This article introduces a framework for incorporating intersectionality into an established integrative learning-based psychotherapy supervision model. We illustrate how an intersectionality lens in supervision can deepen trainee understanding of how cultural and social-structural factors affect client experience, the therapist-client relationship, and the psychotherapy process. Based on the supervision model's learning-based principles, we outline three intersectionality-focused supervisory learning processes. The first of these, intersectional attunement, pertains to cultivating trainee awareness, empathy, and responsiveness to cultural and social-structural power dynamics in supervision and the psychotherapy process. Next, intersectional apprehension focuses on developing trainee capacities to conceptualize clients' cultural experiences and understand how intersecting social positions within systems of privilege and oppression influence psychological functioning. Finally, intersectional praxis involves the development of hands-on skills that facilitate the therapeutic processing of cultural and intersectional experience. Embedding these intersectionality-focused learning processes within an integrative learning-based supervision model provides a structured and intentional approach to cultivating trainees' cultural responsiveness while equipping them to address the psychological impact of social-structural inequities in their psychotherapy work.
Evaluating therapeutic competency training programs is essential for improving the quality of clinical care. Self-practice/self-reflection has been proposed as effective strategy for developing competencies in cognitive-behavioral therapy (CBT). This study examined the impact of the self-practice/self-reflection program Personal Change Project on CBT therapeutic competencies using a sequential explanatory mixed methods design. Thirty-one participants completed the CBT Competence Self-Assessment Scale at baseline, week 8, week 16, and week 24 and also participated in semistructured interviews. Quantitative findings showed a significant increase in total competency scores over time, with improvements in three domains: Mastering CBT Theory and Skills, Generic Psychotherapy Competencies, and Using CBT Techniques Properly. No significant change was found in Formulating Clients' Problems and Plans. Qualitative findings indicated that participants experienced the Personal Change Project as a transformative learning process and reported gains in theoretical, technical, and interpersonal competencies. Overall, the findings support the value of integrating self-practice/self-reflection into CBT training, although they should be interpreted cautiously given the use of self-report measures and the single-program context. Public Significance Statement This study examined a training program in which trainees applied cognitive-behavioral therapy techniques to their own personal difficulties and reflected on what they learned for their clinical work. The results indicate that the self-practice and self-reflection program was effective in improving cognitive-behavioral therapy competencies. These findings underscore the importance of integrating self-practice and self-reflection into therapist training programs.
To better characterize common difficulties encountered in health service psychology programs during the COVID-19 pandemic, this study identified professional and personal challenges reported by graduate trainees during the pandemic. A total of 429 graduate students (71.8% White; M-age = 28.3, SD = 4.0) responded to open-ended survey questions at two separate time points. We used the three-phrase approach to qualitative content analysis to identify and interpret prevalent themes. A total of 14 themes and 41 subthemes were identified across four broad domains: (a) challenges related to training and learning, (b) concerns about clinical care for patients, (c) negative impact on professional lives of trainees, and (d) negative impact on personal lives of trainees. No demographic differences were found across students who reported experiencing a professional and/or personal challenge compared with those who did not. We provide several recommendations to graduate programs to support training goals and maintenance of effective program function in the event of abrupt training disruptions.
The current political climate requires psychologists to move beyond culturally responsive mental health services alone and incorporate socially just counseling practices to address the barriers that equity-denied clients face when accessing psychological care. With results from the present study, we seek to inform a cultural and social justice responsiveness supervision approach to enhance postgraduation skills. Practicum supervision is a critical stage in preservice counselor competency development. The present study was designed to gather supervisees' perspectives of their practicum training by utilizing the Enhanced Critical Incident Technique. In semistructured interviews, supervisee participants shared several insightful observations of what hindered, what helped, and what they wished for to develop counseling competencies with equity-denied clients. The participants asserted that practicum placements lack a diverse caseload, clarity about the role of advocacy in clinical work, and an absence of safety were the most salient issues that hindered their cultural and social justice responsiveness development. A supportive supervisory relationship and opportunities to learn alongside their peers were considered helpful. Interestingly, the supervisees in this study wished for a stronger foundation in theory and its application prior to commencing their practicum, which they felt would have allowed them to make better use of practicum opportunities.
