Becoming a Clinical Psychologist

By: Lilla Dale McManis, PhD

Last Updated: December 21, 2018

Clinical psychologists help people who are struggling with mental, emotional, social, and behavioral disorders by applying their extensive knowledge and expertise in assessment, diagnosis, treatment and prevention. Typically these psychologists focus on more severe issues than do counseling psychologists. Clinical psychology represents the largest subfield within psychology.

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According to the National Institute of Mental Health, approximately 44 million (1 in 5) U.S. adults have a mental health disorder, with just half receiving treatment. This makes clinical psychology a robust and growing field that provides ample opportunity to work with and on behalf of individuals in your area of interest and preferred setting. Becoming a clinical psychologist involves many years devoted to the educational and training requirements. The career itself is on the demanding side, but there is a pressing need for these services and those who enter this profession derive a great deal of personal and professional satisfaction from their career choice.

Clinical psychologists work directly with patients/clients, conduct research, and teach. They can work with individuals across the lifespan, but many choose to focus on a particular age group such as children, adolescents, adults, or the elderly. Clinical psychologists often specialize in one area such as depression, substance abuse, autism, post-traumatic stress, brain injury, or violence.

With a new client, clinical psychologists start by assessing using psychological tests, interviewing, and observing. Significant others may provide information particularly if the client is a child or an adult unable or unwilling to provide the needed information. Because clinical psychologists tend to work with individuals with disorders, this process allows them to learn whether the client meets the criteria for a diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) and, if so, the degree of severity. Clinical psychologists use this information, along with a preferred approach, to determine a course of therapy. Therapy may be provided individually, in a group setting, or both. There are four main types of therapeutic approaches, although some clinical psychologists use a combination.

• Psychoanalytic/psychodynamic is characterized by uncovering the unconscious meaning and motivation behind the client’s feelings, thoughts, and behaviors in a close and typically long-term relationship with the therapist
• Behavioral explores the role played by the learning of abnormal behaviors; therapy consists of the client learning more normal and appropriate behaviors, often using conditioning with positive and negative reinforcement
• Cognitive focuses on a client’s dysfunctional thinking that drives problematic behaviors and emotions; changing these subsequently transforms behaviors and emotions to be more normalized
• Humanistic revolves around the natural capability of human beings in general to make choices which are rational and to reach their maximum potential, with the therapist as guide rather than authority figure

Compared to those who solely provide direct client care, clinical psychologists who conduct basic or applied research often align similarly with regard to the population and/or type of disorder in which they specialize. With basic research, the clinical psychologist might study the systems of the body and brain, such as genes or biochemical mechanisms, as they influence behavior, thoughts, and emotions. Or they might investigate psychological theory. Applied researchers most often look at the application of science; examples would be determining which treatment approaches work most effectively for a particular disorder, or how to prevent a disorder in the first place.

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Clinical psychologists are able to work in a large number of settings including private practice, mental health hospitals, treatment centers, prisons, military bases, and higher education. Since their clients are generally experiencing more severe problems, practitioners are less likely to work in K-12 schools or community-based organizations. Those providing direct care in institutions such as hospitals, treatment centers, and prisons are usually part of a team that delivers a consistent and comprehensive support system. Working in institutions likely means keeping a stricter schedule, as well as potentially heavy caseloads, but this is often where the greatest need for their services resides.

Many clinical psychologists are in private practice, either alone or in a practice group with other similar psychologists. Private practice also allows the clinical psychologist to take on clients in their area of specialization. Those more senior often supervise clinical psychology interns.

There are also many opportunities for clinical psychologists who choose to teach at the post-secondary level or conduct research in universities, think tanks, and research facilities.

Hover over any state to explore local income and job growth data.

The current mean annual income for a clinical psychologist is $78,690, according to the U.S. Bureau of Labor Statistics. This is roughly $35.59 per hour. The salary of a clinical psychologist is influenced by experience, specialty, and location. Salaries for those just starting their careers might be closer to $41,830, which is the median of the bottom 10% of earners. The top 10% of wage earners make a median of $120,320. Those in hospitals, R&D and health practitioners’ offices typically have higher salaries, as do those working in major urban areas. The degree of specialization is another factor that affects the level of compensation.

The job outlook for psychologists is promising. Clinical psychology is a growing field; the BLS expects the demand for clinical psychologists in the United States to increase by 20% from 2014 to 2024, which is much faster than average job growth overall.

The APA recommends specialization for those entering clinical psychology. Areas on the cusp of major growth include:

• Geropsychology (elderly populations), as the number of Americans over 65 will double by 2050
• Neuropsychology (brain and nervous system) due to major advances in imaging technology
• Post-traumatic stress disorder (PTSD) as a viable area of specialization, due to the growing number of veterans suffering from it

With clinical psychology being the most popular subfield, there is a high demand for qualified instructors as well. But keep in mind that many universities are going the route of hiring adjunct faculty (part-time instructors) to teach courses, making securing a full-time faculty position challenging.

