Doctoral students have the enormous task of balancing clinical work, research, teaching and coursework; all while ensuring they have enough clinical hours to be competitive for the process of applying for internship. If your clinical placement is not getting you the hours you need, it can add unneeded stress. Here are some tips for each stage of the process to help you advocate for your training needs successfully.

Before Starting a Placement

1. Know what you’re getting yourself into.

An important way to make sure you’re getting the clinical experience you need is to avoid less than ideal placements altogether. To do this, it is crucial to start the process early, before you even apply for a practicum position. Speak to fellow graduate students who have worked at your site of interest, talk to graduate school professors and research the site diligently.

Look at their materials, their online presence, how many staff psychologists they have and how long they’ve been training practicum students. As a rule of thumb, more established, fully staffed sites are likely to have more structured systems in place to make sure you’re getting the clinical hours you need. Make sure to ask questions about how many clinical hours students usually get, or for the ratio of face-to-face vs. supervision vs. support hours.

2. Know your working style.

When speaking to people about a practicum position where it might be more difficult to get your clinical hours, you might hear them tell you that the site requires “assertiveness” or that the position “is what you make of it.” This is not necessarily a bad thing, but it is important to know ahead of time whether you are the type of person who thrives in this work environment. As you move forward in your career, assertiveness and interpersonal effectiveness skills will be instrumental in advocating for yourself. If you’re poised to begin a practicum position that requires the use of these skills, make sure you consider whether this is a good time in your training (and personal life) to take on a position that requires them. It’s okay if it’s not, but it’s probably not a good idea to accept the position then!

3. Set Goals and Plan Ahead.

If you do plan to take the position, make sure you plan ahead to ensure you get what you need out of it. Most psychology doctoral students will do three to four years of clinical placements before applying to internship. Make sure to strategize ahead of time to know exactly what your goals are for this year’s practicum.

For example, if you already have a lot of assessment experience under your belt, maybe your goal is to spend this year getting at least X number of intervention hours. On the other hand, if you plan on taking an intervention-focused position in the future, maybe this year’s goal is to get X number of hours or assessment experience or complete X number of integrative reports.

It’s also important to consider the setting you are hoping to be in. If your heart is set on a career in health psychology, it may be worth it to take a position in a hospital that will land you fewer hours. Roughly plan out how many hours per week of face-to-face time you would like to get to meet your goals for the year. You can even talk to the site before accepting the position, letting them know your goals for the year. If you get feedback that these goals will be difficult for the site to meet, it may not be the place for you.

During the Placement

1. Be Appropriately Assertive.

It’s always important to ask for what you want, but make sure you do it in a way that respects the integrity of your practicum site. Most practicum sites are full of hard-working people who are not getting paid for their role in training you. Remember to be modest and appreciative of the role that you have taken on.

It is entirely appropriate to tell a practicum site, “I’m really motivated to take on additional therapy/assessment cases. My caseload is currently X, do you think it’s possible in the next few weeks to increase it to Y?” It is less appropriate (and may be interpreted as ungrateful) to say, “This site is not giving me enough hours and I’m not going to be able to apply to internship because of it.”

2. Rely on your supervisor.

Supervision is a time to process personal experiences that we do not want to bring into our clinical relationships. Make sure to use it! Next supervision, reiterate to your supervisor that you’d like to get the most of your training experiences and are really motivated to grow your caseload but don’t know how. Managing a clinical caseload is a great professional development skill; let your supervisor help you navigate learning to do this.

3. Rely on your advisor or DCT.

At times, graduate students may not want to go to an on-site supervisor about their concerns because of personal or practical matters. In these situations, academic research advisors or even directors of clinical training can be great resources. Speaking to someone outside of the practicum site might allow you to practice asking for what you need on-site or find ways to get additional hours through other opportunities (maybe there’s an RCT starting up that requires a therapist, or maybe your school clinic needs help whittling down their assessment waitlist). 

4. Be Creative.

There is more than one way to get clinical face-to-face hours in practicum positions. Students who can make their supervisors aware of a particular role they might be able to fill at the site might find that they go from a sparse caseload to an overflowing one. Some creative ways to “brand yourself” include:

  • Have an EBP you are strong in? Become the clinic’s “ACT Queen” or “DBT Master” so any case with the need for a certain treatment modality will be coming your way.
  • Love to work with certain populations or referral questions? Spread the word that you’re a “teenage boy whisper” or one that “loves working with complex medical cases.”
  • Start therapy groups. Often busy clinics do not have the staff to support all of the group therapies they’d really like to do, so see if you can fill that role for them.
  • Offer to do intake interviews. Intake evaluations are high in demand at many clinics. Volunteer a block of time each week to pick up one or two intakes. The clinic will love you, and you’ll rack up hours without committing to more time-intensive therapy or assessment cases.
  • Supervise more junior students. As a senior graduate student, offer to use your clinical expertise to support other students. Umbrella supervision is a great experience as well as another way to gain more clinical hours.
  • Ask to shadow or be a co-therapist on some of your supervisor’s most challenging or unique cases. Remember, practicums are all about gaining experience – if your supervisor has expertise in a certain modality or clinical presentation, ask if you can sit in on some of their sessions. Watching other talented psychologists is a great way to learn.

5. Be Strategic.

When entering a new clinic, it’s important for practicum students to realize they’re walking into an already functioning clinic with its own unique environment and culture. It’s important to take some time to see how you fit into this environment, and also how you don’t.

  • Introduce yourself and stay friendly with the support staff. Front desk staff, social workers and intake coordinators are often the front lines of new patient contact and can be awesome allies in getting you new and exciting cases and training experiences.
  • Make yourself known to other providers. Go to rounds, take lunch in the staff break room, and introduce yourself to the medical team. Busy clinicians can often accidentally overlook part-time practicum students. Make sure they know your face and what your job is in the clinic (feel free to remind them over and over), so they can make referrals to you when the need comes up.
  • Know when it’s time to work on something else. Sometimes effectively advocating for yourself means knowing when it’s not appropriate. If the clinic is going through major transitions in staffing or is suffering a period of low census numbers, realize that you are not the only person who may not be getting the clinical hours they want or need. If this is the case, take a deep breath, practice some mindfulness and turn to something else on your to-do list. Balancing the demands of graduate school also means knowing that if you get that dissertation proposal done now, you’ll have more time for clinical work next year.

Kelsey Sala-Hamrick, MA

Kelsey is currently a Predoctoral Intern at the University of New Mexico Health Sciences Center. She is completing her PhD in Clinical Psychology at Wayne State University in Detroit, MI. Kelsey is a passionate advocate for increasing access to treatment and reducing health disparities in underserved communities. Her research and clinical interests focus on the protective process involved in the resilient development of children and families. She is interested in taking a holistic (bio-psycho-social) view of how these processes unfold in underserved populations. She is also interested in bio-psycho-social approaches to treating youth with chronic medical conditions, as well as understanding how integrated ambulatory and primary healthcare can support at-risk communities by reducing barriers to high-quality treatment. In addition to her clinical and research pursuits, Kelsey is a dedicated healthcare educator who enjoys training and mentoring junior colleagues in both psychology and the allied health professions.