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Internship: Thoughts from the Thick of It

Internship: Thoughts from the Thick of It

by Christine Jehu, MS

I have read many accounts from students about the internship application process and what life is like after internship, but I have not seen much written from interns who are in the thick of it. I want to share some of what I have learned over the last nine months that I hope will help those who are preparing to go on internship. To provide a bit of context, between October and January I lost my father, uncle, and grandfather, which offered considerable ups and downs during the last five months of my internship experience. Some key experiences and relationships stand out that helped me through this year, which I try to capture for you in the list below. My hope is that regardless of the circumstances you face while on internship, the takeaways below will help you in some way during our internship year.

In no particular order, here are my 7 takeaways from the thick of internship:

Your internship cohort is critical. The truth is we aren’t all going to be pals or best friends simply from matching together. Intentionality is critical when building a foundation within your cohort. Take some time to consider what you want and what you need from your cohort, and clearly communicate that early in your time together. – Our cohort decided personal and professional support was important to us. Each week we take a group selfie, go to lunch together, celebrate holidays, and explore the city together. We say that we hit the “intern jackpot” and it feels completely true! Our collective intentionality has fostered an amazing year and friendship between us.
Find an ally on staff. Make a point to cultivate relationships with people on staff. Find someone who you feel safe with and you feel you can turn to. This could be, but does not have to be your direct supervisor or training director. Be clear as you establish each relationship and share your hopes for the relationship as they become clearer to you. – Having a trusted member on staff has been a saving grace for me on many days when I needed to cry and had the space for it, or needed to have an honest and supportive reality check from someone who has witnessed multiple cohorts of trainees. These relationships can be life changing, personally and professionally.
Imposter syndrome is real folks, be ready for it. You’ve probably heard it before, possibly when you entered your program or maybe on your way out. For me it hit full force smack in the middle of internship. Everyone kept asking, “so what’s next?” or “are you doing a post doc?” I would smile and simply respond with, “I’m not sure yet.” When inside I was thinking, “oh my gosh, can I really be a psychologist? Who let me get this far?!” For about a month I wrestled with imposter syndrome, and man was it rough. Remember that trusted ally in #2 – key player during that month! I can tell you all day long to be ready for it, but the reality is everyone’s experience of imposter syndrome is different and it strikes at different times (likely when you least expect it). What I can tell you, is YES you are supposed to be right where you are. YES you are meant to be a psychologist. NO you did not get where you are now on a fluke. Reach out for support, remember your why you started this crazy intense rewarding journey, have your freak out, and keep moving! You’ve got this!
Maintain your connections. Many of us have to relocate for internship. It is really easy to pack up your home, get in the car, and never look back or keep in touch, because the immediacy of these relationships significantly decreases. Friends, please work to maintain your connections with people in your program cohort, your faculty, friends you made in the city where you went to school, and your family. People in your program and faculty know you and who you are as a developing psychologist. They are the people you want in your corner when the imposter syndrome strikes or when you are applying for post-docs or jobs and cannot for the life of you articulate strengths or growth areas. Just as in #1, intentionality is key. Write it in your planner or put reminders in your phone to call, text, or email these people once every two months or so to touch base. – I’ll be honest. I have not been awesome at this. When my dad died, I lost touch with many people. I am slowly rebuilding those connections, and the past few months have been tremendously different.
Find YOUR balance. I trust you’ve heard this time and time again, and probably find yourself telling your clients this very thing. How many of us truly take our own advice? You know yourself. You know what it takes for you to thrive under pressure – you’ve been doing it for at least the last 3-5 years (thank you graduate school). You don’t lose that when you change cities and become an intern. Stay true to you and do what you need to stay healthy, focused, and balanced. It’s okay to set boundaries, to say no to invitations, and to have fun. Do what works for you.
Be clear about what you want and don’t try to do it all. When you start internship you will write out a set of training goals, identify areas you want to improve in, and then you will be offered a shiny beautiful list of everything that is possible to get involved with on internship. I felt like a kid walking into a candy shop! Everything sounded awesome. Three months from the end of internship I can assure you that you will not have time for it all and you will be okay. Stay true to yourself. Remember your goals for the year and the goals for the few years following. Use those to help you make decisions, and when in doubt talk with your training director about what makes sense for you.
My final suggestion, and you may have picked up on it throughout, is to be true to who you are! You’re entering a new situation. You will be offered many unique opportunities. If your cohort is geeking out about something but it’s not your jam, that’s okay! If you are the person who likes to go to the gym on a Friday night rather than happy hour, go to the gym! Be you, 100% you.

