Clinical psychology
Encyclopedia
Clinical psychology is an integration of science
, theory and clinical knowledge 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, clinical psychology is 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. scientist–practitioner model (requiring a doctoral dissertation and therefore research as well as clinical expertise); and the Psy.D. practitioner–scholar model
(in which a doctoral level dissertation is not required). Clinical psychologists are now considered experts in providing psychotherapy, psychological testing, and in diagnosing mental illness. They generally train within four primary theoretical orientations—psychodynamic
, humanistic
, behavior therapy/cognitive behavioral, and systems or family therapy. Many continue clinical training in post-doctoral programs in which they might specialize more intensively in disciplines such as psychoanalytic approaches, or child and adolescent treatment modalities.
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. Early examples of such physicians included Patañjali
, Padmasambhava
, Rhazes, Avicenna
, and Rumi.
In the early 19th century, 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 magnet
s. 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. It was not 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.
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. 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 US.
Even as clinical psychology was growing, working with issues of serious mental distress remained the domain of psychiatrist
s and neurologist
s. 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. 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.
(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. In 1945, the 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.
When World War II
broke out, the military once again called upon clinical psychologists. As soldiers began to return from combat, psychologists started to notice symptoms of psychological trauma labeled "shell shock" (eventually to be termed posttraumatic stress disorder) that were best treated as soon as possible. Because physicians (including psychiatrists) were over-extended in treating bodily injuries, psychologists were called to help treat this condition. 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. After the war, the Veterans Administration
in the US 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 US went from having no formal university programs in clinical psychology in 1946 to over half of all Ph.D.s 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 scientist–practitioner model, known today as the Boulder Model, for Ph.D. programs in clinical psychology. 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
.
. Today, about half of all American graduate students in clinical psychology are enrolled in Psy.D. programs.
on mental health care; an increasing realization of the importance of knowledge relating to multicultural and diverse populations; and emerging privileges to prescribe psychotropic medication.
In the UK psychology is now one of the most popular degree subjects, and over 15,000 people graduate in psychology each year, many with the hope of developing this into a career, although only around 600 places for doctoral training in clinical psychology means there is intense competition for these places. There is also fierce competition to get into US Ph.D. programs in clinical psychology, with an average acceptance rate of 8%.
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:
Clinical psychologists study a generalist program in psychology plus postgraduate training and/or clinical placement and supervision. The length of training differs across the world, ranging from four years plus post-Bachelors supervised practice to a doctorate of three to six years which combines clinical placement.
In the US, clinical psychology doctoral programs typically range from five to seven years post-college and require a one year full-time clinical internship and dissertation. There is currently an "internship crisis" in the field (see below). Graduates must also accrue 1–2 years of supervised training post-PhD before licensure in most states (3,000 hours) and need to pass the EPPP (plus, other state exams). About half of all clinical psychology graduate students are being trained in Ph.D. programs—a model that emphasizes research—with the other half in Psy.D. programs, which has more focus on practice (similar to professional degrees for medicine and law). Both models are accredited by the American Psychological Association 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 two to three years post-Bachelors. Mean debt related to doctoral education in clinical psychology currently exceeds $85,000 and continues to increase each year. Median debt related to the PsyD degree is currently at $120,000 and increases more each year.
In the UK, clinical psychologists undertake a Doctor of Clinical Psychology (D.Clin.Psych.), 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 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 as only about one-fifth of applicants are accepted each year. These clinical psychology doctoral degrees are accredited by the British Psychological Society
and the Health Professions Council
(HPC). The HPC is the statutory regulator for practitioner psychologists in the UK. Those who successfully complete clinical psychology doctoral degrees are eligible to apply for registration with the HPC as a clinical psychologist.
The practice of clinical psychology requires a license in the United States, Canada, the United Kingdom, and many other countries. Although each of the US states is somewhat different in terms of requirements and licenses, there are three common elements:
All US state and Canadian 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 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).
In the UK, registration as a clinical psychologist with the Health Professions Council (HPC) is necessary. The HPC is the statutory regulator for practitioner psychologists in the UK. In the UK the following titles are restricted by law: "registered psychologist" and "practitioner psychologist"; in addition, the specialist title "clinical psychologist" is also restricted by law.
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. 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:
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 (the DSM version IV-TR). Both assume 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 take changing, intersubjective states into greater account. 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 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.
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).
of Sigmund Freud
. The core object of psychoanalysis is to make the unconscious conscious—to make the client aware of his or her own primal drives (namely those relating to sex and aggression) and the various defenses used to keep them in check. 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 (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.
(often referred to as Rogerian Therapy) and existential psychology developed by Victor Frankl and Rollo May
. Rogers believed that a client needed only three things from a clinician to experience therapeutic improvement: congruence, unconditional positive regard, and empathetic understanding. 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.
and rational emotive behavior therapy
, both of which grew out of cognitive psychology
and behaviorism
. CBT is based on the theory that how we think (cognition), how we feel (emotion), and how we act (behavior) are related and interact together in complex ways. In this perspective, certain dysfunctional ways of interpreting and appraising the world (often through schemas or beliefs) can contribute to emotional distress or result in behavioral problems. The object of many cognitive behavioral therapies is to discover and identify the biased, dysfunctional ways of relating or reacting and through different methodologies help clients transcend these in ways 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 dialectical behavior therapy and mindfulness-based cognitive therapy
.
Behavior therapy is a rich tradition. It is well-researched with a strong evidence base. Its roots are in behaviorism. In behavior therapy, environmental events predict the way we think and feel. Our behavior sets up conditions for the environment to feed back on it. Sometimes the feedback leads the behavior to increase (reinforcement), and sometimes the behavior descreases (punishment). Oftentimes behavior therapists are called applied behavior analysts. They have studied many areas from developmental disabilities to depression and anxiety disorders. In the area of mental health and addictions a recent article looked at APA's list for well-established and promising practices and found a considerable number of them based on the principles of operant and respondent conditioning. Multiple assessment techniques have come from this approach including functional analysis (psychology)
, which has found a strong focus in the school system. In addition, multiple intervention programs have come from this tradition including community reinforcement and family training
for treating addictions, acceptance and commitment therapy
, functional analytic psychotherapy
, integrative behavioral couples therapy
including dialectical behavior therapy and behavioral activation
. In addition, specific techniques such as contingency management
and exposure therapy
have come from this tradition.
, Jay Haley
, Sue Johnson
, and Virginia Satir
.
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."
, 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.
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.
Although clinical psychologists and psychiatrists 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 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. Psychiatrists and medical psychologists (who are clinical psychologists that are also licensed to prescribe) are able 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 generally do not prescribe
medication, although there is a growing movement for psychologists to have prescribing privileges
. These medical privileges require additional training and education. To date, medical psychologists may prescribe psychotropic medications in Guam
, New Mexico
, and Louisiana and military psychologists.
or psychosis
.
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 counseling centers compared to hospitals and private practice for clinical psychologists.
(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.
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 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 at least a one-year practicum (two years for clinicians).
—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.
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. It has been argued that therapeutic practices are inevitably bound up with power inequalities, which can be used for good and bad. 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.
An October 2009 editorial in the journal Nature suggests that a large number of clinical psychology practitioners in the United States consider scientific evidence to be "less important than their personal—that is, subjective—clinical experience."
The following represents an (incomplete) listing of significant journals in or related to the field of clinical psychology.
See also: a list of empirical journals published by the APA
Science
Science is a systematic enterprise that builds and organizes knowledge in the form of testable explanations and predictions about the universe...
, theory and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically-based distress or dysfunction
Mental illness
A mental disorder or mental illness is a psychological or behavioral pattern generally associated with subjective distress or disability that occurs in an individual, and which is not a part of normal development or culture. Such a disorder may consist of a combination of affective, behavioural,...
and to promote subjective well-being
Mental health
Mental health describes either a level of cognitive or emotional well-being or an absence of a mental disorder. From perspectives of the discipline of positive psychology or holism mental health may include an individual's ability to enjoy life and procure a balance between life activities and...
and personal development. Central to its practice are psychological assessment and psychotherapy
Psychotherapy
Psychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group...
