Psychotherapy Bulletin

Psychotherapy Bulletin

Call for Systemic Changes to Alleviate International Students’ Practicum Barriers in APA Accredited Psychology Programs

In counseling psychology programs, students face unique challenges related to the scientist-practitioner model of training.1 Unlike many people in graduate school who only have research responsibilities, counseling psychology students are expected to have dual duties: engaging in research and practicing mental health.  

Practicum experiences shape students’ future careers as mental health professionals. During their doctoral work, students’ direct intervention hours occur in different sites (e.g., Veterans Affairs Hospitals, community mental health clinics, university counseling centers, etc.) and contribute to success in the Association of Psychology Internship Centers (APPIC) match, which is a requirement for students to graduate from American Psychological Association (APA) accredited psychology programs. To apply for APPIC internship programs, students must reach clinical minimums, including at least 300-500 hours of direct therapy or assessment intervention hours. Thus, students in APA-accredited programs must decide whether to apply to field practicums2 inside or outside the university that may change yearly to meet clinical requirements for competitive APPIC internship application.  

The stress of choosing placements and building a clinical resume intensifies in the case of international students who study under student visas.3 International students, especially those from nations that do not use English as their first language, likely face barriers to language and acculturation. On top of these stressors, international students may encounter additional challenges with restrictions from their legal status that limit their opportunities for practicums outside their universities. Full-time students with F-1 Visas are allowed to work on U.S. soil, yet only at their academic institutions, with some exceptions of working outside the host institution during (i.e., Curricular Practical Training; CPT4) or after graduating (i.e., Optional Practical Training; OPT) from the program (USCIS, n.d.). Moreover, it is important to note that certain federal or state facilities, such as Veterans Affairs (VA) or correctional facilities, have restrictions limiting applications to American citizens only (Clay, 2009), which varies depending on their locations.  

What does this mean for international students? Their legal status in the U.S. can lead to complications in gaining experience that may influence their future practice. For some international students who want to work outside academia, practicing only in university settings may limit their opportunities to specialize in such areas and exposure to the target population they want to work with in the future. For example, international students who want to gain expertise in trauma may benefit from training in VAs, which are known for treating post-traumatic stress disorders. However, if local VAs will not accept international applicants, it can be difficult for students to gain experience treating trauma from one of the best practices in the field. Above all, there may be other barriers when searching for field practicum: whether working in that specific practicum can harm students’ legal nonimmigrant status to stay, study, work, and thrive in the U.S. For instance, if the students’ practicum site match was made outside the university without the consultation of International Students and Scholars Services (ISSS), it might jeopardize their legal status, exposing them to the risk of deportation.    

A gradual advocacy effort from the field of counseling psychology has aimed to raise awareness of these challenges of international students through scholarly publications. Last year, The Counseling Psychologist (TCP) dedicated a special issue centered on international students, presenting articles focusing on the career hurdles confronted by international students and the collective experiences shared by international faculty members (Consoli et al., 2022; Domínguez et al., 2022). Despite efforts to draw attention to these issues, translating the discovery into action has a long way to go. In fact, international students are still undergoing issues that Lee (2013) and Clay (2009) stated 10-plus years ago, without substantial guidance from experts who know about the field of psychology.    

Psychology has traditionally attempted to advocate for minorities and to amplify their voices to make meaningful changes in society. We believe that international students deserve the spotlight because of these persistent, predictable systemic challenges. Therefore, this article provides practical recommendations that may help international students successfully maintain their legal status and flourish in their psychology programs during field practicum and internships, with some examples of issues that students are likely to encounter.   

Need for Systematic Approach to International Students’ Practicum Issues

As international students in counseling psychology Ph.D. programs in the U.S., the authors have observed confusion within each department concerning practicum-related matters of international students. Despite the dedicated efforts of the Directors of Clinical Training (DCT) and advisors, there are significant gaps of knowledge among various entities, including the program, department, graduate school, ISSS, and internship sites, in effectively addressing the career concerns of international students within psychology programs.  

Even though field practicum issues can have detrimental consequences for international students’ ability to remain and study in the United States, it often falls on international students to solve these issues. Typically, international students ask and confirm with the ISSS about their eligibility for field practicum applications. However, due to the unique requirements of APA-accredited programs regarding field practicum hours and internships, international students may have to go back and forth to their program, department, and ISSS, and they may not find answers.  

