Self-Care in Graduate School 

Graduate training in clinical psychology is hard, and not just because the skills and content learned take time. After making it through the grueling process of applications, interviews, and getting into a program, you start a journey that is likely to take you between 5 and 7 years from the first day of class to the time you graduate. Those years are full of classes, clinical practica, graduate assistantships (e.g., being a teaching or research assistant), milestone projects (e.g., thesis, comprehensive or qualifying exams, dissertation), and a plethora of other experiences that people seek along the way.  

My Credentials to Talk About Graduate Coping 

I think it is helpful to know that the person who is about to share coping skills for grad school really knows what it is like to be in these programs and have to manage the workload – so here are my credentials. I am currently a 5th year doctoral candidate for a PhD in clinical psychology.  These days, my work week break down looks something like this: 16 to 20 hours of clinical practica, 20 hours of GA/TA work (this is how I earn my stipend), 6 to 8 hours as a neuropsychology technician, 4-5 hours assisting in our community clinic, and another 1 to 5 hours of additional work across research collabs, dissertation work, Society of Pediatric Psych National Campus Rep engagement, etc. If we do the math, that means that before I do anything else, on a light week, I have about 47 hours of work related to this degree. This doesn’t include the hours that I just spent applying for internship this fall and winter (although, admittedly, some of my usual hour commitments were cut back during this period in thanks to understanding advisors and supervisors!). So please know that I speak to this as someone who is continuing to learn how to care for myself as I work to finish this degree. 

What the Data Tells us About Graduate Student Wellbeing 

Broadly speaking, doctoral students across the world and across disciplines experience elevated rates of anxiety and depression (Satinsky et al., 2021); students in clinical and counseling psychology programs are no exception (Rummell, 2015). In addition to anxiety and depression, psychology doctoral students also endorse burnout and financial stress (Swords & Ellis, 2017; Szkody et al., 2023). These challenges aren’t surprising when we consider that students are often working 50 or more hours a week (Rummell, 2015; Swords & Ellis, 2017) while stipends fail to keep up with the cost of living (Szkody et al., 2023). So, what can we do to manage this stress? 

So… How do we Cope? 

My favorite answer to most psychological theory and coping questions applies here: it depends. We are all so unique in terms of what types of coping we prefer. My goal here is not to give you a three-step plan to perfect graduate training coping. Instead, I hope that you read this and reflect on what has/hasn’t worked in the past, what is/isn’t working for you now, and what you may want to try or keep doing in the future. To speak in terms we are all familiar with, or will be once you start graduate training, let’s think of our coping using the biopsychosocial model.  

Bio 

Keeping our biological needs met during graduate training is critical and uniquely challenging. 

Sleep 

 Long work hours, a culture of caffeine dependence, and a desire for downtime often results in missed sleep, alterations in sleep-wake cycles, and general fatigue. Scheduling in sleep time, putting bedtime timers on your phone, and turning off all screens an hour before bed can help improve your sleep. The cost of a consistent 8-hour sleep schedule may be that you get less time engaging in hobbies, less downtime, and less social connection.  

Eat 

Whether the challenge is affording nutrient dense food, having time to eat during the day, finding it hard to pack enough food for a 10-hour day on campus, or all of the above, students are faced with barriers to nourishment. I highly encourage students to explore what benefits they may have access to from a financial standpoint to help them have access to food. While you will likely need to do some of this research yourself, some schools have a liaison or designated individual or office to help students navigate these programs. Having access to the food is just part of the process. Scheduling time to eat, setting alarms/reminders, and planning to eat with peers if working together on campus can all help ensure you follow through with your intake goals. When considering what to eat during the day, think about what foods will help you feel full, support your energy, and are easy to eat either on the go or in a classroom. String cheese got me through my first few months of clinical work. Apple sauce, protein bars, milk or protein drinks, and easy to transport fruits like apples, bananas, or citrus can also all be helpful to have in your rotation.  

Move 

Unless you are in one of the unique therapy settings where you get to move throughout the day (shout out to play therapy), graduate students and psychologists often find themselves sitting for long periods of time with short movement breaks. However, the act of moving can be helpful for many of us when it comes to coping. This may mean intentional exercise. My peers who are yogis, power lifters, or Pilates instructors have shared about the importance of that movement as an outlet, a way to center themselves, and a chance to focus on something other than school. You may also be able to build social connections with others through these experiences as well! If this doesn’t sound like you – that is okay! You may be someone who instead benefits from setting up an hourly reminder to get up and walk around every hour or so or gets off the train/bus one block early to spend a little time intentionally moving. Scheduling a mid-day walk to grab food or to go sit at a park down the street can go a long way for your wellbeing.  

