Clinical Impact Statement: This manuscript sheds light on the cohort experience for graduate student trainees with implications for both students and those involved in clinical training programs. This research has the potential to help improve clinical training climates within programs, as well as begin a conversation regarding how to best support our graduate students.
I presented my first research poster at the 2016 American Psychological Association (APA) Conference in Denver, Colorado. My name had been on other posters in previous years, but never as first author. I was especially excited about this opportunity. The research I presented was about graduate student stress and how it may be important for programs to measure this construct so as to better help their students and possibly reduce attrition. As a third year doctoral student in clinical psychology, I was fully experiencing all stressors that came with graduate school: classes, homework, dissertation, practicum, finances, family, friends, meetings, jobs, and all while trying to maintain some semblance of a social life. To me, examining the topic of graduate student stress seemed logical, especially given that in graduate school for psychology, self reflection is all but required to do effective work. However, my experience during the poster presentation elicited significantly different opinions.
As I watched the students around me talk with fellow conference colleagues about their research, I could not help but wonder why was no one stopping at my poster to talk to me; what was different about my research topic? At the end of the session, I had only two individuals that stopped to talk to me. One conversation in particular stood out to me, as it seemed to explain my experience. The attendee read my poster, questioned why I was looking at this topic, and then proceeded to tell me my research was somewhat unnecessary and nothing can be done about graduate student stress. The underlying message I received was that stress is just part of the process. As my poster hour came to a close, I rolled up my poster, put it in my tube, and left feeling defeated.
I would like to say that I continued my research on graduate student stress, but I instead abandoned it. Why research something no one cares about? Although I knew that was not true, I felt discouraged. After the conference, I shifted my focus to another related topic that I felt might get better traction: cohesion among graduate student cohorts. Due to the demands graduate school places upon us, it is not unreasonable to guess that we as students spend more time with our cohort members than anyone else in our lives. I know that for me personally, my cohort was a major source of support after I moved from California to Kentucky to attend graduate school. With no friends or family other than my husband and my cat, I needed my cohort members to help me acclimate to this new life with all new demands and expectations.
As my cohort progressed through the program, we leaned on each other in times of need and supported one another both academically and personally. When comprehensive exams came around, we helped each other study and shared materials; when someone’s home flooded, we donated money and toys to the family; when I had surgery, I received text after text asking if I needed anything. From these examples, you can see that my cohort is highly cohesive. Even if we do not hang out every day or have classes together, we are there for each other in times of need. And interestingly (read: thankfully), we have not had a single person drop out of the program since our first year. However, not every cohort is like this. Students have told me their cohorts feel disjointed, and students are surprised to hear about how my cohort supports one another. This left me wondering: Why do cohorts differ? What contributes to cohesion, and what hinders it? How does this impact the graduate school experience and a student’s stress level? Through these conversations, research, and my personal experience, I found a question that still addressed the topic of graduate student stress, yet in a more nuanced and complex manner.
While research has evaluated social interaction (Goplerud, 1980) and perceived social support (Cohen, 2004; Dunkley, Blankstein, Halsall, Williams, & Winksworth, 2000; Lepore, Evans, & Schneider, 1991) in relation to positive outcomes for students, there is little information in the literature regarding the impact of a graduate school cohort or how the cohesion of that cohort relates to program and overall life satisfaction. Cohesion is an important relational construct that involves both relationship structure and relationship quality (Burlingame, McClendon, & Alonso, 2011). Research has identified social support, especially peer support, as an important coping tool, including in post-secondary settings, yet it is unknown how the structure and quality of those relationships affect a graduate student’s reliance on that tool.
To find out if cohort cohesion was something that even mattered to students, I conducted a pilot study to assess student perceptions of and experiences with cohort cohesion. An online survey questionnaire was sent to a national sample of doctoral students in APA-accredited programs from around the country. A total of 55 doctoral students in clinical psychology responded. Fifty participants identified as White, three as Black/African American, one as Hispanic/Latino/Latina, and one as Multiracial. Self-identified gender included 45 women and 10 men. The majority of participants were in a relationship (60%) and in their first or second year of practicum (40%). Measures included demographic questions, the Depression, Anxiety, and Stress Scales (DASS-21; Lovibond & Lovibond, 1995), Therapeutic Factors Inventory–Cohesion Subscale (TFI-C; Lese & MacNair-Semands, 2000), Individual Cohesion Questionnaire (ICQ; Gallagher et al., 2014), Inventory of Interpersonal Problems–Short Circumplex Form (IIP-SC; Soldz, Budman, Demby, & Merry, 1995), and Satisfaction with Life Scale (SWLS; Diener, Emmons, Larsen, & Griffin, 1985). Additionally, we asked qualitative questions regarding the importance of cohesion, what contributes to or hinders it, how students’ programs contribute (or do not), and what they wish their programs did to facilitate cohesion among cohorts.
