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Clinical psychology includes the scientific study and application of , although attempts to create methods for assessing and treating mental distress existed long before. Central to its practice are Psychological Assessment and Psychotherapy , although clinical psychologists also engage in a range of professional services including research, teaching, consultation, forensic testimony, and program development and administration. Clinical psychologists usually undergo four to six years of post-Bachelors graduate training in order to demonstrate competence and experience.Brain, Christine. (2002). ''Advanced psychology : applications, issues and perspectives.'' Cheltenham : Nelson Thornes. ISBN 0174900589> Clinical Psychology consists of several components. Assessment includes Intelligence and Achievement tests, Personality tests, Neuropsychological tests, and Clinical observation. Psychotherapy is intended to form a therapeutic alliance, explore the nature of psychological problems, and encourage new ways of thinking, feeling, or behaving. It is often confused with Psychiatry , Counseling Psychology , School Psychology , and Clinical Social Work . In many countries it is a regulated Mental Health Profession , and has been the subject of several controversies. HISTORY See Also: History of psychology History of psychotherapy .]] Although modern, scientific psychology is often dated at the 1879 opening of the first psychological laboratory by , 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 Magnet s. Spiritualism and Phineas Quimby 's "mental healing" were also popular.Benjamin, Ludy. (2005). A history of clinical psychology as a profession in America (and a glimpse at its future). ''Annual Review of Clinical Psychology,'' 1, 1-30. 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. It wasn't until the end of the 19th century, around the time when Sigmund Freud was first developing his " Talking Cure " in Vienna , that the first scientifically clinical application of psychology began. The start of clinical psychology , the father of modern clinical psychology.]] By the second half of the 1800s, the scientific study of psychology was becoming well established in university laboratories. Although there were a few scattered voices calling for an applied psychology, the general field looked down upon this idea and insisted on "pure" science as the only respectable practice. This changed when Lightner Witmer (1867-1956), a past student of Wundt and head of the psychology department at the University Of Pennsylvania , agreed to treat a young boy who had trouble with spelling. His successful treatment was soon to lead to Witmer's opening of the first psychological clinic at Penn in 1896, dedicated to helping children with Learning Disabilities .Alessandri, M., Heiden, L., & Dunbar-Welter, M. (1995). "History and Overview" in Heiden, Lynda & Hersen, Michel (eds.), ''Introduction to Clinical Psychology''. New York : Plenum Press. ISBN 0306448777 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."Compas, Bruce & Gotlib, Ian. (2002). ''Introduction to Clinical Psychology.'' New York, NY : McGraw-Hill Higher Education. ISBN 0070124914 The field was slow to follow Witmer's example, but by 1914 there were 26 similar clinics in the U.S.Evans, Rand. (1999). Clinical psychology born and raised in controversy . ''APA Monitor, 30(11).'' Even as clinical psychology was growing, working with issues of serious mental distress remained the domain of . 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. Due in large part to the success of these tests, assessment was to become the core discipline of clinical psychology for the next quarter century, when another war would propel the field into treatment. Early professional organizations The field began to organize under the name "clinical psychology" in 1917 with the founding of the American Association of Clinical Psychology. This only lasted until 1919, after which the American Psychological Association (founded by G. Stanley Hall in 1892) developed a section on Clinical Psychology, which offered certification until 1927. Growth in the field was slow for the next few years when various unconnected psychological organizations came together as the American Association of Applied Psychology in 1930, which would act as the primary forum for psychologists until after World War II when the APA reorganized.American Psychological Association. (1999). APA: Uniting psychologists for more than 100 years . ''APA Monitor Online,'' 30(11). 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 conducts a group psychological test developed by clinical psychologists for selection purposes.]] When in the U.S. made an enormous investment to set up programs to train doctoral-level clinical psychologists to help treat the thousands of veterans needing care. As a consequence, the U.S. went from having no formal university programs in clinical psychology in 1946 to over half of all PhDs in psychology in 1950 being awarded in clinical psychology. WWII helped bring dramatic changes to clinical psychology, not just in America but internationally as well. Graduate education in psychology began adding psychotherapy to the science and research focus based on the 1947 .Henry, David. (1959). Clinical psychology abroad. ''American Psychologist, 14(9),'' 601-604. The development of the PsyD By the 1960s, psychotherapy had become imbedded within clinical psychology, but for many the PhD educational model did not 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 . Today, about half of all graduate students in clinical psychology are enrolled in PsyD programs. A changing profession Since the 1970s, clinical psychology has continued growing into a robust profession and academic field of study. Although the exact number of practicing clinical psychologists is unknown, it is estimated that between 1974 and 1990, the number in the U.S. grew from 20,000 to 63,000.Menninger, Roy and Nemiah, John. (2000). ''American psychiatry after World War II: 1944-1994.'' Washington, DC : American Psychiatric Press. ISBN 0880488662 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. Other major changes include the impact of Managed Care on mental health care, an increasing understanding of the importance of multicultural knowledge, a growing pressure to give limited Prescription Privileges to psychologists, and the shift in the majority of practitioners of psychotherapy now having masters-level training. PROFESSIONAL PRACTICE Clinical psychologists can offer a range of professional services, including:
In practice, clinical psychologists may work with individuals, couples, families, or groups in a variety of settings, including private practices, hospitals, mental health organizations, schools, businesses, and non-profit agencies. Most clinical psychologists who engage in research and teaching do so within a college or university setting. Clinical psychologists may also choose to specialize in a particular field—common areas of specialization, some of which can earn board certification,American Board of Professional Psychology, Specialty Certification in Professional Psychology include:
TRAINING AND CERTIFICATION TO PRACTICE was the first to offer formal education in clinical psychology.]] See Also: Training and licensing of clinical psychologists Clinical psychologists undergo many hours of graduate training—usually 4 to 6 years post-Bachelors—in order to gain demonstrable competence and experience. About half of all clinical psychology graduate students are being trained in , which usually take 2 to 3 years post-bachelors. In the U.K., clinical psychologists nearly always undertake a D.Clin.Psychol., 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 (NHS) and based in universities and the NHS. 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 is not unusual for applicants to apply several times before being accepted onto a training course.Cheshire, K. & Pilgrim, D. (2004). ''A short introduction to clinical psychology.'' London ; Thousand Oaks, CA : Sage Publications. ISBN 076194768X 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:1 :#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 (i.e. mental health law) examination and/or an oral examination. Most states also require a certain number of continuing education credits per year in order to renew a license, which can be obtained though various means, such as taking audited classes and attending approved workshops. Clinical psychologists require the Psychologist license to practice, although similar licenses can be obtained with a masters-level degree, such as Marriage and Family Therapist (MFT), Licensed Professional Counselor (LPC), and Licensed Psychological Associate (LPA). ASSESSMENT See Also: Psychological testing Projective Personality Test ]] An important area of expertise for many clinical psychologists is psychological assessment, and there are indications that as many as 91% of psychologists engage in this core clinical practice.Groth-Marnat, G. (2003). ''Handbook of Psychological Assessment,'' 4th ed. Hoboken, NJ : John Wiley & Sons. ISBN 0-471-41979-6 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. There exist literally hundreds of various assessment tools, although only a few have been shown to have both high Validity (i.e., test actually measures what it claims to measure) and Reliability (i.e., consistency). These measures generally fall within one of several categories, including the following:
Diagnostic impressions See Also: Mental disorder published by the American Psychiatric Association .]] After assessment, clinical psychologists often provide a and Insurance companies require a diagnosis from the DSM before they will 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 is not the only way to understand or describe psychological impairment. Moreover, there is little empirical justification for the cutoff criteria, which are based on clinical consensus and are therefore essentially arbitrary.Widiger, Thomas & Trull, Timothy. (2007). Plate tectonics in the classification of personality disorder: shifting to a dimensional model. ''American Psychologist, 62(2),'' 71-83. As such, there is 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) and a "psychosocial model", which would take changing, intersubjective states into greater account.Mundt, Christoph & Backenstrass, Matthias. (2005). Psychotherapy and classification: Psychological, psychodynamic, and cognitive aspects. ''Psychopathology, 38(4),'' 219 The proponents of these models claim that they would 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 do not 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.Kinderman, P. and Lobban, F. (2000) Evolving formulations: Sharing complex information with clients. ''Behavioural and Cognitive Psychotherapy, 28(3),'' 307-310 CLINICAL THEORIES AND INTERVENTIONS See Also: Psychotherapy 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 methods used are also different in regards to the population being served as well as the context and nature of the problem. Therapy will look very different between, say, a traumatized child, a depressed but high-functioning adult, a group of people recovering from substance dependence, and a ward of the state suffering from terrifying delusions. Other elements that play a critical role in the process of psychotherapy include the environment, culture, age, cognitive functioning, motivation, and duration (i.e. brief or long-term therapy). Four main perspectives The field can be seen as recognizing essentially four major perspectives: Psychodynamic , Humanistic , Cognitive Behavioral , and Systems Or Family Therapy . Psychodynamic See Also: Psychodynamic psychotherapy The Psychodynamic perspective developed out of the 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 (e.g. 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. Humanistic See Also: Humanistic psychology Humanistic psychology was developed in the 1950s in reaction to both behaviorism and psychoanalysis, largely due to the , 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.Rowan, John. (2001). ''Ordinary Ecstasy : The Dialectics of Humanistic Psychology.'' London, UK : Brunner-Routledge. ISBN 0415236339 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 See Also: Cognitive behavioral therapy Cognitive Behavioral Therapy (CBT) developed from the combination of , 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 .Association for Behavioral and Cognitive Therapies. (2006). What is CBT? . Retrieved 03-04-2007. Systems or Family Therapy See Also: 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.Bitter, J. & Corey, G. (2001). "Family Systems Therapy" in Gerald Corey (ed.), ''Theory and Practice of Counseling and Psychotherapy''. Belmost, CA : Brooks/Cole.'' 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 See Also: List of psychotherapies 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 are generally better known for providing a framework of theory and philosophy that guides a therapist in his or her working with a client.