Psych 

Rest 

Your brain, just like your body, needs rest. I love a good doom scroll session as much as the next person, but restorative rest requires we slow down, put the little dopamine machine(s) away, and let our bodies and minds take a moment. Having nighttime mode on your phone, leaving it in the other room, or using focus apps may be helpful! Some folks love mindfulness and meditation for this reason. Sleep is great, but we need to rest when we are awake too. For me, rest sometimes includes gentle movement, like a quiet walk along Lake Michigan and other times it is doing art or a puzzle. Whatever rest means for you, aim to slow down and find a task that lets both your body and your brain come back into the present.   

Talk 

Suprise, surprise, the clinical psych student is going to recommend therapy! If you have made it this far, I probably don’t need to give you all the data about why mental health therapy can be helpful for graduate students. See if your university has any resources to help get you connected with a provider who has experience working with clinicians in training or graduate students more broadly. Beyond therapy, find a community that you can talk to about the graduate school experience and life that happens outside of school. My cohort, for example, has been a major source of support; they have the uniquely personal understanding of what this program is like and we can each share our own insight and experiences with one another when one of us is having a hard time. 

Engage 

Feeling fulfilled is important. While many of us pick this career path because it will be fulfilling, graduate school is its own trial to get to that career. Many of us though will benefit from engagement in other hobbies and activities that can bring us fulfillment and meaning. Whether your thing is crocheting, pickleball, reading, puzzles, activism, volunteering, training for a marathon, photography, or video games, be sure to keep engaged with this task. These experiences often go above and beyond just making us feel fulfilled and also help us remain engaged socially, encourage activity, and promote good rest. It is important to note that doing these things can be hard when you are busy! Combining these hobbies with other tasks can be helpful. Crochet on the train, volunteer with a friend to get some social time, or block out protected time on your schedule on a regular basis.  

Social 

Connect 

As mentioned earlier, graduate training is a unique experience that is often best understood by those who are also going through the process. I highly recommend making connections with people in your program, at your practicum sites, and/or through professional organizations. Building that support system will take time and effort, but in the long run it will benefit you personally and professionally. 

Stay Connected 

I promise this isn’t a repeat of point one! For all the value that connecting with peers in graduating training will provide, we also need to remain connected with our broader social support system. This means making sure that you and your best friends from college find ways to keep up with each other, it means setting regular times to call loved ones, and maintaining relationships outside of academia. It can be easy to forget that outside of the walls of a university or hospital is a world where most people are not worrying about that revise and resubmit, or their dissertation deadlines, or internship match. Connecting with people who can give you a break from academia will help your academic brain rest!  

Boundaries 

If you have been in psych training for any period of time, someone in your life has undoubtedly asked you a mental health related question. Sometimes that is at the holiday dinner table, other times its a late night text when they’re stressed. Decide early on in your training what you want your boundaries to be around being a resource for those around you. Beyond that, decide how much you do or do not want to share about your academia journey with those around you. Well-meaning people asking about your dissertation or internship may be totally fine with you! Sometimes though, these questions are overwhelming and stressful. You are allowed to have a response ready that is along the lines of “thank you so much for your interest in my training and for supporting me! I am enjoying just being here with everyone today and will not be talking about school. Tell me about what is new with you!”  

So… now what? 

Coping with graduate training is a big part of the road to being a psychologist. Test out what works for you and build coping strategies design for your life. Importantly, change your coping strategies as needed! One day you may just need a quick walk on the lake and a comfort meal to finish your work. Other days you may need to call more on your social support system, take a day off, and to step away from your phone for a bit. Know that you are not in this alone.  

Thank you for reading!  

Rooting for our success! 

Keely Bieniak-Fortier, M.S. 

References 

Rummell, C. M. (2015). An exploratory study of psychology graduate student workload, health, and program satisfaction. Professional Psychology: Research and Practice, 46(6), 391–399. https://doi.org/10.1037/pro0000056 

Satinsky, E. N., Kimura, T., Kiang, M. V., Abebe, R., Cunningham, S., Lee, H., … & Tsai, A. C. (2021). Systematic review and meta-analysis of depression, anxiety, and suicidal ideation among Ph. D. students. Scientific Reports11(1), 14370. 

