research experience, specialize, and get board training (for neuropsychologists, for instance). 

Training Duration. Actually, this one isn’t so different. Psychiatry takes about 4 years med school + 4 years residency, so about 8 years. Clinical psychology takes about 4 or 5 years grad school + 1 year internship + 1 or 2 years postdoc, so between 6 and 8 years. Both groups might spend more time in one area or get additional training. 

Job Duties/Roles. Psychiatrists usually spend the majority of their time doing medication management. They pretty commonly do administration-type stuff and teaching as well and fewer do other things, like therapy, supervision, and research. They most typically work in inpatient settings, acute settings, or private practice. Psychologists most commonly do clinical work, including individual and group therapy, assessment, supervision, treatment planning, etc. They pretty commonly do administration-type stuff, research, and teaching (a good number do no clinical work at all, and are university professors or otherwise paid to do research and teaching fulltime). Fewer do other things, like policy and advocacy work, and a small number get extra training and can prescribe meds. 

Pay. This is the most obvious. Psychiatrists get paid like other MDs (although among MDs, they are among the least well paid). Psychologists… don’t. Sometimes we get paid like psychologists (yay, but we should totally make more given comparable degrees like psychiatrists), sometimes like master’s level clinicians (who are woefully underpaid as well), and sometimes like professors (yup, woefully underpaid). The gap is pretty big- I think the last stats I saw were that psychologists make $80,000 on average and psychiatrists make $140,000 on average (obviously there is a lot of variability and I believe these stats were for the US).

I feel like knowing the difference between psychiatry and clinical psychology makes the choice clear. One of those things is going to be more appealing than the other. 

For me, I didn’t have any interest in being a psychiatrist. I am terrible at route memory (which is necessary in medical school and generally in being a good doctor), I am much better at thinking conceptually, I cannot stand the ickier parts of medical school and being an MD, and I didn’t want to prescribe meds as my primary job. I wanted to do therapy and research and advocacy, and I was okay with lesser pay and prestige. 

Writing With Color – General Topics

A collection of WWC posts that deal with more general writing advice, character creation and diversity topics applicable to most marginalized people, particularly People of Color and some ethnic and religious groups.

Writing Characters of Color: The Generals

On “Overthinking” Writing Characters of Color

On White Authors “Getting it Right”

On White Writers Writing Characters of Color (I, II, III)

Researching PoC + Supporting Writers of Color 

So You Want To Save The World From Bad Representation

Writing POC with Little Experience

Writing Authentically From Your Own Experiences

Useful Non-WWC Posts

Diversity Exists in the Real World by shiraglassman

How to Write WOC and MOC if you are White by kaylapocalypse

“I feel pressured to be inclusive in my writing!” by nimblesnotebook 

On White Fear & Creating Diverse Transformative Works by saathi1013

Diversity/Representation Topics

Diversity vs. Exploiting Cultures

Diversifying a Predominately-White Cast

On “Diversity Quotas”

On Excluding Diversity Out of Fear

Different Heritage POV’s in a Story

Including Realistic Diversity Naturally

“Normalizing” Protagonists of Color

Villains of Color

White-Dominant Rural Areas and Diversity

White Privilege, Publishing, and Diversity Quotas

Writing: Making Efforts in Diversity 

Character Creation

Character Creation: Culture or Character first?

Character Design and Assigning Race and Ethnicity

Characters’ Races Added Last During Development 

Determining your Characters’ Race and/or Ethnicity

More on Assigning Race after Writing

Characters of Color & Culture

A Discussion on Culture and Erasure

“Culturing” Culturally-disengaged PoC

Characters of Color with “No Culture”

Mixed Race + Disconnect from Culture

Stereotyped vs Nuanced & Audience Perception

Tradition and Culture vs. Stereotype

Western Neutral Characters

‘Whitewashed’ Character of Color?

Fantasy & Coding

Defining Coding (& Islam-coded Fantasy)

Denoting Race in Fantasy Setting

Fantasy Races Based off of People of Color

Naming People and Places, Avoiding Explicit Coding

Racially-coding Aliens

Real Religions in a Fantasy World

Religion in Fiction & Fantasy

South Asian-Coded Fantasy Caste System

Whitewashing in a Fantasy Setting

Including Racism in Fantasy

World-building: A Fantasy World without Racism

Writing Sensitive and Controversial Topics

Do I Need Permission to Write About Marginalized People?

Writing a Genocide to which you have No Personal Connection

On Outsider-Written Stories About Issues Of Another Group

Outsider-Written Stories, Issues of other Groups, Speculative Situation

Writing about Prejudice between People of Color

Reclaiming negative, dehumanizing stereotypes outside the group

Representing yourself when “yourself” isn’t white

Racism and Micro-Aggressions 

Everyday Racism, Friendship and White Allies

Incorporating Micro-Aggressions in Writing

Racist Characters + Including Racism in Stories Not “About” Racism

The Pitfalls of Racist Character Redemption Arcs

PoC Educating White Privileged Friend (Context: Black Characters)

What’s a clinical psychologist?