, although clinical psychologists also engage in research, teaching, consultation, forensic testimony, and program development and administration. In many countries, clinical psychology is a regulated mental health profession.
The field is often considered to have begun in 1896 with the opening of the first psychological clinic
Clinic
A clinic is a health care facility that is primarily devoted to the care of outpatients...
at the University of Pennsylvania
University of Pennsylvania
The University of Pennsylvania is a private, Ivy League university located in Philadelphia, Pennsylvania, United States. Penn is the fourth-oldest institution of higher education in the United States,Penn is the fourth-oldest using the founding dates claimed by each institution...
by Lightner Witmer
Lightner Witmer
Lightner Witmer Lightner Witmer is an American psychologist who is credited with the introduction of the term "Clinical Psychology." Witmer also founded the world's first "Psychological Clinic" in the United States at the University of Pennsylvania in 1896.Witmer contributed greatly to numerous...
. 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 therefore research as well as clinical expertise); and the Psy.D. practitioner–scholar model
Doctor of Psychology
The Doctor of Psychology degree is a professional doctorate earned through one of two established training models for clinical psychology...
(in which a doctoral level dissertation is not required). Clinical psychologists are now considered experts in providing psychotherapy, psychological testing, and in diagnosing mental illness. They generally train within four primary theoretical orientations—psychodynamic
Psychodynamic psychotherapy
Psychodynamic psychotherapy is a form of depth psychology, the primary focus of which is to reveal the unconscious content of a client's psyche in an effort to alleviate psychic tension. In this way, it is similar to psychoanalysis. It also relies on the interpersonal relationship between client...
, humanistic
Humanistic psychology
Humanistic psychology is a psychological perspective which rose to prominence in the mid-20th century, drawing on the work of early pioneers like Carl Rogers and the philosophies of existentialism and phenomenology...
, behavior therapy/cognitive behavioral, and systems or family therapy. Many continue clinical training in post-doctoral programs in which they might specialize more intensively in disciplines such as psychoanalytic approaches, or child and adolescent treatment modalities.
History
Wilhelm Wundt
Wilhelm Maximilian Wundt was a German physician, psychologist, physiologist, philosopher, and professor, known today as one of the founding figures of modern psychology. He is widely regarded as the "father of experimental psychology"...
, 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. Early examples of such physicians included Patañjali
Patañjali
Patañjali is the compiler of the Yoga Sūtras, an important collection of aphorisms on Yoga practice. According to tradition, the same Patañjali was also the author of the Mahābhāṣya, a commentary on Kātyāyana's vārttikas on Pāṇini's Aṣṭādhyāyī as well as an unspecified work of medicine .In...
, Padmasambhava
Padmasambhava
Padmasambhava ; Mongolian ловон Бадмажунай, lovon Badmajunai, , Means The Lotus-Born, was a sage guru from Oddiyāna who is said to have transmitted Vajrayana Buddhism to Bhutan and Tibet and neighbouring countries in the 8th century...
, Rhazes, Avicenna
Avicenna
Abū ʿAlī al-Ḥusayn ibn ʿAbd Allāh ibn Sīnā , commonly known as Ibn Sīnā or by his Latinized name Avicenna, was a Persian polymath, who wrote almost 450 treatises on a wide range of subjects, of which around 240 have survived...
, and Rumi.
In the early 19th century, 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
Physiognomy
Physiognomy is the assessment of a person's character or personality from their outer appearance, especially the face...
—the study of the shape of the face—and mesmerism, Mesmer's treatment by the use of magnet
Magnet
A magnet is a material or object that produces a magnetic field. This magnetic field is invisible but is responsible for the most notable property of a magnet: a force that pulls on other ferromagnetic materials, such as iron, and attracts or repels other magnets.A permanent magnet is an object...
s. Spiritualism
Spiritualism
Spiritualism is a belief system or religion, postulating the belief that spirits of the dead residing in the spirit world have both the ability and the inclination to communicate with the living...
and Phineas Quimby
Phineas Quimby
Phineas Parkhurst Quimby , was a New England philosopher, magnetizer, mesmerist, healer, and inventor, who resided in Belfast, Maine, and had an office in Portland, Maine...
'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
Psychiatry
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...
and neurology
Neurology
Neurology is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the central, peripheral, and autonomic nervous systems, including their coverings, blood vessels, and all effector tissue,...
within the asylum
Psychiatric hospital
Psychiatric hospitals, also known as mental hospitals, are hospitals specializing in the treatment of serious mental disorders. Psychiatric hospitals vary widely in their size and grading. Some hospitals may specialise only in short-term or outpatient therapy for low-risk patients...
movement. It was not until the end of the 19th century, around the time when Sigmund Freud
Sigmund Freud
Sigmund Freud , born Sigismund Schlomo Freud , was an Austrian neurologist who founded the discipline of psychoanalysis...
was first developing his "talking cure
Psychoanalysis
Psychoanalysis is a psychological theory developed in the late 19th and early 20th centuries by Austrian neurologist Sigmund Freud. Psychoanalysis has expanded, been criticized and developed in different directions, mostly by some of Freud's former students, such as Alfred Adler and Carl Gustav...
" in Vienna
Vienna
Vienna is the capital and largest city of the Republic of Austria and one of the nine states of Austria. Vienna is Austria's primary city, with a population of about 1.723 million , and is by far the largest city in Austria, as well as its cultural, economic, and political centre...
, that the first scientifically clinical application of psychology began.
Early clinical psychology
Lightner Witmer
Lightner Witmer Lightner Witmer is an American psychologist who is credited with the introduction of the term "Clinical Psychology." Witmer also founded the world's first "Psychological Clinic" in the United States at the University of Pennsylvania in 1896.Witmer contributed greatly to numerous...
(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. 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 US.
Even as clinical psychology was growing, working with issues of serious mental distress remained the domain of psychiatrist
Psychiatrist
A psychiatrist is a physician who specializes in the diagnosis and treatment of mental disorders. All psychiatrists are trained in diagnostic evaluation and in psychotherapy...
s and neurologist
Neurologist
A neurologist is a physician who specializes in neurology, and is trained to investigate, or diagnose and treat neurological disorders.Neurology is the medical specialty related to the human nervous system. The nervous system encompasses the brain, spinal cord, and peripheral nerves. A specialist...
s. 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
World War I
World War I , which was predominantly called the World War or the Great War from its occurrence until 1939, and the First World War or World War I thereafter, was a major war centred in Europe that began on 28 July 1914 and lasted until 11 November 1918...
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 AssociationAmerican Psychological Association
The American Psychological Association is the largest scientific and professional organization of psychologists in the United States. It is the world's largest association of psychologists with around 154,000 members including scientists, educators, clinicians, consultants and students. The APA...
(founded by G. Stanley Hall
G. Stanley Hall
Granville Stanley Hall was a pioneering American psychologist and educator. His interests focused on childhood development and evolutionary theory...
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. In 1945, the 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
World War II
World War II, or the Second World War , was a global conflict lasting from 1939 to 1945, involving most of the world's nations—including all of the great powers—eventually forming two opposing military alliances: the Allies and the Axis...
broke out, the military once again called upon clinical psychologists. As soldiers began to return from combat, psychologists started to notice symptoms of psychological trauma labeled "shell shock" (eventually to be termed posttraumatic stress disorder) that were best treated as soon as possible. Because physicians (including psychiatrists) were over-extended in treating bodily injuries, psychologists were called to help treat this condition. 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. After the war, the Veterans Administration
United States Department of Veterans Affairs
The United States Department of Veterans Affairs is a government-run military veteran benefit system with Cabinet-level status. It is the United States government’s second largest department, after the United States Department of Defense...
in the US 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 US went from having no formal university programs in clinical psychology in 1946 to over half of all Ph.D.s 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 scientist–practitioner model, known today as the Boulder Model, for Ph.D. programs in clinical psychology. Clinical psychology in Britain
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
developed much like in the U.S. after WWII, specifically within the context of the National Health Service
National Health Service
The National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...
with qualifications, standards, and salaries managed by the British Psychological Society
British Psychological Society
The British Psychological Society is a representative body for psychologists and psychology in the United Kingdom. The BPS is also a Registered Charity and, along with advantages, this also imposes certain constraints on what the society can and cannot do...