Our survey yielded interesting, yet not surprising results. Quantitatively, cohort cohesion importance was rated higher than actual perceived cohort cohesion. Although students rated cohort cohesion as significantly important to them, they did not report experiencing it to the degree one might expect, given that importance. Per the students’ reports, programmatic efforts to facilitate cohesion were positively correlated with perceived cohort cohesion, indicating students may feel it is helpful for programs to be actively engaged in fostering cohesion among their students. We will address more specific ways of “how” below. Finally, doctoral clinical psychology students with higher interpersonal problems reported significantly lower life satisfaction.
Qualitatively, several themes emerged from questions related to students’ experiences of cohort cohesion. Themes included: What specifically facilitates cohesion, what hinders it, and whose responsibility it is to make it happen. The following is a description of each theme.
What facilitates cohesion?
Students identified social gatherings, classes, and studying together as the best ways to develop cohesion. One student stated,
I think studying together and hanging out socially [is] important to cohort cohesion. Even more so, I think having support for personal reasons (i.e. family problems, relationship issues, etc) is important for cohort cohesion. Having this type of support is especially important when one is away from their primary support network.
Such responses connect to the quality dimension of cohesion—it is not just about studying together, but being there in a time of need or providing support for sensitive issues. Multiple responses reflected how fellow graduate students, who could understand what it is like to be in graduate school and experience similar unique stressors to this time in their lives, validated respondents’ personal experiences.
Students noted that having classes together and studying helps with feeling connected to their cohort, especially in courses that are highly interactive: “[the program] encourages talking to each other, working together, and facilitates group discussions and working together in class.” One student noted that seminar-style and supervision courses specifically helped with cohesion, likely because of the discussion and engagement these types of course formats allow. However, many students reported that, as they progress in their program, they have fewer courses with cohort members due to selecting specific specialty tracks. As this happened, students felt less connected to their cohort: “We were very cohesive in the beginning of the program, but less as training continued...classes and life circumstances changed.”
What hinders cohesion?
Overwhelmingly, students cited cliques, competition within the program, and time constraints as constructs that hindered the development and maintenance of cohort cohesion. While students may naturally divide into friend subgroups within the cohort over time, it seems that when interpersonal issues enter the picture, cohesion may be harmed. One student described: “As of this past year, my cohort has divided into cliques and there have been many hurtful comments spread about many of our cohort members.” It is noteworthy that the students used the word “cliques” rather than something more benign (e.g., groups)—that is, “clique” possesses a negative connotation and implies exclusivity, both of which impede cohesion quality.
Competition was also cited as an issue in fostering cohesion. Many students stated they felt their programs did a good job of discouraging competition, which in turn made cohesion easier to develop. A student noted, “Our program does not hinder cohesion because they do not encourage intense competition between students.” Others echoed this sentiment, stating that their programs intentionally discouraged competition. This suggests that programs with less competitive environments may have higher rates of cohesion among their students. For another student in a PhD program, competition was especially salient: “Competition between graduate students is a large contributor to difficulty within cohorts. We are often fighting for the same funding, clinical[s] (e.g. internship, practicum), and teaching positions.” For this student, competition was cited as a barrier to creating meaningful relationships with others given the resources each were vying for in the program.
Time constraints were also identified as hindering cohort cohesion; however, respondents normalized that these were natural and unchangeable in graduate school. Students noted that graduate school is both time and labor intensive, which is emotionally taxing. Given the stressful nature of graduate school, cohort cohesion may be even more important, as students do not feel they have the time to invest in these or other relationships:
I think the biggest thing that gets in the way of cohort cohesion is free time ... as time goes on, there is less and less time to hang out with other members of our cohort unless we are studying or doing something school related.
One might categorize these as relationships of convenience due to the time spent together. Further, students have demands outside of school that require their time such as employment or family obligations. One student summarized it well: “It never feels like there is enough time to bond.”
Whose responsibility is it?
Among student responses, there seemed to be uncertainty as to who is responsible for fostering cohort cohesion. Some viewed cohort cohesion as happening organically through student interactions: “Cohesion comes from voluntarily deciding to be closer.” From this perspective, programmatic efforts would not be useful. Some suggested that programs do not really have a role in the cohesion process: “I don't think there is much to do from the program side. I think a majority of cohesion comes from the students.” Others felt more strongly, noting, “If they tried to force cohesion, it would backfire and just make us not want to hang out.” In this camp of thought, students are the ones responsible for building cohesion, and any programmatic efforts would only hinder that organic process.
Other respondents had a different, more moderate perspective. Many expressed a need for more opportunities to build cohesion: “I wish they had more planned gatherings or opportunities for cohorts to work together outside of school.” This is where, respondents felt, a program could play a role in organizing such events. Students noted that although they spend time together in courses, “the program itself does not have anything in place to encourage cohesion.” Respondents suggested that “the program can encourage activities that are in a group and that involved individual cohort members to get to know each other one-on-one.” Although they feel a program is not responsible for cohort cohesion, they do see a role for the program to provide opportunities for cohesion to happen organically among the students.
In sum, responses suggested fostering cohesion is a balancing act between providing opportunities for graduate students who want it, while not forcing experiences upon those who do not.
