first institution to offer formal education in clinical psychology in the u.s. some u.s. schools offer accredited programs in clinical psychology resulting in a master's degree. such programs can range from forty-eight to eighty-four units, most often taking two to three years to complete after the undergraduate degree. training usually emphasizes theory and treatment over research, quite often with a focus on school or couples and family counseling. similar to doctoral programs, master's level students usually must complete a clinical practicum under supervision; some programs also require a minimum amount of personal psychotherapy. while many graduates from master's level training go on to doctoral psychology programs, a large number also go directly into practice—often as a licensed professional counselor (lpc), marriage and family therapist (mft), or other similar licensed practice, which varies by state. there is stiff competition to gain acceptance into clinical psychology doctoral programs (acceptance rates of 2–5% are not uncommon). clinical psychologists in the u.s. undergo many years of graduate training—usually five to seven years after the bachelor's degree—to gain demonstrable competence and experience. licensure as a psychologist may take an additional one to two years post-phd/psyd. some states require a 1-year postdoctoral residency, while others do not require postdoctoral supervised experience and allow psychology graduates to sit for the licensure exam immediately. some psychology specialties, such as clinical neuropsychology, require a 2-year postdoctoral experience regardless of the state, as set forth in the houston conference guidelines. today in america, about half of all clinical psychology graduate students are being trained in phd programs that emphasize research and are conducted by universities—with the other half in psyd programs, which have more focus on practice (similar to professional degrees for medicine and law). both types of doctoral programs (phd and psyd) envision practicing clinical psychology in a research-based, scientifically valid manner, and most are accredited by the apa. apa accreditation is very important for u.s. clinical, counseling, and school psychology programs because graduating from a non-accredited doctoral program may adversely affect employment prospects and present a hurdle for becoming licensed in some jurisdictions. doctorate (phd and psyd) programs usually involve some variation on the following 5 to 7 year, 90–120 unit curriculum: bases of behavior—biological, cognitive-affective, and cultural-social individual differences—personality, lifespan development, psychopathology history and systems—development of psychological theories, practices and scientific knowledge clinical practice—diagnostics, psychological assessment, psychotherapeutic interventions, psychopharmacology, ethical and legal issues coursework in statistics and research design clinical experience practicum—usually three or four years of working with clients under supervision in a clinical setting. most practicum placements begin in either the first or second year of doctoral training. doctoral internship—usually an intensive one or two-year placement in a clinical setting dissertation—phd programs usually require original quantitative empirical research, while psyd dissertations involve original quantitative or qualitative research, theoretical scholarship, program evaluation or development, critical literature analysis or clinical application and analysis. the dissertation typically takes 2–3 years to complete. specialized electives—many programs offer sets of elective courses for specializations, such as health, child/adolescent, family, community, or neuropsychology. personal psychotherapy—many programs require students to undertake a certain number of hours of personal psychotherapy (with a non-faculty therapist) although in recent years this requirement has become less frequent. comprehensive exams or master's thesis: a thesis can involve original data collection and is distinct from a dissertation. psychologists can be seen as practicing within two general categories of psychology: health service psychology, which includes "practitioners" or "professionals" and research-oriented psychology which includes "scientists" or "scholars". the training models (boulder and vail models) endorsed by the apa require that health service psychologists be trained as both researchers and practitioners, and that they possess advanced degrees. psychologists typically have one of two degrees: psyd or phd. the psyd program prepares the student primarily as a practitioner for clinical practice (e.g., testing, psychotherapy), but also as a scholar that consumes research. depending on the specialty (industrial/organizational, social, clinical, school, etc.), a phd may be trained in clinical practice as well as in scientific methodology, to prepare for a career in academia or research. both the psyd and phd programs prepare students to take the national psychology licensing exam, the examination for professional practice in psychology (eppp). within the two main categories are many further types of psychologists as reflected by apa's 54 divisions, which are specialty or subspecialty or topical areas, including clinical, counseling, and school psychologists. such professionals work with persons in a variety of therapeutic contexts. people often think of the discipline as involving only such clinical or counseling psychologists. while counseling and psychotherapy are common activities for psychologists, these health service psychology fields are just two branches in the larger domain of psychology. there are other classifications such as industrial and organizational and community psychologists, whose professionals mainly apply psychological research, theories, and techniques to "real-world" problems of business, industry, social benefit organizations, government, and academia. apa-recognized specialties clinical psychology clinical neuropsychology clinical child and adolescent psychology school psychology behavioral and cognitive psychology couple and family psychology clinical health psychology geropsychology police and public safety psychology sleep psychology rehabilitation psychology group psychology and group psychotherapy forensic psychology industrial and organizational psychology psychoanalysis counseling psychology serious mental illness psychology clinical psychopharmacology clinical psychologists receive training in a number of psychological therapies, including behavioral, cognitive, humanistic, existential, psychodynamic, and systemic approaches, as well as in-depth training in psychological testing, and to some extent, neuropsychological testing. services clinical psychologists can offer a range of professional services, including: psychological treatment (psychotherapy) administering, scoring, and interpreting psychological tests prescribing medications (in some states) conducting psychological research teaching developing prevention programs consulting program administration expert testimony supervision of students or other mental health professionals in practice, clinical psychologists might work with individuals, couples, families, or groups in a variety of settings, including private practices, hospitals, community mental health centers, schools, businesses, and non-profit agencies. most clinical psychologists who engage in research and teaching do so within a college or university setting. clinical