.
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 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 US 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 UniversityRutgers University
Rutgers, The State University of New Jersey , is the largest institution for higher education in New Jersey, United States. It was originally chartered as Queen's College in 1766. It is the eighth-oldest college in the United States and one of the nine Colonial colleges founded before the American...
. Today, about half of all American graduate students in clinical psychology are enrolled in Psy.D. 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 US grew from 20,000 to 63,000. Clinical psychologists continue to be experts in assessment and psychotherapy while expanding their focus to address issues of gerontology, sports, and the criminal justice system to name a few. One important field is health psychology, the fastest-growing employment setting for clinical psychologists in the past decade. Other major changes include the impact of managed careManaged care
...intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on...
on mental health care; an increasing realization of the importance of knowledge relating to multicultural and diverse populations; and emerging privileges to prescribe psychotropic medication.
In the UK psychology is now one of the most popular degree subjects, and over 15,000 people graduate in psychology each year, many with the hope of developing this into a career, although only around 600 places for doctoral training in clinical psychology means there is intense competition for these places. There is also fierce competition to get into US Ph.D. programs in clinical psychology, with an average acceptance rate of 8%.
Professional practice
Clinical psychologists can offer a range of professional services, including:- Administer and interpret psychological assessment and testing
- Conduct psychological research
- Consultation (especially with schools and businesses)
- Development of prevention and treatment programs
- Program administration
- Provide expert testimony (forensic psychology)
- Provide psychological treatment (psychotherapy)
- Teach
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:
- Child and adolescentChild psychopathologyChild psychopathology is the manifestation of psychological disorders in children and adolescents. Oppositional defiant disorder, attention-deficit hyperactivity disorder, and pervasive developmental disorder are examples of child psychopathology...
- FamilyFamily therapyFamily therapy, also referred to as couple and family therapy, family systems therapy, and family counseling, is a branch of psychotherapy that works with families and couples in intimate relationships to nurture change and development. It tends to view change in terms of the systems of...
and relationship counselingRelationship counselingRelationship counseling is the process of counseling the parties of a relationship in an effort to recognize and to better manage or reconcile troublesome differences and repeating patterns of distress... - ForensicForensic psychologyForensic psychology is the intersection between psychology and the criminal justice system. It involves understanding criminal law in the relevant jurisdictions in order to be able to interact appropriately with judges, attorneys and other legal professionals...
- HealthHealth psychologyHealth psychology is concerned with understanding how biological, psychological, environmental, and cultural factors are involved in physical health and illness. Health psychologists work alongside other medical professionals in clinical settings, work on behavior change in public health promotion,...
- Neuropsychological disordersClinical neuropsychologyClinical neuropsychology is a sub-field of psychology concerned with the cognitive function of individuals with neurological and psychiatric disorders. Neuropsychological assessment examines cognitive function in the broadest sense, including the behavioural, emotional, social and functional status...
- Organization and businessIndustrial and organizational psychologyIndustrial and organizational psychology is the scientific study of employees, workplaces, and organizations. Industrial and organizational psychologists contribute to an organization's success by improving the performance and well-being of its people...
- SchoolSchool psychologySchool psychology is a field that applies principles of clinical psychology and educational psychology to the diagnosis and treatment of children's and adolescents' behavioral and learning problems...
- Specific disordersMental illnessA mental disorder or mental illness is a psychological or behavioral pattern generally associated with subjective distress or disability that occurs in an individual, and which is not a part of normal development or culture. Such a disorder may consist of a combination of affective, behavioural,...
(e.g. traumaPsychological traumaPsychological trauma is a type of damage to the psyche that occurs as a result of a traumatic event...
, addictionSubstance dependenceThe section about substance dependence in the Diagnostic and Statistical Manual of Mental Disorders does not use the word addiction at all. It explains:...
, eatingEating disorderEating disorders refer to a group of conditions defined by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual's physical and mental health. Bulimia nervosa, anorexia nervosa, and binge eating disorder are the most common specific...
, sleepSleep disorderA sleep disorder, or somnipathy, is a medical disorder of the sleep patterns of a person or animal. Some sleep disorders are serious enough to interfere with normal physical, mental and emotional functioning...
, sexSexual dysfunctionSexual dysfunction or sexual malfunction refers to a difficulty experienced by an individual or a couple during any stage of a normal sexual activity, including desire, arousal or orgasm....
, clinical depressionClinical depressionMajor depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities...
, anxietyAnxietyAnxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
, or phobiaPhobiaA phobia is a type of anxiety disorder, usually defined as a persistent fear of an object or situation in which the sufferer commits to great lengths in avoiding, typically disproportional to the actual danger posed, often being recognized as irrational...
s) - SportSport psychologySport psychology is an interdisciplinary science that draws on knowledge from the fields of kinesiology and psychology. It involves the study of how psychological factors affect performance and how participation in sport and exercise affect psychological and physical factors...
Salary and employment of clinical psychologists
According to BlS.gov, approximately 34% of psychologists are self-employed, mostly in private practices. Median salary of US clinical psychologists was $64,140 in 2008 (bls.gov). The field is projected to grow at an average pace. Doctoral degree holders from a leading university in an applied specialty will face the best prospects. M.A. degree holders will face keen competition for jobs while there will be very limited positions for those with B.A. degrees in the field of psychology (see reference: http://www.bls.gov/oco/ocos056.htm#outlook). Average doctoral starting and post-doctoral salaries range from $25,000–90,000.Training and certification to practice
Clinical psychologists study a generalist program in psychology plus postgraduate training and/or clinical placement and supervision. The length of training differs across the world, ranging from four years plus post-Bachelors supervised practice to a doctorate of three to six years which combines clinical placement.
In the US, clinical psychology doctoral programs typically range from five to seven years post-college and require a one year full-time clinical internship and dissertation. There is currently an "internship crisis" in the field (see below). Graduates must also accrue 1–2 years of supervised training post-PhD before licensure in most states (3,000 hours) and need to pass the EPPP (plus, other state exams). About half of all clinical psychology graduate students are being trained in Ph.D. programs—a model that emphasizes research—with the other half in Psy.D. programs, which has more focus on practice (similar to professional degrees for medicine and law). Both models are accredited by the American Psychological Association 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 two to three years post-Bachelors. Mean debt related to doctoral education in clinical psychology currently exceeds $85,000 and continues to increase each year. Median debt related to the PsyD degree is currently at $120,000 and increases more each year.
In the UK, clinical psychologists undertake a Doctor of Clinical Psychology (D.Clin.Psych.), which is a practitioner doctorate
Doctorate
A doctorate is an academic degree or professional degree that in most countries refers to a class of degrees which qualify the holder to teach in a specific field, A doctorate is an academic degree or professional degree that in most countries refers to a class of degrees which qualify the holder...
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 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 as only about one-fifth of applicants are accepted each year. These clinical psychology doctoral degrees are accredited by the British Psychological Society
British Psychological Society
The British Psychological Society is a representative body for psychologists and psychology in the United Kingdom. The BPS is also a Registered Charity and, along with advantages, this also imposes certain constraints on what the society can and cannot do...
and the Health Professions Council
Health Professions Council
The Health Professions Council is a statutory regulator of 210,000 health professionals from 15 professions in the United Kingdom. It was set up in 2003 under the National Health Service Reform and Health Care Professions Act 2002, to replace the Council for Professions Supplementary to Medicine ....
(HPC). The HPC is the statutory regulator for practitioner psychologists in the UK. Those who successfully complete clinical psychology doctoral degrees are eligible to apply for registration with the HPC as a clinical psychologist.
The practice of clinical psychology requires a license in the United States, Canada, the United Kingdom, and many other countries. Although each of the US 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 or internship
- Passing a written examination and, in some states, an oral examination
All US state and Canadian 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 licenses can be obtained with a masters-level degree, such as Marriage and Family Therapist (MFT), Licensed Professional Counselor
Licensed Professional Counselor
Licensed professional counselor is a licensure for mental health professionals. The exact title varies by state, but the other most frequently used title is licensed mental health counselor . Several U.S. states, including Illinois, Maine, and Tennessee, have implemented a two-tier system whereby...
