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Report of the Committee on Training in Clinical Psychology of the American Psychological Association Submitted at the Detroit meeting of the American Psychological Association, September 9-13. [*]
Ernest R. Hilgard, E. Lowell Kelly, Bertha Luckey, R. Nevitt Sanford, Laurance F. Shaffer, David Shakow (1947)
First published in American Psychologist, 2, 539-558.
Posted October 2000
At the meeting off the Board of Directors of the American Psychological Association in Ann Arbor, March 28-30, 1947, the President was authorized to appoint a special Committee on Training in Clinical Psychology to perform the following tasks:
a. Formulate a recommended program for training in clinical psychology.
b. Formulate standards for institutions giving instruction in clinical psychology, including both universities and internship and other practicum facilities.
c. Study and visit institutions giving instruction in clinical psychology, and make a detailed report on each institution.
d. Maintain liaison with other bodies concerned with these problems, including the committees of the American Orthopsychiatric Association, the National Committee for Mental Hygiene, and others.
The undersigned persons constitute the Committee as finally appointed. The Committee, because of the relatively short period that it has had to work, has limited itself in this report to presenting a recommended program of training in clinical psychology. The work of our Committee insofar as it relates to a training program grows naturally out of the activities of several previous committees and groups. The historical aspects of the development of clinical psychological training has been thoroughly covered by Morrow (9). Of particular relevance are the 1943 "Proposed Program of Professional Training in Clinical Psychology" of the Committee on Training in Clinical Applied Psychology (1) and the 1945 sub-committee Report on "Graduate Internship Training in Psychology" (4). A recent issue of the Menninger Bulletin (July 1947) describing "The Menninger Foundation School of Clinical Psychology" and the July 1946 "Internship and Externship Programs" issue of the Journal of Consulting Psychology are also of considerable importance in this context. The report of the Committee on Graduate and Professional Training (10), although more directly related to future activities of our Committee, in some respects also bears on the present report.
The program here presented is especially timely because of the existing ferment in the field of psychology, particularly in the area of clinical psychology. The Harvard University Commission's report (6) suggests some of the possibilities which lie ahead of psychology in the near and distant future. With respect to clinical psychology, one sees on the one hand the breathless preoccupation with actual training which has resulted largely from the Veterans Administration and United States Public Health Service programs, and on the other hand the deep concern with the goals and trends of this training both within the Psychological Association and on the part of organizations interested in the fields with which clinical psychology is associated. The Josiah Macy Jr. Foundation has held the first of a series of Conferences on Clinical Psychology (8); the American Psychiatric Association and the Group for the Advancement of Psychiatry have Committees on Clinical Psychology and the American Orthopsychiatric Association and the National Committee for Mental Hygiene are engaged in activities which in one respect or another involve the evaluation of the functions of clinical psychologists. It is, therefore, especially desirable that the Association set forth its own official policy in this important matter of training and that it play the major role in determining the content and goals of such a program.
We are cognizant of the great difficulties which the shift from an academic to a professional program involves in a university setting. We recognize that [p. 540] this change must take much effort and time and that even were it possible to set up a fairly fixed schedule w of training, such a step would at present be both pre mature and ill-advised because of the great need for experimentation in ways of implementing a sound program. We are therefore emphasizing the goals it and principles of what we consider a desirable program rather than attempting to lay out a detailed blueprint. We have decided to limit our present consideration of training to a program at the four-year doctoral level because of our firm conviction that professionally qualified persons cannot be given n adequate background training in less time. This is in line with a decision independently arrived at by the Policy and Planning Board (2) that further s training of clinical psychologists at the MA level be discontinued. It should be emphasized however, that this decision does not preclude the training of persons to apply psychological principles in specialized areas such remedial teaching, vocational and educational testing, etc. However, such persons are in our opinion not clinical psychologists and the present report is not concerned with their training. We have further decided not to let our program be determined in any way by present practices in training which arise from special situations such as those created by the financial arrangements of the Veterans Administration. We have, rather tried to present what we consider ideally desirable in the present state of our knowledge, and we have left to the university the practical working out of the program according to local conditions.
In that wise volume, "Medical Education", (5, p. 176), Abraham Flexner says "...the medical school cannot expect to produce fully trained doctors; it can t most hope to equip students with a limited amount of knowledge, to train them in the method and spirit of scientific medicine and to launch them with a momentum that will make them active learners -- observers, readers, thinkers, and experimenters -- for years to come....The general arrangement of the curricula, if sound, can make this task a bit easier, or if unsound, a bit harder; but in general much more- very much more- depends on teacher and student than on curricular mechanics or teaching devices."
If we substitute clinical psychology for medicine, this statement expresses the essential point which we wish to make in this report. Our task is to find good teachers to give good students good training that will start them of in the first stages of their careers as clinical psychologists. This report will be concerned in some detail with ways of meeting the problems that arise in attempting to achieve this task.
What specific goals do we have in mind in the preparation of the clinical psychologist? Clinical psychology seeks to acquire systematic knowledge human personality and to develop principles methods by which it may use this knowledge to crease the mental well-being of the individual. If we recognize that clinical psychology is both a science and an art calling for scientific rigor tempered by personal and social sensitivity, we specify these goals fairly clearly. The more carefully the present scene is examined and the more the fully the future is viewed, the more convinced are we of the need for preparing the clinical psychologist with a combination of applied and theoretical knowledge in three major areas: diagnosis, therapy and research. The purpose is not to develop persons with encyclopedic proficiencies nor is it directed at disproving the contention of some that the scientific and therapeutic attitudes mix poorly in the same person (a view which we are unwilling to accept until definite proof is forthcoming). Rather is it our purpose to see that the necessary broad training is provided that will make later specialization on a sound foundation possible. It becomes increasingly clear that persons having a specialized background in only of one of these fields, for instance, Rorschach testing, or counseling, or electroencephalographic research cannot function adequately. We go even beyond this and say that broad training, if it is in one of the three major areas, is quite inadequate for ordinary clinical psychological work, to say nothing of teaching and preventative endeavors, two major fields of activity which require special attention.
The ability to carry out effectively the combination of functions called for depends upon the psychologist's being the right kind of person, a person who has a relevant informal experience into which has been integrated the proper formal education, both undergraduate and graduate.
What characteristics does the "right kind" of person possess? As, yet, we do not know definitely for research on this important problem has only [p. 541] begun. It is generally agreed, however, that especially important are the personality qualifications represented by a reasonably well-adjusted and attractive personality. Until dependable research data are available, the following list, which includes the kind of specific qualities experienced observers believe clinical work calls for, may be useful:
1. Superior intellectual ability and judgment.
2. Originality, resourcefulness, and versatility.
3. "Fresh and insatiable" curiosity; "self- learner."
4. Interest in persons as individuals rather than as material for manipulation -- a regard for the integrity of other persons.
5. Insight into own personality characteristics; sense of humor.
6. Sensitivity to the complexities of motivation.
7. Tolerance; "unarrogance."
8. Ability to adopt a "therapeutic" attitude; ability to establish warm and effective relationships with others.
9. Industry; methodical work habits; ability to tolerate pressure.
10. Acceptance of responsibility.
11. Tact and cooperativeness.
12. Integrity, self-control, and stability.
13. Discriminating sense of ethical values.
14. Breadth of cultural background-"educated man."
15. Deep interest in psychology, especially in its clinical aspects.
The list is formidable but in the present state of our knowledge, represents the kind of selection goals towards which we must work. Characteristics of this type seem a necessary foundation for work in a field which requires so much in the way of maturity, sensitivity, and knowledge. How are we to obtain such persons for training? Problems of both recruitment and selection are involved. The problems of recruitment are more difficult than they are in such major professional fields a medicine and law, since the latter are well-established and known to youngsters from quite early years. For the present, the major effort in recruiting will have to be made at the college level through teachers of psychology and vocational advisors who are on the lookout for promising candidates. In coming years, growing general acquaintance with the field and the multiplication of earlier courses in psychology at the secondary level are likely to lead the student to think of clinical psychology as a life work. The first rough selection could then come in the secondary schools.
