Transcript for Video Clip: Dr. Gloria Hamilton (Clinical Psychology)
Interviewer: Welcome to our next guest speaker. I'm going to go ahead and have her introduce herself, and briefly describe her area of specialization.
Dr. Hamilton: Hi, my name is Gloria Hamilton, and my doctorate is from Vanderbilt -- actually, Peabody College at Vanderbilt University. And it's in clinical psychology, which was called "transactional ecological psychology," because it's a more holistic approach than a traditional clinical psychology approach. My specialization is in child and adult. I have a couple of specialties, substance use disorder (post-doc) and chronic pain. And I like both of those.
I: Could you tell us what you see are the career opportunities for students who specialize in this area? In other words, what are some of the things that a person can do in clinical psychology?
Dr. H.: Sure. Well, it's important to keep in mind that ours is not a static discipline. Our discipline changes. Our area changes. Clinical psychology, really, was generated out of a need that the V.A. [Veterans Administration] Hospital had, and V.A. Hospital really contributed and promoted the birth of clinical psychology initially. V.A. is moving in a different direction, and unfortunately we are not seeing some of the original career opportunities still there. I'm not saying the V.A. doesn't need clinical psych. It's just that the V.A. has chosen to go a different route. Most of the people who graduate with doctorates in clinical psych at this point go into the field of health -- health care or behavioral medicine, or health psychology, or working in a hospital setting.
Fewer than 4 of 10 new Ph.D.s in clinical psych go what we think of traditionally as clinical psych, which is private practice. One of the reasons for that is because the median income, according to the 2004 stats, was like $54,900. That's not really high. If you're talking about going into private practice, a large share of your income goes for overhead. So, it turns out that most people who now graduate with a Ph.D. in clinical psych and do their pre- and post-docs, end up going into health care in an existing agency. There are problems and pitfalls with that as well, because if you go into a hospital setting, hospitals traditionally look at the bottom line, and programs come and go according to the bottom line. So, I would highly recommend that whoever goes this, if you decide to go this direction, that you get well prepared in many different facets of working in clinical psych.
I: Okay, that kind of bears on my next question, which is can you describe what a typical workday might be for somebody working in this area, if there is one?
Dr. H.: If you go private practice, you're hoping your clients show, and you're hoping the insurance will pay your clients if you're on a provider panel. Or sometimes in private practice, you just charge less, and people pay out of pocket. So if you're in private practice, you tend to see maybe five clients a day, maybe on average. You need to schedule enough time between clients that you can keep up with your paperwork, because that's a big issue. If you take insurance payments, paperwork will eat up a lot of your time, a lot more than what you expect. Whatever you expect, triple that, and then hire a person to help you out on that as well. Because it's notoriously a quagmire for psychologists.
If you're not in private practice, and you work in, for example, a hospital setting, then your hours will vary according to the need. You may go in at like 9:00 in the morning and work until late afternoon or early evening. You'll do things like bedside consults, or you work with physicians working out diagnostic kinds of issues. Or you work in a hospital program, for example, in chronic pain or in eating disorders. In those cases, you work as part of an interdisciplinary team. So you may be doing individuals, you may be doing intakes, you may be doing group work, you may be working with families. There's just a lot of different ways you work.
If you work with a community agency, typically with a Ph.D., they want to put you up in administration. The problems with that are you don't get to work so much with clients and you're isolated in administrative types of tasks, and those aren't fun. But they figure, more education, you want more money. More money is in administration, so they bump you up the line, leaving people without the Ph.D. often to provide direct service, and that's really unfortunate.
I: How about the training requirements to be able to do the kinds of work that you're talking about?
Dr. H.: Okay, we're talking about approximately 5 years on a doctoral program, and then you do a pre-doc internship. This is if you go Ph.D. route. If you go Psy.D. route, it's a little different. Psy.D. route, you do applied right along with your coursework. So in a Ph.D., you don't get as much direct service (client time) as you do with a Psy.D., as you're going through the program. However, you have to have a pre-doc internship in both. And then you have a post-doc. And the post-doc, we're really talking about approximately two years in most states that you do a post-doc. So you're talking about a 7-year investment, when you're not earning any income. If you're in a Ph.D. in clinical psych, which are pretty hard to get into, but if you're in one, they often will pay you, and that's what you want. But still, you're earning minimum wage, and you're not earning mega-bucks. If you're paying your own way, then you're borrowing money in addition, you've got 7 years without income. So, that's something to think about.