(LPC), and Licensed Psychological Associate (LPA).
In the UK, registration as a clinical psychologist with the Health Professions Council (HPC) is necessary. The HPC is the statutory regulator for practitioner psychologists in the UK. In the UK the following titles are restricted by law: "registered psychologist" and "practitioner psychologist"; in addition, the specialist title "clinical psychologist" is also restricted by law.
Internship crisis in US clinical psychology programs
In the US, clinical psychology Ph.D. and Psy.D. programs typically require students to complete a one-year clinical internship in order to graduate (or a two-year part-time internship). However, there is currently an "internship crisis" as defined by the American Psychological Association, in that approximately 25% of clinical psychology doctoral students do not match for internship each year, and only 50% are matching to APA accredited internships. This crisis has led many students (approximately 1,000 each year) to re-apply for internship, thus delaying graduation, or to complete an unaccredited internship, and often has many emotional and financial consequences. Students who do not complete an APA accredited internship in the US are barred from certain employment settings, including VA Hospitals, the military, and cannot get licensed in some states. Additionally, the majority of post-doctoral fellowships and other employment settings require or prefer an APA Accredited internship. The median match rate for accredited internship sites is 5.5%. The median internship stipend was $23,000 in 2010.Assessment
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:
- Intelligence & achievement tests – These tests are designed to measure certain specific kinds of cognitive functioning (often referred to as IQIntelligence quotientAn intelligence quotient, or IQ, is a score derived from one of several different standardized tests designed to assess intelligence. When modern IQ tests are constructed, the mean score within an age group is set to 100 and the standard deviation to 15...
) in comparison to a norming-group. These tests, such as the WISC-IVWechsler Intelligence Scale for ChildrenThe Wechsler Intelligence Scale for Children , developed by Dr. David Wechsler, is an individually administered intelligence test for children between the ages of 6 and 16 inclusive that can be completed without reading or writing...
, attempt to measure such traits as general knowledge, verbal skill, memory, attention span, logical reasoning, and visual/spatial perception. Several tests have been shown to predict accurately certain kinds of performance, especially scholastic. - Personality tests – Tests of personalityPersonality test-Overview:There are many different types of personality tests. The most common type, the self-report inventory, involves the administration of many questions, or "items", to test-takers who respond by rating the degree to which each item reflects their behavior...
aim to describe patterns of behavior, thoughts, and feelings. They generally fall within two categories: objectiveObjective testAn objective test is a psychological test that measures an individual's characteristics in a way that is independent of rater bias or the examiner's own beliefs, usually by the administration of a bank of questions that are marked and compared against exacting scoring mechanisms that are completely...
and projectiveProjective testIn psychology, a projective test is a personality test designed to let a person respond to ambiguous stimuli, presumably revealing hidden emotions and internal conflicts. This is different from an "objective test" in which responses are analyzed according to a universal standard...
. Objective measures, such as the MMPIMinnesota Multiphasic Personality InventoryThe Minnesota Multiphasic Personality Inventory is one of the most frequently used personality tests in mental health. The test is used by trained professionals to assist in identifying personality structure and psychopathology....
, are based on restricted answers—such as yes/no, true/false, or a rating scale—which allow for computation of scores that can be compared to a normative group. Projective tests, such as the Rorschach inkblot testRorschach inkblot testThe Rorschach test is a psychological test in which subjects' perceptions of inkblots are recorded and then analyzed using psychological interpretation, complex algorithms, or both. Some psychologists use this test to examine a person's personality characteristics and emotional functioning...
, allow for open-ended answers, often based on ambiguous stimuli, presumably revealing non-conscious psychological dynamics. - Neuropsychological tests – Neuropsychological tests consist of specifically designed tasks used to measure psychological functions known to be linked to a particular brainBrainThe brain is the center of the nervous system in all vertebrate and most invertebrate animals—only a few primitive invertebrates such as sponges, jellyfish, sea squirts and starfishes do not have one. It is located in the head, usually close to primary sensory apparatus such as vision, hearing,...
structure or pathway. They are typically used to assess impairment after an injury or illness known to affect neurocognitiveNeurocognitiveNeurocognitive is a term used to describe cognitive functions closely linked to the function of particular areas, neural pathways, or cortical networks in the brain substrate layers of neurological matrix at the cellular molecular level...
functioning, or when used in research, to contrast neuropsychological abilities across experimental groups. - Clinical observation – Clinical psychologists are also trained to gather data by observing behavior. The clinical interview is a vital part of assessment, even when using other formalized tools, which can employ either a structured or unstructured format. Such assessment looks at certain areas, such as general appearance and behavior, mood and affect, perception, comprehension, orientation, insight, memory, and content of communication. One psychiatric example of a formal interview is the mental status examinationMental status examinationThe mental status examination in the USA or mental state examination in the rest of the world, abbreviated MSE, is an important part of the clinical assessment process in psychiatric practice...
, which is often used in psychiatry as a screening tool for treatment or further testing.
Diagnostic impressions
After assessment, clinical psychologists often provide a diagnosticMedical diagnosis
Medical diagnosis refers both to the process of attempting to determine or identify a possible disease or disorder , and to the opinion reached by this process...
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 (the DSM version IV-TR). Both assume 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
Big Five personality traits
In contemporary psychology, the "Big Five" factors of personality are five broad domains or dimensions of personality which are used to describe human personality....
of personality) and a "psychosocial model," which would take changing, intersubjective states into greater account. 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 do not tend to diagnose, but rather use formulation
Clinical formulation
A clinical formulation is a theoretically-based explanation or conceptualisation of the information obtained from a clinical assessment. It offers a hypothesis about the cause and nature of the presenting problems and is considered an alternative approach to the more categorical approach of...
—an individualized map of the difficulties that the patient or client faces, encompassing predisposing, precipitating and perpetuating (maintaining) factors.
Clinical theories and interventions
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
Free association
Free association may refer to:*Free association , a clinical technique of psychoanalysis devised by Sigmund Freud*Free Association, a musical group formed by David Holmes for the Code 46 soundtrack...
, while a psychologist trained in Gestalt
Gestalt psychology
Gestalt psychology or gestaltism is a theory of mind and brain of the Berlin School; the operational principle of gestalt psychology is that the brain is holistic, parallel, and analog, with self-organizing tendencies...
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.
- Insight – emphasis is on gaining greater understanding of the motivations underlying one's thoughts and feelings (e.g. psychodynamic therapy)
- Action – focus is on making changes in how one thinks and acts (e.g. solution-focused therapyBrief therapyBrief psychotherapy or Brief therapy is an umbrella term for a variety of approaches to psychotherapy. It differs from other schools of therapy in that it emphasises a focus on a specific problem and direct intervention...
, cognitive behavioral therapy) - In-session – interventions center on the here-and-now interaction between client and therapist (e.g. humanistic therapy, Gestalt therapy)
- Out-session – a large portion of therapeutic work is intended to happen outside of session (e.g. bibliotherapy, rational emotive behavior therapy)
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 schools
The field is dominated in terms of training and practice by essentially four major schools of practice: psychodynamic, humanistic, behavioral/cognitive behavioral, and systems or family therapy.Psychodynamic
The psychodynamic perspective developed out of the psychoanalysisPsychoanalysis
Psychoanalysis is a psychological theory developed in the late 19th and early 20th centuries by Austrian neurologist Sigmund Freud. Psychoanalysis has expanded, been criticized and developed in different directions, mostly by some of Freud's former students, such as Alfred Adler and Carl Gustav...
of Sigmund Freud
Sigmund Freud
Sigmund Freud , born Sigismund Schlomo Freud , was an Austrian neurologist who founded the discipline of psychoanalysis...
. The core object of psychoanalysis is to make the unconscious conscious—to make the client aware of his or her own primal drives (namely those relating to sex and aggression) and the various defenses used to keep them in check. The essential tools of the psychoanalytic process are the use of free association
Free association (psychology)
Free association is a technique used in psychoanalysis which was originally devised by Sigmund Freud out of the hypnotic method of his mentor and coworker, Josef Breuer....
and an examination of the client's transference
Transference
Transference is a phenomenon in psychoanalysis characterized by unconscious redirection of feelings from one person to another. One definition of transference is "the inappropriate repetition in the present of a relationship that was important in a person's childhood." Another definition is "the...