Beyond the problem of recruiting a sufficiently large number of persons to maintain the necessary supply of clinical psychologists lies the major task of proper selection at the point of entrance into graduate work. Here, besides the ordinary selective devices such as are provided by the credentials of the candidate, the Graduate Record Examination and the devices which are being developed in the "Research Project on the Selection of Clinical Psychologists under contract with the Veterans Administration" under the auspices of the University of Michigan (7) should be of help in selecting the best candidates. It is not necessary to elaborate on the obvious point that besides rigorous selection at the point of entrance into graduate work a process of selection must go on throughout the program.
Given the proper kind of person, what may we expect of him in the way of informal background experience which may be considered relevant? For the present we shall devote our attention to the non- academic experiential background of the person. Since it seems reasonable to expect the clinical psychologist to be interested in people and have a broad base of human contacts, he should have had experiences, particularly in his college years (summer holidays and other spare time), involving close relations with both ordinary and unusual persons in field, factory, institution, or laboratory. In addition to direct contact with people of various kinds he should have had the indirect acquaintance with people that comes from immersion in great literature, because of the emphasis which such portrayals place on the molar aspects of behavior and the insights into human nature that they give. Anything that reading may accomplish to broaden his acquaintance with the wide range of psychological expression, whether in relation to individuals or cultures, is so much relevant background for him.
What can we say about the formal educational background which we may expect from the candidate who is entering the graduate program? Two distinct points of view are generally expressed. On the one hand, there is some demand that students come with a common, fairly defined background, especially in psychology, in order to make graduate [p. 542] instruction easier. On the other hand, some hold that, for the broad development of the field, to cast all the participants in the same mold would be undesirable. Medicine, the proponents of this view indicate, has experimented with a rather rigid prerequisite program but is raising more and more question about its desirability. The solution probably lies somewhere between the two points of view. It seems to us that certain general requirements for the undergraduate program which the student could ordinarily be expected to meet can be laid down. In exceptional cases, provision to waive these should, of course, be made.
The undergraduate program must be recognized as at most pre-professional. The professional and the more advanced courses in psychology should in general not be open to the undergraduate. The undergraduate program should be directed at providing a broad cultural and scientific base for specialized graduate study. The courses should help the student to attain a first insight into the structure and dynamics of human behavior, an understanding of the biological and social development of the individual, and a preliminary acquaintance with the principles and methods of collecting and evaluating data.
More specifically, as an example of what a basic undergraduate program might include, the following is presented:
1. Psychology. An approximate optimum of twenty semester hours, to consist essentially of courses for undergraduates. The student must be permitted to take a sufficient number of psychology courses to enable him to acquire a fair acquaintance with the content of the field of psychology, both in its general and in its laboratory aspects, but he should not be permitted to concentrate heavily in it. The main emphasis should be on courses in dynamic psychology which consider crucial human problems at a fairly rigorous scientific level. Mass "titillating" courses directed at the general student body definitely not what we have in mind here.
2. Biological and physical sciences. Approximately twenty semester hours of which the part should preferably be in biology including genetics, and the balance in physics and chemistry. Satisfactory secondary school preparation in the two would reduce the amount required at the level.
3. Mathematics and statistics. Approximately nine semester hours in mathematics and statistics; with special emphasis on their logical principles.
4. Education. Approximately six semester hours in the fundamentals of educational philosophy, and experimental didactics in the form of practice teaching, if this can be arranged.
5. Social sciences. Approximately twelve semester hours in sociology, anthropology, and economics (Political science or history might be substituted for the last.)
6. History of Culture. Approximately nine semester hours in history of civilization, comparative literature, comparative religion, philosophy, etc.
7. Psychology as revealed in literature. Approximately six semester hours in "literary psychology" if this can be arranged.
8. Languages. Reading knowledge of French and German. (Some consideration should, however, be given to the desirability of substituting of other languages, for example, Spanish and Russian.)
We wish to emphasize that the undergraduate program cannot be appraised according to credit hours or in relation to specific courses. Each candidate's record must be examined on its merits to see how far it meets the spirit of the background requirements of breadth, good introductory acquaintance with psychology, and fair acquaintance with the biological and social sciences. If a choice is to be made between the latter two groups, there seems some reason for postponing further study of the social sciences to the graduate period. The student, being more mature at this time, is better able to grapple with its relatively greater uncertainties. [p. 543]
GRADUATE PROFESSIONAL PROGRAM
General Principles. The general principles which underlie the graduate program appear to us of primary importance -- in fact much more important than the details of the program. If clarity in the formulation of goals exists, there should be relatively little difficulty about agreeing on the means for implementing them. As has already been indicated, it is the opinion of the Committee that the setting up of a detailed program is undesirable. Such a step, if accepted generally, would go far in settling clinical psychology at a time when it should have great lability. Considerable experimentation with respect to the personality and background of students as well as the content and methods of courses will for a long time be essential if we are to develop the most adequate program. Our aims are rather to achieve general agreement on the goals of training and encourage experimentation on methods of achieving these goals and to suggest ways of establishing high standards in a setting of flexibility and reasonable freedom. We also hold that the goals should not be determined by special situations and special demands, but should be oriented toward the question of what is the best training for the clinical psychologist. Against this general background the principles which we consider important are the following:
1. A clinical psychologist must first and foremost be a psychologist (2) in the sense that he can be expected to have a point of view and a core of knowledge and training which is common to all psychologists. This would involve an acquaintance with the primary body of psychological theory, research, and methods on which further training and interdisciplinary relationships can be built.
2. The program of education for the doctorate in clinical psychology should be as rigorous and extensive as that for the traditional doctorate. In general this would represent at least a four-year program which combines academic and clinical training throughout but which includes intensive clinical experience in the form of an internship.
3. Preparation should be broad; it should be directed to research and professional goals, not to technical goals. Participants should receive training in three functions: diagnosis, research and therapy, with the special contributions of the psychologist as a research worker emphasized throughout. Although many will probably tend to specialize in one or another of these areas after obtaining the degree, the Committee feels strongly that them should be training in each of these areas during the graduate period. We are particularly concerned that training shall be of such a quality as to eliminate the possibility that a technician, whether in the sense of a directive or nondirective counselor, a Multiphasic specialist, a Binet tester, a Rorschach specialist, or a remedial instructor, will be turned out as a clinical psychologist, and so depended upon for a range of work he will be unable to do.
4. In order to meet the above requirements the program calls for study in six major areas: a. General psychology; b. Psychodynamics of behavior; c. Diagnostic methods; d. Research methods; e. Related disciplines; f. Therapy. Such a program should go far towards reducing the dangers inherent in placing powerful instruments in the hands of persons who are essentially technicians, persons who from the standpoint of the academic group have no real foundation in a discipline, and who from the standpoint of the clinical group have no well-rounded appreciation of the setting in which they function.
5. The program should concern itself mainly with basic courses and principles rather than multiply courses in technique. It is simple to organize a program that includes innumerable courses of the latter type and come out in the end with a poorly trained person. The stress should be laid on fewer, well-integrated courses which subtly but inevitably leave the student with a sound background, on which he can build knowledge of techniques as he needs them. The courses should be so arranged that more advanced courses really call for knowledge acquired in preceding courses and are built on these. This has too infrequently been true in psychology graduate programs with the result that students have not had the clear notion of progress towards a goal that law students and medical students have. The relationship of the course material to personality theory should be constantly emphasized and unless the whole program is oriented in this direction we doubt its final effectiveness for achieving the stated goals.
6. Courses should be scrutinized for their content, rather than judged by their titles. Equally important is the way the content is handled, that is, the quality of the teachnig[sic]. Other factors to be evalu- [p.544] ated are the internal integration of the course and its integration with other courses, both academic and held. Departments of psychology have perhaps been too much concerned with providing their instructors with freedom to organize their courses as they saw fit under an assigned title. This has frequently resulted in considerable duplication in courses and in the omission of important areas. In either case the student suffered. Without in any way infringing on the instructor's fundamental freedom, it would seem possible, through department and individual conferences, for instructors to lay out courses which are complementary and supplementary to the others given, rather than overlapping because they are ignorant of the general content of colleagues' courses. Courses should as much as possible involve active student participation in preference to merely requiring listening or even watching demonstrations. Individualization of instruction, detailed personal supervision, and the encouragement of initiative and self-reliance must be recognized as important aspects of the teaching. The student should come in contact with a number of instructors representing a variety of points of view and types of experience.