For this reason, at times, international students rely on peers in their programs who have gone through similar processes, as they can be reliable sources to obtain specific tips. However, this might not work if there is only one student visa in a department. Some may be lucky to find nationwide networks of students and psychologists of the same ethnic background who are trying to navigate this issue collectively (e.g., Korean Psychologist Network, Taiwan Psychologists Network). Nonetheless, students in universities that traditionally do not have many international students or who are not members of a larger ethnocultural professional group may wind up with the feeling isolated and without information. It is a complicated task for international students lacking resources to remedy these issues as there may be legal implications, especially if the student wants to migrate to the U.S. in the future.   

Therefore, we believe there should be a more systemic approach that includes the different entities at the macro and micro levels to address the complex issues that international students are expected to encounter. 

Macro Level: Guidelines made by APPIC and APA

International students confront incidents like those minority students face in multicultural counseling classes. Minority students are often asked to elaborate on their experiences of discrimination to students of privileged groups. This happens to international students as well and they are also asked to explain their situation in programs, departments, ISSS, field practicum sites, and even full-time internship sites. 

The problem with this approach is that international students are not experts in the legal execution of these issues. International students may have more interest and knowledge in immigration laws and processes than laypersons, but their recommendations cannot guarantee the best outcome for international students’ legal status. Further, these struggles regarding their legal status can add emotional and financial burdens (that can range from a few hundred dollars to more than $10,000, depending on the institution) for international students that might impact their schoolwork and psychological well-being. Most of all, independently tackling the system does not lead to a dismantling of systemic issues that international students face. 

To dismantle the systematic problems, we believe APA and APPIC are key to solving the issue related to international students’ training site restrictions. APA and APPIC are the accrediting bodies of psychology programs and internship sites. They define and uphold requirements for quality psychology education, these organizations may be most effective in establishing systematic change. Further, these two entities are better resourced than individual students, and can provide more accurate information that DCTs, internship sites, and international students can reference.   

Therefore, we suggest APA and APPIC provide structured, verified information about international students’ hurdles in practicum and internships in the form of guidelines, manuals, or Frequently Asked Questions (FAQ) for students, faculty, institutions, and ISSS. In recent years, there have been efforts to educate internship sites and programs to deal with international students’ issues from APPIC (Hwang & Hurley, 2018). However, these efforts have not been successfully spread to each program and internship site to assist the needs of international students. Thus, like the hiring process of international employees in private companies and universities, where the Human Resources department of each company provides pre-established sets of documents to their new employees, APA and APPIC can compile a list of expected challenges and solutions that international students might encounter and distribute them to each program, field practicum, and the internship site to navigate the issues effectively. It may include a legally compliant contract format that fulfills the necessary requirements while accommodating the students’ needs.  

Micro Level: Increased Connectivity of the Program, Department, and ISSS

Consider the following statement from a 2nd year student in a counseling psychology doctoral program, “I have been between the advisors, training directors, program, department, and ISSS multiple times, wanting verified information by those departments. At the end of the day, I asked my international friend in another program for a guideline.”  

Even if there are guidelines from APA and APPIC that provide broad, structural information for international students, specific regional information may be only available through programs and universities. However, as presented in the quote above, international students can experience a lack of resolution regarding student visa issues in their departments. When something related to immigrant policies emerges (e.g., some financial aid is only for citizens and permanent residents), students are advised to solve the issues with ISSS, a department specialized in dealing with international students’ problems.  

However, sending students to ISSS for practicum applications or internship issues is not as effective for psychology students, as practicum is embedded in the training ideals of the program and students’ career paths. Rather, increased collaborative efforts should be made between programs, departments, and ISSS to reduce confusion over practicum and internship issues.  

One of the challenges international students face during the internship year due to the lack of collaboration between school entities circles around preserving the F-1 visa status and managing the associated tuition fees. It has been individual international students’ responsibility to navigate the number of credits that they should enroll in to ensure visa compliance, as F-1 visa holders are required to be full-time students to maintain their status, as well as find ways to finance the credits that are not covered by tuition benefits from the program during the internship year. This issue is complicated by varying university policies. For example, in many cases, the decision to approve a reduced course load has been left to the discretion of the ISSS, while the provision of reduced tuition to maintain a full course load is determined by the individual program and graduate school. As a result, these discrepancies in policies within the school entities put international students in challenging positions. Stress around legal status can become a significant financial burden, as international students may be obligated to cover the international student tuition fees for the entire course load during their predoctoral internship year when the university often does not financially support them.                

To address these issues, we again recommend fostering collaborations among the psychology program, department, graduate school, and ISSS. Each program may clarify the issues that international students face and verify the requirements and related policies from the ISSS (e.g., whether the program’s reduced/minimum credits on internship affect students’ full-time student status, location (as international students are only allowed to work on campus without CPT or OPT), whether practicum hours are less than 20 hours a week).  

