The availability of training opportunities in personality disorders in American Psychological Association- and Psychological Clinical Science Accreditation System-accredited clinical and counseling psychology doctoral programs.

Abstract

Personality disorders (PDs) are relatively common, especially in clinical settings. A number of evidencebased treatments are now available, especially for borderline personality disorder (BPD). However, little is known about the relevant training available to doctoral students in clinical and counseling psychology. In the current study, data were extracted from 336 clinical and counseling PhD and PsyD programs from the Insider's Guide to Graduate Programs in Clinical and Counseling Psychology (Sayette & Norcross, 2020), including the number of programs with faculty with specific interests in personality disorders and the number of programs with clinical opportunities related to personality disorders. We found that formal training in personality disorders is not widely available to most trainees in American Psychological Association (APA)-accredited doctoral training programs. Only 16% of programs have faculty with interests in personality disorders, all of them clinical psychology programs. PhD programs were more likely to have PD-interested faculty than PsyD programs, and, within clinical PhD programs, Psychological Clinical Science Accreditation System (PCSAS)-accredited programs were more likely to have PD-interested faculty than programs without PCSAS accreditation. Similarly, only 15% of programs (all clinical psychology programs) offer practicum opportunities in psychotherapy for personality disorders. Our findings indicate that doctoral-level psychology programs are not sufficiently preparing their students with personality disorder training, which serves as a substantial disservice to both trainees and the public. Public Significance StatementThis study found that training in personality disorders at American Psychological Association (APA)accredited clinical and counseling doctoral programs is not available to a level commensurate with the prevalence and severity of the problem. This was particularly true among PsyD programs and even more so counseling programs. Although training in personality disorders was statistically more likely to be available at APA-accredited programs that were also Psychological Clinical Science Accreditation System (PCSAS)-accredited, most of these programs, regardless of accreditation, also lacked faculty with declared expertise and/or specified clinical training opportunities in personality disorders. As a profession, we are at risk of not providing needed research and clinical training.

The availability of dialectical behavior therapy in partial hospitalization and residential services for borderline personality disorder: An exploratory longitudinal study of the National Mental Health Services Survey from 2014 to 2021.

“…This variation is consistent with state-level disparities in training in treating patients with personality difficulties; scholars have described a paucity of training and clinical practica in evidence-supported treatments for personality disorder. Scholars have found, for example, that training and practica in personality disorders has generally been found to be underrepresented in clinical psychology programs, with 16.4% of schools reporting at least one faculty member with a research interest in personality disorders and 14.9% offering a specific clinical practicum in treating PDs (Levy & Ellison, 2022). Without greater dissemination of EBTs in PDs, it is unclear that clinic directors will be able to provide comprehensive treatment and supervision for treating PDs in a day-treatment or residential setting.…”

“…Growth in day-treatment programs may be related to greater interest in both internet-based training and delivery of DBT skills, which may provide for greater availability for clinicians to learn DBT principles, and for patients to receive DBT skills training (Frank et al, 2020; Lakeman et al, 2022). Additionally, training in DBT, at least among doctoral-level clinical psychology programs has been increasing during this time (see Levy & Ellison, 2022 vs. Magnavita et al, 2010). Levy and Ellison found a 129% increase in faculty with expertise personality disorders and a corresponding increase in clinic and externship clinical training in personality disorders.…”

“…Meta-analyses have shown small-to-moderate effect sizes for DBT treatment; however, both direct comparisons (Clarkin et al, 2007; McMain et al, 2009; Turner, 2000) and meta-analytic studies (Cristea et al, 2017; Oud et al, 2018; Storebø et al, 2020) suggest that these other treatments are equally effective (see Levy et al, 2022 for a review). These other treatments are not being taught (Levy & Ellison, 2022) nor sufficiently disseminated. Given patient heterogeneity (Ellison et al, 2020), preferences (Swift et al, 2018), and the existence of moderators that favor other treatments (Keefe et al, 2023), more effort is needed to disseminate these treatments (Levy, 2008; Levy & Scala, 2015).…”

Borderline personality disorder.

“…Examples of modifications include the explication of a coherent model of the problem and treatment, a clear focus and priorities, an increased attention to explicit frame issues, vigilance for indications of colluding with the patient, acting out or iatrogenic behaviors on the therapist's part, provision of supervision or intervision, and integration with other services, among other aspects. These modifications require specific skills, and therefore clinicians who treat individuals with BPD should have training in one or more of the empirically supported treatments (but see Levy & Ellison, 2021), and employ evidence-based principles deriving from these treatments.…”

Veterans affairs serious mental illness patients: Differences in high-intensity service use by personality disorder status.

“…Most prevalence studies have found between 9% and 11% in community samples across multiple cultures and geographic areas (Winsper et al, 2019). A review of current prevalence work has shown that these rates increase sharply when using structured diagnostic measures in clinic populations (20-45% outpatient, 45%-50% inpatient; Levy & Ellison, 2021). Persons with PDs have been found to have increased service utilization, decreased functioning, and increased risk of suicide and suicidal behaviors relative to other psychiatric conditions such as major depressive disorder (Skodol et al, 2005).…”