Internships in Counseling: Shedding Light on the Explosive “Match”

ExplosiveMatchIn a world that revels in reports of lack, limitation and shortages; a merciful dawn is on the horizon for doctoral students in the field of psychology and counseling. In 2011 what was deemed an “internship crises,” “severe shortage,” “academic nightmare” and “a totally unacceptable situation” by experts in the field is thankfully being addressed and permanently eradicated.

Potential counselors and psychologists are not alone; career crisis is an equal opportunity employer. Airline pilots were occupationally hazed in the late 1970’s with deregulation of the airline industry.  Future airline flight-engineers, who had for decades immersed themselves in study and training; all the while accepting low-level positions, reached their destination only to find that they had touched down in a tornado. From 1978-2002, nine of the major employing airlines  (Eastern, Midway, Braniff, Pan Am, Continental, America West Airlines, Northwest Airlines, and TWA) as well as over 100 mid-level airlines filed for bankruptcy. Entry-level salary for new hires nose-dived to a monthly amount so low that dry-cleaning the pilot’s uniform was a hardship.

The recent decade has continued to initiate the educated and hungry. Law school students graduating with up to a quarter of a million dollars in debt and hopes soaring high as eagles, continue to serve up coffee at Starbucks and work retail. The reason? Internships are nowhere to be found.  In fact, according to both the New York Times and the Los Angeles Times there are over 20 class actions lawsuits filed across the nation charging law schools with misrepresentations regarding employment promises as well as implied internships.

It seems to be a fact of academic life that if a career takes great dedication, a good chunk of time and significant monetary commitments; socio-economic forces will somehow culminate to rear an ugly, discouraging head.

The Match: A Dim History

In his article, “Intern Gap Frustrates Clinicians in Trainingaward-winning New York Times journalist, Joseph Berger masterfully describes what the “Match” is and what the situation has been in the past;

“They call it ‘the match.’ Every year, thousands of graduate students in clinical psychology pick the hospitals and clinics where they would like to do yearlong internships. They rank their choices. The internship programs also rank the applicants.

A computer algorithm then digests the lists in an attempt to link mutually desired applicants and programs. But in recent years the process has broken down: In psychology, there are simply not enough internships to go around…Students who do not match must hunt for unaccredited internships, positions that can hobble their careers. Almost half end up without an internship at all and must try again the next year.”

Doctoral students without internships or even some with unaccredited ones are left without the ability to be licensed and therefore unable to practice their profession.  In 2011 Dr. Melba J.T. Vasquez, PhD, ABPP, then president of the American Psychological Association delineated the situation in her article, “The Internship Crisis: Strategies and Solutions;”

“Every year, more than 3,000 students apply for an important aspect of their doctoral programs in professional psychology: a doctoral internship. The Association of Psychology Postdoctoral and Internship Centers (APPIC) match connects psychology doctoral students with internship programs that provide a required year of experience working with clients or patients under the supervision of a licensed psychologist. Following rounds of interviews, applicants and programs submit their preferences and a computer program matches applicants with available positions. Unmatched students may seek internships through a second round of the match (called Phase II), or through the APPIC Post-Match Vacancy Service, or apply again next year. Not matching to an internship can delay and complicate the path to a doctorate for many students, and often has significant financial and emotional consequences as well.

For at least three years now, one-fourth of all students who applied did not get ‘matched.’ In fact, this year, a record number of 4,199 registered students applied to a record number of internships; 3,166 positions were offered by 690 registered internship sites. These numbers reflect an increase of 309 applicants and an increase of 65 positions as compared with last year at this time.

Particularly concerning is the fact that 937 students — or 24 percent — who participated in the match did not get matched to a position in Phase I of the match, while only 256 positions remained unfilled. Further, of the 4,199 who registered to take part in the 2011 match, 352 withdrew or did not submit rankings.

These results are unacceptable."

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The Federal Factor

Mental Health EssentialsAs if the situation was not already challenging enough; recently implemented federal mandates are literally a calling of the APA to arms. The Affordable Care Act has guaranteed that medical insurers must provide 10 essential benefits, one of which is “mental health and substance abuse disorder services, including behavioral health treatment.”  This particular benefit presents state and local providers with a requirement they are not prepared to meet. While the reality will have institutions of higher learning doing back-flips; it presents an additional demand with regards to internships.