Majoring in clinical psychology – or, at a minimum, completing substantial coursework and having work or volunteer experience related to clinical psychology – is recommended to promote acceptance into the doctoral program of your choice.

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States almost universally require a doctorate for licensing as a clinical psychologist. A master’s degree is generally expected before entering a doctoral program, but in some universities these degrees are combined. If you’re certain you want to become a licensed clinical psychologist and are able to enroll in a combined program, it will be the most efficient path toward your goal.

When selecting candidates, programs commonly make decisions based on coursework, experience, and standardized test scores (such as the GRE-Graduate Record Exam). Clinical psychologists have an option of a PhD and or PsyD. Both require coursework and an internship, but a PhD in addition requires a dissertation of original research. A PhD prepares you for research and/or practice and to teach, whereas a PsyD is designed for those more interested in practice, although you can still participate in research in some settings as well as teach. Both require a supervised internship of at least 2,000 hours. Keep in mind that as clinical psychology is a popular choice, internships are competitive. The PsyD is a newer degree, but is gaining popularity with its focus on clinical practice, shorter time to complete, and higher acceptance rates into doctoral programs compared to a PhD.

The length of time to receive a doctorate depends on whether you already have a master’s, whether you take the PhD or PsyD route, and the various requirements of the individual university. But in general, the average length is 5 to 8 years. It’s important to be aware that earning a doctorate is expensive, with almost three-fourths of graduates having debt between $10,000 and $100,000.

Supervised practicum training approved by the APA through the internship and post-doctoral level (another 2,000 hours on average) is expected prior to licensure.

For clinical psychology, licensure at the state level is required to practice/provide direct therapeutic services in the U.S. The majority of states require the doctoral program to be regionally accredited or government-chartered and many require it to be APA (American Psychological Association) accredited. The APA does not accredit entirely online programs at this time.

A major component of the licensure process is to sit for the Examination for Professional Practice in Psychology (EPPP). To reduce obstacles around licensure, it is vital to choose a doctoral program carefully. Those who teach or conduct research and work in universities, state or federal agencies, research labs, or corporations may be exempt from licensure requirements, though this varies by state.

In order to practice as a clinical psychologist, you’ll need to earn one of the following doctoral degrees:

• Doctor of Philosophy (PhD). Best option if you hope to conduct research or teach at the university level.
• Doctor of Psychology (PsyD). A good option if you plan to focus on clinical practice rather than academia.

But before you can attend graduate school, you’ll have to earn a bachelor’s degree. During your undergraduate years, always remember that admission to clinical psychology doctoral programs is highly competitive. You can prepare by earning a bachelor’s degree in psychology (or a closely related behavioral science).

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Good grades matter; try to keep your undergrad GPA above 3.0. Earning a master’s degree in psychology can also give you an edge. Finally, research and teaching experience can do a lot to strengthen your application.

Most doctoral programs in psychology are found at large research universities. Some follow a generalist curriculum. Others focus on a specialty like child and adolescent psychology, health psychology, or neuropsychology.

There are many benefits to attending a doctoral program accredited by the American Psychological Association (APA). For one, holding a degree from an accredited school makes it easier to get licensed and certified after graduation. In addition, some employers hire psychologists from accredited programs either exclusively or preferentially.

Clinical psychology doctoral candidates spend a year or two taking courses in:

After a year or two, doctoral candidates begin a series of supervised fieldwork experiences called practica. The final year of the program is spent working full-time in an APA-approved internship.

PhD candidates in clinical psychology also spend considerable time in the psych lab assisting faculty and designing their own studies. These activities culminate in an original research project and dissertation.

After graduating from a PhD program, many clinical psychologists complete an additional year of specialty training called a postdoctoral fellowship. In many states, fellowship training is required to practice clinically. Psychologists with academic aspirations often complete research fellowships to strengthen their resumes.

Clinical psychologists (and psychologists in several clinical subspecialties) can pursue optional board certification with the American Board of Professional Psychology.

Candidates must be graduates of APA-accredited programs and licensed to practice. They must also meet education and experience requirements specific to their specialty. Each specialty also has a slightly different exam process.

Board certification is available in the following clinical specialties:

• Clinical psychology
• Clinical child & adolescent psychology
• Clinical health psychology
• Clinical neuropsychology

To explore the clinical psychologist’s career further, here are some action steps:

• Learn more about clinical psychology at the American Board of Professional Psychology and the American Psychological Association
• Interview clinical psychologists in your community. The APA and Psychology Today Therapists provide in-depth profiles and allow you to search by location and then by area of specialty, ages served, treatment orientation, and more.
• Volunteer. To determine if this is what you would like as your career, it can be illuminating to work with those experiencing psychological disorders. You can find such opportunities by using sites like Volunteer Match or Mental Health America.
• Evaluate educational programs. The Office of Graduate and Postgraduate Education and Training from APA has an excellent database of accredited programs. You can search by state, specialization, and degree with a direct link to the program to learn about individual programs including course work, faculty, and admissions. Learning more about the differences between a PhD and a PsyD can also be helpful.