The Clinical Psychology Doctoral (PsyD) Program is one of 14 academic degree programs of California Institute of Integral Studies, a private, nonsectarian, nonprofit institution of higher learning, founded in 1968 and regionally accredited by the Western Association of Schools and Colleges in 1981. The program admitted its first class in 1991 and awarded its first PsyD degree in 2000. The program's alumni are a highly regarded professional presence with many working in leadership positions in the Bay Area, in other states, and abroad.
Located in the heart of San Francisco, ours was the first accredited university in North America to offer programs that connect the insights of Western psychology with Eastern spirituality. Our course offerings reflect the broad-minded, integrative perspective pioneered at CIIS decades ago. Alan Watts, a leading figure in the transmission of Eastern spirituality to the West, described the American Academy of Asian Studies (which later became CIIS) as "one of the principal roots of what later came to be known, in the early sixties, as the San Francisco Renaissance." During that time, the Bay Area became synonymous with new currents in psychology that continue to transform the field. Like CIIS's founders, our faculty and students continue to work at psychology's cutting edge, in its deepest traditions, and toward the project of realizing our most profound human potentials.
PsyD program's mission is to provide broad and general training in clinical psychology that prepares students for the professional practice of psychology. Our curriculum and environment are sequential, cumulative, graded in complexity, and are consistent with the mission and ideals of CIIS.
Our program's training philosophy is based on the practitioner-scholar model, which prepares students for clinical practice in public and private health service contexts, while also giving students the skills to evaluate, apply, and participate in contemporary psychological science. The program is consistent with the American Psychological Association's guidelines for education and training in professional psychology (APA, 2012; Rozensky et al. 2015). The program's philosophy, goals, and objectives are also imbedded in the National Council of Schools and Program of Professional Psychology's (NCSPP) competency model, which places a particular emphasis on the delivery of human services that recognize and value human diversity (Peterson et al., 1997, 2006, 2010).
We value community as an important element in building an engaging learning environment that embraces diverse perspectives. Peer collaboration, academic support, and clinical mentorship are emphasized throughout the Program as central aspects of students' experiences. In this important sense, we endorse Lubin and Stricker's (1992) notion that a professional education in clinical psychology should endeavor to create a learning environment "that parallels the values which we hold for practice" (p. 44).
We aspire to train psychologists who are concerned with the health and well-being of whole persons as well as with symptom-relief or problem-solving. Consistent with this holistic emphasis, the clinical assessment and therapeutic intervention models explored in the Program address the unique individual in his or her complex relational contexts including those with intimate others, family, community, culture, nature, and spirituality.
We recognize spirituality as an important dimension of diverse human experience. The meaning of "spirituality" endorsed by the Program affirms an existential concern with life as a whole in the various contexts of our personal, interpersonal, cultural, and natural worlds. Without privileging any particular religious or spiritual belief system as foundational to spirituality, the Program endorses an openness that can draw from any such belief system or from none at all.
Reflective learning incorporates the above-named elements and expands upon them to allow the "how to" knowledge and skills learned in specific educational contexts to be applied with intelligence, sensitivity, and effectiveness to ill-defined or novel, not previously encountered problems and situations. This process calls for ongoing critical reflection and self-appraisal. Its development in our students is facilitated by faculty and clinical supervisors, who offer mentorship and role modeling (Slotnik, 1996; Svinicki, 1991), and who pay special attention to how students grow in their:
- critical thinking, which involves awareness of perspectives and uncovering and assessment of assumptions (Seeley, 1999)-one's own as well as that of the other (client, supervisor, instructor, idea, or text);
- sensitivity to context, complexity, and subtlety, which involves awareness of cultural and other factors that define the larger context of an often ill-defined problem situation at hand (Jarvis, l992);
- openness to and utilization of feedback, which involves welcoming of constructive criticism, skill and willingness to take appropriate risks, and appreciation of "mistakes" as opportunities for learning; and
- growth of individualized reflective practices that set the stage for ongoing consideration of one's own learning process and for sustained deepening of lifelong professional development (Bolton 2010; Boud et al, 1985; Moon, 2004; Wise et a., 2010).
