Everything about Clinical Psychology totally explained
Clinical psychology includes the scientific study and application of
psychology for the purpose of understanding, preventing, and relieving psychologically-based distress or
dysfunction and to promote subjective
well-being and personal development. Central to its practice are
psychological assessment and
psychotherapy, although clinical psychologists also engage in research, teaching, consultation, forensic testimony, and program development and administration. In many countries it's a regulated
mental health profession.
The field is often considered to have begun in 1896 with the opening of the first psychological
clinic at the
University of Pennsylvania by
Lightner Witmer. In the first half of the 20th century, clinical psychology was focused on psychological assessment, with little attention given to treatment. This changed after the 1940s when World War II resulted in the need for a large increase in the number of trained clinicians. Since that time, two main educational models have developed—the
Ph.D. (focusing on research) and the
Psy.D. (focusing on practice). Clinical psychologists are now considered experts in providing psychotherapy, and generally train within four primary theoretical orientations—
Psychodynamic,
Humanistic,
Cognitive Behavioral, and
Systems or Family therapy.
Clinical psychology may be confused with
psychiatry, which generally has similar goals (for example the alleviation of mental distress), but is unique in that psychiatrists are
medical practitioners. The most obvious difference is they're licensed to prescribe
medication. Perhaps more subtly psychiatrists' training allows them to take a multi-dimensional biological, psychological and social perspective of mental health problems. In practice psychologists and psychiatrists often work closely together in multidisciplinary teams with other professionals such as occupational therapists and social workers to bring a multimodal approach to complex patient problems.
History
Although modern, scientific psychology is often dated at the 1879 opening of the first psychological laboratory by
Wilhelm Wundt, attempts to create methods for assessing and treating mental distress existed long before. The earliest recorded approaches were a combination of religious, magical and/or medical perspectives.
In the early 1800s, one could have his or her head examined, literally, using
phrenology, the study of personality by the shape of the skull. Other popular treatments included
physiognomy—the study of the shape of the face—and
mesmerism,
Mesmer's treatment by the use of
magnets.
Spiritualism and
Phineas Quimby's "mental healing" were also popular.
While the scientific community eventually came to reject all of these methods, academic psychologists also were not concerned with serious forms of mental illness. That area was already being addressed by the developing fields of
psychiatry and
neurology within the
asylum movement. Ten years later in 1907, Witmer was to found the first journal of this new field,
The Psychological Clinic, where he coined the term "clinical psychology," defined as "the study of individuals, by observation or experimentation, with the intention of promoting change." The field was slow to follow Witmer's example, but by 1914 there were 26 similar clinics in the U.S.
Even as clinical psychology was growing, working with issues of serious mental distress remained the domain of
psychiatrists and
neurologists. However, clinical psychologists continued to make inroads into this area due to their increasing skill at
psychological assessment. Psychologists' reputation as assessment experts became solidified during
World War I with the development of two intelligence tests,
Army Alpha and
Army Beta (testing verbal and nonverbal skills, respectively), which could be used with large groups of recruits. In 1945 APA created what is now called Division 12, its division of clinical psychology, which remains a leading organization in the field. Psychological societies and associations in other English-speaking countries developed similar divisions, including in Britain, Canada, Australia and New Zealand.
World War II and the integration of treatment
When
World War II broke out, the military once again called upon clinical psychologists for their assessment expertise. As soldiers began to return from combat, psychologists started to notice symptoms of psychological trauma labeled "shell shock" (eventually to be termed
Post-Traumatic Stress Disorder) that were best treated as soon as possible. At the same time, female psychologists (who were excluded from the war effort) formed the National Council of Women Psychologists with the purpose of helping communities deal with the stresses of war and giving young mothers advice on child rearing. Clinical psychology in
Britain developed much like in the U.S. after WWII, specifically within the context of the
National Health Service with qualifications, standards, and salaries managed by the
British Psychological Society.