7. The specific program of instruction should be organized around a careful integration of theory and practice, of academic and field work, by persons representing both aspects. Just as there is great danger, in the natural revolt against "academic" dominance, of ending up with a "practical" program, so is there danger in the continued dominance of the academy. It is important to break down the barriers between the two types of approach and through their smooth integration impress the student with the fact that he is taking one course of training provided by one faculty.
8. Through all four years of graduate work the student should have contact, both direct and indirect, with clinical material. This can be accomplished in the theoretical courses through the constant use of illustrative case material with which the instructor has had personal contact. The student should from the first year be provided with opportunities for actual contact with human material in naturalistic, test, and experimental situations in the setting of practicum, clerkship, and internship. Throughout, the effort should be made to maintain and to build upon that most valuable quality, the naive enthusiastic interest in human beings with which the student first comes into the program.
9. We have just made the point that the student should have contact with clinical material throughout the four years of training. Equally is the need for contact with normal material. Opportunities should be provided to enable the student to become acquainted with the range of normal and borderline persons who never establish clinical contacts. Such training is essential in order to keep the student balanced in his interpretation and understanding of the abnormal.
10. The general atmosphere of the course training should be such as to encourage the increase of maturity, the continued growth of the desirable personality characteristics earlier considered. The environment should be "exciting" to the degree that the assumed "insatiable" interest in psychological problems is kept alive, the cooperative attitude strengthened, and the passivity usually associated with so much of traditional teaching kept at a minimum. The faculty must recognize its obligation to implant in students the attitude that graduate work is only the beginning of professional education.
11. A distinct weakness in the training of psychologists, when compared with that of physicians and social workers, is the lack of sufficient feeling of responsibility for patients and clients. The program should do everything possible to bring out responsibilities associated with the activities of the psychologist. There should be persistent effort to have the student appreciate that his findings make a real difference to a particular person and to that person's immediate group. [p. 545]
12. A systematic plan should be laid to use representatives of related disciplines for teaching the trainee in clinical psychology, and opportunities for joint study with students in these disciplines should be provided. Through these approaches the student learns to work closely and in cooperative fashion with those whose methods may be different but whose goals are quite similar. In these settings he learns to acquire modesty about his own contribution, and to value the "team" approach to the problems of both a service and research nature that he meets, problems which, because of their difficulty and complexity, require a concentrated group attack. In the service aspect he must learn that the team approach calls for the coordinated thinking of various specialists on the problems of a particular patient and that participation in such group activity involves not only immediate, but continuing, responsibility for the client, whether direct or delegated, on the part of all of the members of the team.
13. Throughout the course of training there should be an emphasis on the research implications of the phenomena with which he is faced, so much so that the student is finally left with the set constantly to ask "how" and "why" and "what is the evidence" about the problems with which he is faced. There is probably no more important single task placed on the teaching staff than this direction towards research.
14. In addition to the research implications of the data he should become sensitive to their social implications; he must acquire the ability to see beyond the responsibilities he owes to the individual patient to those which he owes to society. Medicine has developed a code which is admirable so far as concerns responsibility to the individual patient, but has paid relatively less attention to the other type responsibility. It is our hope that psychologists will gradually acquire more of the medical attitude towards individual patients but develop a high degree of social responsibility as well.
Program of Graduate Training.
As has already been indicated, the program of graduate training falls naturally into six major instructional areas: general psychology, dynamics of behavior, related disciplines, diagnostic methods, therapy, and research methods. For purposes of exposition of the general plan it seems best to consider the program according to these categories than by . Under each heading will be discussed the progressively advancing courses falling roughly into the particular category. The classification is, of course, arbitrary and there is a considerable amount of overlapping in both the theoretical and practical aspects. The description of an experiment in perception, for instance, can be significant not only because it points up fundamental perceptual theory, but it can also do the same for psychodynamic theory, research methodology, and physiological relations and -- it is not inconceivable-- for therapy.
Although it is not our intention to encourage filling up the student's time with courses to so great an extent as is the present practice, for instance, in the medical program, it is still our belief that graduate students in this program can carry heavier schedules than are ordinarily called for by graduate schools. The students must be given time to read and think but we believe these goals need not be sacrificed -- in fact they might even be strengthened -- if the program were thought of as requiring more semester hours of teaching contact through the year in order to get in necessary course work.
A. General Psychology. In view of the fundamental tenet accepted by the Committee, namely, that clinical psychologists are primarily psychologists, it is clear that due attention must be paid to preparation in the general aspects of psychology. It is our hope, however, that in the presentation of the general courses now under consideration instructors will keep in mind the need for including material related to personality theory and that they will consider the implications of the phenomena they are discussing in the context of total behavior. It is our hope, too, that the trend of the past towards emphasizing the segmental aspects exclusively will be considerably reduced. The courses  in this category which should generally be included are:
1. General, physiological, and comparative psychology.
2. History of psychology and contemporary schools of thought. [p. 546]
3. Developmental psychology- Fundamentally theories of genetic development: child, adolescent and adult; individual differences.
4. Social psychology.
B. Psychodynamics of Behavior. If we are to develop the kind of clinical psychologist this program aims for, considerably more emphasis than in the past will have to be placed on permeating the program with theory of personality and psychodynamics. There is no other aspect of the program that is more important and that has so many ramifications. If a dynamic orientation is what we are after, then there can be no half-measures. To accomplish such a purpose it is necessary that as many of the instructors as possible be well acquainted with psychodynamic theory and that they present their material in light of such theory both in the classroom and in the field. The suggested courses in this area are:
1. Dynamic psychology- Fundamental theories of personality and motivation of normal and abnormal behavior.
2. Experimental dynamic personality- Conferences and laboratory work. Starting with a selected group of classical experiments in general psychology that bring out fundamental experimental principles, the course might go on to the consideration of the theory and design of clinical research and experiments on personality characteristics and dynamics. It should also involve the critical analysis of published studies and the application of experimental techniques to actual problems in the experiment of conducting this course concurrently with the previous course- conceivably even as a single unit.
3. Psychopathology- The consideration of symptoms and symptom complexes in various mental disorders with emphasis on nosology to some extent but more particularly on the mechanisms and dynamics behind symptoms. The course should be organized largely around actual case presentations.
C. Diagnostic Methods. Diagnostic study has taken on an increasingly important role in the functioning of the clinical psychologist. This statement may seem somewhat anomalous considering the fact that for a long time "testing" was widely considered the only function of the clinical psychologist. The difference lies in the fact that whereas the functions of the clinical psychologist have been broadened considerably there has been an equal broadening of the concept of what testing involves and a great expansion of the variety of procedures available to him. Besides standard tests there are work samples, psychodrama, real life segments, and situational tests among the methods now at his command. At one time diagnosis implied merely a type of "pigeon-holing." At present this represents only a minor aspect of what is called for. Now diagnosis concerns itself with the origin, nature, and especially the dynamics of the conditions under investigation, and with suggesting hypotheses as to outcome under varying forms of disposition. Its important contribution to personality research, to psychiatric diagnosis, and to therapy are being recognized increasingly. The need for detailed and intensive training in this area is obvious. How shall this training be carried out?
There is a certain logical order in the steps of training which seem to us to be essentially these: Principles and theory, demonstrations, laboratory experience (in the sense of practice by students on each other and on any other available subjects), practicums in the form of clerkships (organized short periods of part-time training at established field centers) and internships (organized, full-time, extended periods of training at field centers).
