The success of graduate programs in clinical psychology did not go unnoticed. The 1970s saw the birth of freestanding "professional schools" of psychology, most of which were not associated with a college or university. Like many trends, this one began in California. College students often found psychology to be a fascinating subject, and graduate school was difficult to get into. There were plenty of students to fill these new professional schools. As these schools grew the number of students competing for clinical psychology internships also grew. The number of internships could not keep up with this growth in students, and competition for the limited number of internship slots became fierce.
In 1999, for example, the Association of Psychology Postdoctoral and Internship Centers reported matching 2,413 students with internships. 510 students were not matched, and 212 students withdrew from the process (and were likely unplaced). 218 internship positions remained unfilled. These numbers do not take into account the number of psychologists who find internship positions in other ways.
By the 1980s health costs had begun to skyrocket. Managed care appeared as an attempt to control these costs. Psychologists and other therapists found their practices directed by managed care company employees who usually have much less training. Paperwork increased dramatically and many therapists' incomes fell. Many psychologists began to look for work settings with more job security and fewer hassles. With all of this change in the field, some are asking whether we really need 2500 plus new psychologists every year.
What will happen to the current crop of psychology majors? Psychology is still a broad field with careers in academic and research settings as well as clinical settings. School psychology and industrial/organizational psychology are also fields unaffected by managed care. The APA is actively encouraging clinical and counseling psychologists to consider other career niches. Health psychology is a field that places psychologists in medical settings. Psychologists have made significant contributions in fields such as chronic pain treatment, cancer care, organ transplant evaluation, relapse prevention and smoking cessation. Health insurance plans may not reimburse for a psychologist's services in these areas, but they are increasingly being seen as a valuable part of the healthcare team. The psychologist's emphasis on the whole person is becoming a helpful counterpoint to the prevailing disease model.
Other clinical and counseling psychologists are finding that their skills are useful to organizations. Organizational consultation and executive coaching are fields that utilize therapy skills to help people and organizations change in positive ways. Mediation and arbitration are also attracting some clinicians. Divorce mediation is becoming a popular alternative dispute resolution technique for helping divorcing couples develop their own agreement without getting "dueling lawyers" involved. Attorneys are still needed to assist each partner, but the cost is often less than with the traditional approach.
"Online therapy" is also gaining in popularity - perhaps partly because managed care is not involved in the process. This frontier is developing rapidly as second generation sites offer built-in security features. Many ethical issues remain to be resolved in this area, however. No aspiring psychologist should count on earning a full time income doing Online work.
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