A clinical psychologist* is a person with a clinical psychology PhD or PsyD. Typically clinical psychologists focus on topics associated with mental health or psychopathology in any group, including children, people with chronic health conditions, older adults, forensic populations, families, people living in poverty, students, and people with developmental disabilities, among others. Often clinical psychologists work within mental health systems to improve care or other outcomes among people with mental health issues.

(*Although many of these things will apply internationally, this post is geared towards psychologists in the United States and Canada. If you are in another country, your mileage may vary.)

Clinical psychologists can work:

• In medical hospitals • In psychiatric hospitals • In research hospitals • In forensic hospitals • In state and federal institutions • In private institutions • In prisons and other forensic settings • At Veteran’s Affairs • At the Department of Defense • In community mental health settings • In outpatient clinics • In private practices • In universities • In rehabilitation centers • In halfway houses • In residential settings • In research settings • In advocacy settings • In policy settings • In administrative settings

Clinical psychologists work with:

• People diagnosed with mental illnesses • People diagnosed with physical illnesses • People currently experiencing distress or dysfunction • The families, loved ones, or other people associated with the people mentioned above • Other people for lots of reasons. Typically clinical psychologists work with a more severe population (people experiencing more significant problems) compared to counseling psychologists (who often focus on things like wellbeing), but not always.

Clinical psychologists can work with:

• All ages • All genders • All sexual orientations • All cultural and ethnic backgrounds • All abilities • All educational levels • All socioeconomic backgrounds • All religions • All people in general, as long as the particular clinical psychologist is competent to treat that particular person and their particular presenting problem(s)

Clinical psychologists have extremely varied responsibilities and day-to-day tasks, including:

Clinical work

Individual therapy

Group therapy

Couples’ therapy

Family therapy

Diagnostic assessments

Neuropsychology assessments

Disability assessments

Functional assessments

Legal assessments

Aptitude assessments

Intellectual assessments

Needs assessments

Creating treatment plans

Monitoring treatment progress

Coordinating care

Research

Creating research ideas and questions

Conducting literature reviews

Applying for grants

Conducting research

Conducting clinical work within research projects

Analyzing data

Writing journal articles, books, and chapters

Presenting findings at conferences and other events

Disseminating research to non-academics, including mental health clinicians

Applying research in real world settings (for example, implementing a new treatment found to be helpful)

Teaching

Mentoring

Mentoring undergraduate students, graduate students, interns, postdoctoral fellows, early career psychologists, research assistants

Supervising

Supervising clinical work

Supervising research

Training other clinicians

Administration

Leading a mental health team

Leading a mental health treatment program

Leading a research lab

Leading a psychology department

Developing new treatments

Developing new treatment programs

Developing new policies

Evaluating treatments

Evaluating treatment programs

Evaluating policies

Consulting

13 not-easy steps to becoming a clinical psychologist

1. Complete a bachelor’s degree You will need a bachelor’s degree to get into graduate school. The easiest route to a PhD/PsyD in clinical psychology is a psychology BA or BS, possibly with another major or minor in something like biology or sociology (meaning, something connected to your interests in psychology). However, a degree in psychology is not required to get into a PhD/PsyD program in clinical psychology. If you do not major in psychology, you may need to take post-baccalaureate classes later as most PhD/PsyD programs require specific psychology classes, usually including intro, abnormal, and research & statistics.

2. Get research experience You will need research experience to get into a PhD/PsyD program in clinical psychology. I recommend at least two years and at least two presentations. You can do this while in undergrad or afterwards. You don’t need to do research full-time (5-10 hours/week is okay) but you do need to learn about research while doing it. Don’t accept a position where all you do is data entry or mundane tasks like that. Be a part of the action- developing research ideas, conducting research, analyzing data, presenting findings. Learn all that you can from your supervisor and other people involved. Use this time to develop research skills and become better at understanding other peoples’ research and developing your own.

3. Get clinical experience (optional) You do not need clinical experience to get into a PhD/PsyD program, but it might help. I tend to recommend it so that you can get experience in a clinical setting and/or with a clinical population so you understand better what you’re getting into. 

4. Get teaching experience (optional) You do not need teaching experience to get into a PhD/PsyD program, but it might help. 

5. Get a master’s degree (optional) Some people choose to get a master’s degree in clinical psychology, counseling, or experimental psychology before applying to PhD/PsyD programs. I only recommend this if you need to show you have an improved GPA and/or you want to use a master’s program to get research experience. In either case I recommend a experimental psychology program first, and then clinical psychology. 

6. Apply to PhD and/or PsyD programs in clinical psychology You need to get in to go! (here is a post about applying to PhD/PsyD programs and a post about picking the best programs)

7. Complete a PhD or PsyD program in clinical psychology This is the key thing. While you are in your program, get varied experience in different clinical settings with different clinical populations. Get involved with research. Say yes to many opportunities but say no to things you’re not interested in or don’t have time for. Don’t stick only to your number 1 interest- try different things, explore the possibilities. Listen to feedback and use it to get better but don’t take criticism as a comment on you as a person. Publish. Get involved with leadership and/or administrative roles. Essentially, build an impressive CV that shows that you have well-rounded skills and experience, but also are creating a niche of your own expertise. See this ask for more.