The devices with which the student should become acquainted and in which he should attain proficiency are many and of varying degrees of difficulty. Increasing experience with students in this field convinces us, however, that before actually beginning to work on diagnostic devices the student should have a preliminary and fairly extensive period of training devoted to naturalistic observation and description, procedures on which these devices are fundamentally based. Because so much of clinical psychology (and psychiatry depends on the description of the complexities of behavior, we would recommend that a considerable portion of the time to be set aside for diagnostic devices in the first year be spent rather in training students in careful observation and report. For this purpose one-way screens, paired and recording devices of both sound and visual types, should be used in settings where individuals and groups are under observation in free and con- [p. 547] trolled situations. Constant checking of observer's reports against each other, against supervisor's observations, and against the mechanical devices should be standard practice. It is important that healthy respect for careful observation and report be developed in students who are going to work in a field where a good share of the time the major instrument, in both respects, is the observer himself. With regard to reporting, both in this connection and in connection with diagnostic study, strictness and insistence on high standards of succinctness and accurate terminology are essential. A further argument for early training in observation is suggested by a reading of Flexner(5, p. 253), who, quoting Wenkebach's statement, "Das Wissen verdrängt das Sehen," points out the dangers which come from the early acquisition of technical terms and how frequently such knowledge serves as a barrier to accurate observation of the conditions with which the student is concerned.
Concurrent with the observational field work of the first year might come a broad survey course in clinical psychology whose purpose it would be to provide the student with a perspective of the whole field of clinical psychology. This would include a consideration of the varieties of duties and responsibilities which may be involved in different settings in relation to clients, other professions, and the public. Such a course might be followed by instruction in the technique of taking histories and interviewing, at least in part given under the guidance of experienced social workers and psychiatrists. The preparation of an autobiography during this period is also to be recommended.
After this preliminary background, which has emphasized molar techniques and has provided acquaintance with some clinical material, there follows naturally a systematic course in the theory and practice of diagnostics. Such a course should begin with a consideration of the theory and philosophy of diagnostics; it should provide an understanding of the place of diagnostic procedures in systematic psychology, its relationship to other forms of directed acquisition of knowledge such as naturalistic observation and experiment, its history in detail, and its strengths and weaknesses as a scientific method and as an applied technique. A presentation of the theory and practice of test construction might follow.
The student, should then acquire an extensive, if superficial, acquaintance with the wide variety of test and other diagnostic devices: sensory and motor; intelligence: verbal and performance, individual and group; educational and vocational guidance; personality: objective, projective, and situational; and some general notions about their applicability, roughly in the stated order. He should, of course, have a more intensive acquaintance with the selected devices generally used in clinical settings. Whereas he may acquire knowledge of the former from general test survey courses, his knowledge of the latter should be acquired from specialized courses devoted to these techniques. In this connection, the faculty must resist pressure from the students who will put up considerable clamor to be permitted to do projective testing (just as some press for therapy) before they have the necessary relevant clinical and theoretical background for the proper use of these complex techniques. Knowledge about tests should not be derived from didactic teaching alone nor from occasional practice on fellow-students tacked on to the course. Practicums and clerkships, as has repeatedly been emphasized, must be recognized as essential and integral parts of the university training, and periods of practice with subjects in clinical settings must be provided. The general emphasis during the university period should, however, not be on too intensive practice in any one device nor with any one type of subject; rather, it should be directed toward getting across to the student the "feel" of contact with a variety of types of patients as well as the "feel" of a variety of types of test procedures. With this in mind the university should have available many neighboring clinical centers for clerkships, such as schools, child guidance units, schools for the feebleminded, psychopathic and other psychiatric hospitals, mental hygiene clinics, general medical and surgical hospitals, educational and sensory-motor disability clinics, prisons, industrial units and vocational guidance centers. Each student should rotate among at least four of these.
During the internship or externship it is inevitable, and in fact desirable, that a certain amount of the activity of the previous years is duplicated. The student should at the time he commences the internship have, besides a general background in basic general and dynamic psychology, a broad ac- [p. 548] quaintance with test techniques and an elementary appreciation of their application. He has now come to a setting whose major contribution is to throw him into direct, constant, and intensive contact with human material -- a setting in which he can apply both his theoretical knowledge and his beginning skills.
In this environment, where the emphasis is on the individual patient, rather than the problem or the technique, there are certain goals related to test procedures which one expects the student will reach. It is expected that besides acquiring skill, through repeated practice, in the administration and understanding of a wide variety of tests, he will learn when tests are called for and when they are not, what tests and combinations of tests are required in specific problems, and that he will learn their weaknesses as well as their strengths. Besides acquiring a sensitivity to the diagnostic and prognostic aspects of his test findings one hopes that he will become sensitive to their therapeutic implications as well. In fact, there should be an effort to develop in him a "therapeutic attitude" towards his diagnostic work; an attitude that involves learning to avoid probing and carrying out misplaced therapy; an attitude that involves leaving the patient the better rather than the worse for the experience -- this without violating the controls or the spirit of good diagnostic procedure. It is expected that he will acquire some sense of balance between the extremes of rigorous pedantic exactness and sloppy guessing, that he will recognize that different problems lend themselves to differing degree of control, and that there are times and stages of development when a rough negative correlation appears to obtain between psychological meaningfulness and degree of control. It is to be hoped that he will learn that what is important, while working always for reasonably greater control in the clinical setting, is to be honest about the degree of control obtained at the particular time, to admit that one is ignorant or merely hypothesizing when such is the case. His supervisors should strive to have him attain enough security about presenting tentative conclusions so that he does not escape into meaningless profundities or into exactness about the insignificant when he is overcome by the complexities and the difficulties of the significant.
These courses are suggested for the diagnostic series:
1. Observational techniques and reporting.
2. Survey of clinical psychology.
3. Methods of case study, case analysis and interviewing.
4. Theory and practice of psychological diagnostics:
a. Theory of testing and test construction
b. Verbal "intelligence" tests
c. Non-verbal ability tests
d. Tests of sensory and perceptual function
e. Tests of motor function and motor skill
f. Educational achievement tests
g. Vocational tests
h. Clinical tests of psychological deficit, aphasia, conceptualization, etc.
i. Projective and other personality procedures
j. Clinical analysis and integration of diagnostic devices.
D. Therapy. It is our thesis that no clinical psychologist can be considered adequately trained unless he has had sound training in psychotherapy. The social need for the increase of available therapists is great. Clinical psychologists are being called upon to help meet this need, as well the greater research need, and we anticipate that many will devote a part of their time to some form of psychotherapy. Our strong conviction about the need for therapeutic experience grows out of the recognition that therapeutic contact with patients provides an experience which cannot be duplicated by any other type of relationship for the intensity and the detail with which it reveals motivational complexities. A person who is called upon to do diagnostic or general research work in the field of clinical psychology is seriously handicapped without such a background; a person who is called upon to do research in therapy (a field to which psychologists of the future must, for various reasons, devote themselves prominently) cannot work at all without such a background.
Many important problems of an inter-disciplinary, social, and legal nature are raised by such a program, [p. 549] questions which are not pertinent to the discussion here. There is no reason, however, why these cannot be taken care of eventually by the various Committees and Conferences concerned with the problem. We feel that members of other groups, such as psychiatrists, psychoanalysts, and social workers, who have been concerned predominantly with problems of therapy should be called upon, to as great an extent as possible, to take an important role in the teaching of the clinical psychologist. A by-product of this association could not help but be a reduction of some of the difficulties raised by the mentioned problems.
Because of the greater complexity and inexactness of the therapeutic process it would seem reasonable that study in this area begin not before the second year. The work might be introduced by lecture and discussion courses on theory and methods, followed by practicums on simpler therapeutic techniques and on problems such as those which are involved in remedial work and guidance. Therapeutic activity of a more advanced (though still simple) kind should perhaps be left for the internship and fourth years of the program. During the internship, the student should be in an institution where detailed and close supervision is available. In the fourth year he has gained sufficiently in background, maturity, and appreciation of his responsibilities to the client, and to his own and other professions. Really advanced training in therapy is, with few exceptions, a problem of the post-doctoral period which requires considerable thought devoted to it. The courses which should be included are:
1. Therapeutic theory and methods -- Lectures and discussion, introductory course in therapy and counseling; methods and techniques; evaluation of results. There should be considerable emphasis on different points of view in therapy and on common factors in the various forms of therapy.
