20 Questions: Jeffrey J. Skowron, PhD, BCBA-D

By Juliet Farmer

Dr. Jeffrey J. Skowron is senior vice president for clinical services at Guidewire Inc. (formerly Sullivan & Associates), located in Springfield, Massachusetts, with additional offices in Pittsfield and West Boylston. He is also a visiting assistant professor at Westfield State College in the psychology department, where he teaches Adult Psychology and Treatment in the psychology master?s degree program. Prior to his work at Guidewire Inc. and Sullivan & Associates, Dr. Skowron was program director at The May Center for Education and Neurorehabilitation in Brockton. Prior to that, he was director of community consultation for the Center for Children and Families at St. Anne?s Hospital in Fall River. Dr. Skowron has also worked with The May Center for Education and Vocational Training, May Institute Inc. School and Family Consultation Program, and The Groden Center Inc./Behavioral Associates of Massachusetts.

Dr. Skowron earned a bachelor?s degree in sociology in 1992, a master?s degree in clinical psychology in 1998 and a PhD in clinical psychology in 2000 all from the University of Massachusetts, Amherst. He is a licensed psychologist and a doctoral level board certified behavior analyst (BCBA-D). He is also a certified Non-Violent Physical Crisis Intervention instructor through the Crisis Prevention Institute. He is a member of the Berkshire Association for Behavior Analysis and Therapy and the Association of Professional Behavior Analysts. Dr. Skowron has been published in Behavioral Interventions, Brain Injury, Encyclopedia of Behavior Modification and Cognitive Behavioral Therapy: Volume 2- Child Clinical Applications, and Handbook of Gender, Culture, and Health.

When did you first decide to become a clinical psychologist? Why?
During and following my undergraduate education, I worked in several clinical settings such as nursing homes, rehab centers, and special education schools. As a result, I became very interested in human behavior, with a more specific interest in the behavioral problems associated with neurological impairments, such as acquired brain injury and dementia. It wasn?t until a practica student from a local clinical psychology program began working at the same facility as me that I realized the connection between my interests and clinical psychology.

How/why did you choose the school you went to?
I had completed my undergrad at UMass Amherst, and was still living and working in the area two years later when I met a practica student from the clinical psychology program. She introduced me to the work of the professor who would become my future mentor and encouraged me to apply. Though I did apply to a few other programs, I was really only interested in UMass. My partner (who would become my wife at the end of my first year) and I loved the area, and we both had stable jobs that we didn?t really want to leave. We were very fortunate to not have to move for graduate school.

What surprised you the most about your studies?
Having worked and socialized with students from the program for about a year before applying, I think I was pretty well informed of the good, the bad, and the ugly of the program. I was probably most surprised at the lack of emphasis on grades and GPA. While classes were important, they were (appropriately, in my opinion) seen as complementary to the primary learning we did on our clinical and research teams. I was also a little put-off by the whole focus on ?theoretical orientation.? It seemed that professors and students had this need to define people by their orientation, and made a lot of assumptions about your clinical strengths (e.g. what clients you would be successful with in the training clinic) based on this orientation. As self-identified ?behavioral? person, I found that I was routinely assigned cases that involved simple phobias, test anxiety, etc.- clients who the more psychodynamically oriented intake clinicians had deemed to be ?less psychologically sophisticated.? I had not seen such a focus on theoretical orientation before graduate school, nor have I since.

If you had it to do all over again, would you still become a clinical psychologist? (Why or why not? What would you have done instead?)
I would definitely do it all over again. I really enjoyed my time at graduate school, as well as the internship and post-doctoral training. I?m still enjoying my career, and it has worked out well for me and my family. If I didn?t take the clinical psychology route, I think I would have still ended up working in human services in some capacity, either in medicine/rehab, or as a social worker, behavior analyst, or case manager. The only hesitation I would have about doing it again would be the cost. Even though my program was fully funded, I still have substantial student loan debt. Though I?m able to make a good living now, it can take awhile to get your career going relative to other fields, and there may be more cost effective degrees out there.

Has being a clinical psychologist met your expectations? Why?
It really has. I had always wanted to work in a senior-level clinical/operational capacity within a human-services or health-services agency. My training as a clinical psychologist provided me with the skills and credentials, as well as the personal and professional contacts to do so. While I think I may have been able to get bits and pieces of my training in other programs (e.g. social work, behavior analysis, experimental psychology), I think the clinical psychology PhD program, combined with my pre- and post-doctoral training, afforded me a more comprehensive (and marketable) skill set.

What do you like most about being a clinical psychologist?
I really like the variability and flexibility in my work. I am able to be involved in direct clinical work, clinical supervision, systems level work, teaching, and research. I have a relatively flexible schedule that fits in well with the needs of my family. Also, despite the costs of getting here (both monetary and opportunity costs), I?m able to make a decent living.