Development of the Doctor of Psychology degree
By the 1960s, psychotherapy had become imbedded within clinical psychology, but for many the Ph.D. educational model didn't offer the necessary training for those interested in practice rather than research. There was a growing argument that said the field of psychology in the U.S. had developed to a degree warranting explicit training in clinical practice. The concept of a practice-oriented degree was debated in 1965 and narrowly gained approval for a pilot program at the
University of Illinois starting in 1968. Several other similar programs were instituted soon after, and in 1973, at the Vail Conference on Professional Training in Psychology, the
Practitioner-Scholar Model of Clinical Psychology—or
Vail Model—resulting in the Doctor of Psychology (Psy.D.) degree was recognized. Although training would continue to include research skills and a scientific understanding of psychology, the intent would be to produce highly trained professionals, similar to programs in medicine, dentistry, and law. The first program explicitly based on the Psy.D. model was instituted at
Rutgers University. Clinical psychologists are still experts in assessment and psychotherapy, and have expanded their focus to address issues of prevention, gerontology, and even sports and the criminal justice system. The fastest growing area appears to be health psychology, which is reflected in hospitals being the fastest-growing employment setting for clinical psychologists in the past decade. include:
» *
Specific disorders (for example
trauma,
addiction,
eating,
sleep,
sex,
clinical depression,
anxiety, or
phobias)
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Neuropsychological disorders » *
Child and adolescent
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Family and
relationship counseling » *
Health
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Sport » *
Forensic
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Organization and business » *
School
Training and certification to practice
Ph.D. programs—a model that emphasizes research and is usually housed in universities—with the other half in
Psy.D. programs, which has more focus on practice (similar to professional degrees for medicine and law). and many other English-speaking psychological societies. A smaller number of schools offer accredited programs in clinical psychology resulting in a
Masters degree, which usually take 2 to 3 years post-bachelors.
In the U.K., clinical psychologists nearly always undertake a D.Clin.Psychol./Clin.Psy.D, which is a practitioner
doctorate with both clinical and research components. This is a three-year full-time salaried program sponsored by the
National Health Service (N.H.S.) and based in universities and the N.H.S. Entry into these programs is highly competitive, and requires at least a three-year undergraduate degree in psychology approved by the
British Psychological Society or an approved conversion course, plus some form of experience, usually in either the NHS as an Assistant Psychologist or in academia as a Research Assistant. It isn't unusual for applicants to apply several times before being accepted onto a training course as only about a fifth of applicants are accepted each year. More information about the path to training in the UK can be found at
the central clearing house for clinical psychology training applications
, and at
www.ClinPsy.org.uk where questions can also be answered on the forum, which is run by qualified clinical psychologists.
The practice of clinical psychology requires a license in the United States, Canada, the United Kingdom, and many other countries. Although each of the U.S. states is somewhat different in terms of requirements and licenses, there are three common elements:
» #Graduation from an accredited school with the appropriate degree
#Completion of supervised clinical experience
» #Passing a written examination and, in some states, an oral examination
All U.S. state and Canada province licensing boards are members of the Association of State and Provincial Psychology Boards (ASPPB) which created and maintains the Examination for Professional Practice in Psychology (EPPP). Many states require other examinations in addition to the EPPP, such as a jurisprudence (for example mental health law) examination and/or an oral examination. Such evaluation is usually done in service to gaining insight into and forming hypotheses about psychological or behavioral problems. As such, the results of such assessments are usually used to create generalized impressions (rather than diagnoses) in service to informing treatment planning. Methods include formal testing measures, interviews, reviewing past records, clinical observation, and physical examination. Most American
HMO and
insurance companies require a diagnosis from the DSM before that'll approve payment for treatment.
The DSM uses a categorical medical model and views psychological problems in terms of discrete illnesses that can be defined by a minimum set of criteria—such as self-reported symptoms, intensity, behaviors, duration, onset, et cetera. There is a growing awareness that this model isn't the only way to understand or describe psychological impairment. Moreover, there's little empirical justification for the cutoff criteria, which are based on clinical consensus and are therefore essentially arbitrary. As such, there's a debate in the field regarding alternative methods of diagnosing psychological problems.
Several conceptual models are being discussed, including a "dimensional model" based on empirically validated models of human differences (such as the
five factor model of personality The proponents of these models claim that they'd offer greater diagnostic flexibility and clinical utility without depending on the medical concept of illness. However, they also admit that these models are not yet robust enough to gain widespread use, and should continue to be developed.
British clinical psychologists don't tend to diagnose, but rather use
formulation—an individualized map of the difficulties that the patient or client faces, encompassing predisposing, precipitating and perpetuating (maintaining) factors.
