Erin Crozier BS, and Samuel Collier BA
This paper elaborates on a brief report about survey data collected by Division 49 leadership. The purpose was to obtain an overview of group training opportunities in APA-accredited clinical and counseling psychology programs in the United States and to determine if opportunities are different across types of program. The sample was 55 directors of clinical training. A majority (64%) reported that their school offers a group course, but over a third have no group course available and only three reported offering an advanced group course. Most of the open responses received stated that group experience is available at affiliated practicum sites, and 67% stated that students in their program have opportunities for involvement in group research. Most respondents indicated that group therapy has a moderate to high level of value in their program. Directors of counseling psychology programs gave a higher rating for the value of group therapy in their programs and were more likely to report offering a group class than were directors of clinical psychology programs. Based on these data, group training is available to many students, but opportunities are inconsistent, leaving the possibility that many will enter the profession with little or no group training.
An oft-discussed concern among group psychotherapists is the growing demand for group work in the field (Fuhriman & Burlingame, 2001; Taylor et al., 2001), without a corresponding increase in group training provided to students in psychology and other mental health professions (Barlow, 2008; Conyne & Bemak, 2004; Kovach, Dubin, & Combs, 2014). For many emerging practitioners of group psychotherapy, much of their group-specific training is gained on the job, or they are never formally trained at all. In such a case, it could benefit both clinicians and clients if these practitioners were able to gain a more extensive background in group therapy in their masters or doctoral programs. Indeed, several recent studies have demonstrated that trainees in social work (Goodman, Knight, & Khudododov, 2014), psychiatry (Kovach et al., 2014), and counseling (Ohrt, Ener, Porter, & Young, 2014) desire more group work training in their years of formal education.
Despite this inconsistency of group training in graduate programs, some scholars in psychology have expressed hope that pre-doctoral internships provide solid training in group psychotherapy that makes up for inconsistent training in doctoral programs. However, this appears to be a false hope, as group training in internship programs has been found to be inconsistent as well (Markus & King, 2003). Currently, there are multiple options for obtaining specialty training and certifications in group psychotherapy (Barlow, 2008, 2013; Stone, 2010) at the pre- and post-doctoral level. However, the current reality is that many providers of group therapy do not have the time, inclination, or administrative support to seek out such credentials and therefore must rely solely on the training that they received in their doctoral education. Given this reality, it is important to understand precisely what training opportunities exist in doctoral training programs in psychology.
A few previous studies have sought to directly assess available training opportunities; however, these studies are now either outdated (Fuhriman & Burlingame, 2001) or limited by only surveying student experiences in a single training program (Goodman et al., 2014). The present study, therefore, aimed to provide a current overview of the training opportunities available in APA-accredited clinical and counseling psychology graduate training programs. This article elaborates on a brief survey report by Lee Gillis (2014). These survey data were gathered by Division 49 leadership, including Lee Gillis, Sean Woodland, Rosamond Smith, and Leann Diederich.
In addition to obtaining a general overview of current training opportunities in clinical and counseling psychology programs, this study sought to reassess some previous findings. Fuhriman and Burlingame (2001) found that clinical psychology programs reported fewer required courses in small group experience, supervised clinical experience, and group theory than did counseling psychology programs, and that directors of counseling programs reported valuing group therapy more than did directors of clinical programs. Thus, this study sought to discover whether these differences still exist in the current training landscape, as well as to determine the overall availability of group psychotherapy training opportunities in graduate training programs in the United States.
Surveys were sent via email to directors of 57 Council of Counseling Psychology Training Programs (CCPTP), 31 directors from National Council of Schools and Programs of Professional Psychology (NCSPP; identified from webpages), and to the listserv of the Council of University Directors of Clinical Training (CUDCP; approximately 80 members). From each of these requests, 24, 8, and 21 responses were received, respectively. In addition, 3 board members of Division 49 responded to a pilot study with usable data about their programs. Of these 56 responses, 1 respondent declined to participate, leaving a total N of 55. The full response rate (56 of approximately 168) was about 33%. Note that 2 additional responses were received since the original brief survey report (Gillis, 2014).