Goals and Objectives
The PsyD training philosophy and curriculum aim to cultivate our students' knowledge, skill, and attitudes needed for the multiple aspects of clinical work. In the PsyD Program these aspects are recognized in the elements of the curriculum which are pursued through multiple in-house and extramural learning activities including coursework, personal psychotherapy, practica, internship, supervision, dissertation, and other professional development activities such as professional development workshops. Program objectives allow the Program maintain consistency in how these activities are contextualized and, subsequently, evaluated. The following are the seven training objectives for our Program:
- Diversity and Identity
- Ethics and Legal Standards
- Assessment and Diagnosis
- Supervision and Consultation
1. Diversity and Identity
This objective includes a knowledge base concerning human differences in terms of culture, race, ethnicity, class, language, ability status, gender, sexuality, age, spirituality, religion, as well as ongoing self-reflection on how one's own identity influences understanding of clients and effective clinical practice (Cohen, 2009; Constantine et al., 2007; Kenkel & Peterson, 2004). The objective also includes an appreciation the dynamics of power, privilege, oppression, and historical social structures in the lives of clients and their therapists (Johnson & Jackson-Williams, 2014; Lee, 2004; Rogers & O'Byon, 2014; Roysircar et al., 2010; Warner et al., 2013). Peterson et al (2010) emphasize that "both academic and interpersonal material relevant to inequalities of power and authority appear in a variety of educational topics. These issues occur academically ... in the study of racism and diversity, in some interpretations of gender issues, and in critiques of traditional epistemologies. All of these issues underscore the importance of training in both reflective practice and person-focused (ie, social and interpersonal) sorts of educational experiences that provide a context in which such conversations can occur (p. 33)."
We aim to develop cultural competence among our students, where cultural competence is understood as a set of problem-solving skills that include cultural sensitivity manifested in the ability to (a) recognize and understand the dynamic interplay between the heritage and adaptation dimensions of culture in shaping human behavior; and (b) use the knowledge about an individual's heritage and adaptational challenges to maximize the effectiveness of assessment, diagnosis, and treatment. These aspects of cultural sensitivity are seen as precursors to cultural competence where knowledge, recognition, and use of cultural dynamics are integrated into one's clinical problem-solving repertoire, resulting in routine application of cultural sensitivity to diverse groups (Hong et al., 2000; Whaley and Davis, 2007). First year curriculum, including its required Culture and Ethnicity course, build the foundation for multicultural competence and intercultural sensitivity, which later unfolds and deepens through practicum and internship training, dissertation, and broader aspects of student's emerging self-reflectiveness and insight into one's lifelong professional practice.
We take seriously the contributions of spirituality, religion, and wisdom traditions to an individual's orienting system. Required courses in Religion and Spirituality, Buddhism and Psychotherapy, and Neuroscience and Spirituality are specifically designed to deepen students' understanding in these areas. Throughout its curriculum our Program recognizes the values and ultimate concerns in which individuals are invested as variables critical to psychological health and individual well-being (Emmons, 1999; Sperry and Shafranske, 2005). We recognize at least the following three functions to which religion and spirituality may contribute in people's lives: (1) coping with stress, (2) meaning making, and (3) spiritual questing or meaning seeking (Sperry and Shafranske, 2005). Our approach is nondenominational and aims at sensitizing students to the diversity of systems of belief and practice with which clients may identify, and helping them to develop skill and confidence in addressing religious or spiritual issues when these arise in a clinical context (Crook-Lyon et al, 2010; Vieten et al, 2013).
Another form of cultural competence that receives attention in our Program is gender and sexuality. In the required Gender and Sexuality course and curriculum at large, we aim to understand these aspects of human experience as socially situated and constructed, and to go beyond limited dichotomous and heterosexist understandings (e.g., Foster & Scherrer, 2014). In accord with professional practice guidelines for psychologists (APA, 2000; Rogers & O'Byon, 2014), we seek to develop clinicians who are skilled at working with individuals and couples with differing sexualities, sexual preferences, and genders. We are fortunate to be situated in San Francisco, where practicum training in psychotherapy with sexually diverse clients is readily available in community agencies.
Relationship objective is described by Peterson et al. (2006) as "the foundation and prerequisite of the other competencies" and requires six essential attitudes: intellectual curiosity, open-mindedness, belief in the capacity for change in human attitudes, appreciation of diversity, integrity, and a belief in the value of self-awareness (p. 27). This definition underscores the importance of relationships to both educational processes and clinical outcomes. Research has consistently pointed to the importance of an effective therapeutic relationship to psychotherapy outcome (Horvath and Symonds, 1991; Martin, Garske, and Davis, 2000; Lambert and Barley, 2001). Ability to enhance interpersonal aspects of professional functioning is also among key aspects of lifelong professional development (Elman, Illfelder-Kaye, & Robiner, 2005; Wise et al, 2010). Therefore, students are taught not only specific knowledge and techniques, but also to understand professional roles, develop and maintain empathy and curiosity about other people, handle difficult interpersonal and clinical situations, and, importantly, develop the capacity to continuously reflect on themselves in the context of their work.