Other perspectives
Integration See Also: Integrative Psychotherapy 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.Norcross, John and Goldfried, Marvin. (2005). The Future of Psychotherapy Integration: A Roundtable. ''Journal of Psychotherapy Integration, 15(4),'' 392 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 is designed to guide responsible behavior, the protection of clients, and the improvement of individuals, organizations, and society.APA. (2003). '' Ethical Principles of Psychologists and Code of Conduct .'' Retrieved July 28, 2007. 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. Detailed elements address how to resolve ethical issues, competence, human relations, privacy and confidentiality, advertising, record keeping, fees, training, research, publication, assessment, and therapy. COMPARISON WITH OTHER MENTAL HEALTH PROFESSIONS See also: Mental Health Professional Psychiatry , branded by Lilly as Prozac, is a common Antidepressant Drug prescribed by Psychiatrist s. There is a small but growing movement to give prescription privileges to qualified psychologists.]] Although clinical psychologists and Psychiatrist s can be said to share a same fundamental aim—the alleviation of mental distress—their training, outlook, and methodologies are often quite different. Perhaps the most significant difference is that psychiatrists are medical doctors with four years of medical school and another four years of residency in a medical setting where they may specialize in certain age groups or specific conditions. Being medical doctors, they tend to use the Medical Model to assess psychological problems (i.e. those they treat are seen as patients with an illness) and therefore often rely on Psychotropic Medications as the chief method of addressing themGraybar, S. & Leonard, L. (2005). In defense of listening. ''American Journal of Psychotherapy, 59(1),'' 1-19.—although many also employ Psychotherapy as well. Their medical training also enables them to conduct physical examinations, order and interpret laboratory tests and EEG s, and may order brain imaging studies such as CT or CAT , MRI , and PET scanning. Clinical psychologists do not usually . To date, qualified psychologists may prescribe psychotropic medications in Guam , New Mexico , and Louisiana .Halloway, Jennifer. (2004). Gaining prescriptive knowledge . ''Monitor on Psychology, 35(6).'' p.22. In general, however, when medication is warranted many psychologists will work in cooperation with psychiatrists so that clients get all their therapeutic needs met. Unless a psychiatrist voluntarily chooses to get extra training beyond medical school—such as at a Psychoanalytic institute—they will have less training in psychological assessment and psychotherapy than will a licensed clinical psychologist.Mariani, Matthew. (1995). Beyond psychobabble: Careers in psychotherapy. ''Occupational Outlook Quarterly, 39(1),'' 12-26. 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.Downs, Martin. (2005). " Psychology vs. Psychiatry: Which Is Better? " WebMD. 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. Many counselors also receive specialized training in career assessment, group therapy, and relationship counseling, although some counselors also work with the more serious problems that clinical psychologists are primarily trained for, such as Dementia or Psychosis . In the United States, all but two states license or certify counselors for private practice.American Mental Health Counselors Association. (2004). " Why use a mental health counselor? ". Retrieved July 21, 2007. There are fewer counseling psychology graduate programs than those for clinical psychology and they are 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. Norcross, John. (2000). Clinical versus counseling psychology: What's the diff? ''Eye on Psi Chi, 5(1),'' 20-22. There is considerable overlap between the two fields and distinctions between them continue to fade. School Psychology School Psychologists , also known as educational psychologists, are primarily concerned with the academic, social, and emotional well-being of children within a scholastic environment. Unlike clinical psychologists, they receive much more training in education, child development and behavior, and the psychology of learning, often graduating with a post-Masters Educational Specialist Degree (EdS) or Doctor Of Education (EdD) degree. Besides offering individual and group therapy with children and their families, school psychologists also evaluate school programs, provide cognitive assessment, help design prevention programs (e.g. reducing drops outs), and work with teachers and administrators to help maximize teaching efficacy, both in the classroom and systemically.Silva, Arlene. (2003). '' Who Are School Psychologists? ''. National Association of School Psychologists. Clinical Social Work Social Work ers 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. MAJOR INFLUENCES Related lists REFERENCES EXTERNAL LINKS Organizations
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