Students identify natural places for cohesion to happen, such as in the classroom or when studying together, yet as they progress through the program, it becomes difficult for cohorts to be their main source of socialization. By offering additional social hours or events, programs could extend opportunities to socialize that otherwise might not occur. With such busy schedules, it is difficult for graduate students to find time to socialize with peers outside the classroom. If social hours or events are scheduled by the program with student schedules in mind, it may increase the opportunity for students to be able to attend and interact with one another.
After aggregating my pilot data, I once again unrolled my poster and hung it up on the board to present it at the 2017 APA National Convention in Washington, DC, to see what others in the field thought about these findings. Given my previous experience presenting data about graduate students, I did not expect to have much engagement. Surprisingly, I had significantly more attendees stop at my poster, and many attendees reported being able to relate to the survey results. Several students expressed frustration with the formation of cliques in their cohort, and how challenging it is to find time to socialize with others outside the classroom. Some even noted that the isolation experienced later in programs caused additional stress or dissatisfaction with their programs. Many student attendees stated they wished their programs at least offered opportunities for more socialization within and between cohorts. A professor from a PsyD program noted her students talk about this topic all the time, yet her program was unsure of what to do to help.
By narrowing the topic of graduate student stress to a specific issue, an honest dialogue began to take place. While the broad statement of “students are stressed!” did not garner attention, people recognized and related to the specific issue and need to have connection and cohesion within a graduate program. After all, we are spending four to six years of our time with peers; why would it not be an important factor in the journey? After researching this topic and obtaining feedback, I found myself asking this question: In a field of individuals who are supposed to care about the wellbeing of one another, why is it so difficult to talk about the wellbeing of our future professionals? A response on my survey reflected this well: “One would think psychology students would be able to foster a positive environment, but there have been times when the cohort is so split (which it will naturally) that you can feel the tension within the room.” How can we do better?
First, programs need to ask the questions. Given the survey results, students are willing to share their experiences and ideas if programs are willing to ask and genuinely listen. Part of the responsibility is on the students themselves, and cohort cohesion is undoubtedly affected by individual differences; however, the overwhelming feedback from students surveyed indicates it would be helpful for programs to offer more opportunities for cohesion. This could be offering study groups, events scheduled after common class end times, or monthly events involving both student to student and student to faculty interactions. Given the comments regarding environments of competition, programs may wish to assess the current climate and make intentional steps towards fostering a supportive and collaborative environment. The more we discuss the stressors graduate students face and are intentional about offering opportunities for support, the better we may be able to support them in becoming competent, self-aware clinicians.
If you are interested in the topic, have questions or comments, or would like to collaborate on future projects, please do not hesitate to reach out to continue the dialogue. You are welcome to contact Jen Schager, M.A. at email@example.com.
Cite This Article
Schager, J. A., Stout, K. G., & Chapman, N.A. (2017). What are we missing? An investigation of graduate stress and cohort cohesion. Psychotherapy Bulletin, 52(4).
Burlingame, G. M., McClendon, D. T., & Alonso, J. (2011). Cohesion in group therapy. Psychotherapy, 48(1), 34-42. http://dx.doi.org/10.1037/a0022063
Cohen, S. (2004). Social relationships and health. American Psychologist, 59(8), 676-684. http://dx.doi.org/10.1037/0003-066X.59.8.676
Diener, E., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The Satisfaction with Life Scale. Journal of Personality Assessment, 49(1), 71-75. http://dx.doi.org/10.1207/s15327752jpa4901_13
Dunkley, D. M., Blankstein, K. R., Halsall, J., Williams, M., & Winkworth, G. (2000). The relation between perfectionism and distress: Hassles, coping, and perceived social support as mediators and moderators. Journal of Counseling Psychology, 47(4), 437-453. http://dx.doi.org/10.1037/0022-0188.8.131.527
Gallagher, M. E., Tasca, G. A., Ritchie, K., Balfour, L., Maxwell, H., & Bissada, H. (2014). Cohesion Questionnaire–Individual Version [Database record]. Retrieved from PsycTESTS. http://dx.doi.org/10.1037/t30044-000
Goplerud, E. N. (1980). Social support and stress during the first year of graduate school. Professional Psychology, 11(2), 283-290. http://dx.doi.org/10.1037/0735-7028.11.2.283
Lepore, S. J., Evans, G. W., & Schneider, M. L. (1991). Dynamic role of social support in the link between chronic stress and psychological distress. Journal of Personality and Social Psychology, 61(6), 899-909. http://dx.doi.org/10.1037/0022-35184.108.40.2069
Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the Depression Anxiety Stress Scales. (2nd ed.) Sydney, Australia: The Psychology Foundation of Australia.
Lese, K. P., & MacNair-Semands, R. R. (2000). The Therapeutic Factors Inventory: Development of a scale. Group, 24(4), 303-317.
Soldz, S., Budman, S., Demby, A., & Merry, J. (1995). Inventory of Interpersonal Problems–Short Circumplex Form [Database record]. Retrieved from PsycTESTS. http://dx.doi.org/10.1037/t05018-000