What I Got Right and Wrong About Choosing a Clinical Psychology PhD Program

A Postmortem on cost, location, and clinical training

I’m getting close to the end of my time at a clinical psychology PhD program. I’ve now been training in this field for five years, first in a master’s program, then at a doctoral program.

I’m currently applying for what’s called “predoctoral clinical internship,” which is essentially a one-year clinical residency that’s required before becoming licensed to practice therapy as a psychologist. Most trainees move across the country for it, and I am hoping to head to the mountains.

The internship application process closely resembles applying to doctoral programs, which has forced some retrospection. There’s already plenty of great advice out there, so what follows isn’t meant to be a definitive checklist of things to keep in mind. In fact, that kind of checklist might even end up obscuring some of the points most worth making.

So instead, this is a postmortem on what I did, didn’t, and should have focused on when I was applying to clinical psychology PhD programs four years ago. First I’ll touch on one factor I did take into account, and then touch on two that I didn’t.

First off:

1. Financial Cost

Highly Weighted by Almost Everyone, yet Still Underweighted by Almost Everyone

If you remember one thing from this post, let it be this: unless your last name is Bezos, the financial cost of your clinical psychology graduate training should be the single most important factor dictating where you go.

Unlike JD or MD programs, it is possible to get paid to earn a PhD in clinical psychology. However, that headline fact obscures an uncomfortable truth: many programs offer little to no real funding, and the variation in compensation is enormous. Some programs offer tuition remission but no stipend. Some offer a stipend but no tuition remission. Some claim to offer both while charging thousands in student fees. Two real examples:

• I once met a PhD student receiving $14k/year at South Central Redacted University. His program had a policy prohibiting outside employment for graduate students, but this guy had a secret full-time job as a waiter to make ends meet. When I spoke to him, he had just decided to push back his academic milestones by a year to help forestall burnout from the grind.

• The year I applied for PhD programs, Northeastern State Redacted University reportedly told applicants on interview day that their tuition remission would only cover 50% of tuition.

And this is among nominally funded programs. Many others—especially PsyD programs—offer nothing at all. The difference between a fully funded program and a fully unfunded one is often on the order of $250–400k in non-dischargeable student debt.¹ That debt follows you forever; bankruptcy won’t touch it. This is particularly rough because the path to a clinical psych PhD requires you to spend most of your twenties—prime earning, saving, and investment compounding years—earning just enough to get by in the best of cases.

Every once in a while, an undergraduate student tells me they’re considering PsyD programs because they like the idea of a life spent directly helping people in clinical work more than a life spent on statistical analyses. But I’d push back: the decision is, more precisely "should I spend the next five or so years doing research and statistics on a part-time basis, or should I take out six figures of student loans?”

When faced with these sorts of questions from clinically-oriented undergraduates, clinical psychology professors and PhD students usually just recommend a master’s degree that leads to licensure. I don’t feel very confident about this advice for several reasons; for one, it doesn’t grapple honestly with many underlying motivations for doctoral training.

An important aside here while we’re on this topic: it’s simply a myth that funded PhD programs are primarily for people who want to go on to academic careers, whereas PsyDs are for people who want to do clinical work. Even in the most clinical science-y programs, up to 70% of graduates end up working in primarily clinical roles. This myth is partially perpetuated by an odd kind of psychologically protective know-nothingism in clinical science programs, where students are incentivized to tell both their advisors and themselves something like: “I am not sure what I’d like to do after graduating…” I suspect that, at some level, many graduate students know quite well that they don’t want to spend the next 40 years publishing peer-reviewed journal articles.

All this is to say: training costs matter a great deal. I am sorry, and I wish this weren’t so, but again: training costs matter a great deal.

2. Location Location Location

I Slightly Underweighted this Factor

Before coming to my PhD program, I had lived most of my life in or near major cities; in retrospect, I took this proximity for granted, and underestimated how important geographic location would be in shaping my time in graduate school.

Location is important for at least two reasons. First, all else equal, it’s good to lay down personal and professional roots that will stay with you after you graduate. This rarely happens. Clinical psychology is an unusually nomadic field. You often move for graduate school, then again for internship, sometimes again for postdoc, and only then settle somewhere permanently. Each move resets your social circle, professional network, and familiarity with local systems, none of which is portable. To make matters trickier, many programs are located in places where psychologists don’t actually want to live long-term. That’s a shame, because grad school is also pretty long; 4 - 6 years during your 20’s is a defining time, and so going to graduate school somewhere that you can lay down permanent personal and professional roots is a major plus.

Location is also important because living in certain places unlocks unique career opportunities. This is most apparent in large cities, which generate agglomeration effects, meaning that you will grow faster personally and professionally when you’re surrounded by other serious, ambitious people. If you want opportunity—professional, intellectual, or otherwise—you want a major city. I’ll get more concrete about this in the next section, but suffice it for now to say: success has a lot to do with hard work, and a lot to do with luck. Luck involves putting yourself in situations where you can get lucky, and cities are lucky places to be.

I think this logic of agglomeration effects also applies outside of careerism. E.g., there are more opportunities to find really great, compatible romantic partners in larger metro areas, due simply to the number of people there. Of course, cities have their own issues on this front, but I would take a New York or Denver Hinge account over a 100k-population college town any day of the week.²

The one silver lining here is that college towns and flyover cities have lower cost of living, which loops back to the all-important cost factor. I’m happy with my decision to go where I did for my PhD, but, in retrospect, it was a tougher trade-off between location and cost than I’d expected.