2. Remedial aspects of special disabilities -- Lectures and systematic supervised practice.
3. Techniques of guidance and counseling -- Lectures and systematic practice under supervision in individual personality guidance and counseling of minor problems.
4. Personality therapy -- Detailed consideration of case material in seminars; carefully supervised practice.
5. Techniques of group therapy -- Lectures, systematic participation, and supervised practice.
E. Research Methods. Because of the academic background of psychology, a natural development has been that of all the disciplines in the mental hygiene field it is psychology which has been most concerned with research. It is important that this interest in research on the part of psychology continue, for as one surveys the scene the likelihood that the major burden of research will fall on the psychologist becomes clearer. If he permits himself to be drawn off into private therapeutic practice as has the psychiatrist, or into institutional therapeutic work as has the social worker, the outlook for research is dim in a field where the need is enormous. As has already been indicated, if a social need for therapy exists, then the need for research is even greater. The fact that there is not equal pressure for the latter is mainly due to the excusable but still short-sighted outlook of the public. The universities, with their more far-sighted orientation, have a serious responsibility to develop research interests and abilities in the clinical psychologists they train. The interest should be in research on the laws of human behavior primarily and on technical devices and therapy secondarily. Throughout the course of training, research attitudes and problems should permeate all aspects of the program, in the diagnostic courses and in therapy, as well as in the courses in general psychology and psychodynamics. The emphasis on personality theory, already mentioned, is closely related and should serve as further support to this point of view. Only from a concentrated attempt to build up such an attitude can we expect to draw from our training programs a substantial number of psychologists who will be interested in devoting themselves primarily to research, and a further number who will devote at least part of their time to such activity.
The courses in this area should include:
1. Experimental psychology -- Conference and laboratory course of a basic kind in experimental techniques, devoted mainly to the consideration of the more meaningful problems in general psychology, e.g., learning, reaction mechanisms, work activity, etc. Consideration should be given to variability of response -- to the significance of the extremes of the distribution as well as to the modal and typical [p. 550] response -- and to the clinical implications of these general problems
2. Advanced statistics and quantitative methods in psychology and psychopathology.
3. Research in dynamic psychology -- Conference and laboratory course which considers the theory and design of experiments in personality characteristics and dynamics; application of experimental and other research methods to the problems in the clinical field.
4. Dissertation -- Preliminary work on the dissertation including the setting of the problem, preparatory reading, and the outlining of the project in detail during the second year. Actual experimental work on the dissertation carried out during the third (internship) year under joint supervision of university and field center. Final work on the dissertation during the fourth year.
F. Related Disciplines. Because of the problems with which he is constantly faced there is no psychologist who needs a broader background than the clinical psychologist. He works in a setting with medical specialists of many kinds: psychiatrists, physiologists, neurologists, to mention the most prominent, and with representatives of other disciplines such as social workers and educators with all of whom he has the closest contacts. On the one hand, his work may have specific physiological implications, on the other, broad educational and social aspects. He cannot be narrow; he must be able to meet his colleagues on common ground and at the same time see what the remoter implications of his findings are.
That an adequate training program could be organized which does not include in it some of the background which such an assignment calls for is inconceivable. It has already been suggested that some of this background should have been acquired during the undergraduate period. But the greater part must necessarily come during the graduate period. Here, too, representatives from other disciplines should be used as much as possible in the training; in fact, it cannot be carried out without them.
The program should include:
1. Physiological sciences -- Lectures and demonstrations. Selected aspects of physiology and anatomy: especially neurophysiology, neuroanatomy, autonomic nervous system, endocrinology, etc.
2. Introduction to clinical medicine -- Lectures. Introductory course in clinical medicine to acquaint the psychologist with the major characteristics of the clinical pictures of various diseases with technical medical procedures which hear about in the settings where he works. Special attention should be given to those diseases which today are usually referred to as psychosomatic.
3. Social organization and social pathology. Lectures and field visits. A course to acquaint the psychologist with social structure; the pathological aspects of this structure as seen in crime, poverty, etc., and the agencies set up to take care of these. The major part of this course could most effectively be given by psychiatrically oriented social workers rather than sociologists.
4. Influence of culture on personality -- Lectures on cultural anthropology's contribution to the understanding of personality.
We might summarize what has been presented in the preceding section, which covered the content of the program according to areas, by a brief statement of the content according to year levels.
The primary purpose of the first year of study is to lay the systematic foundation of knowledge of psychology, to achieve some degree of acquaintance with the physiological and other sciences needed for professional clinical work, and to train the student in good observational technique.
The program of the second year of graduate work is directed mainly at providing the student with the necessary background in the experimental, diagnostic, and therapeutic approaches to the problems of clinical psychology. Although a certain amount of teaching may still be carried on in the form of lectures, the major emphasis is on direct contact with patients, clients, or other subjects, either in the diagnostic or in the experimental setting. Practicum courses and clerkships in different settings are essential element[sic] of this year's program.
The third year consists of an internship whose content is discussed in fuller detail in a later section. The Committee believes that the third year spent in an internship and the fourth in a final year at the university is the most desirable arrangement, although other patterns should be experimented with. The advantages of this proposal are many: (1) The student is enabled to complete the analytic and final work on his dissertation at the university. (2) It permits the final integration of the experiences [p. 551] acquired during the internship with the more theoretical principles emphasized by the university, and emphasizes the unity of the course of training. Otherwise the internship may be considered as a mere appendage. (3) The return of graduate students with internship background to the university should have some influence in integrating the kind of training provided by the university and the internship center. It might also serve as a reciprocating educational influence upon the non-clinical university group, both students and instructors. (4) The student is placed geographically close to the agency which already has an established placement service and is therefore in a better position to aid him in the consideration of employment opportunities.
The program of the fourth year should be relatively elastic and could include most of the following:
1. Final work on dissertation.
2. Cross-discipline seminars (attended by representatives of psychology, anthropology, sociology, social work, psychiatry, etc.) that devote themselves to the discussion of psychology's relation to the other sciences concerned with the adjustment problems of the individual and the group. The purpose of these seminars should be to integrate the major principles of previous study and to point out the broader implications of the course of instruction for the personal and social scenes.
3. Seminar on professional problems -- standards, ethics, etc.
4. Additional courses in psychology as needed to round out the individual student's program.
5. Additional courses in related fields as needed to round out the individual student's program.
6. Advanced therapeutic work, if indicated.
7. A program of self-evaluation, if indicated. (See later discussion of the problem of personal analysis.)
Since certain aspects of the program raise special questions they are considered in this section. The first of these is the internship.
Internship. What are the aims of a psychological internship? Underlying all of its aims is the principle now recognized for the whole clinical psychology program, but particularly true for the internship, namely, that the knowledge essential to the practice of clinical psychology cannot be obtained solely from books, lectures, or any other devices which merely provide information about people or about ways of studying them. Rather, extensive and intensive experience with people is held to be essential if the student is to acquire a proper perspective and the ability to apply effectively the scientific facts and techniques which he has acquired in the academic setting. It should be pointed out that the internship is not a "repair shop" in which the failures of the academic center are taken care of. The university must adequately carry out its function of providing the necessary training in tool subjects so that the student may take the fullest advantage of what the internship is set up primarily to provide, namely, material on which to use these tools. Before he can become either a competent practitioner or investigator, the student must become sensitive to the many relevant aspects of the real person under actual study and learn to view him as an individual. In this process, he also learns to view himself as an essential instrument in the study of other persons. Because of the recognition of these needs, clinical clerkships and internships, the only devices that can accomplish these goals adequately, have been made integral parts of the program.
The major contribution of the internship is the provision of extended practical experience of gradually increasing complexity under close and competent supervision. The building up of an apperceptive mass of experience which gives concrete meaning to general principles can be attained only by volume and variety of contact with actual clinical problems in association with other disciplines. The program should provide the student with a broad base for later specialization by throwing him into full-time contact with human clinical material, contact of a much more intensive kind than he can possibly achieve during the clinical clerkships of the second year. This aspect of the instruction gains its value from being organized around the case material to be found in the institution, that is, the person rather than the condition is made the center of interest. Not only is the person seen in cross- section but it is possible to follow him longitudinally, [p. 552] either as the psychological processes develop and unfold, or as they may have been previously conditioned.
