Is a Gradualist Approach to Clinical Training Helpful or Necessary?

Regarding severe presentations of eating disorders, Anorexia Nervosa (AN), more so than most or all other conditions, certainly may require medical care. Two points in this regard, however: (1) So may other conditions (e.g., a case in my own clinical experience of a patient with NSSI severe enough that it resulted in the loss of a body part); (2) for severe AN, though no mental health profession has good answers in the short-term, the most astute long-term approach in my awareness was described by psychiatrist Michael Strober (2004), and it is one that psychologists and their trainees are at least as able to provide if not more so as compared to other mental health professionals.

For the years in which this data collection occurred, data on binary sex were collected; the term from the assessment form was “gender” (a term-of-art when this effort was initiated years ago). Gender identity data were not systematically collected for clients, a definite limitation.

My research program is on suicidal behavior, and though the clinic and that research program are mostly separate, the research does influence the clinic, for example, in signaling that we have familiarity and expertise with regard to the complex issue of suicidality. Moreover, the clinic sees virtually anyone who approaches us who has a mental disorder, including people whom many other providers will not see (e.g., due to clinical severity, lack of resources, students whose conditions require more intensive services than those provided by the campus’ student counseling center, etc.). It is in these ways that we have an overall above-average level of clinical acuity in our patient group.

Though by far most supervisors are licensed psychologists, licensure is not required, because psychologist employees of the state of Florida are exempt from state licensure requirements as long as their work is fully limited to the state’s remit. FSU is a state university; FSU personnel are thus employees of the state of Florida.

These meetings lasted two hours until 2006, at which point they were shortened to one hour. This returned approximately 50 h per year to students to focus on non-clinic work, especially their scientific work.

Analyses were run and are presented in an unnested fashion. When multilevel models (cf. Bryk & Raudenbush, 1992) were run to account for nestedness, results and conclusions were very similar.

Over the years, patient clinical acuity has heightened at our clinic, and at the same time, over the years we have had increasingly good outcomes. Thus, we are performing better and better even as our patients’ clinical severity became more and more severe over time (cf. Joiner et al., 2022).