8. Complete a dissertation The major research milestone in a PhD/PsyD program (of any type) is the dissertation. This is your major research project, where you start to carve out your area of expertise in your field. You use the dissertation to show what you’ve learned, to learn new things, and to add something important to your field. It is an enormous and difficult undertaking, but so worth it. I recommend you pick something that is achievable in the amount of time you have left (don’t make your goal “discover all genes that cause depression,” make it “determine whether cortisol is higher among people with chronic depression compared to acute depression”) and something that you will enjoy enough to keep you motivated during the years you will be working on that project.

9. Apply for a predoctoral internship program The last clinical milestone is a pre-doctoral internship. A match process is how it’s determined where each student applying for an internship goes (similar to medical school residency programs). Students apply for internships around the United States and Canada in the fall, and interview in December and January. Students each rank the places they interviewed at in the order of their preference, and put that ranking into an online system. Each internship does the same- ranks each student in order of their preference. The system “matches” each student with an internship, attempting to match each student with the highest ranked internship possible. However, there are more students applying each year than internships, so every year students go unmatched. This year about 82% of students matched, and of those, 80% matched to an accredited internship. Accreditation is very important for future licensure and employment. This gap in matching is one reason to go to a really really good graduate program- better programs have better match rates, and many internship programs won’t review applications from students who go to unaccredited or low quality schools. See this ask for more. 

10. Complete a pre-doctoral internship program in clinical psychology This is your last big chance to get clinical experience. So my advice is to look for programs that will help you fill important gaps in your training (for example, are you interested in PTSD but don’t have experience in Cognitive Processing Therapy? Find a program that trains in CPT) and helps you fill out your area of expertise. So, both broaden and deepen your experience. Find programs that are really interested in training you and not just getting a cheap therapist for a year. Look for places that often hire their interns as postdocs or staff psychologists, and for places that send interns to the sorts of postdocs or jobs you will want. 

11. Receive your PhD or PsyD You’re done! Congratulations! (Remember to do your exit counseling!)

12. Apply for and complete a postdoctoral fellowship (optional) Many (maybe most) psychologists do a postdoctoral fellowship. A postdoctoral fellowship or residency is additional training after you finish your doctoral degree.  Typical clinical postdocs are 1 year, research postdocs are 2 years, and speciality training postdocs like neuropsychology are 2 years. However some postdocs might be longer or shorter. You might do one so you can gain specific training you want or need- for example, clinical psychologists specializing in neuropsychology nearly always do a postdoc in neuropsychology (and have to in order to be boarded as a neuropsychologist), or you might want training in a particular area of research you don’t have. You might do one so you can get licensed because many jobs require applicants to already be licensed or license-eligible (and many states require supervised hours post-degree and/or other requirements). You might do one because you want a research job and it’s difficult to get one without a postdoc, particularly in academia or academia-adjacent positions. You might do one because you want to get in with a specific institution and they don’t have a job for you that year (many places hire from within, particularly from their intern and postdoc pool). 

13. Get licensed Clinical psychologists generally get licensed within a 2-3 years of graduating (but it’s possible to do it sooner). State requirements vary a lot, so do your research so you can a) get licensed in the state you want to right now, and b) make it possible to get licensed in other states you might want to in the future. Licensure in the US always requires passing the EPPP, the national licensing exam and graduation from an APA-accredited or equivalent graduate program and internship. Many states have additional requirements like 1500 post-degree supervised clinical hours, a state exam, or additional coursework. The process is long and expensive (like everything else in this process). 

14. Get a job This is when you finally get to be a full-fledged clinical psychologist! There are many jobs available for psychologists, but the biggest areas of need are rural and other poorly served areas. Think about what’s most important to you- type of position, type of institution, money, location, etc. –and find something that’ll work for you. 

So how long will this take?

A typical path to being a clinical psychologist looks like this:

Bachelor’s degree: 4 years

Postgraduate research experience (optional): 2 years

PhD/PsyD: 4-6 years

Predoctoral internship: 1 year

Postdoctoral fellowship (optional): 1-2 years (get licensed during this)

Job! 

So an average range is 9 to 15 years from beginning your undergraduate degree to starting your first job as a licensed clinical psychologist. Some people will need more time but it’s very unlikely to do it faster than this.

You keep mentioning “APA” and “accreditation.” What’s that?

APA is the American Psychological Association, and it is the main body that accredits (recognizes as quality and meeting minimum standards) graduate programs, Predoctoral internships, and postdoctoral fellowships in psychology. The Canadian Psychological Association (CPA), California Psychology Internship Council (CAPIC), and Psychological Clinical Science Accreditation System (PCSAS) are also reputable and professionally recognized accrediting bodies.

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Arresting Flowers On The Streets of Sao Paulo

“Flower Messenger” is Japanese artist Azuma Makoto’s breathtaking work of art where people carrying beautiful floral arrangements are seen to roam on the streets of Sao Paulo, bringing vigor and color to the otherwise nondescript streets.