psychologists may also choose to specialize in a particular field. prescriptive authority for psychologists (rxp) psychologists in the united states campaigned for legislative changes to enable specially-trained psychologists to prescribe psychotropic medications. legislation in idaho, iowa, louisiana, new mexico, and illinois has granted those who complete an additional master's degree program in clinical psychopharmacology authority to prescribe medications for mental and emotional disorders. as of 2019, louisiana is the only state where the licensing and regulation of the practice of medical psychology by medical psychologists (mps) is regulated by a medical board (the louisiana state board of medical examiners) rather than a board of psychologists. while other states have pursued prescriptive authority, they have not succeeded. similar legislation in the states of hawaii and oregon passed through their respective legislative bodies, but in each case the legislation was vetoed by the state's governor. in 1989, the u.s department of defense was directed to create the psychopharmacology demonstration project (pdp). by 1997, ten psychologists were trained in psychopharmacology and granted the ability to prescribe psychiatric medications. licensure the practice of clinical psychology requires a license in the united states and canada. although each of the u.s. states is different in terms of requirements and licenses (see and for examples), there are three common requirements: graduation from an accredited school with the appropriate degree completion of supervised clinical experience passing a written and/or oral examination all u.s. state and canada provincial licensing boards are members of the association of state and provincial psychology boards (asppb) which created and maintains the examination for professional practice in psychology (eppp). many states require other examinations in addition to the eppp, such as a jurisprudence (i.e., mental health law) examination or an oral examination. nearly all states also require a certain number of continuing education credits per year in order to renew a license. licensees can obtain this through various means, such as taking audited classes and attending approved workshops. there are professions whose scope of practice overlaps with the practice of psychology (particularly with respect to providing psychotherapy) and for which a license is required. ambiguity of title to practice with the title of "psychologist", in almost all cases a doctoral degree is required (phd, psyd, or edd in the u.s.). normally, after the degree, the practitioner must fulfill a certain number of supervised postdoctoral hours ranging from 1,500 to 3,000 (usually taking one to two years), and passing the eppp and any other state or provincial exams. by and large, a professional in the u.s. must hold a doctoral degree in psychology (psyd, edd, or phd), and/or have a state license to use the title psychologist. however, regulations vary from state to state. for example, in the states of michigan, west virginia, and vermont, there are psychologists licensed at the master's level. differences with psychiatrists further information: mental health professional § psychiatrists and clinical psychology although clinical psychologists and psychiatrists share the same fundamental aim—the alleviation of mental distress—their training, outlook, and methodologies are often different. perhaps the most significant difference is that psychiatrists are licensed physicians, and, as such, psychiatrists are apt to use the medical model to assess mental health problems and to also employ psychotropic medications as a method of addressing mental health problems. psychologists generally do not prescribe medication, although in some jurisdictions they do have prescription privileges. in five u.s. states (new mexico, louisiana, illinois, iowa, and idaho), psychologists with clinical psychopharmacology training have been granted prescriptive authority for mental health disorders. psychologists receive extensive training in psychological test administration, scoring, interpretation, and reporting, while psychiatrists are not trained in psychological testing. in addition, psychologists (particularly those from phd programs) spend several years in graduate school being trained to conduct behavioral research; their training includes research design and advanced statistical analysis. while this training is available for physicians via dual md/phd programs, it is not typically included in standard medical education, although psychiatrists may develop research skills during their residency or a psychiatry fellowship (post-residency). psychologists from psyd programs tend to have more training and experience in clinical practice (e.g. psychotherapy, testing) than those from phd programs. psychiatrists, as licensed physicians, have been trained more intensively in other areas, such as internal medicine and neurology, and may bring this knowledge to bear in identifying and treating medical or neurological conditions that present with primarily psychological symptoms such as depression, anxiety, or paranoia (e.g., hypothyroidism presenting with depressive symptoms, or pulmonary embolism with significant apprehension and anxiety). mental health professions comparison of mental health professionals in the us occupation degree common licenses prescription privilege mean 2020income (usd) clinical psychologist phd/psyd/edd psychologist varies by state $89,290 counseling psychologist (doctorate) phd/psyd/edd psychologist no $65,000 counselor (master's) ma/ms/med mft/lpc/lhmc/lpa no $47,660 school psychologist phd/edd/ms/eds school psychologist no $74,000 psychiatrist md/do psychiatrist yes $217,100 clinical social worker phd/dsw/msw lcsw no $51,760 psychiatric nurse msn/bsn rn no $75,330 psychiatric and mental health nurse practitioner dnp/phd/msn aprn/apn/pmhnp yes (varies by state) $117,670 expressive/art therapist ma atr no $55,900 sources: marriage and family therapist (mft). an mft license requires a doctorate or master's degree. in addition, it usually involves two years of post-degree clinical experience under supervision, and licensure requires passing a written exam, commonly the national examination for marriage and family therapists, which is maintained by the american association for marriage and family therapy. in addition, most states require an oral exam. mfts, as the title implies, work mostly with families and couples, addressing a wide range of common psychological problems. some jurisdictions have exemptions that let someone practice marriage and family therapy without meeting the requirements for a license. that is, they offer a license but do not require that marriage and family therapists obtain one. licensed professional counselor (lpc). similar to the mft, the lpc license requires a master's or doctorate degree, a minimum number of hours of supervised clinical experience in a pre-doc practicum, and the passing of the national counselor exam. similar licenses are the licensed mental health counselor (lmhc), licensed clinical professional counselor (lcpc), and clinical counselor in mental health (ccmh). in some states, after passing the exam, a temporary lpc license is awarded and the clinician may begin the normal 3000-hour supervised internship leading to the full license allowing to practice as a counselor or psychotherapist, usually under the supervision of a licensed psychologist. some jurisdictions have exemptions that allow