On a Tuesday morning, a 5-year-old boy and his grandmother met two Duke students in a small room at Duke's Pediatric Psychology Lab. The boy, with short, shiny blond hair and wearing a bright red T-shirt and jeans, fidgeted playfully as Taryn Allen, a fourth-year grad student in clinical psychology, and Erin Schoenfelder, a predoctoral intern at the medical center, led him through a series of activities designed to assess his verbal and nonverbal abilities, memory and attention.
The boy suffers from a rare genetic disorder that compromises his immune system, leaving him vulnerable to infections and illness. What Allen and Schoenfelder learn will be an important part of his ongoing medical care, says Melanie Bonner, a professor and director of graduate studies in Duke's Department of Psychology & Neuroscience.
"Taryn and Erin are learning how to administer assessment tests and manage behavior in the broader context of the disease. They will interpret the test findings and develop interventions," Bonner explains while watching the session through a one-way mirror.
Such interactions with patients are a critical part of Duke's Collaborative Clinical Training Program, which provides training and research opportunities to graduate students in clinical psychology.
The program, a partnership between the College of Arts & Sciences' Department of Psychology & Neuroscience and the School of Medicine's Department of Psychiatry and Behavioral Science, is one of the country's best, ranked sixth in the nation in 2012 by U.S. News & World Report. It attracts some 300 applicants annually for just four to seven slots -- and the opportunity to work with patients is a big reason why.
"Most clinical psychology programs in psychology departments don't have ready access to medical center patients, so the students have a harder time getting trained clinically or doing research with patients in a medical center setting," says John Curry, professor of psychology and neuroscience who directed the collaborative program from 1997 to 2011.
But the close partnership between academic and clinical psychology that today sets Duke's program apart hasn't always been in place. In fact, it grew from one of the most desperate times in the psychology department's history.
At the end of the 1980s, Duke's psychology department had split -- one side carrying on with clinical, social and developmental psychology, the other focusing on experimental psychology, a separation that would last some 20 years.
"The clinical people and the experimental people didn't get along," recalls Richard Surwit, a professor in psychiatry and behavioral sciences at the School of Medicine who's been at Duke 35 years.
As the decade wound down, aging faculty began retiring, and funding for graduate-student training dwindled. Federal funding cuts left Duke's clinical-psychology training program strapped for funds, making it harder to provide students with real-world clinical experience. By 1990, "the clinical program couldn't really function. It didn't have the budget and didn't have faculty because of retirements," Surwit says.
It was a low point for a program that had been accredited by the American Psychological Association since 1948.
The salve came in the form of an arranged marriage. Duke's president at the time, Keith Brodie, a psychiatrist himself and former health system chancellor at Duke, knew the university had a wealth of clinical psychology expertise literally next door to the A&S psychology department in the School of Medicine. He encouraged psychology faculty in A&S and Medicine to form a partnership to train graduate students.
The clinical training program was launched in 1991, uniting faculty from what's now the Department of Psychology & Neuroscience in A&S and the Division of Medical Psychology in the School of Medicine's Department of Psychiatry and Behavioral Science. Together, they provided clinical training and research opportunities to graduate students.
"We had built a really strong program in clinical psychology in the School of Medicine," Surwit recalls. "It made no sense not to take full advantage of that. The idea was how can we take advantage of that and use that resource to staff the clinical psychology program. We developed a way for the programs to be lashed together."
It hasn't always been an easy marriage. A frequent sticking point has been how to pay for about eight medical school faculty who train A&S grad students. The program has relied on a patchwork of sources, including the president's discretionary fund, the School of Medicine, A&S, research grants and a Behavioral Medicine Research Center endowment, Surwit says.
"There were a number of times when it was threatened with separation because you didn't know where the dollars would come from," says Phil Costanzo, a psychology professor in A&S since 1968.
Starting in fall 2013, A&S will pay for the lion's share of the collaborative. Trinity Dean Laurie Patton points to the program's success and the fact that completion results in a Ph.D., an A&S degree, as reasons for the new arrangement.
From left, Ashley Moskovich, a fifth-year graduate student in clinical psychology, Melanie Bonner, director of graduate studies in Psychology & Neuroscience, and predoctoral intern Carlye Kincaid observe an assessment at Duke’s Pediatric Psychology Lab. Photo by Jon Gardiner/Duke University Photography
The training program has also played a critical role in helping the psychology department attract high-caliber faculty such as Terrie Moffitt, who along with husband and fellow Duke psychology researcher Avshalom Caspi shared the 2010 Klaus J. Jacobs Research Prize for Productive Youth Development for their work on genetic influences on behavior. Duke lured Moffitt and Caspi from King's College in London in 2007.
"I wanted, indeed insisted on, a university that had a clinical psychology Ph.D. training program because those attract the brightest students, as well as strong neuroscience, strong genetics and a medical school with a good psychiatry department," says Moffitt.
The combined strength of the departments' faculty give students options to explore a range of psychological fields, says Kathleen Sikkema, a professor of psychology and neuroscience and director of the collaborative program since 2011.
"The first great benefit is the students get exposure to such a variety of professional role models who integrate research and practice in different ways," she says.
Another student who trains in Bonner's lab, second-year psychology grad student Lindsay Anderson, says such easy access to patients translates what she learns in the classroom to the real world.
"A lot of places say they collaborate, but here I think it really happens," says Anderson, who eventually wants to work in an academic setting that has a medical center, like Duke. "When I was looking at Duke the collaborative nature is one of the things that drew me here; it had all the practicum opportunities through the medical center."
Bonner says she knows firsthand what it's like not to have easy access to patients while pursuing a Ph.D. As a graduate student at Virginia Tech in Blacksburg, Va., she drove 250 miles to Johns Hopkins Hospital in Baltimore so she could work with patients in a clinical setting.
"It took a lot of work to negotiate training sites and contracts," she says of her grad school experience. "These students at Duke merely have to walk across the street to have it all readily available."
Adds Costanzo: "The way psychology is today, to have a good program you really need good connections to the medical program. It was a unique way to draw students in, and the program is and was excellent. That took it to the top 10."