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
Self psychology
Self Psychology is a school of psychoanalytic theory and therapy created by Heinz Kohut and developed in the United States at the Chicago Institute for Psychoanalysis. Self psychology explains psychopathology as being the result of disrupted or unmet developmental needs...
, ego psychology
Ego psychology
Ego psychology is a school of psychoanalysis rooted in Sigmund Freud's structural id-ego-superego model of the mind.An individual interacts with the external world as well as responds to internal forces. Many psychoanalysts use a theoretical construct called the ego to explain how that is done...
, and object relations theory
Object relations theory
Object relations theory is a psychodynamic theory within psychoanalytic psychology. The theory describes the process of developing a mind as one grows in relation to others in the environment....
. 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
Humanistic psychology was developed in the 1950s in reaction to both behaviorism and psychoanalysis, largely due to the person-centered therapy of Carl RogersCarl Rogers
Carl Ransom Rogers was an influential American psychologist and among the founders of the humanistic approach to psychology...
(often referred to as Rogerian Therapy) and existential psychology developed by Victor Frankl and Rollo May
Rollo May
Rollo May was an American existential psychologist. He authored the influential book Love and Will during 1969. He is often associated with both humanistic psychology and existentialist philosophy. May was a close friend of the theologian Paul Tillich...
. Rogers believed that a client needed only three things from a clinician to experience therapeutic improvement: congruence, unconditional positive regard, and empathetic understanding. By using phenomenology
Phenomenology (psychology)
Phenomenology is an approach to psychological subject matter that has its roots in the philosophical work of Edmund Husserl. Early phenomenologists such as Husserl, Jean-Paul Sartre, and Maurice Merleau-Ponty conducted their own psychological investigations in the early 20th century...
, intersubjectivity
Intersubjectivity
Intersubjectivity is a term used in philosophy, psychology, sociology and anthropology to describe a condition somewhere between subjectivity and objectivity, one in which a phenomenon is personally experienced but by more than one subject....
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.
Behavioral and cognitive behavioral
Cognitive behavioral therapy (CBT) developed from the combination of cognitive therapyCognitive therapy
Cognitive behavioral therapy is a psychotherapeutic approach: a talking therapy. CBT aims to solve problems concerning dysfunctional emotions, behaviors and cognitions through a goal-oriented, systematic procedure in the present...
and rational emotive behavior therapy
Rational emotive behavior therapy
Rational emotive behavior therapy , previously called rational therapy and rational emotive therapy, is a comprehensive, active-directive, philosophically and empirically based psychotherapy which focuses on resolving emotional and behavioral problems and disturbances and enabling people to lead...
, both of which grew out of cognitive psychology
Cognitive psychology
Cognitive psychology is a subdiscipline of psychology exploring internal mental processes.It is the study of how people perceive, remember, think, speak, and solve problems.Cognitive psychology differs from previous psychological approaches in two key ways....
and behaviorism
Behaviorism
Behaviorism , also called the learning perspective , is a philosophy of psychology based on the proposition that all things that organisms do—including acting, thinking, and feeling—can and should be regarded as behaviors, and that psychological disorders are best treated by altering behavior...
. CBT is based on the theory that how we think (cognition), how we feel (emotion), and how we act (behavior) are related and interact together in complex ways. In this perspective, certain dysfunctional ways of interpreting and appraising the world (often through schemas or beliefs) can contribute to emotional distress or result in behavioral problems. The object of many cognitive behavioral therapies is to discover and identify the biased, dysfunctional ways of relating or reacting and through different methodologies help clients transcend these in ways that will lead to increased well-being. There are many techniques used, such as systematic desensitization
Systematic desensitization
Systematic desensitization is a type of behavioral therapy used in the field of psychology to help effectively overcome phobias and other anxiety disorders. More specifically, it is a type of Pavlovian therapy / classical conditioning therapy developed by a South African psychiatrist, Joseph Wolpe...
, socratic questioning
Socratic questioning
Socratic questioning is disciplined questioning that can be used to pursue thought in many directions and for many purposes, including: to explore complex ideas, to get to the truth of things, to open up issues and problems, to uncover assumptions, to analyze concepts, to distinguish what we know...
, and keeping a cognition observation log. Modified approaches that fall into the category of CBT have also developed, including dialectical behavior therapy and mindfulness-based cognitive therapy
Mindfulness-based Cognitive Therapy
Mindfulness-based cognitive therapy is psychological therapy which blends features of cognitive therapy with mindfulness techniques of Buddhism. MBCT involves accepting thoughts and feelings without judgement rather than trying to push them out of consciousness, with a goal of correcting...
.
Behavior therapy is a rich tradition. It is well-researched with a strong evidence base. Its roots are in behaviorism. In behavior therapy, environmental events predict the way we think and feel. Our behavior sets up conditions for the environment to feed back on it. Sometimes the feedback leads the behavior to increase (reinforcement), and sometimes the behavior descreases (punishment). Oftentimes behavior therapists are called applied behavior analysts. They have studied many areas from developmental disabilities to depression and anxiety disorders. In the area of mental health and addictions a recent article looked at APA's list for well-established and promising practices and found a considerable number of them based on the principles of operant and respondent conditioning. Multiple assessment techniques have come from this approach including functional analysis (psychology)
Functional analysis (psychology)
Functional analysis in behavioral psychology is the application of the laws of operant conditioning to establish the relationships between stimuli and responses...
, which has found a strong focus in the school system. In addition, multiple intervention programs have come from this tradition including community reinforcement and family training
Community reinforcement and family training
Community reinforcement approach and community reinforcement and family training approach are behavior therapy approaches to treating substance abuse.-Research:...
for treating addictions, acceptance and commitment therapy
Acceptance and Commitment Therapy
Acceptance and commitment therapy or ACT is a cognitive–behavioral model of psychotherapy. It is an empirically-based psychological intervention that uses acceptance and mindfulness strategies mixed in different ways with commitment and behavior-change strategies, to increase psychological...
, functional analytic psychotherapy
Functional Analytic Psychotherapy
Functional analytic psychotherapy is an approach to clinical psychotherapy that uses a radical behaviorist position informed by B.F. Skinner's analysis of verbal behavior....
, integrative behavioral couples therapy
Integrative behavioral couples therapy
Behavioral marital therapy, sometimes called Behavioral couple, or couples, therapy, has its origins in behaviorism and is a form of behavior therapy. The theory is rooted in social learning theory and behavior analysis. As a model, it is constantly being revised as new research...
including dialectical behavior therapy and behavioral activation
Behavioral activation
Behavioral activation is a third generation behavior therapy for treating depression. It is one of many functional analytic psychotherapies which are based on a Skinnerian psychological model of behavior change, generally referred to as applied behavior analysis...
. In addition, specific techniques such as contingency management
Contingency Management
Contingency management is a type of treatment used in the mental health or substance abuse fields. Patients are rewarded for their behavior; generally, adherence to or failure to adhere to program rules and regulations or their treatment plan...
and exposure therapy
Exposure therapy
Exposure therapy is a technique in behavior therapy intended to treat anxiety disorders and involves the exposure to the feared object or context without any danger in order to overcome their anxiety. Procedurally it is similar to the fear extinction paradigm in rodent work...
have come from this tradition.
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. Contributors include John GottmanJohn Gottman
John Mordecai Gottman is a Ph.D. psychologist known for his work on marital stability and relationship analysis through scientific direct observations published in peer-reviewed literature...
, Jay Haley
Jay Haley
Jay Douglas Haley was one of the founding figures of brief and family therapy in general and of the strategic model of psychotherapy, and he was one of the more accomplished teachers, clinical supervisors, and authors in these disciplines.-Life and works:Conceived in a log cabin on his family's...
, Sue Johnson
Sue Johnson
Sue Johnson is one of the creators of Emotionally Focused Therapy or EFT. She is a Professor of Clinical Psychology at the University of Ottawa and Director of the Centre for Emotionally Focused Therapy. She is also the director of the Ottawa Couple and Family Institute.-Works:*Johnson, S.M. . ...