There have been recent calls to action centered on the need for culturally responsive and antiracist therapy and psychological assessment. Continuing education (CE) is essential to a psychologist's ongoing education and training and serves to hold them accountable for maintaining professional competence. The present study examines the content areas required in mandatory CE for licensed psychologists in the United States. The primary research question is as follows: To what extent do states require CE for licensed psychologists to include culturally responsive topics? The present study conducted a content analysis of CE requirements across all 50 states, Puerto Rico, and the District of Columbia to examine the presence of specialty CEs focused on cultural competence. Results revealed that only seven states have mandatory CE requirements related to culturally responsive care. Relatedly, only Connecticut requires CE hours on mental health conditions common to veterans and family members of veterans, and only the District of Columbia has a CE requirement that requires 2 hr in lesbian, gay, bisexual, transgender, or queer care. The findings highlight the potential need for integrating cultural diversity into CE and ongoing professional development. Recent changes have been implemented to incorporate equity, diversity, inclusion, and accessibility into all CE offerings, which will be discussed.
Training in health psychology is a constantly evolving field. With developments in the delivery of integrated behavioral health care, we describe the addition of an integrated care (IC) track to an American Psychological Association-accredited doctoral psychology internship program to inform the future of education and training in health service psychology at the internship and postdoctoral levels with a lens toward training in IC. Existing IC research has found benefits consistent with the quadruple aim of health care; however, research on IC training, supervision, and curricula is limited, particularly for systems serving medically underserved populations. We report "lessons learned" in a doctoral psychology internship program that recently added and has evaluated major rotation training in integrated primary care. We supplement this review with rapid cycle quality improvement data related to this program. A mixed methods design was used to collect quantitative surveys and qualitative in-depth interview data (July 2024-December 2024) on demographics, clinical activities, and IC practices. Data from three sources yielded an analytic sample of 21 participants (n = 8 intern surveys, n = 4 intern in-depth interviews, n = 9 site leader surveys). Quantitative analyses identified descriptive characteristics of interns and training, level of integration of training sites, and whether IC practices among interns changed after 6 months in the program. Qualitative analyses highlighted identified strengths and gaps in programming. Our findings underscore the use of IC models as a way of improving access to care for medically underserved populations, increasing trainee competencies, and improving interprofessional skills as a means of advancing health care delivery.
Health care systems face persistent challenges in hiring and retaining direct care staff, particularly in pediatric mental health settings, where turnover is often linked to insufficient supervision and limited support. In response, our hospital developed a 2-year, salaried postbaccalaureate clinical fellowship to provide structured training, mentorship, and career development for recent college graduates. This article describes the program's design, implementation, and outcomes, with the goal of informing similar workforce development efforts. The full-time fellowship emphasizes four core values: community and connection, supervision and mentorship, professional growth, and continuous learning. Fellows are selected through a competitive process involving written applications and structured interviews. They are embedded in multidisciplinary teams and engage in direct care, therapeutic interventions, scholarly projects, and community outreach. The program offers comprehensive supervision (group, individual, cross-program), a tiered mentorship model (peer and professional), and academic development via monthly seminars. The structure has evolved based on participant feedback to better support fellows' clinical and academic growth. Since 2019, the fellowship has received over 250 applications annually and enrolled 25-30 fellows per cohort. Graduate school acceptance rates have steadily risen (52%-61%), while attrition rates have declined (from 30% to 11%). Fellows report high satisfaction with supervision, mentorship, and clinical exposure and describe the experience as foundational to their career development. Program adaptations include eliminating rotating placements and enhancing support for scholarly and identity-based groups. A structured postbaccalaureate fellowship is a promising model for strengthening the pediatric mental health workforce through intentional training, mentorship, and professional development. Public Significance Statement This article describes a structured postbaccalaureate clinical fellowship designed to strengthen the mental health workforce by providing intensive training, supervision, and mentorship to recent college graduates. By addressing critical gaps in recruitment, preparation, and retention of direct care staff, the program supports continuity of care in pediatric psychiatric settings and contributes to the development of future clinicians and researchers in child and adolescent mental health.
Graduates of psychology doctoral programs are expected to possess knowledge and competencies in the delivery of evidence-based practice (EBP). Graduate student practicum training sites are ideally positioned to provide training in EBP, which has been shown to promote later EBP practice. In this article, we describe how an advanced practicum clinical training site within a large academic medical center prepares its graduate student clinical fellows to become informed, competent, and versatile practitioners of EBP. We examine how key training components, including orientation, didactic instruction, supervision, research, and evaluation, support the development of the foundational and functional competencies necessary for future EBP practice, and we present fellows' mid-year and year-end evaluations of the advanced practicum. The aim of this article is to provide a framework for clinical programs aiming to provide robust training in the development of EBP competency.