Relationship competency involves the capacity to develop and maintain constructive working alliance with clients and includes the ability to work in collaboration with others such as peers, colleagues, students, supervisors, and members of other disciplines, consumers of services, and community organizations (Peterson et al., 1997). During their first year, students learn the essential attitudes and skills of this competency with peers and professors in foundational coursework. This includes self-reflection in experiential learning activities and responding to feedback from peers and instructors. As the students move through our Program, they deepen their capacity to create alliances in other professional contexts such as development of supportive connections with their dissertation advisors, professional seminar instructors, and supervisors at practicum and internship sites. They also expand their capacity to independently and successfully engage in a broad range of professional communities. This may involve participation in collaborative professional projects with colleagues, memberships in professional or community organizations, taking on advocacy or leadership roles, leading workshops or colloquia, and participation in professional conferences.
3. Ethics and Legal Standards
This objective involves a knowledge base of ethical and legal standards as well a personal commitment to ethical conduct. Students are expected to develop familiarity and ability to follow the Ethical Principles of Psychologists and Code of Conduct (APA, 2010). As they move into advanced stages of training, they become more familiar with the laws and regulations related to the practice of psychotherapy (e.g. confidentiality, reporting laws, dual relationships, etc.). Since "different ethical principles become relevant as [these] professional psychologists move through multiple roles" (p. 30, Peterson et al., 2006), students expand and deepen knowledge, skills, and attitudes in these areas over time, eventually developing an internalized ethical sense that transcends specific clinical and research standards. Having an internalized ethical sense is likely to enable the student to confront complicated ethical dilemmas with a thorough and well-reasoned decision-making style as they move through practicum and internship training, complete their dissertation, and, eventually, engage in independent professional practice.
Students' understanding and appreciation of the laws, regulations, and ethical codes for psychologists emerge in their first year as they participate in the Foundation Clinical Skills coursework and practicum at our Program's clinic, the Psychological Services Center. As they prepare for their practicum in the Bay Area agencies, students take an Ethics and Legal Standards course where they are invited to examine how ethical and legal standards emerge in clinical practice. This applied knowledge deepens during students' second and third year of practicum and Professional Seminar sequence where they are challenged to think more deeply about integration between theory and practice and to examine their own identities as growing clinicians. During the second and third years students also get involved in applying ethical principles and standards to research, particularly in their own dissertation and associated institutional review of research with human subjects. Clinical and research competency examinations mark students' increased understanding of core ethical and legal challenges in practice of clinical psychology. During pre-doctoral internship and final stages of their dissertation, students further prepare for independent professional practice where connection to ethics and legal standards is fully integrated into one's identity and ongoing lifelong learning practices.
4. Assessment and Diagnosis
Assessment is a highly complex and comprehensive activity, interwoven with all other aspects of professional practice, such as intervention and supervision. It is an ongoing, interactive, and inclusive process that serves to describe, conceptualize, characterize, and predict relevant aspects of clients and their presenting concerns (Krishnamurthy & Yalof, 2010). It also takes into account clients' cultural context, as well as integrating information about clients' limitations and dysfunctions with their strengths and competencies (Peterson et al., 2006). Consequently, students are expected to develop a strong foundation in conceptualizations of psychopathology and wellness, psychological measurement, logic of clinical inference, and complexities of emic and etic influences (e.g., use of standardized tests in diverse socio-cultural contexts). A thorough assessment and diagnostic evaluation, whether it be formal (e.g., involving the use of standardized psychological or neuropsychological testing batteries) or less formal (e.g., based on unstructured clinical interviews and behavioral observations), is viewed as a prerequisite for all clinical activities.
The first year Assessment Sequence provides students with the foundations for understanding and engagement in discussions of psychopathology and wellness, logic of clinical inference, psychological measurement, and standardization. The sequence helps students develop foundational mastery of formal assessment procedures involving administration, scoring, and interpretation of standardized instruments and test batteries. Through this sequence and the Foundations Clinical Skills coursework, students also learn to effectively perform clinical interviews resulting in an improved ability to describe, conceptualize, characterize, and predict relevant aspects of clients and their presenting concerns. As students move into their second and third year of practicum and associated coursework, they deepen their clarity of expression in written and oral communication regarding assessment findings. In preparation for pre-doctoral internship, students also learn to integrate theory and practice of assessment into their interventions, including ability to use initial and ongoing evaluations to examine treatment outcomes.