Editor’s note: Christine Jehu, MS, is a doctoral candidate at the University of Memphis and is currently the Chair-Elect of APAGS.

Standardized Reference Form: What Students Need to Know

The Fall 2015 round of applicants for internship will be greeted with a new feature that levels the playing field for everyone entering the pool: the Standardized Reference Form (SRF). Over the course of two years, a working group from the Council of Chairs of Training Councils (CCTC) collaborated to improve the process of evaluating applicants in a way that was meaningful to reviewers and equitable for students.

Instead of the sometimes vague letters students may have received in the past, this form asks for writers to speak to specific competencies that are relevant to training in a narrative format. This includes student strengths and areas for growth. We all have both, and now there won’t be a penalty for honest assessments of where students are in their skills and abilities before internship. It even allows for recommenders to indicate the years they trained you, so that the reviewers can see your developmental progression.

We don’t expect this letter to influence the match statistics, but the intention is that it results in a better fit for the intern and the site. CCTC will continue to work with The Association of Psychology Postdoctoral and Internship Centers (APPIC) to evaluate the letter in the next year, allowing the form to evolve and improve over time. Students are welcomed to share feedback about it as well.

Most change requires adjustment and a little anxiety, but here are some “To Dos” to assist students with making this a smooth transition:

Go to the AAPI and download the SRF for yourself to see how you will be evaluated. Write a letter on yourself to self-assess on the competencies being addressed.
Tell all your cohort members to do the same. Spread the word.
Give anyone who may be writing a letter for you a copy of the SRF well in advance, especially if they’ve written letters before. This allows them to have a heads up on the new format, in case they have not yet been introduced. Share the FAQs with them, to answer any questions.
Talk with your recommenders about the SRF and how you see your strengths and areas for growth related to each competency. Make the process collaborative, especially if they have not seen the progression of your skills.

APAGS continues to work on the internship crisis and standardizing the way interns are evaluated is one piece of the larger puzzle. Check back here for any updates about the SRF along the way.

Meet the Candidates! Member-at-Large, Education Focus

It’s election season for APAGS! The voting period for APAGS elections will be the entire month of April. APAGS members will be provided with voting instructions in the beginning of April and will have the chance to vote for the following positions:

APAGS Chair-Elect
APAGS Member-at-Large, Education Focus
APAGS Member-at-Large, Communications Focus

This blog post is the first in a series of posts where candidates for the above-mentioned positions will answer questions to give voters some insight into what they will bring to the position for which they are running.

Member-at-Large, Education Focus

Question: If you weren’t studying psychology, what other career would you pursue and why?

Jake Nota – If I wasn’t going to be a clinical psychologist… Oh trust me, at some particularly trying moments in graduate school I’ve certainly thought about it! While I’ve continued to reaffirm my choice to pursue psychology, I also enjoy working with computers. My lab mates know that I am always the first to volunteer for programming computerized tasks or automating some process of our data collection and organization. I find the problem solving aspect of coding and the iterative testing and tweaking to be really satisfying. I also get a kick out of using technology to improve the types of research questions we can address. In an alternative life I think it could be fun to build on those skills and work as a computer scientist. Or, you know, open a dog training business with my fiancé. Where better to apply our knowledge of conditioning and learning!

Eric Samuels – Psychology is actually my third career. After undergrad, I worked on a political campaign. I grew up with a Jewish religious faith that valued social justice and political engagement. And while I enjoyed working to elect a political candidate that I believed in, I realized that I wanted to work more directly with people to help them with their issues. From there, I decided to go into a career in Higher Education & Student Affairs to help young adults develop holistically during their time in college. I grew a lot while in college, and I desired to help others to do so. I found this work to be exciting, and I enjoyed developing personal relationships with college students. However, this work got me interested in becoming a psychologist, so I decided to pursue a doctorate. Therefore, if I wasn’t studying psychology, then I’d work in politics or with college students.