Clinical theories and interventions
Generally speaking, psychotherapy involves a formal relationship between professional and client—usually an individual, couple, family, or small group—that employs a set of procedures intended to form a therapeutic alliance, explore the nature of psychological problems, and encourage new ways of thinking, feeling, or behaving.
Clinicians have a wide range of individual interventions to draw from, often guided by their training—for example, a
CBT clinician might use worksheets to record distressing cognitions, a
psychoanalyst might encourage
free association, while an
expressive therapist would employ forms of artistic expression. Clinical psychologists generally seek to base their work on research evidence and outcome studies as well as on trained clinical judgment. Although there are literally dozens of recognized therapeutic orientations, their differences can often be categorized on two dimensions: insight vs. action and in-session vs. out-session. The essential tools of the psychoanalytic process are the use of
free association and an examination of the client's
transference towards the therapist, defined as the tendency to take unconscious thoughts or emotions about a significant person (for example a parent) and "transfer" them onto another person. Major variations on Freudian psychoanalysis practiced today include
Self Psychology,
Ego Psychology, and
Object Relations Theory. These general orientations now fall under the umbrella term
psychodynamic psychology, with common themes including examination of transference and defenses, an appreciation of the power of the unconscious, and a focus on how early developments in childhood have shaped the client's current psychological state. By using
phenomenology,
intersubjectivity and first-person categories, the humanistic approach seeks to get a glimpse of the whole person and not just the fragmented parts of the personality. This aspect of holism links up with another common aim of humanistic practice in clinical psychology, which is to seek an integration of the whole person, also called
self-actualization. According to humanistic thinking, each individual person already has inbuilt potentials and resources that might help them to build a stronger personality and self-concept. The mission of the humanistic psychologist is to help the individual employ these resources via the therapeutic relationship.
Cognitive behavioral
Cognitive Behavioral Therapy (CBT) developed from the combination of
Cognitive psychology and
Behaviorism, and from more specific earlier therapies known as
cognitive therapy and
rational emotive behavior therapy. CBT is based on the theory that how we think (cognition), how we feel (emotion), and how we act (behavior) all interact together. In this perspective, certain thoughts or ways of interpreting the world (often called
schemas) can cause emotional distress or result in behavioral problems. Certain behaviors, such as avoidance of feared situations, can also maintain distress. The object of CBT is to discover the biased or irrational thinking that leads to emotional problems and to help the client take control over his or her thinking processes and behaviors in such a way that will lead to increased well-being. There are many techniques used, such as
systematic desensitization,
socratic questioning, and keeping a cognition observation log. Modified approaches that fall into the category of CBT have also developed, including
Dialectic Behavior Therapy and
Mindfulness-based Cognitive Therapy.
Systems or Family Therapy
Systems or Family therapy works with couples and families, and emphasizes family relationships as an important factor in psychological health. The central focus tends to be on interpersonal dynamics, especially in terms of how change in one person will affect the entire system. Therapy is therefore conducted with as many significant members of the "system" as possible. Goals can include improving communication, establishing healthy roles, creating alternative narratives, and addressing problematic behaviors. Important contributors include
John Gottman,
Jay Haley,
Susan Johnson, and
Virginia Satir.
Other major therapeutic orientations
There exist literally dozens of recognized schools or orientations of psychotherapy—the list below represents those that have been pivotal in the development of clinical psychology. Although they all have some typical set of techniques practitioners employ, they're generally better known for providing a framework of theory and philosophy that guides a therapist in his or her working with a client.
Existential. Existential psychotherapy postulates that people are largely free to choose who we're and how we interpret and interact with the world. It intends to help the client find deeper meaning in life and to accept responsibility for living. As such, it addresses fundamental issues of life, such as death, aloneness, and freedom. The therapist emphasizes the client’s ability to be self-aware, freely make choices in the present, establish personal identity and social relationships, create meaning, and cope with the natural anxiety of living. Important writers in existential therapy include Rollo May, Victor Frankl, James Bugental, and Irvin Yalom.One influential therapy that came out of Existential therapy is Gestalt Therapy, primarily founded by Fritz Perls in the 1950s. It is well-known for techniques designed to increase various kinds of self-awareness—the best-known perhaps being the empty chair technique—which are generally intended to explore resistance to authentic contact, resolve internal conflicts, and help the client complete "unfinished business".
