No doctorate required!: Shifting mental health tasks to master’s level helpers to bridge gaps

Hayden, E. P. (2024). Reconsidering the integration of science and practice in training in clinical psychology. Canadian Psychology/Psychologie Canadienne. Advance online publication. https://dx.doi.org/10.1037/cap0000391

Background

In her thought-provoking new article, Elizabeth Hayden provides a comprehensive critique of the scientist-practitioner model, which has been the predominant approach to doctoral training in clinical psychology in Canada and the United States for decades. Hayden argues that this dual training model, aimed at producing graduates competent in both research and clinical practice, is remarkably inefficient and ill-equipped to address the pressing mental health needs of the population. The author traces the historical development of the scientist-practitioner model, highlighting its origins in the post-World War II era when there was a surge in demand for mental health professionals. While acknowledging the well-intentioned goals of this training approach, Hayden contends that it has failed to live up to its potential, necessitating a radical shift in how we train future clinical psychologists.

Methods

The author’s critique is grounded in a thorough review of the literature on the scientist-practitioner model, drawing from seminal works and historical accounts that shed light on its evolution and implementation. Hayden examines the core tenets of the model, including the emphasis on training psychologists to be competent in both scientific research and applied clinical domains, the setting for such training (psychology departments at universities), and the degree to be earned (PhD).

To substantiate her arguments, the author cites empirical evidence demonstrating the lack of incremental benefit of extended doctoral training for producing effective clinicians. Hayden also draws upon data illustrating the economic pressures and job market realities that often compel PhD graduates to prioritize either research or clinical practice, rather than seamlessly integrating both domains.

Results

Hayden’s comprehensive analysis identifies several key limitations and inefficiencies inherent in the scientist-practitioner model:

1. Small class sizes: Due to constraints on the number of students who can be adequately trained within PhD programs, clinical psychology programs in North America typically admit small incoming classes, limiting the field’s ability to produce enough frontline service providers to meet the growing demand for mental health care.

2. Duration of study: The dual training required for the scientist-practitioner model necessitates a lengthier period of study compared to other subdisciplines within psychology, often extending beyond the intended timeframe. This prolonged training not only delays graduates’ entry into the workforce but also contributes to the high costs associated with such training.

3. Feasibility challenges: Balancing research training and clinical practice becomes increasingly difficult as the field advances, with students needing to acquire increasingly sophisticated research skills while also meeting the demands of clinical training. Additionally, the economic pressures faced by graduates often force them to prioritize either research or clinical work, rather than integrating both domains.

4. Lack of evidence for incremental benefit: Empirical evidence suggests that extended doctoral training may not necessarily produce superior clinicians compared to those with less extensive training. This calls into question the necessity of the lengthy and resource-intensive scientist-practitioner model for producing effective clinical practitioners.

Discussion

Hayden proposes an alternative training model in which applied clinical training occurs at the master’s level, while doctoral training is focused exclusively on research and other non-applied activities [1]. This approach, the author argues, would rapidly increase access to master’s-level clinical psychologists delivering evidence-based interventions, while also creating more job opportunities for those with PhDs in clinical psychology as trainers, supervisors, and researchers.

Hayden acknowledges potential hazards of this proposed model, such as a potential decrease in the applicant pool for clinical PhD programs and concerns about the prestige of the profession if the master’s degree becomes the primary entry point. However, she contends that these risks are outweighed by the potential benefits, including increased accessibility to clinical psychology training, a more diverse clinical workforce, and a more efficient use of resources.