What do you like least about being a clinical psychologist?
Mental health services are too often a slave to government budgets, insurance reimbursement, etc. It can get frustrating and discouraging when you know that there is a solution to someone?s mental or behavioral health problems, but they can?t access that solution due to resource limitations. I spend way too much time in meetings, and many of these meetings are only indirectly related to the clinical needs of the clients.

On a more personal level, I think people sometimes don?t know how to act around you when you tell them you?re a clinical psychologist. I find that sometimes people think that you have some kind of magical ability to know what is secretly wrong with them just from a few social interactions. There is an overall lack of understanding in the general population regarding the empirically derived techniques underlying the professional practice of clinical psychology. I think people often think that all it takes to be a clinical psychologist is the right type of personality and a ?gift? for listening. This discounts the years of hard work involved in learning the science and acquiring the necessary skills to be competent in this field.

What was it like finding a job in your chosen career field? What were your options and why did you decide what you did?
I was very fortunate that my mentor put a big emphasis on personal and professional mentoring. She emphasized the importance of presenting my work at regional and national conferences, not just to build up the vita, but to meet people in the field who I may want to collaborate with or need something from in the future. She encouraged me to join and volunteer for special interest groups (e.g. the Behaviorism and Aging and the Autism SIGs of what at the time was the Association for the Advancement of Behavior Therapy). Through these endeavors, I met the directors of both my future pre-doctoral internship and post-doctoral placement and job during my first few years of training. When it came time to apply to internship, I already knew many of the faculty at the sites I applied to. My first ?real job? was working for a colleague of my mentor, and my jobs since then have resulted from the agency contacting me to see if I was interest in their open position, rather than my having to apply blindly to a posted position.

Why did you choose the specialty (or specialties) you did?
I have been interested in applied behavior analysis since undergrad. I worked summer and work study jobs in residential special education schools, and these led to my first full-time job after graduating undergrad, working as the behavioral services coordinator in a brain-injury rehab center. I followed this with a similar position at a specialized nursing facility for patients with dual psychiatric and medical illness. It was there that I refined my interests in applied behavioral analysis with psychiatric population, and during graduate school and internship I was able to expand this work to include school-aged and developmental disabilities populations. During this time, the field of applied behavior analysis did a very good job of better defining itself, including developing an international certification board. I was able to obtain my board certification in behavior analysis last year. The combination of clinical psychology and applied behavior analysis are very complementary and beneficial within my current position, as most of the individuals we support in my current agency have both psychiatric and developmental disabilities and benefit from a combination of approaches. Also, the combination of board certification in ABA and licensure as a clinical psychologist allows me to provide supervision to practica students from both clinical psych and ABA programs. This has allowed me to vary and change some of the official practica placements within my current agency to better meet the needs of the clients at any given time.

Describe a typical day at work.
I currently spend my day doing mostly clinical supervision, systems level analysis and program development, and administrative work. In a typical day, I?ll spend an hour or so reviewing incident reports. I?ll usually have either a clinical staff meeting or another type of internal meeting (e.g. with residential managers). As a senior vice president of my agency, I spend a lot of time in meetings with the chief executive officer and other VPs, analyzing and planning for the overall operations of the agency (e.g. strategic planning; employee relationships; marketing). I generally will spend an hour or two total in either formal or impromptu meetings with the master?s level clinician who I supervise. There is usually some daily phone or email contact with someone from one of our funding sources (e.g. state Department of Developmental Disabilities). I may have to put together some data for a risk meeting or other quality improvement related project. I make an effort to review at least one journal article per week. If I?m lucky, I may even get to spend a few minutes providing direct services to individuals or groups. Depending on the time of year, I may have to spend some time in the evening preparing/delivering a lecture or correcting papers for an evening graduate course I teach at a local university.

On average: How many hours a week do you work? How many hours do you sleep per night? How many weeks of vacation do you take?
I?ll generally work around 45 hours per week when I?m not also teaching. That will go up to around 60 during the semester I am teaching. I sleep about six hours per night. I get six weeks paid vacation per year.

Are you satisfied with your income?
I am very happy with my current income. I am compensated fairly for the work I do, and in line with other psychologists who do similar work. It has only been in the past year (12 years post PhD) that I have felt like I have financially caught up with some of the debt and missed earning potential of graduate school.

If you took out educational loans, is/was paying them back a financial strain?
Paying my student loans remains a financial strain. Even though I went to a fully funded program, I still took out loans to defray the ?opportunity costs? associated with not be able to work full-time for five years. These loans, combined with my undergrad student loans, translate to a monthly payment of approximately $400. That payment will be part of my life for the next decade or so.