In the United States, health care professionals face increasingly complex restrictions on clinical practice involving their client's reproductive lives. To date, however, no studies have examined clinical psychologists' training in reproductive health, development, and psychology as preparation for work in this environment. From 2024 to 2025, we conducted an exploratory study of websites of American Psychological Association accredited doctoral programs in clinical psychology in the United States (n = 237) and surveyed the programs' training directors; however, survey findings were ultimately considered supplemental given a low response rate (13.9%). Results suggest most programs offer little to no formal training, and when they do, it is likely subsumed in coursework focused on other topics (e.g., development, sexuality). Lack of training in reproductive health, development, and psychology may compromise care, perpetuate stigma, increase health risks for marginalized populations, and eclipse potential roles for psychologists. We make recommendations as to how graduate programs training doctoral-level clinical psychologists in the United States might address this gap.
Large language models such as ChatGPT and Gemini are rapidly transforming education and clinical training within health services and psychology. Their integration offers new opportunities for balanced access to instruction, adaptive learning, and simulated clinical experiences that can strengthen diagnostic reasoning and therapeutic communication (Obradovich et al., 2024). At the same time, emerging research warns of substantial risks, including cultural and algorithmic biases, reduced variability in simulated responses, and epistemic overreliance on automated systems (Abdurahman et al., 2024). This review critically examines current and potential applications of large language models in clinical psychology training, focusing on their use in research generation, skill development, and ethical decision making. It highlights key indicators of successful training outcomes, including critical thinking, empathy, and evaluative judgment, and discusses frameworks such as the biological, psychological, economic, and social model that can guide responsible integration of artificial intelligence into education and practice. The article concludes that large language models should supplement, not replace, traditional pedagogy and supervision. Ongoing interdisciplinary research, transparent evaluation, and adherence to established ethical principles remain important for ensuring that innovation in psychology training enhances, rather than diminishes, human-centered care.
Due to rising global mental health needs and the continued inaccessibility of evidence-based treatments, innovation in the training of behavioral health workforce is a public health imperative. Health service psychology (HSP) graduate programs are uniquely positioned to address this need as trainees tend to hold more favorable attitudes toward learning and adoption of evidence-based treatments than practicing clinicians. This article argues for the integration of transdiagnostic evidence-based treatments in HSP training programs as a strategic response to the critical need for more effective and scalable mental health care. Transdiagnostic treatments, which are applicable across a broad range of presenting problems and often target shared psychological mechanisms, have accumulated strong empirical evidence supporting their effectiveness. In addition to their broad applicability, these treatments are efficient (i.e., able to target multiple concerns concurrently) and flexible, which is of particular importance in resource-limited settings. The present article first reviews current HSP graduate program training standards, followed by a proposal for how training HSP students in at least one transdiagnostic treatment might enhance training efficiency, reduce burden on training programs, and maximize students' readiness to meet clinical demands in real-world settings. As a case example, the integration of a transdiagnostic treatment into a social work training program is presented. Last, recommendations for further implementation and future research for training in evidence-based practice among HSP students are offered.
Political polarization in the United States has introduced challenges to Health Service Psychology (HSP) training. Governmental mandates have targeted diversity, equity, and inclusion efforts, restricted academic discourse, and undermined gender-affirming care. These developments create conflicts between legal mandates and ethical principles. Subsequently, HSPs are navigating increasingly complex environments in which adhering to professional standards may have legal consequences. In this article, we examine threats to competence-based training and their consequences. In response, we outline proactive strategies designed to preserve core competencies while navigating the sociopolitical landscape. Strategies include curricular innovations, supervisory enhancements, and faculty and student-led initiatives aimed at policy resistance and coalition-building. By reaffirming their ethical commitments and embracing proactive educational reform, HSP educators can ensure that graduates remain prepared to serve diverse communities with integrity, resilience, and cultural humility.
Only about half of those in need of mental health services in the United States actually receive such services. The current approach to delivery of health service psychology interventions, with a reliance on doctoral providers, is unlikely to meet the ever-growing need for mental health services. However, the American Psychological Association has recently begun accrediting master's programs in health service psychology, with the aim of increasing master's degree clinicians. This change provides an opportunity for the field to reconsider how psychologists are educated and trained and their respective roles. This article presents an overview of what a unified education and training continuum may look like, with differentiation across the roles and responsibilities at the undergraduate, master's, and doctoral degrees, and recommendations for education and training. We propose the development of an undergraduate health service psychology concentration, describe the importance of ensuring quality training for master's degree clinicians, and recommend an emphasis on advanced skills in doctoral training. While such a radical change to the field would be an undoubtedly complex process, it is critical that the field of health service psychology takes advantage of this opportunity to meet today's mental health needs.