, and Virginia Satir
Virginia Satir
Virginia Satir was an American author and psychotherapist, known especially for her approach to family therapy and her work with Systemic Constellations...
.
Other major therapeutic orientations
There exist dozens of recognized schools or orientations of psychotherapy—the list below represents a few influential orientations not given above. 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.- Existential – Existential psychotherapy postulates that people are largely free to choose who we are 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 MayRollo MayRollo May was an American existential psychologist. He authored the influential book Love and Will during 1969. He is often associated with both humanistic psychology and existentialist philosophy. May was a close friend of the theologian Paul Tillich...
, Victor Frankl, James BugentalJames BugentalJames Frederick Taylor Bugental was one of the predominant theorists and advocates of the Existential-Humanistic Therapy movement. He was a therapist, teacher and writer for over 50 years. He received his Ph.D...
, and Irvin Yalom.
One influential therapy that came out of existential therapy is Gestalt therapy
Gestalt therapy
Gestalt therapy is an existential/experiential form of psychotherapy that emphasizes personal responsibility, and that focuses upon the individual's experience in the present moment, the therapist-client relationship, the environmental and social contexts of a person's life, and the self-regulating...
, primarily founded by Fritz Perls
Fritz Perls
Friedrich Salomon Perls , better known as Fritz Perls, was a noted German-born psychiatrist and psychotherapist of Jewish descent....
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 therapyNarrative therapyNarrative Therapy is a form of psychotherapy using narrative. It was initially developed during the 1970s and 1980s, largely by Australian Michael White and his friend and colleague, David Epston, of New Zealand....
, solution-focused therapy, and coherence therapyCoherence therapyCoherence therapy is a system of psychotherapy based in the theory that symptoms of mood, thought and behavior are produced coherently according to the person's current models of reality, most of which are implicit and unconscious. It was founded by Bruce Ecker and Laurel Hulley in the 1990s...
.
- Transpersonal – The transpersonal perspectiveTranspersonal psychologyTranspersonal psychology is a form of psychology that studies the transpersonal, self-transcendent or spiritual aspects of the human experience....
places a stronger focus on the spiritualSpiritualitySpirituality can refer to an ultimate or an alleged immaterial reality; an inner path enabling a person to discover the essence of his/her being; or the “deepest values and meanings by which people live.” Spiritual practices, including meditation, prayer and contemplation, are intended to develop...
facet of human experience. It is not a set of techniques so much as a willingness to help a client explore spirituality and/or transcendentTranscendence (religion)In religion transcendence refers to the aspect of God's nature which is wholly independent of the physical universe. This is contrasted with immanence where God is fully present in the physical world and thus accessible to creatures in various ways...
states of consciousness. It also is concerned with helping clients achieve their highest potential. Important writers in this area include Ken WilberKen WilberKenneth Earl Wilber II is an American author who has written about mysticism, philosophy, ecology, and developmental psychology. His work formulates what he calls Integral Theory. In 1998, he founded the Integral Institute, for teaching and applications of Integral theory.-Biography:Ken Wilber was...
, Abraham MaslowAbraham MaslowAbraham Harold Maslow was an American professor of psychology at Brandeis University, Brooklyn College, New School for Social Research and Columbia University who created Maslow's hierarchy of needs...
, Stanislav GrofStanislav GrofStanislav Grof is a psychiatrist, one of the founders of the field of transpersonal psychology and a pioneering researcher into the use of non-ordinary states of consciousness for purposes of analyzing, healing, and obtaining growth and insight into the human psyche...
, John WelwoodJohn WelwoodJohn Welwood is an American psychotherapist, teacher, and author, known for integrating psychological and spiritual concepts.-Bibliography:* The Meeting of the Ways: Explorations in East/West Psychology ISBN 0805206191...
, David BrazierDavid BrazierDavid Brazier is a British author and psychotherapist known for his writings on Zen Buddhism and psychotherapy. He is the leader of the Amida Order-Bibliography:* Beyond Carl Rogers: Towards a Psychotherapy for the 21st Century. ISBN 0094726108...
and Roberto AssagioliRoberto AssagioliRoberto Assagioli was an Italian psychiatrist and pioneer in the fields of humanistic and transpersonal psychology. Assagioli founded the psychological movement known as psychosynthesis, which is still being developed today by therapists, and psychologists, who practice his technique...
.
Other perspectives
- Multiculturalism – Although the theoretical foundations of psychology are rooted in European culture, there is 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 acculturationAcculturationAcculturation explains the process of cultural and psychological change that results following meeting between cultures. The effects of acculturation can be seen at multiple levels in both interacting cultures. At the group level, acculturation often results in changes to culture, customs, and...
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 mainstream psychotherapeutic theory and practice. As such, there is a growing movement to integrate knowledge of various cultural groups in order to inform therapeutic practice in a more culturally sensitive and effective way.
- Feminism – Feminist therapyFeminist therapyFeminist therapy is a set of related therapies arising from what proponents see as a disparity between the origin of most psychological theories and the majority of people seeking counseling being female. It focuses on societal, cultural, and political causes and solutions to issues faced in the...
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 psychologyPositive psychologyPositive psychology is a recent branch of psychology whose purpose was summed up in 1998 by Martin Seligman and Mihaly Csikszentmihalyi: "We believe that a psychology of positive human functioning will arise, which achieves a scientific understanding and effective interventions to build thriving in...
is the scientific study of human happiness and well-being, which started to gain momentum in 1998 due to the call of Martin SeligmanMartin SeligmanMartin E. P. "Marty" Seligman is an American psychologist, educator, and author of self-help books. His theory of "learned helplessness" is widely respected among scientific psychologists....
, then president of the APA. The history of psychologyHistory of psychologyThe history of psychology as a scholarly study of the mind and behavior dates back to the Ancient Greeks. There is also evidence of psychological thought in ancient Egypt. Psychology was a branch of philosophy until the 1870s, when psychology developed as an independent scientific discipline in...
shows that the field has been primarily dedicated to addressing mental illnessMental illnessA mental disorder or mental illness is a psychological or behavioral pattern generally associated with subjective distress or disability that occurs in an individual, and which is not a part of normal development or culture. Such a disorder may consist of a combination of affective, behavioural,...
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 neuroscienceNeuroscience
Neuroscience is the scientific study of the nervous system. Traditionally, neuroscience has been seen as a branch of biology. However, it is currently an interdisciplinary science that collaborates with other fields such as chemistry, computer science, engineering, linguistics, mathematics,...
, genetics
Genetics
Genetics , a discipline of biology, is the science of genes, heredity, and variation in living organisms....
, evolutionary biology, and psychopharmacology
Psychopharmacology
Psychopharmacology is the scientific study of the actions of drugs and their effects on mood, sensation, thinking, and behavior...
. 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 US, 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. 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.
Psychiatry
Medical model
Medical model is the term cited by psychiatrist Ronald D. Laing in his The Politics of the Family and Other Essays , for the "set of procedures in which all doctors are trained." This set includes complaint, history, physical examination, ancillary tests if needed, diagnosis, treatment, and...
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. Psychiatrists and medical psychologists (who are clinical psychologists that are also licensed to prescribe) are able to conduct physical examinations, order and interpret laboratory tests and EEG
EEG
EEG commonly refers to electroencephalography, a measurement of the electrical activity of the brain.EEG may also refer to:* Emperor Entertainment Group, a Hong Kong-based entertainment company...
s, and may order brain imaging studies such as CT or CAT, MRI
Magnetic resonance imaging
Magnetic resonance imaging , nuclear magnetic resonance imaging , or magnetic resonance tomography is a medical imaging technique used in radiology to visualize detailed internal structures...
, and PET
Positron emission tomography
Positron emission tomography is nuclear medicine imaging technique that produces a three-dimensional image or picture of functional processes in the body. The system detects pairs of gamma rays emitted indirectly by a positron-emitting radionuclide , which is introduced into the body on a...
scanning.