3. Breadth, Depth, and Quality of Clinical Training

Wildly Variable, Wildly Misunderstood

Of all the factors I did and did not consider in graduate school, this is where I was the most naive. But on reflection, this is probably the easiest critical factor to lose sight of during the PhD application process.

Programs vary enormously in how they do clinical training. The variation comes down to what the program values and the clinical opportunities readily available.

What a Program Actually Values

Clinical science programs are structurally optimized around scientific output (see also science as a strong-link problem) and are more concerned with minting one academic phenom per decade than ten competent therapists per cohort. This just is what it is, and perhaps it’s in the best interests of the field to have programs like this that punch out the next generation of star researchers. It does, however, mean that many students at these types of programs leave their graduate training with fewer clinical skills than you might expect. When such programs claim to offer “elite research and elite practice,” treat that rhetoric with skepticism. There are only 24 hours in a day. If you spend 12 of them on research, you will be skimming that treatment manual an hour before session, to nobody’s benefit.

But these contextual factors don’t have to make you a passive victim of the grind and a mediocre therapist, provided you lean into your own agency. I once received advice that turned out to be brutally accurate: you are responsible for your own professional development. This is true in graduate school and triply true in clinical science programs. Faculty incentives, peer culture, and institutional prestige all push you toward research output. But if you plan for a clinical career, you must devote yourself to psychotherapy as a craft—a blend of art and science, learned not just through the memorization of aesthetically lifeless (though catchy) acronyms, but through repetition, humility, and hundreds of imperfect, jarringly human clinical encounters.

Funded scientist-practitioner programs tend to fare a lot better here, as do PsyD programs. At the latter, classes and practicum experiences are the entire point. You pay for them, and you get them. I’ve spoken to PsyD students who received a full course in ACT and another full course in DBT. In contrast, we had 1.5 classes on how to practice therapy, followed by instructions to read the manuals as needed. There is a fine line that some programs walk between “Learn By Doing” and “Just Figure It Out.”

Nearby Clinical Opportunities

Clinical training lives or dies by the practicum ecosystem around your program. This is the part I most profoundly underappreciated.

Some metro areas have too many practicum sites. New York, Philadelphia, Boston, and Los Angeles have so many specialized placements that they run internal matching systems just for graduate students. In these cities, you don’t ask whether you can train in OCD, eating disorders, trauma, or personality disorders—you ask which clinic, with whom, and in what theoretical orientation. You can trip over world-class clinical mentors just walking to get coffee. This is classic economies of agglomeration you’d find in major cities.

This is a world away from the clinical training on offer in a small college town or flyover city. In a town of 20–50k people, there simply is no OCD specialty clinic, no high-volume DBT program, no trauma center with serious supervision depth. Instead, your options tend to converge on the same handful of sites: a generalist community mental health center, a chronically understaffed hospital, a jail, or some other placement that is only tangentially aligned with what you actually want to learn. You can still become a good clinician in these settings, but it’s not as straightforward.

And then there’s the quality of your clinical supervision. Clinical training quality is not just about where you train, but who trains you. Supervisors matter enormously. Their judgment and clinical instincts will shape your practice for years. Here’s an uncomfortable truth: the same agglomeration effects that help trainees in cities also select for stronger clinical supervisors.

This is fundamentally a structural issue. Specialization and high-volume training pipelines need a market, and major metros have more patients, more referral networks, more specialty programs, and more dense professional communities. That creates more centers of gravity where strong clinicians congregate and where supervision gets sharpened by repetition, competition, peer effects, and high institutional standards. That doesn’t mean every supervisor in a small town is bad, or that every supervisor in a big city is good. But on average, the distribution is not symmetric, and upstream selection and training effects matter.

Conclusions

So, given all that, would I change anything about how I approached the graduate school application process? Maybe on the margins. I think I would have given more thorough consideration to finding fully-funded programs in larger metro areas, even if that meant working in a research area that I wasn’t all that enthusiastic about. But I also would have also been bolder about my research interests and beelined harder to the woods. But all this retrospective analysis is predicated on the faulty assumption that you can choose where you go to graduate school in clinical psychology. Given how competitive it is to get even a single offer to a more-or-less funded program, this is an uncommon dilemma to have.

So, at the end of the day, perhaps the best advice for those applying now would be: just focus on getting in somewhere, and then grow where you’re planted.

Best of luck to all those in the midst of interview season.

1. Sidenote: there are some federal programs that offer full debt write-offs, but they require you to work for the government or some kind of public sector something-or-other for (I believe) a decade or two. I haven’t looked into it too deeply, because I shrivel and die in large institutions. Even if I had the constitution for government work, I wouldn’t feel comfortable banking my career on a loan repayment program, which is subject to future policy changes, et cetera. That said, if you’re sold on the PsyD route, this might be worth looking into.

2. The college town I’m in now has a great dating scene… as long as you enjoy day drinking until you can’t feel your face, throwing up in Uber pool rides, and generally killing time in debauchery. True story: a couple years ago, public health experts thought that there might be a new STD going around this city. They looked into it and learned that it was just a bunch of people who had gonorrhea and chlamydia at the same time. Stay classy, Tallahassee.