People with disabilities represent one of the largest minority groups in the United States, and, as health care providers, health service psychologists will almost universally interact with people with disabilities and their families in their work. However, disability is often not well addressed in health service psychology curricula and training. In this article, we provide strategies for integrating disability throughout the health service psychology curriculum as well as ideas for partnerships that health service psychology programs can develop to increase trainee exposure to and knowledge of disability without requiring the development of new resources. We specifically discuss Veterans Health Administration hospitals and clinics, Veterans Benefits Administration Veteran Readiness and Employment programs, and University Centers for Excellence on Developmental Disabilities/Leadership and Education in Neurodevelopmental Disabilities programs as potentially strong partners for health service psychology programs.
Counseling and clinical psychology doctoral students face competition related to funding, clinical training, and mentorship, which may shape their professional development and well-being. This constructivist phenomenological study explored the impacts of competition on students in counseling and clinical psychology doctoral programs. Semistructured interviews were conducted in 2025 with seven U.S.-based doctoral students with responses analyzed via thematic analysis. Three primary themes were generated: (a) professional and career development, (b) psychosocial concerns, and (c) well-being. Findings suggest both adaptive and maladaptive impacts of competition and encourage program transparency, equity, and collaborative cultures to support student development and mitigate potential harms of competition. Implications for education and training, research, and advocacy are discussed.
A significant part of advancing the overall behavioral health workforce is providing evidence-based training and practice opportunities for one of the largest providers of behavioral health-psychologists. One evidence-based practice, integrated care (IC), has only recently seen expanded and nuanced research, including on stakeholders' perceptions of IC benefits and implementation barriers. Thus, it is poorly understood what underlying factors influence the presence of positive or negative attitudes. The present study surveyed health care professionals that work in proximity to psychologists (medicine, dentistry, pharmacy, nursing, social work). Surveys measured IC practices, attitudes, and perceived implementation obstacles among educators, students, and clinicians. More availability of IC practices was associated with less perceived difficulty implementing IC and more perceived benefits. Varying positive opinions toward IC were correlated, with negative opinions (e.g., professional identity threat, barriers including lack of support) also being correlated. Previous IC experience or formal training was associated with greater perceived difficulties learning IC. Younger participant age was associated with greater perceived difficulties learning IC and future research may investigate alternative techniques for teaching IC to improve the learning experience, particularly for younger students. This may include increasing education accessibility through asynchronous online courses, and hybrid virtual/on-site learning options, and finding methods to streamline learning with peers from differing educational backgrounds (e.g., making content applicable to psychology and medicine trainees that is consumed and practiced in the same space). These initial results suggest improvements in IC education may facilitate an increase in the implementation of IC practices within the field of psychology.
The rapid adoption of Gen artificial intelligence (AI) by universities and students suggests that many applicants to and trainees in our health service psychology graduate programs will be using Gen AI and may have received Gen AI training during college. I obtained and examined 140 handbooks out of 179 APA-accredited clinical psychology PhD programs, of which 27 (19.3%) included a policy on the use of artificial intelligence or Gen AI. Of 60 randomly selected programs, none included a Gen AI policy in the application instructions, although one was in a graduate school that had a clear policy. The use of Gen AI by applicants could be a barrier for less privileged applicants and may degrade the informational value of personal statements. Programs should continue to develop policies for inclusion in admission instructions and student handbooks or clearly reference existing institutional policies.
Health psychologists have often focused on providing direct patient care. However, they are uniquely suited also to serve as medical educators because they can conduct behavior observations, navigate complex systems, synthesize information, and provide strengths-based feedback. We train postdoctoral psychology fellows with a focus on integrated, biopsychosocial care in primary and specialty care settings. As part of the fellowship, our team developed a curriculum supporting fellows' skill development as medical educators that prepares them to serve as communication coaches. This article describes this coaching training program, including our process, lessons learned, challenges, and the ways our postdoctoral fellow coaches contribute to individual as well as system-wide change. Coaching expands the role of health psychologists in medical settings with potential for far-reaching implications on patient care, clinician well-being, and systems culture. Public Significance Statement Postdoctoral fellows training in health settings are effectively prepared for diverse roles in health care systems, including as medical educators. Those with specialty training as communication coaches bring additional expertise regarding communication strategies that promote improved patient-family-physician relationships, clinical outcomes, patient satisfaction, and team experience.