In addition to the 1 respondent who declined to participate, 8 provided incomplete data. Their responses were included in the analyses for the items to which they provided a response. Of the 47 respondents who provided complete data, 26 (55%) were directors of clinical psychology programs and 21 (45%) were from counseling psychology programs. A total of 37 respondents (79%) were from Ph.D. programs, while 10 respondents (21%) were from Psy.D. programs. Six of the respondents (5 Ph.D. and 1 Psy.D.) reported that students from their programs also receive a master’s degree.
Materials and Procedure
After providing consent to participate, participants responded to a questionnaire created specifically for this study. The questionnaire included five multiple choice and seven open response questions about group training opportunities available in the respondents’ training programs, as well as one scaled question (0-10) asking participants to rank the perceived value of individual, couple, family, and group therapy in their training program. Additionally, participants answered brief demographic questions about their program and were asked if they would like their program’s information to be shared by name on the Division 49 webpage. Information from this component of the survey will be published online at a later date. Respondents were free to skip questions as desired.
The open response data were sorted qualitatively by grouping data from each question into categories of similar responses, with one author first working independently and then the other checking all work and regrouping responses when appropriate. The full dataset was referenced to clarify responses when needed.
To determine whether any group differences existed between responses of clinical and counseling psychology program directors, simple t-tests were conducted. Paired samples t-tests were also used to examine the differences in the perceived value of individual, couple, family, and group therapy in the full sample.
Of the total survey respondents (N = 55), a majority (n = 35; 64%), indicated that their school offers some form of group psychotherapy course. Of the 29 respondents who provided additional qualitative descriptions of their courses, almost all offer a basic, semester-long course. Only 3 respondents indicated that their program offers an advanced group therapy course. Although only 8 respondents identified specifically that their group course was required, the actual number of programs requiring students to take a course in group work may be much higher because our survey did not ask directly about the presence of a required course.
Of those respondents who said their program provides a group course, 78% (n = 25) indicated the presence of an experiential component. In addition, half of those with group classes reported that their class includes peer leadership opportunities (n = 16; 50%) and a similar number of courses include rotating leadership (n = 17; 53%). Of the 23 respondents who described the experiential component of the class, 17 (74%) described the use of some form of group process simulation. Additionally, 34% of the 50 respondents who provided data on this item (n = 17) reported that group training is included in other coursework within the program, such as within practicum class, multicultural or diverse populations classes, and intervention or technique classes, among others.
In terms of group psychotherapy experiences available during practicum, 37 of 39 open responses reported that group psychotherapy was currently being administered by students at one or more affiliated practicum sites. However, none of the programs indicated the presence of any group-specific practicum opportunity.
In regards to research opportunities, 31 of 46 valid responses (67%) indicated that group-focused research opportunities are available to students within their program. According to the 28 respondents who described these opportunities in an open response question, types of research vary broadly and include student dissertations, special projects, and faculty-driven research.
When asked to rate the value placed on each of four psychotherapy modalities on a scale of 0 to 10, individual therapy was consistently ranked the highest with an average rating of 9.68 and a standard deviation of only 0.66. Not one of the 47 respondents to this question ranked individual therapy lower than a score of 8. Within the value ratings for group therapy (M = 6.15; SD = 2.21), most scores (n = 32) fell between 5 and 8, indicating that group therapy is consistently of a moderate-high importance level in the majority of programs. Examination of the scores for couples therapy (M = 5.19, SD = 2.52) and family therapy (M = 5.87, SD = 2.76) reveals that group therapy is consistently valued as much as or more than these modalities. In fact, results from paired samples t-tests indicate that our sample placed a higher value on group therapy than on couples therapy (t = -2.28, df = 46, p < .05) and that scores for the value of family therapy and group therapy were not significantly different from one another (t = -.58, df = 46, p = .56).
Lastly, while the slight majority of respondents to the survey identified as clinical psychology programs, 100% of counseling psychology programs indicated presence of a group psychotherapy class in their program, while only 35% of clinical programs reported the presence of such a class. Even when accounting for the unequal variance between these two segments of our sample, the difference in the presence of a group class between clinical and counseling programs is clearly significant (t = -6.87, df = 25, p < .001). Additionally, in the aforementioned value ratings of different therapy modalities, respondents from clinical psychology programs gave lower ratings for the value of group therapy than did those from counseling psychology programs (t = -2.35, df = 45, p < .05).
