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.
The PsyD program has as its mission broad and deep training in clinical psychology that prepares students for the professional practice of psychology. The curriculum and environment of the PsyD program are infused with the Seven Ideals of CIIS. Of particular importance in the PsyD curriculum are the ideals of spirituality, diversity, and multiple ways of learning and teaching.
Training Philosophy: Core Values
The program’s training philosophy is based on the practitioner-scholar model of training that prepares students for professional practice in varying public and private contexts as active consumers of psychological science. The program endorses a broad understanding of psychological science which includes quantitative empirical science and methods as well as qualitative and experiential methods of inquiry.Training under the practitioner-scholar model equips students to evaluate, apply, and participate in contemporary psychological science. The training philosophy and curriculum goals are in accordancethe National Council of Schools and Program of Professional Psychology’s (NCSPP) competency model (Peterson et al., 1997, 2006), which emphasizes the use of disciplined inquiry in professional practice, development of the person of the trainee therapist, and reflective practice together with the scientific knowledge bases of clinical psychology.
At CIIS, training in the PsyD program is guided by the following six core values:
- Inquiry and reflective practice
- Learning in context
The program is concerned first and foremost with the health and well-being of whole persons and secondarily with symptom-relief or problem-solving, Consistent with its 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.
The PsyD program recognizes spirituality as an important dimension of human experience which to varying degrees may infuse all others. 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. The same openness informs the program's approach to those traditions in which the faculty's expertise, as currently constituted, is more substantial than in others.
In keeping with the ideals of the Institute, with the NCSPP competency model, and with the demands of contemporary clinical practice, diversity, conceived broadly, is a central value in the PsyD program. Learning and reflection on human diversity cuts across the curriculum, in that every course syllabus includes a statement on how diversity is understood and addressed within the particular content and skill area of the course. Thus, students are exposed to many aspects and definitions of diversity. Of considerable importance in the program's engagement with diversity issues are students’ and faculty’s ongoing self-reflection on how identity influences understanding of clients and effective clinical practice. The training program offers specific study in three primary areas of human difference: culture and ethnicity, religion and spirituality, and gender and sexuality.
Culture and Ethnicity
The program aims to develop cultural competence in trainee psychologists, where cultural competence is understood as Whaley and Davis (2007) have described it: [C]ultural competence as a set of problem-solving skills that includes (a) the ability to recognize and understand the dynamic interplay between the heritage and adaptation dimensions of culture in shaping human behavior; (b) the ability to use the knowledge acquired about an individual’s heritage and adaptational challenges to maximize the effectiveness of assessment, diagnosis, and treatment; and (c) internalization (i.e., incorporation into one’s clinical problem-solving repertoire) of this process of recognition, acquisition, and use of cultural dynamics so that it can be routinely applied to diverse groups. The first stage of recognition of the dynamic interaction between adaptation and heritage dimensions of culture reflects cultural sensitivity as a precursor to cultural competence. (p. 565)
One form of cultural competence focuses on trainee awareness of differences in heritage, ethnic background, and geographical origins of clients and themselves, and the ways in which this difference may influence therapeutic relationships, participation, and outcomes
Religion and Spirituality
The PsyD program takes seriously the contributions of spirituality and religion to an individual’s orienting system. Our program accommodates the larger paradigm, expressed in humanistic/ existential and more recently positive psychology, that 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). With 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. 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.
Gender and Sexuality
A third form of cultural competence that receives attention in the curriculum is gender and sexuality. The curriculum aims to understand these aspects of human experience as socially situated and constructed, and to go beyond limited dichotomous and heterosexist understandings. In accord with professional practice guidelines (APA, 2000), the PsyD program seeks to develop clinicians who are skilled at working with individuals and couples with differing sexualities, sexual preferences, and genders. The program is fortunate to be situated in San Francisco, where practicum training in psychotherapy with sexually diverse clients is readily available in community agencies.
The PsyD program recognizes that to exist is to be in relationship—with self, with others, and with the world at large. Human relationships are fundamental to clinical practice and clinical education, and the development of relationship competency is a core value in the program. In accordance with the NCSPP model, 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).
This definition underscores the importance of relationships to both educational processes and clinical outcomes. In regard to the latter, 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). Therefore, students in the program 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 reflect on themselves in the context of their work.
The program also believes that relationship is essential in the learning process. As “the foundation and prerequisite of the other competencies” (Peterson et al., 1997), relationship competency is developed in the context of an interpersonally engaging learning environment. Peer collaboration, academic support, and clinical mentorship are emphasized through the program as central aspects of the learning environment. In this important sense, we endorse Lubin and Stricker's (1992) notion that a professional education program in clinical psychology should endeavor to create a learning environment “that parallels the values which we hold for practice” (p. 44).
The program fosters inquiry as an attitude of openness and curiosity which employs a variety of modalities such as empathic attunement, discernment, and reflective learning and practice. Empathic attunement and discernment allow for accurate and nuanced sensitivity to “what's going on” in the therapeutic or learning encounter and is fundamental to the development of an effective healing relationship. Empathic attunement and discernment are recognized by many professionals as essential skills for a successful clinician and therapist, yet they are also recognized as elusive and as not easily taught or trained. The PsyD program strives to cultivate these skills by encouraging and modeling them through an attitude of open inquiry and experiential exploration in an atmosphere of safety and mutual respect.