The United States Department of Health and Human Services (USDHHS) has stated that The Affordable Health Care Act expands “mental health” and “substance use disorder” benefits for 62 million Americans. Four specialists at the USDHHS published an article regarding the new implementations. Quoting them;

“The Affordable Care Act will provide one of the largest expansions of mental health and substance use disorder coverage in a generation. Beginning in 2014 under the law, all new small group and individual market plans will be required to cover ten Essential Health Benefit categories, including mental health and substance use disorder services, and will be required to cover them at parity with medical and surgical benefits.”

-Kirsten Beronio, Rosa Po, Laura Skopec, Sherry Glied

Further evidence of the immense impact this will have on the field of psychology is found in the Employment Outlook statistics given by the United States Bureau of Labor. In the aggregate, the normal rate of job growth (across the board) is 11%. In the field of Marriage and Family Counseling, the statistic is 31%; almost three times the average. In Mental Health Counseling the figure is a healthy 29%.

Light at the End of the Internship Tunnel

In an article published by the American Psychological Association, “The Internship Match Gets an Overhaul” author Alice Walton beams a massive ray of hope onto the situation. She writes;

“The American Psychological Association (APA) and its student arm — the American Psychological Association of Graduate Students (APAGS) — have been working to find solutions to the mismatch between the number of qualified graduate students and the number of available internship slots. Now, it looks as if their efforts may be paying off. More students matched to internships this year compared with last year (see below for the latest numbers). But the even better news is that solutions are in the works to address the internship crisis in ways that are expected to boost match rates even more.”

According to Watson, the industry’s top 8 associations and councils have joined hands to restructure the Match system. The following entities are participating:

  • The Association of Psychology Postdoctoral and Internship Centers (APPIC)
  • APA's Education Directorate
  • The Council of Counseling Psychology Training Programs
  • Council of University Directors of Clinical Psychology
  • The Council of Directors of School Psychology Programs
  • The National Council of Schools and Programs in Professional Psychology
  • The Council of Combined Integrated Doctoral Programs in Psychology
  • The American Psychological Association (APAGS)

One of the changes being made is that by 2015, only graduates attending accredited institutions will be eligible for the matching process. While this seems to present an obstacle for many candidates desiring to attend an unaccredited college, the college accreditation process is also being revamped to provide a virtual fast-track for institutions seeking accreditation. Industry shapers hope this will both ease the burden on the matching process as well as promote excellence in the field.

Dr. Vasquez also spoke out on the changes being implemented. The strategy as described by her includes the following (quoting):

  • Pressing psychology programs for “truth in advertising.” APA emphasizes that students must have easy access to information about match rates for doctoral programs.
  • Urging those who manage existing internship training sites to create additional internship slots.
  • Fostering the creation of new internship slots. CCTC has created a kit that provides tips on finding funding and acquiring administrative support to ease the way for developing new internship sites in such settings as community mental health clinics, counseling centers, hospitals and VA facilities.
  • Helping graduate students increase their chances at matching (visit APA’s gradPSYCH magazine and search for “internships.”) For example, APA recommends that students apply to sites that match their interests, ensure that their application materials reflect their experience and practice their interviewing skills.
  • Advocating at state and national levels for an increase in psychology training funds and reimbursement for services that interns provide. APA educates policymakers about the need for psychologists to provide services to the nation’s underserved communities and the need for psychology graduate education. The Graduate Psychology Education Program, for example, provides monies that contribute to both internship and postdoctoral training opportunities.

Additionally, the APA is putting their money where their mouth is. In 2012, $3 million were made available via an Internship Stimulus Program to develop more accredited programs.

The formerly dark and cloudy Match process is now looking forward to a bright and sunny future. While other disciplines and professions may not garner industry support for upcoming professionals; the field of psychology has taken a pro-active and zealous approach, thus insuring that when lawyers, pilots and the like need their services, it will actually be there and be qualified.