Clinical psychology is an integration of the science, theory and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically-based distress or dysfunction and to promote subjective and behavioral 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, clinical psychology is regulated as a health care profession.
The field is often considered to have begun in 1896 with the opening of the first psychological clinic at the University of Pennsylvaniaby LightnerWitmer. 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. scientist–practitioner model (requiring a doctoral dissertation and extensive research experience in addition to clinical expertise) and, in the U.S. the Psy.D. practitioner–scholar model (requiring completion of either a dissertation or other doctoral project, with extensive focus on clinical expertise in addition to research). While training programs using either model, if accredited by the American Psychological Association, are required to teach the full spectrum of psychological science, including both research and clinical practice, the primary objective of Ph.D. programs has historically been training students in conducting research as well as clinical practice; while the primary objective of Psy.D. programs has been preparing students to apply their knowledge in clinical practice.
Clinical psychologists provide psychotherapy, psychological testing, and diagnosis of mental illness. They generally train within four primary theoretical orientations—psychodynamic, humanistic, cognitive-behavioral (CBT), and systems or family therapy. Many continue clinical training in post-doctoral programs in which they might specialize in disciplines such as psychoanalytic approaches or child and adolescent treatment modalities.
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,include:
• Family therapy and relationship counselling
• Forensic psychology
• Health psychology
• Medical psychology
• Psychosomatic medicine
• Clinical neuropsychology
• Child psychopathology
• Organization and business
• School psychology
• Mental disorders (e.g. psychological trauma, addiction, eating disorders, sleep disorders, sexual dysfunction, clinical depression, anxiety, or phobia, and psychosis)
• Sport psychology
• Clinical Geropsychology
An important area of expertise for many clinical psychologists is assessment, and there are indications that as many as 91% of psychologists utilize this core clinical practice.Such evaluations are usually conducted in order to gain insight into, and form hypotheses about, psychological or behavioral problems. As such, the results of these assessments are often used to clarify a person’s diagnosis and assist in planning treatments or arranging for services. Methods used to gather information include formal tests, clinical interviews, reviews of past records, and behavioral observations.There exist literally hundreds of various assessment tools, although only a few have been shown to have both high construct 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:
Intelligence & achievement tests :
These tests are designed to measure certain aspects of cognitive functioning (often referred to as IQ) in comparison to a group of people with similar characteristics (such as age or education). These tests, including the WISC-IV and WAIS-IV, attempt to measure traits such as general knowledge, verbal comprehension, working memory, attention/concentration, logical reasoning, and visual/spatial perception.Several of these tests have been shown to accurately predict scholastic achievement and occupational performance, and help to identify a person’s cognitive strengths and weaknesses.
Personality tests :
These tests aim to describe patterns of behavior, thoughts, and feelings, and generally fall within two categories: objective and projective. Objective measures, such as the MMPI-2 or the MCMI-III, are based on forced-choice responses—such as yes/no, true/false, or a rating scale—and generate scores that can be compared to a normative group. Projective tests, such as the Rorschach inkblot test, use open-ended responses, often based on ambiguous stimuli, to reveal non-conscious psychological dynamics such as motivations and perceptions of the self and the world.
Neuropsychological tests :
Tests in this category are often used to evaluate a person’s cognitive functioning and its relationship to a person’s behavior or psychological functioning. They are used in a variety of settings, for purposes such as clarifying a diagnosis (especially in distinguishing between psychiatric and neurological symptoms), better understanding the impact of a person’s neurological condition on their behavior, treatment planning (especially in rehabilitation settings), and for legal questions, such as determining if a person is faking their symptoms (also referred to as malingering) or if they are capable to stand trial.
Clinical interviews :
Clinical psychologists are also trained to gather data by observing behavior and collecting detailed histories. The clinical interview is a vital part of assessment, even when using other formalized measures, as it provides a context in which to understand test results. Psychologists can employ a structured format (such as the SCID or the MMSE), a semi-structured format (such as a sequence of questions) or an unstructured format to gather information about a person’s symptoms and past and present functioning. Such assessments often include evaluations of general appearance and behavior, mood and affect, perception, comprehension, orientation, memory, thought process, and/or communication.