The results of this study have provided an assessment of the current availability of group psychotherapy training for clinical and counseling psychology doctoral students. Despite a few limitations, several conclusions may be drawn, and further research into the sufficiency of group therapy training is warranted.
Although the majority of our sample reported offering at least one course in group psychotherapy, over one third of the responding programs offer no such course. This is even more striking in clinical psychology programs, where just over one third reported offering a class in group. Additionally, only three programs in our sample reported that they offer an advanced group therapy course. In advocating for the importance of group training in today’s professional landscape, several authors have argued that even a one-semester course is wholly insufficient (Barlow, 2008; Ohrt et al., 2014; Stockton et al., 2014). Based on the results of this research, additional opportunities for group training in graduate programs are warranted to meet the demands in the industry.
While almost all of the respondents who answered our open response question about practicum training reported that there are opportunities for their students to provide group therapy at affiliated practicum sites, it is unclear if those who did not respond to this question simply skipped the open response for time or convenience, or if they did so because they do not offer any opportunities for group training at practicum sites. Additionally, regardless of whether students are afforded opportunities for group practice at practicum sites, those who were not offered a group class in their academic curriculum may still be left at a disadvantage due to lack of exposure to the theoretical foundations of group process, group leadership, and other topics essential to developing competency in group psychotherapy. Essentially, more must be done to ensure both proper training and practical experience are offered to practitioners to ensure basic competence in group therapy before entering the field.
It is encouraging that most training directors in our sample placed a moderate to high level of value on group therapy. However, it appears that sufficient training opportunities in group therapy may be falling second to the emphasis placed on other modalities and the varied coursework necessary in training future psychologists. As members of Division 49, we sincerely hope that group will continue to be an increasingly strong presence in those competencies viewed as necessary, but much work is still needed in this area. Perhaps this argument can be strengthened by authors like Counselman (2008), who argued that training in group modalities provides a profound impact on all clinical work, including individual psychotherapy and other aspects of one’s professional identity. The authors of this paper agree with Counselman that an increase in group training within programs across the board will bring a variety of benefits whether or not practitioners in training ever choose to pursue group therapy interventions.
Several limitations within this study are also of note, and some of these could be overcome in future research. First, the study is limited by a relatively small initial sample size and several incomplete responses, resulting in a final sample of only 47 responses. Although the response rate was certainly respectable for online survey-based research, a larger sample would strengthen the implications that could be drawn from the results. This may be helped by targeting group training faculty, sending email reminders after the initial survey distribution, or rephrasing some questions from open response to multiple, although the latter may result in the loss of some rich qualitative data.
Second, response bias may have skewed the sample towards graduate programs more interested in group training. Of the 168 program directors who were contacted, it is possible that those who were most interested in the subject matter of the survey were more likely to complete it. If this is the case, the results may show only a skewed view of the actual status of group training across all programs.
Third, there were some limitations in the phrasing of survey questions, which could be modified or added in order to gain additional information. For example, as Gillis (2014) pointed out in the initial brief synopsis of the survey, the survey asked “Does your program provide a group-specific class or classes?” instead of asking whether such a class is required, which would determine whether group training is mandatory in each program. Additional questions such as “Approximately what percentage of affiliated practicum sites administer group psychotherapy at your school?” could also provide valuable information. Questions qualifying the respondents’ role in the program and expertise in the field of group psychotherapy may also be important in determining whether follow-up could be conducted by a more qualified member of the faculty, as well as allow for the assessment of potential response bias.
This study has provided a snapshot of the current state of group psychotherapy training within clinical and counseling psychology doctoral programs. Future research should continue to assess demand in the field in order to determine whether group training in programs is adequate for the demand placed on emerging practitioners. Because group therapy is performed by professionals from many different disciplines, additional research on group training in training programs in social work, psychiatry, and counseling may also be valuable. If demand is not being met, this research will also set the stage for how programs can be further enhanced. For example, an increasing demand at clinical sites may warrant the creation of advanced level group training courses. This study provides one small piece of a complex puzzle as we continue to pursue the development of high quality group therapy competencies in our emerging practitioners.
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