Clinical psychologists generally do not prescribe
Medical prescription
A prescription is a health-care program implemented by a physician or other medical practitioner in the form of instructions that govern the plan of care for an individual patient. Prescriptions may include orders to be performed by a patient, caretaker, nurse, pharmacist or other therapist....
medication, although there is a growing movement for psychologists to have prescribing privileges
Prescriptive authority for psychologists movement
The Prescriptive authority for psychologists movement is a public health initiative to give prescriptive authority to psychologists with 2 years of postdoctoral Masters degreed training in clinical psychopharmacology, followed by 1 - 2 years of supervised prescribing, or a Certificate from the...
. These medical privileges require additional training and education. To date, medical psychologists may prescribe psychotropic medications in Guam
Guam
Guam is an organized, unincorporated territory of the United States located in the western Pacific Ocean. It is one of five U.S. territories with an established civilian government. Guam is listed as one of 16 Non-Self-Governing Territories by the Special Committee on Decolonization of the United...
, New Mexico
New Mexico
New Mexico is a state located in the southwest and western regions of the United States. New Mexico is also usually considered one of the Mountain States. With a population density of 16 per square mile, New Mexico is the sixth-most sparsely inhabited U.S...
, and Louisiana and 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 dementiaDementia
Dementia is a serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging...
or psychosis
Psychosis
Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...
.
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 counseling centers 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." Like clinical psychologists and counselling 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 the Educational Specialist DegreeEducational Specialist
The Education Specialist, also referred to as Educational Specialist, Specialist in Education, or Ed.S., is an advanced academic degree in the U.S...
(Ed.S.), Doctor of Philosophy
Doctor of Philosophy
Doctor of Philosophy, abbreviated as Ph.D., PhD, D.Phil., or DPhil , in English-speaking countries, is a postgraduate academic degree awarded by universities...
(Ph.D.), and Doctor of Education
Doctor of Education
The Doctor of Education or Doctor in Education degree , in Latin, Doctor Educationis, is a research-oriented professional doctorate that prepares the student for academic, administrative, clinical, or research positions in educational, civil, and private organizations.-Differences between an Ed.D...
(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 workSocial work
Social Work is a professional and academic discipline that seeks to improve the quality of life and wellbeing of an individual, group, or community by intervening through research, policy, community organizing, direct practice, and teaching on behalf of those afflicted with poverty or any real or...
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 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 at least a one-year practicum (two years for clinicians).
Occupational therapy
Occupational therapyOccupational therapy
Occupational therapy is a discipline that aims to promote health by enabling people to perform meaningful and purposeful activities. Occupational therapists work with individuals who suffer from a mentally, physically, developmentally, and/or emotionally disabling condition by utilizing treatments...
—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.
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. 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 treatment in use in clinical psychology.It has been reported that clinical psychology has rarely allied itself with client groups
Psychiatric survivors movement
The psychiatric survivors movement is a diverse association of individuals who are either currently clients of mental health services , or who consider themselves survivors of interventions by psychiatry, or who identify themselves as ex-patients of mental health services...
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. It has been argued that therapeutic practices are inevitably bound up with power inequalities, which can be used for good and bad. A critical psychology
Critical psychology
Critical psychology is an approach to psychology that takes a critical theory–based perspective. Critical psychology is aimed at critiquing mainstream psychology and attempts to apply psychology in more progressive ways, often looking towards social change as a means of preventing and treating...
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.
An October 2009 editorial in the journal Nature suggests that a large number of clinical psychology practitioners in the United States consider scientific evidence to be "less important than their personal—that is, subjective—clinical experience."
Clinical psychology journals
- American Journal of PsychotherapyAmerican Journal of PsychotherapyThe American Journal of Psychotherapy is the official scientific journal of the Association for the Advancement of Psychotherapy. It began publishing in 1947. It is published 4 times a year. Since 2001, it incorporates the Journal of Psychotherapy Practice and Research. The editor in chief is T....
- Annual Review of Clinical Psychology http://arjournals.annualreviews.org/loi/clinpsy
- Annual Review of Psychology http://arjournals.annualreviews.org/loi/psych
- British Journal of Psychotherapy
- British Journal of Clinical PsychologyBritish Journal of Clinical Psychology'The British Journal of Clinical Psychology is a medical journal published by Wiley-Blackwell on behalf of the The British Psychological Society covering topics in 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 PsychologyJournal of Abnormal PsychologyThe Journal of Abnormal Psychology is a scientific journal published by the American Psychological Association.It was previously titled Journal of Abnormal & Social Psychology. It publishes basic research as well as theoretical articles in the general field of abnormal behavior, its determinants,...
- Journal of Affective Disorders
- Journal of Anxiety Disorders
- Journal of Child Psychotherapy
- Journal of Clinical Child Psychology
- Journal of Clinical Psychiatry
- Journal of Clinical PsychologyJournal of Clinical PsychologyThe Journal of Clinical Psychology is a peer-reviewed medical journal published eight times a year covering psychological research, assessment, and practice. It was established in 1945...
- Journal of Clinical Psychology in Medical Settings
- Journal of Clinical PsychopharmacologyJournal of Clinical PsychopharmacologyThe Journal of Clinical Psychopharmacology is a peer-reviewed medical journal published by Lippincott Williams & Wilkins covering psychopharmacology.- Abstracting and indexing :...
- Journal of Consulting and Clinical PsychologyJournal of Consulting and Clinical PsychologyThe Journal of Consulting and Clinical Psychology is a bimonthly psychology journal of the American Psychological Association. Its focus is on treatment and prevention in all areas of clinical and clinical-health psychology and especially on topics that appeal to a broad clinical-scientist and...
- 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
- PsychopathologyPsychopathology (journal)Psychopathology is an academic journal that specialises in the understanding and classification of mental illness in clinical psychiatry, the field of psychopathology. Originally founded in 1897 and named Psychiatria Clinica, the journal changed its name to Psychopathology in 1984...
- Psychotherapy & Psychosomatics
- Psychotherapy ResearchPsychotherapy ResearchPsychotherapy Research is a bimonthly peer-reviewed academic journal covering research in all fields of psychotherapy: outcome, process, education and training of therapists, as well as investigations of services. It is published by Routledge on behalf of the Society for Psychotherapy Research. The...
See also: a list of empirical journals published by the APA
Major influences
- Aaron Beck
- Abraham MaslowAbraham MaslowAbraham Harold Maslow was an American professor of psychology at Brandeis University, Brooklyn College, New School for Social Research and Columbia University who created Maslow's hierarchy of needs...
- Albert BanduraAlbert BanduraAlbert Bandura is a psychologist and the David Starr Jordan Professor Emeritus of Social Science in Psychology at Stanford University...
- Albert Ellis
- Alfred AdlerAlfred AdlerAlfred Adler was an Austrian medical doctor, psychotherapist, and founder of the school of individual psychology. In collaboration with Sigmund Freud and a small group of Freud's colleagues, Adler was among the co-founders of the psychoanalytic movement as a core member of the Vienna...
- Anna FreudAnna FreudAnna Freud was the sixth and last child of Sigmund and Martha Freud. Born in Vienna, she followed the path of her father and contributed to the newly born field of psychoanalysis...
- Carl Gustav Jung
- Carl RogersCarl RogersCarl Ransom Rogers was an influential American psychologist and among the founders of the humanistic approach to psychology...
- David ShakowDavid ShakowDavid Shakow was an accomplished American psychologist. He is perhaps best known for his development of the Scientist-Practitioner Model of graduate training for clinical psychologists, adopted by the American Psychological Association in 1949.He also did pioneering research in schizophrenia,...
- Donald Woods Winnicott
- Erich FrommErich FrommErich Seligmann Fromm was a Jewish German-American social psychologist, psychoanalyst, sociologist, humanistic philosopher, and democratic socialist. He was associated with what became known as the Frankfurt School of critical theory.-Life:Erich Fromm was born on March 23, 1900, at Frankfurt am...
- Erik H. Erikson
- Fritz PerlsFritz PerlsFriedrich Salomon Perls , better known as Fritz Perls, was a noted German-born psychiatrist and psychotherapist of Jewish descent....
- George KellyGeorge Kelly (psychologist)George Kelly or George Kelley was an American psychologist, therapist and educator. He was best known for developing Personal Construct Psychology.- Biography :...