Diagnostic impressions :
After assessment, clinical psychologists often provide a diagnostic impression. Many countries use the International Statistical Classification of Diseases and Related Health Problems (ICD-10) while the US most often uses the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Both utilize medical concepts and terms, and state that there are categorical disorders that can be diagnosed by set lists of descriptive criteria. Several new 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 place greater emphasis on changing, intersubjective states.In fact, the DSM-5, which is still being edited, will be using a dimensional approach.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.Some clinical psychologists prefer not to use diagnoses and instead use clinical formulations—an individualized map of the strengths and difficulties that the patient or client faces, with an emphasis on predisposing, precipitating and perpetuating (maintaining) factors.
Clinical theories and interventions :
Clinical psychologists work with individuals, children, families, couples, or small groups.
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 cognitive behavioral therapy (CBT) clinician might use worksheets to record distressing cognitions, a psychoanalyst might encourage free association, while a psychologist trained in Gestalt techniques might focus on immediate interactions between client and therapist. 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).
Fluoxetine hydrochloride, branded by Lilly as Prozac, is a commonantidepressant drug prescribed by psychiatrists. There is a small but growing movement to give prescription privileges to qualified psychologists
Although clinical psychologists and psychiatrists can be said to share a same fundamental aim—the treatment of mental disorders—their training, outlook, and methodologies are often quite different. Perhaps the most significant difference is that psychiatrists are licensed physicians. As such, psychiatrists often use the medical model to assess psychological problems (i.e., those they treat are seen as patients with an illness) and rely on psychotropic medications as the chief method of addressing the illness—although many employ psychotherapy as well.
Clinical psychologists are not allowed to prescribe medication, although there is a movement for psychologists to have prescribing privileges. These medical privileges require additional training and education. To date, medical psychologists may prescribe some psychotropic medications in Guam, New Mexico, Louisiana, and Illinois as well as United States military psychologists.
Counseling psychology :
Counseling psychologists study and use many of the same interventions and tools as clinical psychologists, including psychotherapy and assessment. Traditionally, counseling psychologists 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 counseling psychologists also receive specialized training in career assessment, group therapy, and relationship counseling, although some counseling psychologists also work with the more serious problems that clinical psychologists are trained for, such as dementia orpsychosis
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 counseling psychologists are more frequently employed in university counselingcenters compared to hospitals and private practice for clinical psychologists.
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 UK, they are known as “educational psychologists.” They typically hold a master’s degree.Like clinical 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. Common degrees include theEducational Specialist Degree (Ed.S.), Doctor of Philosophy (Ph.D.), and Doctor of Education(Ed.D.). 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 (e.g. 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 the US and Canada), in addition to more traditional social work. The Masters in Social Work in the US is a two-year, sixty credit program that includes a practicum each year, totaling at least 900 hours.The requirements to become a Licensed Clinical Social Worker, which offers similar privileges to that of a psychologist, vary by state. The requirements in NY, for example, include a master’s degree in Social Work from an accredited graduate school that includes course hours in clinical coursework, 2000 post-graduate, practice hours directly with clients at an approved site providing “diagnosis, psychotherapy and assessment-based treatment planning” under the supervision of a qualified psychiatrist, clinical psychologist, or LCSW; the experience hours must be accumulated over a minimum of 3 years & cannot exceed 6 years, and there is an additional minimum of 60 minutes each week for supervision meeting. After meeting the educational, experience, and supervision requirements, the candidate must pass a written exam demonstrating clinical knowledge and ethical responsibility.
Occupational therapy :
Occupational therapy—often abbreviated OT—is the “use of productive or creative activity in the treatment or rehabilitation of physically, cognitively, or emotionally disabled people.” Most commonly, occupational therapists work with people with disabilities to enable them to maximize their skills and abilities. Occupational therapy practitioners are skilled professionals whose education includes the study of human growth and development with specific emphasis on the physical, emotional, psychological, sociocultural,cognitive and environmental components of illness and injury. They commonly work alongside clinical psychologists in settings such as inpatient and outpatient mental health, pain management clinics, eating disorder clinics, and child development services. OT’s use support groups, individual counseling sessions, and activity-based approaches to address psychiatric symptoms and maximize functioning in life activities. In chronic pain management, occupational therapists use the common cognitive behavioral therapy approach, often incorporating cognitive behavioral therapy techniques and helping clients generalize or integrate their pain management strategies into their lives. In this way, occupational therapists both support and extend the work that clinical psychologists carry out in a clinical setting.
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