Blaire C. Schembari – I would pursue a career in veterinarian medicine and own/operate a non-profit animal rescue. In addition, I would advocate for animal rights—working with government agencies to push for tougher laws against animal abuse and neglect. Anyone who knows me knows I love animals, especially my little pound puppy, Abby. As an only child, my parents allowed me to have and care for a “zoo” of pets (birds, fish, rabbits, cats, and dogs). As I reflect on why animals mean so much to me, I consider the nature of my relationships with them. A relationship with an animal is one of the purest forms of loyalty between two beings. I care for my animals physically and they care for me emotionally. I would be honored to have a career focused on enhancing the lives of animals, just as they enhance mine.

Question: APAGS is doing a lot regarding the internship crisis. Which of these strategies outlined in our position statement – or something else we did not mention – do you think should be emphasized in the next two years, and how would you hope to work on it if elected? (150 word maximum)

Jake Nota – I am glad the APA takes the internship imbalance seriously. It is tragic that highly capable, achieving, and motivated mental health trainees are being blocked from moving into their careers by no fault of their own. Furthermore, there is an enormous need for well-qualified practitioners to deliver needed evidence-based practices that is not being met. In particular, the APA’s commitment to lobbying for the creation and maintenance of incentives for internship sites that provide top-notch training is a critical endeavor. The clout of the APA and its partners is needed to make clear the importance of these training experiences; especially in this time of major changes to our healthcare system. I am also an advocate for exploring ways of easing the internship bottleneck through collaboration with other healthcare disciplines. For example, psychologists in training on healthcare teams may simultaneously gain needed experience and demonstrate our field’s great value.

Eric Samuels – As the accreditation of graduate programs becomes more linked to whether a certain percentage of a program’s students are matched to an APA or CPA accredited internship program, I believe that graduate programs that have struggled with their match rate will take action to increase it. As an example, my graduate program is creating affiliated internship sites that my program is helping to become APA-accredited as long as the internship positions at these sites are only for students at my program. If given the opportunity to serve in this position, I will work to create more internship positions by advocating for the continuation of the Internship Stimulus Fund, for increased funding of the Graduate Psychology Education program, and for legislation in the states that would make interns eligible for Medicare reimbursement. I will also work with training councils to encourage training sites to pursue accreditation by using the Internship Toolkit.

Blaire C. Schembari – Among APAGS’ outlined solutions/strategies, I strongly believe both enabling more internships to become accredited and supporting state and federal policies to motivate the development of new internships and the expansion of available internship positions are the most worthwhile and impactful to pursue over the next two years. If elected, I will implement the aforementioned strategies by:

(1) Targeting select government representatives to advocate for the advancement of policies at the state and federal levels,

(2) Soliciting accredited internships’ opinions regarding the accreditation process to determine what aspects can be improved, and

(3) Based on these insights, working with the Education Directorate to develop a plan to streamline the accreditation process in order to grow the number of accredited programs.

Finally, I will focus on increasing state and federal funding for internships; therefore, enabling internships to support additional supervisors and more interns—ultimately increasing internship position quantity, while maintaining training quality.

*****

Be on the look out for the next blog post in this series Meet the Candidates! and be sure to vote in the upcoming APAGS election!

Match Day 2015: The Dialectic of the Internship Crisis

Correction (9:00pm): Due to an editorial mistake, not the author’s, the Phase I match rate was reported in the original post to be 90%. The actual figure is 82% and has been corrected below. The 90% figure represents the possibility of all students who submitted rank lists matching to all available positions after the completion of APPIC Phases I, II, and the Post Match Vacancy Service; however, a small number of positions historically remain unfilled each year. We regret the error.

Today is the day. The day that students enrolled in clinical, counseling, and school psychology programs have been anxiously and excitedly anticipating for months. Today is “Match Day” for internship, the culmination of a journey from applications to interviews to ranking…to waiting.