- Gordon AllportGordon AllportGordon Willard Allport was an American psychologist. Allport was one of the first psychologists to focus on the study of the personality, and is often referred to as one of the founding figures of personality psychology...
- Hans EysenckHans EysenckHans Jürgen Eysenck was a German-British psychologist who spent most of his career in Britain, best remembered for his work on intelligence and personality, though he worked in a wide range of areas...
- Harry Stack SullivanHarry Stack SullivanHarry Stack Sullivan was a U.S. psychiatrist whose work in psychoanalysis was based on direct and verifiable observation .-Life and works:Sullivan was a child of Irish immigrants and allegedly grew up in an...
- Heinz KohutHeinz KohutHeinz Kohut was an Austrian-born American psychoanalyst best known for his development of Self psychology, an influential school of thought within psychodynamic/psychoanalytic theory which helped transform the modern practice of analytic and dynamic treatment approaches.-Early life:Kohut was born...
- Irvin Yalom
- James BugentalJames BugentalJames Frederick Taylor Bugental was one of the predominant theorists and advocates of the Existential-Humanistic Therapy movement. He was a therapist, teacher and writer for over 50 years. He received his Ph.D...
- John BowlbyJohn BowlbyEdward John Mostyn "John" Bowlby was a British psychologist, psychiatrist and psychoanalyst, notable for his interest in child development and for his pioneering work in attachment theory.- Family background :...
- John GottmanJohn GottmanJohn Mordecai Gottman is a Ph.D. psychologist known for his work on marital stability and relationship analysis through scientific direct observations published in peer-reviewed literature...
- Joseph WolpeJoseph WolpeJoseph Wolpe was born on April 20, 1915, in Johannesburg, South Africa, and died on December 4, 1997, from lung cancer. He is one of the most influential figures in behavior therapy....
- Karen HorneyKaren HorneyKaren Horney born Danielsen was a German-American psychoanalyst. Her theories questioned some traditional Freudian views, particularly his theory of sexuality, as well as the instinct orientation of psychoanalysis and its genetic psychology...
- Lightner WitmerLightner WitmerLightner Witmer Lightner Witmer is an American psychologist who is credited with the introduction of the term "Clinical Psychology." Witmer also founded the world's first "Psychological Clinic" in the United States at the University of Pennsylvania in 1896.Witmer contributed greatly to numerous...
- Milton H. EricksonMilton H. EricksonMilton Hyland Erickson, was an American psychiatrist specializing in medical hypnosis and family therapy...
- Otto F. KernbergOtto F. KernbergOtto Friedmann Kernberg is a psychoanalyst and professor of psychiatry at Weill Cornell Medical College. He is most widely known for his psychoanalytic theories on borderline personality organization and narcissistic pathology...
- Otto RankOtto RankOtto Rank was an Austrian psychoanalyst, writer, teacher and therapist. Born in Vienna as Otto Rosenfeld, he was one of Sigmund Freud's closest colleagues for 20 years, a prolific writer on psychoanalytic themes, an editor of the two most important analytic journals, managing director of Freud's...
- Rebecca Hill
- Robert YerkesRobert YerkesRobert Mearns Yerkes was an American psychologist, ethologist, and primatologist best known for his work in intelligence testing and in the field of comparative psychology....
- Rollo MayRollo MayRollo May was an American existential psychologist. He authored the influential book Love and Will during 1969. He is often associated with both humanistic psychology and existentialist philosophy. May was a close friend of the theologian Paul Tillich...
- Ronald David LaingRonald David LaingRonald David Laing was a Scottish psychiatrist who wrote extensively on mental illnessin particular, the experience of psychosis...
- Sigmund FreudSigmund FreudSigmund Freud , born Sigismund Schlomo Freud , was an Austrian neurologist who founded the discipline of psychoanalysis...
- Stanislav GrofStanislav GrofStanislav Grof is a psychiatrist, one of the founders of the field of transpersonal psychology and a pioneering researcher into the use of non-ordinary states of consciousness for purposes of analyzing, healing, and obtaining growth and insight into the human psyche...
- Marsha M. LinehanMarsha M. LinehanMarsha M. Linehan is an American psychologist and author. Linehan is a Professor of Psychology, Adjunct Professor of Psychiatry and BehavioralSciences at the University of Washington and Director of the Behavioral Research and TherapyClinics...
- Martin SeligmanMartin SeligmanMartin E. P. "Marty" Seligman is an American psychologist, educator, and author of self-help books. His theory of "learned helplessness" is widely respected among scientific psychologists....
- Mary AinsworthMary AinsworthMary Dinsmore Salter Ainsworth was a Canadian developmental psychologist known for her work in early emotional attachment with "The Strange Situation" as well as her work in the development of Attachment Theory.-Life:...
- Melanie KleinMelanie KleinMelanie Reizes Klein was an Austrian-born British psychoanalyst who devised novel therapeutic techniques for children that had an impact on child psychology and contemporary psychoanalysis...
- Morita ShomaMorita ShomaMorita Masatake , also read as Morita Shoma Morita Masatake (1874-1938), also read as Morita Shoma Morita Masatake (1874-1938), also read as Morita Shoma (1874 - 1938 (森田 正馬), was a contemporary of Sigmund Freud and the founder of Morita Therapy, a branch of clinical psychology strongly influenced...
- Viktor FranklViktor FranklViktor Emil Frankl M.D., Ph.D. was an Austrian neurologist and psychiatrist as well as a Holocaust survivor. Frankl was the founder of logotherapy, which is a form of Existential Analysis, the "Third Viennese School of Psychotherapy"...
- Wilhelm ReichWilhelm ReichWilhelm Reich was an Austrian-American psychiatrist and psychoanalyst, known as one of the most radical figures in the history of psychiatry...
See also
- Anti-psychiatryAnti-psychiatryAnti-psychiatry is a configuration of groups and theoretical constructs that emerged in the 1960s, and questioned the fundamental assumptions and practices of psychiatry, such as its claim that it achieves universal, scientific objectivity. Its igniting influences were Michel Foucault, R.D. Laing,...
- Applied psychologyApplied psychologyThe basic premise of applied psychology is the use of psychological principles and theories to overcome problems in other areas, such as mental health, business management, education, health, product design, ergonomics, and law...
- Clinical Associate (Psychology)Clinical Associate (Psychology)In the United Kingdom, a Clinical Associate is a shortened designation for a Clinical Associate in Applied Psychology . A Clinical Associate is a specialist regulated mental health professional with expertise in the delivery of Psychological interventions to adults, children and adolescents...
- Clinical neuropsychologyClinical neuropsychologyClinical neuropsychology is a sub-field of psychology concerned with the cognitive function of individuals with neurological and psychiatric disorders. Neuropsychological assessment examines cognitive function in the broadest sense, including the behavioural, emotional, social and functional status...
- Clinical trialClinical trialClinical trials are a set of procedures in medical research and drug development that are conducted to allow safety and efficacy data to be collected for health interventions...
- List of Clinical Psychologists
- List of credentials in psychology
- List of psychology topics
- List of psychotherapies
- Psychiatric and mental health nursingPsychiatric and mental health nursingPsychiatric nursing or mental health nursing is the specialty of nursing that cares for people of all ages with mental illness or mental distress, such as schizophrenia, bipolar disorder, psychosis, depression or dementia...
- PsychoneuroimmunologyPsychoneuroimmunologyPsychoneuroimmunology is the study of the interaction between psychological processes and the nervous and immune systems of the human body...
External links
- American Academy of Clinical Psychology
- American Association for Marriage and Family Therapy
- American Board of Professional Psychology
- Annual Review of Clinical Psychology
- APA Society of Clinical Psychology (Division 12)
- Psychology Careers Blog Articles and other great content on Careers in Psychology
- Association of State and Provincial Psychology Boards (ASPPB)
- Info on the field of psychology form the U.S. Department of Labor, Bureau of Labor Statistics
- International Society of Clinical Psychology
- Journal of Clinical Psychiatry
- NAMI: National Alliance on Mental Illness
- National Institute of Mental Health
- Psychology definitions