Early Career Perspective

Thinking Through the Next Steps in Your Career: Clinical Internship

Keanan J. Joyner, PhD 

University of California, Berkeley

During the pandemic, there has been widespread re-consideration of the structure of work, both inside and outside of the academy. In 2021, there were unprecedented numbers of workers voluntarily leaving or changing jobs, reaching a 20-year high¹, coining the phrase “the Great Resignation.”² Academia was not immune to this movement; however, some have argued that it has manifested somewhat differently, in what they term “the Great Faculty Disengagement,” as academics reconsider the ways in which they engage with their jobs.³ Call it whatever you like – the fact of the matter is that there is a transformation brewing in the way that academics approach our jobs. In the midst of this backdrop, one of the things clinical psychology trainees are reconsidering about their careers is the clinical internship period, and I was asked to write about my experience and decision process for opting out of it for this column.

I was finishing my fifth year of my clinical psychology PhD program at Florida State when the COVID-19 pandemic hit the United States. I had begun worrying about exactly how many clinical hours I had and had started leading a dialectical behavior therapy group to make sure I would have enough diversity of clinical experiences to match for internship, which I dreaded. As I sat inside my house with all the time in the world to think, I realized something important for me – that I really didn’t want to do my clinical internship. I had joked about not looking forward to it before, but this feeling intensified during the pandemic, and I really, actually, didn’t want to do it anymore. Moreover, I realized that the last time I truly considered whether or not I would do this was when I was an undergrad deciding I wanted to do my PhD in clinical psychology, and accepting that clinical internship was a normal part of that process. I also realized how young I was at that point, and then it dawned on me – why would I trust my undergrad self with this important career decision now? As everyone is trying to determine the ways to engage in their careers in a fulfilling way, it’s important to evaluate what your current values and goals are. Just because you had a specific idea of how your career would go several years ago doesn’t mean that you must continue down that path. Your time earning your degree has given you an incredible number of skills and opportunities for how to make an impact in reducing the burden of mental illness on our society, and continuing through the traditional clinical internship. 

There are many pros and cons to completing a clinical internship, and before making the decision, it’s important to consider which pros are most important to you, and which cons you can tolerate. Saliently, completing an accredited internship is often a requirement for graduation from most clinical psychology PhD programs. However, one can approach their faculty and request this requirement be waived, or to graduate with a more general psychology PhD degree (the latter of which is what happened in my case). Despite widespread belief, however, it is not true that there is no path to licensure without an internship in all cases – while there are certainly requirements about number of pre- and postdoctoral supervised hours, state licensing boards vary in whether they specify a unique clinical internship period, and in what form. Check out the Association of State and Provincial Psychology Board’s (ASPPB) “Handbook of Licensure and Certification Requirements” to find out more about state-level licensure requirements as a starting point. On the other hand, the financial cost simply to apply and interview for a clinical internship is extremely high, not to mention typically having to move twice in as many years. For individuals with significant others and families, or from low-income backgrounds, or with disabilities, these financial costs and logistical challenges alone may prove untenable and may not be worth the potential benefits of an internship.

Another thing to consider is what your intended career path looks like. If your intention is to go into academia, it is worth reading current job ads at the types of institutions you would like to work for one day; do they specify ‘license eligibility’ as a requirement? This will also vary as a function of whether clinical faculty routinely supervise students at an in-house clinic. Do you want to be in a clinical area, or are you open to other areas of psychology? Lastly, the advice of not letting your younger self make decisions for your current self also translates to you currently making decisions for your future self. It’s important to consider how the choice of whether to do an internship impacts flexibility in other jobs you’d like to do if the first doesn’t work out – do you need the flexibility in relation to clinical work? Data science and industry jobs seemed much more attractive to me than something that involved practicing, so I was comfortable with this potential reduced flexibility.

In my case, it was a difficult decision to forego internship, but in the end, it was the right one for me given my personal and professional goals. If I had been in a different program, at a different time in my life, I might have chosen a different path, but I wasn’t, and I didn’t. I don’t think that it’s always the solution to go on internship, or to always opt out of internship, but what I do know is that each person has to balance their individual priorities and goals with the reality of a clinical internship system that has remained largely unchanged for the last 50 years. Clinical scientists at all levels are raising significant concerns about the clinical internship system as it stands, and hopefully improvements will be implemented soon. But until that happens, each of us should consider if the current clinical internship model helps us individually achieve our career goals. I hope the topics highlighted in this column help encourage trainees to consider talking about their current goals with their mentors, and if clinical internship still serves a function in achieving those goal