For many students, the process itself is wrought with complicated emotions, financial stress, and moments of both triumph and struggle. The match today will mean celebration for many students as they reap the rewards of their hard work. Even for some who did match, conflicting emotions may emerge as they consider the implications of moving away from friends, families, partners, and in some cases children, to complete their training. For others, it is a day of disappointment and heartache as they receive the news that they did not match and are forced to face the difficult decision of how to move forward.

The internship crisis continues to be a huge concern for many graduate students in psychology. For those who might not be familiar with this issue, trainees are required to obtain a doctoral internship to satisfy graduation and licensure requirements. Yet, there are not enough internship positions to meet demand.

In 2013 and 2014, the crisis has demonstrated some overall improvement. There have been significant efforts on behalf of many in the education and training communities to influence our numbers, including internship stimulus funds, partnering with colleagues creatively to create new sites, and other efforts. The data from 2015 again show improvement. This is the great dialectic of our time: There has been improvement, and yet we can and must do better.

The Stats

The 2015 Phase I match statistics, released today, show the following:

4,247 students entered the match, with 3,928 completing the process and submitting a rank-order list
3,684 positions were available in the match, including 2,732 accredited positions
3,239 students matched to any internship site in Phase I of the match
2,600 students matched an accredited internship site in Phase I

Taken together, the 2015 match rate for all applicants to the match in Phase I is 82% (up from 80% in 2014). Meanwhile, the rate for all applicants to an an APA- or CPA- accredited internship in Phase I is 66% (up from 62% in 2014). There is more work to be done.

The 2015 match rate in Phase I is 82% (up from 80% in 2014); it is 66% for applicants to APA- and CPA-accredited internships (up from 62%).

An important note: APPIC data at Phase I tells just some of the story. When we look at the crisis as it relates to only students from APA accredited doctoral programs going to accredited internships (source), the numbers show small signs of improvement. We don’t yet have the latest data from APA’s Commission on Accreditation, but from 2011 to 2014 we can see some modest gains:

Internship year	Match rate of students from APA-accredited doc programs to any internship	Match rate of students from APA-accredited doc programs to APA-accredited internships
2011-2012	83.1%	51.9%
2012-2013	88.8%	54.6
2013-2014	90.1%	57.7%

Another dialectic—improvement, but not enough.

The Crisis Continues

The fact that 34% of students from accredited programs — that were deemed to be ready for internship by their programs — did not match to an accredited site should be a concern for all in the training community. This is not just a problem for training programs or internship sites. It is the responsibility of the psychology community at large to address this issue for the future of our profession.

As APAGS past-chair Jennifer Doran highlighted last year, there is so much more to the match than the data. The emotional toll, financial stress, and consequences of not matching weigh heavily. To advocates, the data matters. To individual students, these factors will count for more than any compiled statistic when describing the internship crisis.

What is APAGS Doing?

The crisis remains a key issue that APAGS collaborates with key stakeholders to address. We have tirelessly advocated for efforts that address the crisis and are partnering with others in the training community to find innovative ways to address the crisis. Some of the highlights of our efforts and advocacy include:

Last year, APAGS produced a video highlighting multiple aspects of the crisis in addition to advocacy, awareness and action steps students and psychologists can take to end the crisis. We need you to help spread the message in this video.
APAGS partnered with APA Past-President Nadine Kaslow, Ph.D. and others in the training community during the 2014 APA Convention to present innovative solutions to the crisis. We are currently working toward ways to implement the ideas presented during this panel.
APAGS supported the passage of APA’s Internship Stimulus Package in 2012, providing $3 million in grant funding to increase the number of accredited internship positions. As of December 2014, this money resulted in 10 internship programs receiving accreditation, 27 internship programs with pending accreditation, and at least 57 internship positions. Remaining funds will also be allocated toward further creative efforts in ameliorating the crisis, including helping states seek Medicaid reimbursement for intern services.
APAGS formed an Internship Working Group to analyze and promote solutions to the internship crisis. In July 2012, APAGS released a policy and expanded response to explain how it will continue to advocate on multiple fronts for graduate students.
APAGS has compiled some of its actions since 2000 to mitigate this problem, and further describes its latest actions in a 2014 journal article.
APAGS and other departments in APA are developing a toolkit of resources to help psychology training programs advocate for Medicaid reimbursement for intern. This may help entice the creation of and funding for more internship positions.
APAGS staff attend several regional psychology conferences each year to teach prospective grad students how to decipher publicly available data related to internship match and 14 other factors. We also produced a recorded webinar on this topic.
APAGS is attending the annual meetings of many psychology training councils to promote the development of new internships.