Postmodern. Postmodern psychology says that the experience of reality is a subjective construction built upon language, social context, and history, with no essential truths. Since "mental illness" and "mental health" are not recognized as objective, definable realities, the postmodern psychologist instead sees the goal of therapy strictly as something constructed by the client and therapist. Forms of postmodern psychotherapy include Narrative Therapy, Solution-Focused Therapy, and Coherence Therapy.
Transpersonal. The transpersonal perspective places a stronger focus on the spiritual facet of human experience. It isn't a set of techniques so much as a willingness to help a client explore spirituality and/or transcendent states of consciousness. It also is concerned with helping clients achieve their highest potential. Important writers in this area include Ken Wilber, Abraham Maslow, Stanislav Grof, John Welwood, and David Brazier.
Other perspectives
Multiculturalism. Although the theoretical foundations of psychology are rooted in European culture, there's a growing recognition that there exist profound differences between various ethnic and social groups and that systems of psychotherapy need to take those differences into greater consideration. Further, the generations following immigrant migration will have some combination of two or more cultures—with aspects coming from the parents and from the surrounding society—and this process of acculturation can play a strong role in therapy (and might itself be the presenting problem). Culture influences ideas about change, help-seeking, locus of control, authority, and the importance of the individual versus the group, all of which can potentially clash with certain givens in psychotherapeutic theory and practice. As such, more psychologists and training programs are integrating knowledge of various cultural groups in order to inform therapeutic practice in a more culturally sensitive and effective way.
Feminism. Feminist therapy is an orientation arising from the disparity between the origin of most psychological theories (which have male authors) and the majority of people seeking counseling being female. It focuses on societal, cultural, and political causes and solutions to issues faced in the counseling process. It openly encourages the client to participate in the world in a more social and political way.
Positive Psychology. Positive psychology is the scientific study of human happiness and well-being, which started to gain momentum in 1998 due to the call of Martin Seligman, then president of the APA. The history of psychology shows that the field has been primarily dedicated to addressing mental illness rather than mental wellness. Applied positive psychology's main focus, therefore, is to increase one's positive experience of life and ability to flourish by promoting such things as optimism about the future, a sense of flow in the present, and personal traits like courage, perseverance, and altruism. There is now preliminary empirical evidence to show that by promoting Seligman's three components of happiness—positive emotion (the pleasant life), engagement (the engaged life), and meaning (the meaningful life)—positive therapy can decrease clinical depression.
Integration
In the last couple of decades, there has been a growing movement to integrate the various therapeutic approaches, especially with an increased understanding of cultural, gender, spiritual, and sexual-orientation issues. Clinical psychologists are beginning to look at the various strengths and weaknesses of each orientation while also working with related fields, such as neuroscience, genetics, evolutionary biology, and psychopharmacology. The result is a growing practice of eclecticism, with psychologists learning various systems and the most efficacious methods of therapy with the intent to provide the best solution for any given problem.
Professional ethics
The field of clinical psychology in most countries is strongly regulated by a code of ethics. In the U.S., professional ethics are largely defined by the APA Code of Conduct, which is often used by states to define licensing requirements. The APA Code generally sets a higher standard than that which is required by law as it's designed to guide responsible behavior, the protection of clients, and the improvement of individuals, organizations, and society. The Code is applicable to all psychologists in both research and applied fields.
The APA Code is based on five principles: Beneficence and Nonmaleficence, Fidelity and Responsibility, Integrity, Justice, and Respect for People's Rights and Dignity.—although many also employ psychotherapy as well. Their medical training also enables them to conduct physical examinations, order and interpret laboratory tests and EEGs, and may order brain imaging studies such as CT or CAT, MRI, and PET scanning.
Clinical psychologists don't usually prescribe medication, although there's a growing movement for psychologists to have limited prescribing privileges. Such privileges require additional, supervised training and education, and would mostly be limited to psychotropic medications. To date, qualified psychologists may prescribe psychotropic medications in Guam, New Mexico, and Louisiana. In general, however, when medication is warranted many psychologists will work in cooperation with psychiatrists so that clients get all their therapeutic needs met. Even though psychiatrists do seek out such training, the majority of them increasingly focus on medication management, possibly because insurance tends to pay far more for this service than for psychotherapy.