In your position now, knowing what you do ? what would you say to yourself 10 years ago?
Don?t be so dogmatic. The people who don?t think like you or aren?t of the same ?theoretical orientation? aren?t much of threat to you. As long as you maintain your focus and work hard, it doesn?t matter what they do. Also, save your money. If you play your cards right, you?ll do okay in 10 years, but it?ll be easier along the way if you don?t spend your money on so many unnecessary or just plain stupid things.

What information/advice do you wish you had known when you were beginning your clinical psychology studies?
I received a lot of great advice from my mentor and supervisors throughout my career. I do think that there is a tendency for new students to get a lot of their initial career mentoring from academic psychologists who aren?t necessarily knowledgeable about clinical service provision outside of a university affiliated setting. Though I have never worked in settings where third party billing was a factor, it does seem like I should have been given more information about this and other financial aspects of professional psychology sometime before internship.

From your perspective, what is the biggest problem in healthcare today?
I find it ludicrous that in the United States, the type and cost of the healthcare you receive is so directly linked to your employment status. Along those same lines, it also seems crazy that the health benefits you receive are largely dependent upon what type of insurance you get. Employee health insurance premiums are a major expense for my agency. These costs rise exponentially each year, far outpacing the increases in our contracted service provision rates. The end result is that, as more money is spent on employee insurance, there is less to spend on client care.

Where do you see clinical psychology in 10 years?
This is a very difficult question to answer. There is the oft-cited trend towards master?s level clinicians doing the majority of direct therapy provision. This is compounded by the overall increases in the number of doctoral level clinicians coming out of training programs. This really points to full-time direct therapy eventually not being a viable financial option for clinical psychologists. I do see a positive trend of agencies looking to clinical psychologist to be leaders not only in clinical service provision, but also in the areas of administrative leadership, quality assurance, and systems level outcome analysis. A bolder model trained clinical psychologist should be well prepared to help an agency better understand how to measure and evaluate its clinical service provision and outcomes.

I do see huge problems with the current pre-doctoral internship imbalance, as well as the proliferation of stand alone and/or for profit training programs. It is embarrassing that, as a profession, we tolerate a system where a student can work hard, do everything right, and still not be able to finish their training because of there are not enough internships. Personally, I think this a problem on the supply side of the equation. Any ?weeding out? process should be accomplished at the front end, through limiting the acceptance to training programs, rather than at the back end, after the student has invested five-plus years and tens (hundreds?) of thousands of dollars in opportunity, if not real, costs. A dozen years ago, when I was applying, the internship process was competitive and tough. Today, it too often seems just cruel. That any program with horrible APA internship match rates would allow a student to accumulate a hundred thousand dollars in debt is despicable. With much of this potentially unrepayable debt subsidized by the government, the problem is that much bigger.

What types of outreach/volunteer work do you do, if any?
My volunteer activities are focused largely on my children. I have volunteered as a softball coach, and on a lot of fundraising committees for my children?s school. I have also run fly-fishing and fly-tying clinics for adults with developmental disabilities.

Do you have family? If so, do you have enough time to spend with them?
I am married and have a 10 year-old daughter and 8-year-old son. I make plenty of time to spend with them. My job affords me the flexibility to attend school functions and activities. Like many of my grad school cohorts, I didn?t have children until after graduate school and internship. As a result, my kids are much younger than those of many of my undergrad college friends who started there families much earlier in life and are now enjoying their ?empty nests? while I?m driving my kids to practice and play-dates .

Do you have any final piece of advice for students interested in pursuing clinical psychology as a career?
Do your research and realize what you are getting yourself in to. If your goal is to be a therapist, then clinical psychology may be a very inefficient path. Also, watch out for some of the clich?s and misconceptions that you see out there (e.g. PhD?s do research, PsyD?s do applied work). Understand that the internship imbalance represents a major crisis in clinical training ? fully one quarter of student will not be able to complete their training on schedule because there are not enough pre-doctoral internships to meet the demand. Realize that there are no shortcuts ? if things go as planned you will likely spend four to five years on campus and another two to three in pre- and post-doctoral internship training, just to be eligible to be licensed. During this time you will not make any real money, will likely have to move to a different area of the country more than once, and this will require a large amount of strength, perseverance, and understanding if you hope to maintain anything like a normal relationship with a significant other. When you are through with the training, it might take up to another 10 years to finally start recouping the costs of your training. In the meantime, many of your friends will have gotten on with their lives, gotten married, had kids, bought a house, etc., all while you?ve been living in crappy student apartments. In the end, you may have a really cool job with a lot of flexibility and benefits, but you?ll have earned it.

Source: http://studentdoctor.net/2012/10/20-questions-jeffrey-j-skowron-ph-d-bcba-d/

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