The content of the internship program comprises two major categories of activity: that involving contact with the patients or clients and that involving the acquisition of experience in the administrative sphere.
Contact with clients is of two types: direct -- the acquisition of information from the patient by the investigator himself; indirect -- the acquisition of information from and about the patient through other investigators and sources.
In direct contact with clients the main avenues of approach are those concerned with diagnosis and those concerned with disposition. Each of these requires separate consideration.
A most important aspect of the education of the intern is the further instruction he receives in the use of diagnostic procedures, the procedures directed at acquiring knowledge about the origin and nature of the patient's condition. Under this heading are included a great variety of techniques of different levels of objectivity and degrees of complexity among which history-taking, interviewing, clinical psychometrics and analytic and projective techniques are of particular importance.
An equally important aspect of his direct contact with clients is that involving disposition: what is to be done about the presented problem on the basis of the findings obtained through the use of the various diagnostic procedures. The worker himself may be directly concerned with disposition or he may serve in the role of consultant. In the former, the direct execution of the implications of the diagnosis may be at a technical aid level, at a therapeutic aid level, or at a quite advanced professional therapeutic level. In the latter instance, when the intern acts as a consultant, the recommendations which frequently are part of a much broader set of recommendations deriving from studies made by several disciplines, are carried out by another person. In such a case the intern should have the opportunity to find out how effective are the actions taken with respect to the recommendations he has made, that is, he should at least be able to follow the case through written or oral reports. One of the advantages of the full-time internship is that the student is in a position to follow personally the evaluation and disposition made of the patient whom he has studied. A major disadvantage of part-time appointments is the likelihood of lapses in this follow-up process -- the experience in too large a part consists of a succession of unclosed gestalten.
The direct contact with subjects just discussed lends itself to two different types of approach, each with a different end in view. The first is the service approach, that is, the study of the patient with the aim of solving his particular problem without regard for the general implications involved. I of the work which is done by the inter level. The second is the research approach, that is, the study of the patient not only for himself but for the general implications which his particular problem presents to psychology and psychopathology. This may be based either on a very thorough study of the client as an individual case or as a unit in a series of cases. Research experience, as has been indicated, is an essential part of the background of the clinical psychologist and a considerable part of the intern's time -- perhaps up to one-third -- should be devoted to the study of a problem on which he can accumulate a body of data during the course of the year's internship. This material, as suggested earlier, may very well be used for a dissertation. One of the most valuable contributions of the internship is repeated the repeated opportunity which it affords for intensive team work, for intimate association with members of related disciplines on specific cases and problems. Such practical opportunities for coordinated activity and thinking are indispensable for proper training.
In addition to these direct contacts with a considerable part of the instruction which the student receives involves only indirect contact with them, that is, is about patients with whom he himself has had no direct association. This includes experience of three kinds: (1) individual -- about a particular subject; (2) general -- about classes of subjects; and (3) technical -- about methods used with such subjects.
Indirect contacts with individual patients may arise either within the setting of the institutions psychology department or outside the department. In the former are included conferences and department staff meetings which consider the diagnostic or therapeutic aspects of cases carried by other members of the department. In this type of re- [p. 553] lationship with clients the extra-departmental contributions are usually the more extensive. A major contribution to the student's education is the knowledge which he acquires from regular attendance at the institution staff meetings which consider patients for initial orientation, for diagnosis, for disposition, or for special pedagogic purposes. At these, the student has the opportunity to become acquainted with the contribution made towards the understanding of a case by other disciplines, such as psychiatry, social work, pediatrics, education, occupational therapy, or nursing, and the manner in which the various contributions integrate with the psychological findings.
Contact of the general kind, that is, about general problems and classes of subjects, is obtained by the intern both in and out of the institutional psychology department through lectures, courses, and seminars in one or more fields, such as psychiatry, psychosomatics, neurophysiology, experimental psychopathology, and re-education and rehabilitation, and in the approaches to the problems of clinical psychology from the standpoints of particular disciplines, namely, social work, neurology, psychiatry, internal medicine, pediatrics, education, pastoral work. The student thus continues his "academic" education in the setting of concrete material and personal day- by-day meaningful illustration. This education has the further advantage of being carried on without the interruptions which shifts back and forth in geographical setting entail. During the internship year opportunity is afforded for extensive seminar study of advanced techniques in therapy, and advanced work in diagnosis with such devices as the Rorschach and the Thematic Apperception Test, techniques about which only the first essentials are actually learned in the first courses which are taken at the university.
Another aspect of this indirect contact with patients is the instruction which may be provided in sessions which consider new technical procedures. Here, too, the emphasis should be on the exemplification of the techniques by case material from the clinical setting.
An important point which administrators of internship centers must keep in mind is the necessity for constantly providing experience with normal material. The institutional personnel, by serving as subjects in psychological experiments and tests, frequently offers a rich source in this respect.
There is one other type of experience which is of some importance. We refer to the administrative aspects of departmental activity, including the mechanics of relationships with colleagues, superiors, members of other disciplines, and the institutional administration. At the start of the course of internship the supervision should be close and the supervisor should assure himself of the ability of the student to handle even the simplest problems or procedures. As the student shows increasing competence, the supervision should be proportionately reduced and greater responsibility placed on the students to supervise each other with only a final check by the supervisor. The latter should, however, always be available for consultation. The importance of competent supervision cannot be overemphasized and any institution which accepts the responsibility of providing an internship program must recognize this as one of its important tasks. In the intra-departmental sphere each intern should carry some of the responsibility for departmental functions. This may be in the nature of assisting in the supervision of other interns (rotated regularly among the group), the teaching of students who are serving clinical clerkships, and the care of departmental records of the patients.
A fundamental purpose which must lie behind the process of instruction of the intern is the gradual development in him, through judicious supervision, of a sense of a responsibility and self-reliance in handling clinical problems. The program as a whole should be organized to provide the student with increasing responsibilities commensurate with his growth in the ability to accept these. Such a task requires constant knowledge by the supervisor of the state of the student's progress through active contact; absentee, routinized, or overloaded supervision cannot achieve this goal. The optimum number of students that a supervisor can handle depends on the nature of his other responsibilities; in general, five is about right. As soon as possible, the student should become a productive staff member, one who contributes practically to the service activities of the department. Even if his contribution is limited, as it necessarily is at first, the psychological effect on the student in giving him a sense of responsibility and a feeling of usefulness is [p. 554] great. Such contributions also make the administrators of internship centers more receptive to the establishment and maintenance of internship opportunities.
Another important aspect of the problem of the mechanics of instruction is the way in which the internship is organized. A full consideration of the various types (concurrent as opposed to block or consecutive, straight as opposed to rotating) leaves the Committee with the judgment that the block system, in which a full year is devoted solely to the work at the institution, especially that involving residence there, is to be preferred. As suggested earlier other forms should, however, be experimented with. For the present, too, it seems preferable to concentrate on the straight internship, if for no other reason than because of the much greater simplicity of its organizational aspects as compared with the rotating type. (In the latter the problem is complicated because the student has to move at intervals from institution to institution.) In the medical field rotation has in many instances been found to result in a "smattering of knowledge." This, as well as many other important aspects of the problem, is discussed in some detail in the Sub-committee Report (4), and should be referred to.
What kind of institution is to be preferred for the internship -- child or adult, state or private, mental disease or mental deficiency, out-patient or in- patient? Careful consideration of the problem impresses the Committee that it is not the type of institution which should be the major determining factor but rather the nature of the particular institution. "Good" institutions, that is, those providing opportunities for diagnosis, research, and therapy with a reasonably varied population under adequate supervision, of any type are better than poor institutions of what might be considered a favored type.