Reflective learning and practice incorporates the above-named elements and expands upon them to allow the “how to” knowledge and skills learned in specific relational contexts to be applied with intelligence, sensitivity, and effectiveness to ill-defined or novel, not previously encountered clinical problems and situations. Reflective learning and practice calls for ongoing critical reflection and self-appraisal in classroom learning as well as in clinical work at practicum and internship sites. Its development in our students is facilitated by faculty who mentor and provide role models for them (Slotnik, 1996; Svinicki, 1991). Specifically, reflective learning and practice comprises the following:
- 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); and
- 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. Our faculty members create safe learning environments for fostering these qualities and skills in their classroom teaching, supervision, dissertation work, advising, and other encounters with the students.
Learning in Context
The PsyD training philosophy assumes that clinical training succeeds most readily when students learn in contexts that successively approximate clinical practice. Therefore, clinical training includes cumulative and graded experiences integrating academic knowledge with practice opportunities. Such experiences include role- play in early foundation clinical skills courses, experiential didactics in the two-year Proseminar series, two years of supervised practicum placement in one of two dozen diverse agencies throughout the San Francisco Bay Area, one to two years of internship training in California and throughout the United States, and the trainee’s personal psychotherapy. One-fourth of practicum trainees each year are placed in the program’s own Psychological Services Center, located in downtown San Francisco, where they work with adults, couples, and groups from diverse backgrounds and have the opportunity to develop psychological assessment skills.
The PsyD program emphasis on contextual learning is congruent with the first ideal of CIIS, which affirms its goal to be an institution that practices an integral approach to learning that encompasses all aspects of learning: the intellectual, the experiential, and the applied.
PsyD Training Philosophy and Elements of the Curriculum
Program Curriculum: Eight Training Goals
The PsyD training philosophy and curriculum aim at cultivating in 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 weekly colloquium participation. The following are the elements of the curriculum:
- Scientific foundations of clinical psychology
- Diversity and identity
- Assessment and Diagnosis
- Supervision and consultation
- Research and evaluation
- Ethics and professional practice
Scientific Foundations of Clinical Psychology
These involve contemporary knowledge bases 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. This goal also encompasses knowledge of the history of psychology and the many systems of thinking that have emerged in varying historical and social contexts. Overall, in their acquisition of scientific 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).
“Relationship” 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). Inherent in this competency is a capacity to develop and tend to ongoing healthy therapeutic alliances with clients. This competency’s broader aspects include the capacity for collaborative work with the full range of individuals with whom a clinical psychologist may work: colleagues/peers, supervisors/ supervisees, professionals in other disciplines, students, governmental agencies, and community organizations. Initially, the student at CIIS learns the essential attitudes and skills of this competency with peers and professors in foundational coursework in interpersonal skill development, self-reflection in experiential learning, and feedback from peers and instructors. As the students move through their training, they develop advanced competency in the creation of working alliances in the supervisory relationship, as a client themselves, in participation in empirical research projects, in team building at clinical training sites, and as presenters in conference and workshops.
Diversity and Identity
This goal includes a knowledge base concerning human differences in terms of gender, sexuality, culture, race, ethnicity, ability status, age, spirituality and religion, and class, as well as ongoing self-reflection on how one’s own identity influences understanding of clients and effective clinical practice. The goal also includes an appreciation the dynamics of power, privilege, oppression, and historical social structures in the lives of clients and their therapists (Peterson et al., 2006).
Intervention is essential to the development of practitioner-scholar identity and is viewed as a complex process that demands integration of all other goals and objectives. Success in this area involves becoming grounded in theory, research, and application of best available psychological interventions. It encompasses activities that “promote, restore, sustain, and/or enhance positive functioning and a sense of well-being in clients” (Peterson et al., 2006, p. 23). It also involves application of a broad range of clinical skills, such as establishing a positive therapeutic relationship and becoming effective in selection, implementation, evaluation, and modification of therapeutic process.
Assessment and Diagnosis
This process is 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. 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 sociocultural 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.
Supervision and Consultation
“Supervision” is 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). Peterson et al. (2006) describe “consultation” as a “collaborative interaction between the professional psychologist and one or more clients or colleagues, . . . in which the professional psychologist has no direct control of the actual change process” (p. 28). Students typically begin to learn the role as supervisee in their first practicum. In their practica and internship, they are exposed to professionals in the role of supervisor. In supervision coursework, they practice aspects of the role of supervisor themselves in role-play. In the course of advanced field placements and internship, students learn consultation in their position as a multidisciplinary team member as well as in their role as consultant to allied professionals and laypeople affiliated with their sites.
Research and Evaluation
These skills emerge during ongoing, disciplined inquiries that inform and are informed by students’ clinical work. In accord with NCSPP descriptions of the local clinical scientist (Peterson et al., 2006; Stricker and Trierweiler, 1995), the PsyD 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. 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.
Ethics and Professional Practice
These principles involve a knowledge base of ethical and legal standards, a personal commitment to ethical conduct and professionalism, and a competence to act in ways that communicate respect for oneself, one’s clients, one’s colleagues, and the profession of clinical psychology. For CIIS students, “different ethical principles become relevant as [these] professional psychologists move through multiple roles” (Peterson et al., 2006, p. 30), such as practicum student, clinical intern, and dissertation researcher. Students are expected to develop knowledge and skill as well as an internalized ethical sense that transcends specific clinical and research standards. These competencies will enable the student to confront complicated ethical dilemmas with a thorough and well-reasoned decision-making style. Peterson et al. (2006) emphasize that “preparation in professional psychology involves the education of the personal and professional selves of students so as to develop the habits of reflective practice and lifelong learning” (p. 30). CIIS students are expected to develop awareness of self, commitment to lifelong learning, and a professional demeanor that is conscientiously applied through the wide array of their professional roles.