Further, we suggest that each program create internal guidelines for current and future international students. There is another underlying issue with the lack of resources for international students within the program or department: not preserving what is learned. To prevent losing valuable information, we recommend documenting important information related to working with international students. For instance, the program may include an international student section in the student handbook. Moreover, programs might create a list of practicum sites where international students have successfully completed their practicums and routinely check international students’ application eligibility within each practicum site with ISSS. It is also important to acknowledge international students’ lived experiences and hardships, use the opportunity to advocate for themselves and other remaining students, and compensate international students for their efforts. 

Increased Communication and Networking: A National-Level International Psychology Students Association

For international students who cannot find useful resources in their own program or university, an alternative and supplemental nationwide network of international students in APA-accredited programs might provide a forum to ask others who may know about the issue. To that end, we recommend creating an interactive, year-round networking community of international students. Currently, there is a Facebook page run by the international psychology sector in Division 17, yet they are mostly active around the annual APA convention and less active at other times. Annual communication is helpful for international students, but it would be more useful to have a timely and responsive forum as issues arise. Thus, we suggest mediums that enable an interactive international student community, such as a mailing list, group chat, or an internet bulletin where individuals can communicate freely and interactively, asking questions and getting responses more promptly.  

Conclusion

International students have encountered practicum and internship challenges for decades, and these serve as systemic barriers to becoming psychologists. To resolve these prolonged issues of international students, we suggest alternative ways to enhance the situation at the macro (APA and APPIC guidelines) and micro levels (more connectedness among sectors at the university level, documentation of international students’ issues within the program). We also call for a more interactional international student community to exchange information and support. 

Finally, the matter of international student issues should not merely be regarded as isolated concerns related to international students. Rather, it necessitates open discussion within the program, fostering an environment where the community can engage in dialogue and gain insights into the common challenges encountered by international students. By empowering and facilitating the exchange of valuable information brought forth by international students, not only will the international students themselves benefit, but also so will other students and faculty members. This discourse can foster an inclusive and welcoming culture for international students, while also preparing other students and faculty to provide effective support and guidance to international students and clients in the future. 

Author Note

We would like to thank Joonwoo Lee, MEd, faculty, and all international students for their thoughtful feedback on our article. 

JiSoo Park is a second-year Counseling Psychology Ph.D. student at the University of Utah. She received a bachelor’s degree in education and law and a master’s in counseling from Yonsei University in Seoul, South Korea. She is interested in psychotherapy process research, especially on how to mitigate outcome disparities among racial/ethnic minority clients and enhance their experiences in therapy.

Cite This Article

Park, J & Kim, Y. (2023). Call for Systemic Changes to Alleviate International Students’ Practicum Barriers in APA Accredited Psychology Programs. Psychotherapy Bulletin, 58(2,3), 5-10.

References

Clay, R. A. (2009, November). Welcome to America coming to the United States for your studies? Check out these practical tips. American Psychological Association. https://www.apa.org/gradpsych/2009/11/welcome 

Consoli, A. J., Çiftçi, A., Poyrazlı, Ş., Iwasaki, M., Canetto, S. S., Ovrebo, E., Wang, C. D. C., & Forrest, L. (2022). International students who became U.S. counseling psychology faculty members: A collaborative autoethnography. [Special issue]. The Counseling Psychologist, 50(6), 874–910. https://doi.org/10.1177/00110000221098377 

Department of Homeland Security. (n.d.). Training opportunities in the United States. Retrieved June 29, 2023, from https://studyinthestates.dhs.gov/students/training-opportunities-in-the-united-states 

Domínguez, D. G., Cheng, H.-L., & De La Rue, L. (2022). Career barriers and coping with international students in counseling psychology programs. [Special issue]. The Counseling Psychologist, 50(6), 780–812. https://doi.org/10.1177/00110000221097358 

Hwang, B., & Hurley, D. (2018). Successfully matching, training, and graduating international psychology interns and postdocs. APPIC. https://www.appic.org/Portals/0/2018%20Conference/2018_APPIC_Presentation_Hwang_Hurley.pdf 

Lee, K. C. (2013). Training and educating international students in professional psychology: What graduate programs should know. Training and Education in Professional Psychology, 7(1), 61–69. https://doi.org/10.1037/a0031186 

USCIS. (n.d.). Students and employment. USCIS. Retrieved May 2, 2023, from https://www.uscis.gov/working-in-the-united-states/students-and-exchange-visitors/students-and-employment 

USICE. (n.d.). Nonimmigrants: Who can study? US Immigration and customs enforcement. Retrieved July 6, 2023, from https://www.ice.gov/doclib/sevis/pdf/Nonimmigrant%20Class%20Who%20Can%20Study.pdf 

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