Intervention competency is a cornerstone of the PsyD Program (Betan & Binder, 2010; Binder & Wechsler, 2010). Our approach is firmly grounded in the evidence-based practice of psychology (EBPP), which is committed to the "integration of the best available research with clinical expertise in the context of patient characteristics, culture and preferences" (APA, 2006). EPPP requires attention to a complex set of factors, including treatment method (Nathan and Gorman, 2002), the individual psychologist (Wampold, 2012), the treatment relationship (Norcross, 2002), and the characteristics of individual patients (Bohart and Tallman, 1999).
Students in our Program receive intensive training in each of the areas noted above. During the first year students learn introductory intervention skills in the Foundations series, including how to express empathy, establish professional boundaries, maintain positive therapeutic relationships, develop and deepen rapport and create collaborative treatment plans. These "common factors" are evidenced to have a significant impact on treatment outcome (Lambert & Ogles, 2014; Laska et al, 2014). As they progress into their second and third years, students receive broad-based education in evidence-based treatment and its application. Students take theory and practice courses focused on psychodynamic (Shedler, 2010), humanistic/existential (Bazzano, 2014; Cooper et al, 2013; Schulenberg, 2015; Wampold, 2012; Van Doesum & Takens, 2013), cognitive-behavioral (Beck & Dozois, 2014) and emerging treatment approaches (e.g., Linehan & Dexter-Mazza, 2008; Hayes et al. 2011). During advanced stages of their training, as they get ready and proceed to pre-doctoral internship, students' intervention skills move into deeper integration of theory and practice where they begin to consistently apply intervention-related knowledge and skills to complex real-life clinical contexts.
6. Supervision and Consultation
The provision of clinical supervision is an important and distinctive professional practice for psychologists (APA, 2014; Watkins, 2012). Falendaer & Shefranske (2004) define it as an "activity in which education and training aimed at developing science-informed practice are facilitated through a collaborative interpersonal process." They note that supervision "involves observation, evaluation, feedback, and facilitation of supervisee self-assessment," as well as "the acquisition of knowledge and skills by instruction, modeling, and mutual problem solving" (p.3). Supervision is similarly defined by Peterson et al. (2006) as "a form of management blended with teaching in the context of a relationship directed to the enhancement of competence in the supervisee" (p. 28).
The process of developing competence begins with the experience of becoming a supervisee. Students in their first year complete a Foundation Skills Practicum at the Program's clinic, during which time they are exposed to group supervision/case conference activities. In the second year students enter fully into clinical training at their practicum sites, where they receive weekly supervision. With this experience in hand, during their third year students enroll in a required Supervision and Consultation course that introduces them to the conceptual models and evidence-base upon which clinical supervision is competently conducted. The focus of this course, which is taken concomitantly with a student's second practicum, is theory-practice integration. In addition to more fully preparing students for their roles as supervisees during pre-doctoral internship, it is designed to help students make the professional transition to the role of supervisor.
A related yet distinct objective of our Program is to teach students to how to serve in the role of psychologist-consultant. This area of practice requires the broad ability to maintain collegial and mutually enhancing relationships with other professionals, as well as knowledge, skills and attitudes specific to the interface between mental health promotion and other aspects of well-being (e.g. physical health, education). These competencies are developed throughout the training sequence, but their particular application to the role of consultant is addressed in a third-year course.
In their acquisition of research foundations, students are expected to develop an understanding of what constitutes psychological science as a source of "consensually verifiable, replicable, and universally communicable" information (Peterson et al., 2006). This understanding is grounded in contemporary knowledge of the biological, developmental, cognitive, affective, and social foundations of human functioning found in peer-reviewed scientific journals, along with critical thinking skills necessary to appreciate and critique ongoing scientific developments. Knowledge of the history of psychology and the many systems of thinking that have emerged in psychology over time also informs students' ability to put their contemporary knowledge into a broader evolving sociocultural context.
Students' research and evaluation skills emerge during ongoing, disciplined inquiries that inform and are informed by students' clinical work, providing a grounding in evidence-based practice of psychology (EBPP; APA, 2006). In accord with NCSPP descriptions of the local clinical scientist (Peterson et al., 2006; Stricker and Trierweiler, 1995; Trierweiler et al. 2010), our Program trains developing practitioners to engage the challenge of the human condition directly, starting with the needs of each client and bringing the best available theoretical conceptions and research evidence, along with individual and collective professional experience, to bear in studying and improving the client's functional condition. In the second year of the Program, students complete a two-semester sequence in research and statistics, which provides a foundation for dissertation research under supervision of core Program faculty. Coursework in dissertation proposal writing and a second-year research milestone examination provide structure that helps students complete their dissertation proposals prior to applying for pre-doctoral internship. Through engagement in problem identification and the acquisition, organization, and interpretation of information pertaining to psychological phenomena, students gain specific skills that prepare them to be users of research in the conduct of informed clinical practice.