Swords, B. A., & Ellis, M. V. (2017). Burnout and vigor among health service psychology doctoral students. The Counseling Psychologist45(8), 1141-1161. 

Szkody, E., Hobaica, S., Owens, S., Boland, J., Washburn, J. J., & Bell, D. (2023). Financial stress and debt in clinical psychology doctoral students. Journal of Clinical Psychology79(3), 835-853. 

Applying to Grad School for Peds Psych: When and Where

Applying to a doctoral program with the hopes of becoming a pediatric psychologist can be a daunting task. Deciding when and where to apply, submitting applications, and navigating interviews takes time, forward thinking, and persistence. This guide is designed to help you navigate deciding your when and where to apply.

When?

There is no simple equation to decide when you should apply to a doctoral program. There are, however, factors to consider while trying to decide.

  • Do you have enough experience to be a competitive applicant? For those seeking a PhD, it is increasingly unlikely that you will be able to gain enough experience during an undergraduate degree to transition directly from a bachelor’s to a PhD program. This is largely because the nature of these degrees requires that you have gained more research experience than most folks can fit into a 4-year college experience. PsyD programs, which are less focused on research production, are more likely to accept folks directly from undergrad, however the more competitive the program, the more experience you will need prior to acceptance. If you’re worried about having enough experience, especially related to research, consider a post-bacc position working as a research assistant. This can allow you to gain valuable research exposure, the opportunity to disseminate research via conferences and papers, and networking opportunities. Here are some resources to help you search for a post-bacc position:
  • Are you financially ready and able to begin this process? Graduate school applications are often pricey. Between individual program application fees, GRE exams, and transcript costs, things add up quickly. Beyond that, the cost of graduate school continues to rise. PsyD programs in clinical psychology are expensive. For example, the annual cost of tuition to earn a PsyD across the 6 accredited programs in Illinois (The Chicago School of professional Psychology, Adler University, Wheaton College, Roosevelt, Midwestern, and National Louis University), based on available data, is approximately $47,538 (value based on available tuition data and https://psydprograms.org/illinois-psychology-doctorate/). This number does not account for additional school fees, supplies, or housing costs. Many students accrue substantial debt to earn this degree. Working outside of these programs is often discouraged and sometimes not allowed. PhD programs, in contrast, often have some amount of stipend or funding to support their students paired with partial or total tuition waivers. While this means students are not paying for their education, they are unlikely to be earning enough to meet the cost of living in their area. Consequently, funding does not promise financial security throughout the duration of the program.
  • Is your biopsychosocial wellbeing in a place that would allow you to engage in a program in the way you want? Psychology doctoral programs, whether PsyD or PhD require 5 to 6 years of commitment to long hours, lots of learning, and persistence. You deserve to enter this program when you are in a place to follow through on this commitment. Immediately after undergrad, folks are often dealing with academic burnout, uncertainty about the next steps in life, and “what next” questions from everyone in their lives. While there may never be a ‘perfect’ time to start graduate training, it is important to consider how your wellbeing may be impacted, for better or worse, by the application process and starting a program. Keep an eye out in the coming weeks for a blog on coping with grad school for ideas of what to do to take care of yourself while you navigate the world of higher education.   

Where

When you decide it’s time to apply, then you are faced with the question of where to apply. Here are some things to help you narrow your search:

  • What are your research and clinical interests? It’s important to find a program that aligns well with your interests. Pediatric psychology is a field that has a wide range of research focuses and clinical niches. You do not need to know exactly what you want to do with your career, but think about your broad interests: do you want to study pediatric pain? Diabetes? Cancer? Sickle cell? Primary care? Prevention? Being as aligned as possible with the focus on the programs and labs you apply to will a) increase your fit on your application and b) increase your ability to get what you want out of the program. Research faculty, clinical placements for practicum and internship of current and past students, and think about how the geography of the program may influence your experiences (e.g., there tends to be fewer practicum training sites in more rural areas, you want to be sure those that are available align with your training goals).
  • What do you want your next 5 years to look like? This is a question I was asked (thanks Dr. Tran!) that made a big impact on my planning. Think about this not just about what you want to learn and do academically, but what you want the environment around you to look like, which leads me to the next point…
  • Where are you okay with living? There are pediatric psychology programs across the United States and Canada. For some, moving across the country is an option. For others, you may only be willing to look for programs near a certain city. The more open you are to moving, the more places you will have to apply. Sure, it sounds simple to apply without geographic worries, but in practice we all have factors that influence where we are able to move. Whether it be your family, health, cost of living, or any other factor limiting your ability to move – know you are not alone! You will just need to consider what you can do to make your applications to the sites you are able to attend even stronger to increase your chances.