Counseling psychology
Counseling psychologists study and use many of the same interventions and tools as clinical psychologists, including psychotherapy and assessment. Traditionally, counselors help people with what might be considered normal or moderate psychological problems—such as the feelings of anxiety or sadness resulting from major life changes or events.
There are fewer counseling psychology graduate programs than those for clinical psychology and they're more often housed in departments of education rather than psychology. The two professions can be found working in all the same settings but counselors are more frequently employed in university counseling centers compared to hospitals and private practice for clinicians. There is considerable overlap between the two fields and distinctions between them continue to fade.
School psychology
School psychologists are primarily concerned with the academic, social, and emotional well-being of children and adolescents within a scholastic environment. In the U.K., they're known as 'educational psychologists'. Like clinical (and counseling) psychologists, school psychologists with doctoral degrees are eligible for licensure as health service psychologists, and many work in private practice. Unlike clinical psychologists, they receive much more training in education, child development and behavior, and the psychology of learning. The majority of school psychologists possess a terminal post-Masters Educational Specialist Degree (Ed.S.), with a minority holding the Doctor of Philosophy (Ph.D.) or Doctor of Education (Ed.D.) degree. Traditional job roles for school psychologists employed in school settings have focused mainly on assessment of students to determine their eligibility for special education services in schools, and on consultation with teachers and other school professionals to design and carry out interventions on behalf of students. Other major roles also include offering individual and group therapy with children and their families, designing prevention programs (for example for reducing dropout), evaluating school programs, and working with teachers and administrators to help maximize teaching efficacy, both in the classroom and systemically.
Clinical social work
Social workers provide a variety of services, generally concerned with social problems, their causes, and their solutions. With specific training, clinical social workers may also provide psychological counseling in addition to more traditional social work. The Masters in Social Work in the U.S. is a two-year, sixty credit program that usually includes at least a one year practicum. Unlike the PhD, which is an academic degree, the MSW is considered a professional degree.
Clinical psychology journals
The following represents an (incomplete) listing of significant journals in or related to the field of clinical psychology.
American Journal of Psychotherapy
Annual Review of Clinical Psychology (External Link)
Annual Review of Psychology (External Link)
British Journal of Psychotherapy
British Journal of Clinical Psychology
Clinical Psychology and Psychotherapy
Clinical Psychology Review
Clinical Psychology: Science and Practice
In Session: Psychotherapy in Practice
International Journal of Psychopathology,
Psychopharmacology, and Psychotherapy
International Journal of Psychotherapy
Journal of Abnormal Psychology
Journal of Affective Disorders
Journal of Anxiety Disorders
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Journal of Child Psychotherapy
Journal of Clinical Child Psychology
Journal of Clinical Psychology
Journal of Clinical Psychology in Medical Settings
Journal of Clinical Psychopharmacology
Journal of Consulting and Clinical Psychology
Journal of Contemporary Psychotherapy
Journal of Family Psychotherapy
Journal of Psychotherapy Integration
Journal of Psychotherapy Praxis & Research
Journal of Rational-Emotive and Cognitive Behaviour Therapy
Journal of Social and Clinical Psychology
Psychopathology
Psychotherapy & Psychosomatics
Psychotherapy Research
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Major influences
Criticisms and controversies
Clinical psychology is a diverse field and there have been recurring tensions over the degree to which clinical practice should be limited to treatments supported by empirical research. It is also unclear as to what exactly constitutes adequate evidence to qualify as "support". Despite some evidence showing that all the major therapeutic orientations are about of equal effectiveness, there remains much debate about the efficacy of various forms of assessment and treatment in use in clinical psychology.
Clinical Psychology can be subject to similar criticisms leveled at psychiatry, for example by the anti-psychiatry movement, especially when more aligned with a biomedical model or using psychiatric diagnostic categories such as in the DSM. Others may view this positively. It has been reported that clinical psychology has rarely allied itself with client groups and tends to individualize problems to the neglect of wider economic, political and social inequality issues that may not be the responsibility of the client. A critical psychology movement has argued that clinical psychology, and other professions making up a "psy complex", often fail to consider or address inequalities and power differences and can play a part in the social and moral control of disadvantage, deviance and unrest.Further Information
Get more info on 'Clinical Psychology'.
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