These general goals can of course most easily be achieved in large training centers where various disciplines are represented. Too much training in psychology has gone on in starved environments and a change in this respect is long overdue. A major characteristic of the "rich" environment is that concurrent training is provided in a variety of related disciplines, such as psychiatry, social work, nursing and occupational therapy, as well as in psychology. For the latter, it is most important that at least the first two be represented. Such a setting provides the possibility for students of several disciplines to work jointly, under supervision, on common cases. Some of the most profitable learning about the case itself, about the relative complementary contributions of the different disciplines, and about ways of working together effectively for the benefit of the client comes from contacts. Besides the appreciation of the complexity and many-sidedness of the problem which comes from the different philosophies and points of view which are ordinarily represented, there is considerable learning by example from the other disciplines. Instances of this are the appreciation of rigorous experimentation that is derived from physiologist and biochemist, the appreciation of the importance of meaningfulness as represented in the systematic viewpoint of the psychoanalyst toward molar data, and the sensitivity to the practical social implications of a problem that comes from social worker.
Optional Courses. Although the four-year program should have a common core for all those training in clinical psychology, and should in general be similar for all students in the program at a particular university, it is important that a certain degree of option for special courses be permitted. This can ordinarily be worked out most satisfactory in the fourth year, but should be possible at other points in the program. One may expect that the concept of what constitutes desirable clinical training programs will change with the years and best to permit students, through elective courses, to do a certain amount of experimenting with programs as one aspect of this search for the satisfactory program.
Dissertation. Because of our interest in developing a research-oriented professional person it is quite important to retain the feature of the dissertation as part of the requirements for the doctorate. However, universities will have to rethink the whole question of the nature of the dissertation and its proper function, especially as it relates to the present type of program. With respect to its place in the proposed program, advantage should be taken of the opportunity provided by the internship to carry out a research project in the field of major interest to the student, both because of this interest and because it is important for him to obtain research [p. 555] experience in the clinical field. The student can learn as much about the nature and rigors of methodology and make an equally significant contribution to knowledge in working on some problem in personality or in psychopathology as he can in the more conventional fields. Although a dissertation on some aspect of personality which is based on normal subjects in the university laboratory should of course be acceptable, the Committee feels that preference should be given to projects involving clinical material since the student must receive as much training as possible in research with such material. The present program is so organized that research on clinical material could probably be carried out most economically in time if the internship period were utilized for this purpose. In the ordinary course of events, the student would, during his second year, do whatever preliminary work was necessary on his dissertation: he would select the problem with the aid of the faculty and the supervisor at the prospective internship center, and draw up a project outline. If preliminary experimentation is necessary it might be possible to carry this out at the university or at one of the clerkship centers. During the internship year, the student would collect the data for the dissertation. Supervision of his project should continue a joint responsibility of the university and the field training center. When the student returns to the university for his fourth year of work, he would be in a position to do the final analytic work and writing.
It is our hope that as a result of the more extensive and careful selective devices which this program is advocating, the dissertation will become much less of a major hurdle than it has heretofore been. As in professional schools, the student should by the end of the second year be so certain of having been carefully screened and of having met the requirements as to capacity and achievement, that, given conscientious attention to the balance of his program, there should be little doubt about his completing the course. The development of such an atmosphere would do a great deal to reduce the anxiety with which the latter part of the PhD program is so heavily laden, an anxiety which is largely created by the multiple and generally illogical uncertainties connected with the dissertation. If such an atmosphere can be developed the productivity of students during this period would certainly become greater.
Integration of Academic and Field Program. After what has already been said in different sections of this report it is unnecessary to discuss further the importance of integrating the two parts of the program. The techniques of implementation, however, require additional consideration. The problem of integration arises with respect to three aspects: (1) content, (2) supervision, and (3) accrediting and certification.
For the program to be most effective the content provided by the two teaching centers must be well integrated. In this respect, faculty members have in the past been quite lax. They have left too much to the student the task of correlating and integrating the material in the variety of courses which he has taken at the university. The integration of university and field center activities has been neglected even more. If training is to be optimally effective, strenuous effort will have to be directed at correcting the situation. In order to achieve such integration the whole group must become essentially one faculty. Arrangements for reciprocal visits and conferences between the staffs should be made to discuss such problems as the points of view to be emphasized, the techniques of teaching, and the avoidance of overlap. It is most important for the instructors at each place to know the general content of the teaching at the other. Such mutual acquaintance would go far towards making easier for the student the transition to the internship center and back to the university.
In the matter of supervision an integrated program must also be achieved. The supervisor at the internship center must obviously be held responsible for the major part of the student's activity. If the candidate is to use his available research time at the institution for work on his dissertation, a very close relationship between supervisors and agreement as to the division of supervisory responsibilities must be achieved by the two groups. The appointment by the university of several of its instructors, on a rotating basis, to act as field supervisors should be considered. It would be their responsibility to hold scheduled conferences with the interns in order to maintain contact with them and help supervise their dissertations.
All of the aspects requiring integration point to [p. 556] the obvious need for a combined responsibility in setting and maintaining standards. Such unification can only be achieved by accepting the internship center as an institution of comparable status with the university and in some respects an integral part of it. This can be achieved by interchange of personnel, joint conferences, and by interchange of student visits. There is no better way of achieving integration than through an interchange of staffs. The teaching staff of the university should be encouraged to spend summers or other periods at the institution on guest appointments. The staff of the institution should be given temporary full-time or permanent part-time appointments at the university on a regular faculty or lectureship basis. The latter arrangement is generally quite practicable and does not become too involved in the problems of university administration.
Self-evaluation. As psychologists become more involved in the clinical field, they become increasingly impressed with the importance of the observer as instrument. An important aspect of this problem, one which arises particularly in dealing with motivational questions, is the degree to which one's own biases, affects, and problems, frequently only different from the patient's in intensity, color the material provided by the patient. It has become obvious to those working in the clinical field that some kind of control of this source of error is necessary. Psychiatrists and social workers, from their more extended experience with this type of material, have long accepted the principle of the need for intensive self-evaluation as a prerequisite for their work, especially their therapeutic work.
Psychologists, in our opinion, must come around to the acceptance of some kind of intensive self-evaluation as an essential part of the training of the clinical psychologist. We are not prepared to recommend any special form of such procedure, although some of us believe that whenever possible this should take the form of psychoanalysis because of its relative completeness. Others of us believe that shorter methods of self-evaluation, because they may be less time-consuming and less indoctrinating, are preferable. Whatever the form, training should include detailed self-examination under the competent guidance of persons relatively free from dogma who have an interest in psychological theory as well as in therapy.
Psychologists can adopt from social work a procedure that has been found effective in achieving at least partial self-knowledge. We refer to their use of detailed case supervision of students. As a result of almost daily contacts with the on his own cases a relationship is established between the sensitive supervisor and student which may indirectly have therapeutic benefits. Such a setting makes it possible for the student to examine critically his own behavior and interpretations as they grow out of his handling of case material and provides an opportunity for considerable personal growth. The profit from these personal contacts is increased when backed up by classroom discussion of cases on a less personal motivational basis.
Administrators of training programs should make an effort to promote such supervisory practices and canvass the possibilities for the more intensive type of self-evaluative experience in their own regions. Students, during the last part of their doctoral training, or immediately after this training, should be encouraged to undertake such a program.
Professional Responsibilities. No group can become a profession overnight, a fact which psychology is in the process of discovering.
What really counts in the making of a profession -- professional ideals and practices -- cannot (un)fortunately be taught in courses. Proper technical training, professional certification and state certification, of course, play important roles. More important, however, are identification with a group having high ideals, and constant association in the actual work situation with persons having professional goals. It is in the work relationship that the student can learn to think of himself as a professional person. It is here that the student can gain an appreciation of how people meet such problems as maladjustment, illness, and handicaps and in this context gain a feeling of responsibility about his work because he understands that his findings really make a difference in what happens to an individual and his family. It is here that to carry, in addition to this responsibility for the individual, the broader social one which transcends the need of the individual patient. It is in this setting, too, that another important aspect of professional training, his relationship with other professions, is constantly brought to his attention. He learns the techniques and importance of the [p. 557] group attack on problems: how best to work with other professional groups for the benefit of the individual client and the frequent necessity for identifying himself with a group even broader than his own professional group, namely, the "team."