Here are some tools you may want to use as you consider different programs:

Chronic pain: What is it? What do we know? What are we trying to find out?

Chronic pain can take many forms: arthritis, consequence of an injury, and migraines are a few. Here in the CHILL Pediatric Lab, chronic pain is one of our main research interests. So what exactly is chronic pain? What do we know about chronic pain? And what do we still need to find out?

What is chronic pain?

Chronic pain is a type of pain that lasts for longer than a few months or longer than we would expect with a specific injury and impacts anywhere from 11 to 40% of the United States population (Interagency Pain Research Coordinating Committee. 2016). This pain can take many different forms and even within specific diagnosis can vary greatly, making it difficult to give a specific definition of what chronic pain is. Chronic pain is not just something that adults deal with, but also an issue for many youth. Some research in our lab focuses on pediatric chronic pain more generally, and some projects specifically focus on Hypermobile Ehlers-Danlos Syndrome (hEDS), a chronic condition that results in pain, fatigue, and a variety of other symptoms (Levy, 2002).

What do we know about chronic pain?

Chronic pain research broadly and research in our lab has given us a lot of information about these disorders. We know that those with chronic pain often experience other symptoms aside from their pain. For example, our hEDS research has supported previous findings for other disorders that there are other physical symptoms associated with the disorder. Those with hEDS also experience fatigue, gastrointestinal distress, and joint instability. Their chronic pain disorder is much more than just pain. Not only are there other physical symptoms, but there are also psychological consequences. We have found increased rates of anxiety and depression in hEDS patients, which has also been found in other chronic pain conditions. 

What do we still need to find out?

There are still so many questions left about chronic pain, and the questions are different for unique conditions. Can we cure chronic pain? What is the best way to manage each condition? How can we help people regain quality of life? What about mental health? These questions continue to fuel research, which is where the CHILL lab comes in! In the past the lab has analyzed sociodemographic and environmental risk factors for chronic pain in pediatric patients, a parent and child interpretations of their condition, and the relationship between pain, peer relationships, and mental health.  

One of the many projects we are currently working on analyzes responses of children with hEDS and their parents to the questions “What makes living with hEDS easier?” and “What is the hardest part about living with hEDS?”. Our hope with this research is to gain an understanding of the different ways that parents and children view a child’s chronic condition. My Master’s thesis will attempt to see what factors, if any, are associated with psychological outcomes in pediatric hEDS patients. I hope to find both what may help and what may hurt mental health in hEDS patients. 

-KB

References

Interagency Pain Research Coordinating Committee. (2016). National pain strategy: a comprehensive population health-level strategy for pain. Washington, DC: US Department of Health and Human Services, National Institutes of Health. 

Levy HP. (2004). Hypermobile Ehlers-Danlos Syndrome. In: Adam MP, Ardinger HH, Pagon RA, et al., (Eds.). GeneReviews [Internet]. Seattle, WA: University of Washington, Seattle. Available from: https://www.ncbi.nlm.nih.gov/books/NBK1279/

SPPAC 2019

In April, members of the Pediatric CHILL Lab went to New Orleans for the Society of Pediatric Society Annual Conference.

Attending a national conference every year provides me with exposure to the most recent research being done in my field and allows me an opportunity to build connections.  This past April, members of the Pediatric CHILL Lab attended the Society of Pediatric Society Annual Conference (SPPAC) in New Orleans, LA.  What I love about SPPAC is the exposure to many different areas of pediatric psychology that I might not have exposure to through my research and clinical training.  Last year when I attended this conference, I happened to attend a talk focused on an unfamiliar area of pediatrics, integrative primary care.  Through this presentation, I realized how well this field aligned with my interests; integrative primary care has a community based component and also a focus on interdisciplinary care. 

After gaining knowledge about this field, I made it my goal to learn about the field by attending relevant poster sessions and talks.  SPPAC offers an exciting opportunity for trainees to attend a mentoring lunch to connect with an established clinician or researcher in the field.  I met with a pediatric psychologist who works in integrative primary care which allowed me an opportunity to ask questions about the field and find ways to gain training in primary care. 

Attending a national conference is a one-stop shop place to build connections, learn about research, and connect with old friends.  I always leave conferences feeling inspired and excited to explore new ideas. 

-AJ