What the Future Holds

The trends have been positive over the last few years, but change has continued to be slow. There is no simple solution to the crisis. We know it will require multifaceted and creative solutions to continue the trend in a positive direction. There is much that trainees and psychologists alike can do to make a difference. The links I’ve shared, particularly to our video (which I’ll embed below) provide steps individuals at all levels can take today to make a difference for next year and future students.

APAGS would like to congratulate the students and programs celebrating today’s match results. We commend you on your accomplishments. You might wonder what to do now that you have matched, and APAGS has resources for you.

APAGS would also like to extend support for those of you who received disappointing news and did not match today. We have resources and support for you as well. For our colleagues and friends who did not match today, we as a psychology community need to offer them our support and encouragement.

The dialectic of change is that it is difficult and necessary. We have already made positive change, and APAGS is working to continue to advocate for students and ameliorate the crisis. I would like to encourage everyone, regardless of your outcome, to share your story, in the comments section, on our Facebook page, or personally. Please contact me or APAGS staff with your thoughts, ideas, and concerns. We are here to support you. Together, we can all make change.

Fun with data: Internship Stipends, cost of living, and practicum hours

Many graduate students in clinical, counseling and school psychology programs are preparing applications to internship positions across the country this fall. The internship component has been a requirement to earn a doctoral degree in these programs for decades. And every year the American Psychological Association’s Commission on Accreditation (CoA) collects data on students in accredited doctoral and internship programs.

Let’s have some fun with those data!

The first chart shows the mean and standard deviation of stipends from APA accredited internships from 1998 to 2012. Click the chart to magnify it:

Since 1998, the mean stipend for clinical, counseling, and school psychology interns has increased steadily. In fact, the stipends one standard deviation below the mean have increased by almost $5,000. (Source.)

While internship stipends have generally been increasing, do they cover the cost of living? My second chart presents the percent change in the median internship stipend and the percent change in the consumer price index (CPI) from year to year:

As you can see, the percent change in median stipend amount is greater than the percent change in CPI for some years but not others. It seems that although many stipends cover the cost of living, the percent change in stipend amounts is not always in pace with this marker of inflation (source). The good news? The 1998 mean intern stipend, adjusted for inflation, still beats the amount one would expect to earn in adjusted dollars for 2012 by nearly $1,500.

The percent change in stipend amounts is not always in pace with this marker of inflation.

Beyond stipends, I decided to look at the trends in practicum hours reported by internship applicants. In particular, I wondered if the internship crisis was leading to greater accumulation of hours by students who desire to appear more competitive. This third chart shows practicum hours of applicants from 2006 to 2012, broken into supervision and assessment/intervention categories:

It appears that the trends in supervision and in assessment/intervention hours are similar between the APA mean (blue) and APPIC median (red) hours. If we look at the most recent data, it appears that median hours are increasing over time. Students applied to internships with 18% more intervention/assessment hours in the eight years between 2006 and 2013.

It appears that median hours are increasing over time.

(Sources: Mean practicum hours are reported by APA, though public release of data in this area ceased in 2010. Median hours are reported by the Association of Psychology Postdoctoral and Internship Centers, or APPIC. It is important to note that APA accredits some doctoral and internship programs, almost all of which send students through the APPIC national match. APPIC data report students from accredited and unaccredited doctoral programs vying for accredited and unaccredited internships.)

Any thoughts on the data I presented? Are you surprised by the trends? Do any possible interpretations come to mind? I welcome you to comment on this post!

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