If the student, after having achieved strong identification with psychology, learns to divest himself of this identification in order to become part of larger wholes for the benefit of a patient or a group, then he may be said to have achieved true professional growth. It is in this setting that ethical problems constantly arise and that the greatest learning in dealing with them naturally occurs. When this opportunity for "field" learning has been afforded, then "talk" learning becomes profitable. Seminars on professional and ethical professional problems have a contribution to make and should generally be made available during the fourth year. In these courses the ethical problems that arise from relationships with clients, and those that arise from relationships with other psychologists and with other professions and the public should be considered, especially as they develop from concrete situations.
Student Relationships. We have stressed, in one context or another, the importance of the development of a sense of responsibility. Such a sense comes only in proportion to the opportunities for practice afforded a person. Besides those we have already discussed, another area where students may exercise responsibility is in helping to shape the program in which they are enrolled. Such thinking about professional problems, whether group or individual, should be encouraged, as should the organization of colloquia which the students themselves administer. The opportunity to express themselves freely on policy will insure reduction in the dissatisfactions and irritations which naturally arise in any program.
Another aspect of this problem has to do with the individual problems of the students -- whether personal, or connected with the program. Provision should be made for adequate conferences on such problems when they arise. In fact, each student should have an active advisor whose responsibility it would be to keep track of the student's progress and who would be readily available to consider his individual problems.
Evaluation of Accomplishment. A problem which necessarily follows the organization of a program such as the one outlined is that of accrediting and certification, that is, the official recognition of the adequacy of those who take part in it -- the student, the university, the field center.
For the student, at the various levels of individual advancement, some appropriate symbols of achievement seem necessary. The following are suggested:
1. Doctoral degree following the four-year course of professional preparation. Although there are some professional groups, notably the legal, which practice on the basis of a bachelor's degree, there are various considerations which make it doubtful if anything less than a doctoral degree would be satisfactory for the practice of clinical psychology.
2. Membership in the special division of the professional association of the group, the American Psychological Association's Division of Clinical and Abnormal Psychology. The first grade of active membership, Associateship, as recommended by the Policy and Planning Board (2) would come for participants in this program, with the attainment of the doctorate; the second, Fellowship, with an additional five years of acceptable experience -- essentially at the level of diplomate as discussed later.
3. After a year's post-doctoral experience would come state certification as recommended in the Policy and Planning Board Report (2). Closely linked with the problem of study beyond the doctoral degree is that resulting from the establishment of the American Board of Examiners in Professional Psychology (3). This Board has as its function the certification of candidates who after five years of actual experience, three years of which have been spent in recognized training centers, have passed examinations in stated aspects of the field of clinical psychology. (The nature of this advanced residency type of training requires special consideration and is not directly pertinent to the present problem. We hope to consider the matter in a later report.) Diplomas of the Board would serve as evidence of competence in the specialty of clinical psychology. Such a program emphasizes the important point that the attainment of the doctoral degree is only a step in the process of professional education, an education which continues through to specialist rating and beyond; in fact, throughout professional life. [p. 558]
Training universities and field centers as well as students must be evaluated. The universities should be evaluated according to their ability to meet the requirements set forth by this program. (Our Committee has been charged with such an evaluation and hopes to be able to commence this task shortly,) Not only the formal meeting of standards with respect to the courses given but the actual quality of the courses, as it relates both to content and instruction, should be carefully scrutinized.
The field centers should be given the same careful scrutiny as the schools. Standards as to content, quality, and amount of supervision, facilities (personnel, clinical, library, teaching), and living arrangements, should all be carefully set up and used in the evaluation. Since it is likely that the degree of expansion of clinical psychological training will depend to a great extent upon the number of really adequate internship centers which are available, considerable effort should be directed by universities to encouraging their development.
The Committee on Training in Clinical Psychology believes that the program outlined in the present report, if effectively carried out, should provide the basic background for clinical psychologists who will undertake both teaching and practice functions in the diagnostic, therapeutic, and research aspects of the field. This program, it believes, should also prepare persons who can eventually contribute to its preventive aspects, a goal towards which more and more of our future efforts must be directed.
The Committee on Training in Clinical Psychology therefore recommends to the Council of Representatives:
1. That the present report be endorsed.
2. That the program here outlined be presented to the universities offering doctoral training in clinical psychology as a recommended program.
3. That the report be recommended for publication in The American Psychologist.
ERNEST R. HLGARD
E. LOWELL KELLY
R. NEVITT SANFORD
LAURANCE F. SHAFFER
DAVID SHAKOW, Chairman
[*] The Committee wishes to acknowledge with gratitude the support received from the following persons who read preliminary drafts of the report: Mrs. Ethel L. Ginsburg, Mrs. Elizabeth Ross, Drs. Alan Greg, Robert R. Holt, James G. Miller, and David Rapaport.
 We shall have occasion to refer repeatedly to "dynamic psychology," a term which has to some extent taken on the "blessedness" of James’ old lady’s "Mesopotamia." Because of this, the term is not in good repute with some persons. However, we find no term so satisfactory for describing what we have in mind -- the "how" and "why" of human behavior as opposed to the static, structural "what." Without getting involved in what would in the present context be merely irrelevant semantics, the definition given in Warren: "A systematic interpretation of mental phenomena, regarded a succession of cause and effects with emphasis upon internal drives and motives" or the definition provided by one of us: "Fundamental theories of motivation, conflict, and resolution of conflict, applied to an understanding of normal and abnormal behavior" essentially describing what we refer to as "dynamic" psychology."
 The words "patient" and "client", although not quite satisfactory terms for the person with whom the psychologist establishes "interpersonal relationships," are used throughout this report, either together or singly, but always interchangeable. Because of the variety of situations in which the clinical psychologist is called upon to work -- medical and non-medical, normal and abnormal — either term accurately designates all the persons with whom he deals. The old psychological term "subject" is sufficiently broad, but unsatisfactory because of its implications of exaggerated dominance and direction; the other old term "observer" is even more unsatisfactory because of the implication of emotional distance and marked non-dependence which it carries. For the present, to avoid awkwardness in expression, we must be satisfied with "patient" or "client," with the understanding that either term carries the broader meaning here indicated.
 At this point and elsewhere when specific courses are considered we have deliberately refrained from indicating the semester hours to be devoted to them. We conceive of some of thee as being three-hour courses and others as much as 12-hour courses. The decision as to their length had best be left to the individual university.
 Psychotherapy is a process involving interpersonal relationships between a therapist and one or more patients or clients by which the former employs psychological methods based on systematic knowledge of the human personality in attempting to improve the mental health of the latter.
. The term internship (residence appointment) is used in this report interchangeably with the externship (non-residence appointment).
1. American Association for Applied Psychology. Commitee on Training in Clinical (Applied) Psychology. (B. Moore, Chairman.) Proposed program of professional training in clinical psychology. J. Consult. Psychol., 1943, 7, 23-26.
2. American Psychological Association. Annual Report of the Policy and Planning Board: 1947. Amer. Psychologist, 1947, 2, 191-198.
3. American Psychological Association: Committee on the American Board of Examiners in Professional Psychology: Report. Amer. Psychologist, 1946, 1, 517.
4. American Psychological Association and American Association for Applied Psychology Committee on Graduate and Professional Training: Subcommittee report on graduate internship training in psychology. (D. Shakow, Chairman.) J. consult. Psychol., 1945, 9, 243-266.
5. FLEXNER, A. Medical Education. NewYork: Macmillan, 1925. Pp. ix + 334.
6. GREGG, A. (Chairman.) The place of psychology in an ideal university. The report of the University mission to advise on the future of psychology at Harvard. Cambridge: Harvard University Press, Pp. 42.
7. KELLY, E. L. Research on the selection of clinical psychologists. J. clin. Psychol., 1947, 3, 39-42.
8. KUBIE, L. S. (Chairman). Training in clinical psychology. Transactions of the First Conference, March 27-28, 1947, New York, N. Y. New York: Josiah Macy, Jr. Foundation, 1947. Pp. 88.
9. MORROW, W. R. The development of psychological internship training. J. consult. Psychol., 1946, 10, 165-183.
10. SEARS, R. R. Clinical training facilities: 1947. A report from the Committee on Graduate and Professional Training. Amer. Psychologist, 1947, 2, 199-205.