And I want to make a point here that I think is real important in career counseling, because I do a lot of career counseling. Think in terms of, "What do I want to do?" "What do I want to do with my life?" "What would make me happy?" "Where do I see myself in my dream job 10 years from now?" And when you get that fairly clearly in mind, then go to people who do that work. We're isolated and insulated in academe. A lot of people in academe don't work outside of academe. I do, but that's not the norm. So people in academe don't experience the real world of clinical psych outside of the university, by and large. So, go to people who actually do the work, ask them (and it may not be clinical psych, they may be something else), ask them what degrees they have, what training they have. So you ask yourself, "What do I want to do?" You go to people who actually do it, and ask them about it, and then you ask them (and you), "Who's going to pay me to do this work?" And then, what degrees I need to do the work. Because people assume a lot of times, it's like a Ph.D. in clinical, where in actuality, APA [American Psychological Association] makes no distinction between internships in clinical psych and counseling psych. But most people don't even know what counseling psych is, because there's this mystique about clinical. So, make sure you know what you want to do first, and then start gearing up in that direction.
I: Is there a certain kind of person who you think is best suited for working in clinical psych? Or, put another way, what personal characteristics do you think are most important for somebody working in this area?
Dr. H.: Well, in actuality, clinical psych programs make their choices based on GPA and GRE. I've actually been in a situation where I saw a colleague asked to leave a program because while GREs were 1600 and GPA was 4.00, and it was a highly prestigious Ivy League bachelor's degree that he brought to the program, he couldn't relate to people. So, I think it's a mistake that clinical psych doctoral programs put their emphasis on paper. And so they don't meet the person before they come in. All they're looking at is "We want that GRE at the top of the score, and GPA at the top!" For example, 1350 is a median GRE. Well, that's pretty high, and everyone has a 4.00 undergrad GPA. But that doesn't make them a good therapist. So I think, maybe, clinical psych doctoral programs often have emphasis in the wrong place. I meet students at MTSU who are so good at relating to people, and they say to me, "I could do this work if they would let me in." And I'm listening, and I agree. Unfortunately, the hurdles that doctoral programs put, preclude a lot of our students.
So if you're looking for a doctoral program in clinical psych, and that's just absolutely what you have to have, then look south, look at places most people don't look at. Vandy says it's not a regional university, so look at universities that are state-operated universities. And then look outside the psychology department, because a lot of them have doctorates that are licensable. And that's the last thing. In most states, with Ph.D. in psychology, to be licensed, it has to be in clinical, counseling, or school. And they make no distinction at the state level. You claim your area of expertise, based on what you've done and been trained in.
I: OK. Just a couple more questions. What would you say are the major positives (you've already kind of talked about this) and major negatives about working in this area?
Dr. H.: The major positives have to do with how flexible you are, and how open to new experiences and new training. Because, if you look ahead and stay current, and keep training, keep adding skill sets, then you can make it with or without a Ph.D. in clinical psych.
The negatives are that clinical psych is expensive. Its insurance pays less and less. If you're on a provider panel, you give up some of your legal rights, and you give up potential income. If you work in a hospital setting, you can go home on Friday night, thinking about what you're going to do on Monday, and you show up Monday, the unit's locked, and they give you two hours to clean out your desk, and you're gone because the hospital says your unit's not cost-effective. I have watched friends of mine go through these experiences again and again.
It may be that your love is, for example, working with anorexia nervosa, and that's what you want to do. You think, "Gee, clinical psych is the only way. I have to get a doctorate." In actuality, find out how many Ph.D.s in clinical psych work in this area. Most of the work that's done isn't done by clinical psychologists. You really need to invest yourself in finding out everything you can about the real world of what it is you want to do. Go with the flow on negatives. I do consulting with Ph.D. clinical psychologists, who are licensed, who say, "What can I do to make a living?" You need to do that out before you make decisions about higher education.
I: That was pretty much my last question and you've already answered it, I think. What advice would you give to interested students about preparing for a career in this area? Is there anything else you'd want to add to that?
Dr. H.: I think getting a mentor off campus, getting a mentor out in the community, and talking to a handful of people, so that you really get some good, good feedback. And be aware that by the time you practice, things are going to be really different. So, you're going to be looking way ahead to know how to position yourself. I was trying to think, was there anything else?
I: Well, we're going to be including some other resources online for students to follow up, some web sites and resources, and so on. So, we'll see everybody back online!
Dr. H: My office number is Jones 102, my number is 898-5745. I love to talk to students, and I love to do career counseling.
I: Thank you Dr. Hamilton!