Clinical psychology includes the scientific study and application of
psychologyPsychology is an academic and applied discipline involving the systematic, and sometimes scientific, study of human or animal mental functions and behavior...
for the purpose of understanding, preventing, and relieving psychologically-based distress or
dysfunctionA mental disorder or mental illness is a psychological or behavioral pattern that occurs in an individual and is thought to cause distress or disability that is not expected as part of normal development or culture. The recognition and understanding of mental disorders has changed over time and...
and to promote subjective
well-beingMental health is a term used to describe 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...
and personal development. Central to its practice are
psychological assessmentPsychological testing is a field characterized by the use of samples of behavior in order to infer generalizations about a given individual. The technical term for the science behind psychological testing is psychometrics...
and
psychotherapyPsychotherapy or personal counseling with a psychotherapist, is an intentional interpersonal relationship used by trained psychotherapists to aid a client or patient in problems of living.It aims to increase the individual's sense of their own well-being...
, 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 professionA mental health professional is a person who offers services for the purpose of improving an individual's mental health or to treat mental illness. This broad category includes psychiatrists, clinical psychologists, clinical social workers, psychiatric nurses, mental health counselors as well as...
.
The field is often considered to have begun in 1896 with the opening of the first psychological
clinicA clinic is a small private or public health facility that is devoted to the care of outpatients, often in a community, in contrast to larger hospitals, which also treat inpatients. Some grow to be institutions as large as major hospitals, whilst retaining the name clinic...
at the
University of PennsylvaniaThe University of Pennsylvania is a private research university located in Philadelphia, Pennsylvania, USA. Penn is the fourth-oldest institution of higher education in the United States, and is one of several institutions that claims to have been the first university in America...
by
Lightner WitmerLightner Witmer is regarded as the inventor of the term "Clinical Psychology" and the co-founder of the world's first Psychological Clinic in 1896 at the University of Pennsylvania.-Biography:Dr...
. 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. science-practitioner modelThe scientist–practitioner model, also called the Boulder model, is a training model for graduate programs that focuses on creating a foundation of research and scientific practice. It was developed primarily to train clinical psychologists but has been adapted by other specialty programs...
(focusing on research) and the
Psy.D. practitioner-scholar modelThe Doctor of Psychology degree is an American professional doctorate earned through one of two established training models for Clinical Psychology. In the United States, the other doctorate-level degree in Clinical Psychology is the Ph.D.. An individual who earns a Psy.D. or Ph.D...
(focusing on clinical practice). Clinical psychologists are now considered experts in providing psychotherapy, and generally train within four primary theoretical orientations—
PsychodynamicPsychodynamic 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, but psychodynamic therapy tends to be briefer and less...
,
HumanisticHumanistic psychology is a school of psychology that emerged in the 1950s in reaction to both behaviorism and psychoanalysis. It is explicitly concerned with the human dimension of psychology and the human context for the development of psychological theory....
, Cognitive Behavioral, and
Systems or Family therapyFamily therapy, also referred to as couple and family therapy and family systems therapy, 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 interaction between family...
.
Clinical psychology may be confused with
psychiatryPsychiatry is a medical specialty officially devoted to the treatment and study of mental disorders. The term was first coined by the German physician Johann Christian Reil in 1808....
, which generally has similar goals (e.g. the alleviation of mental distress), but is unique in that psychiatrists are physicians with medical degrees. As such, they tend to focus on
medicationA psychoactive drug, psychopharmaceutical or psychotropic substance is a chemical substance that acts primarily upon the central nervous system where it alters brain function, resulting in changes in perception, mood, consciousness and behavior...
-based solutions, although some also provide psychotherapeutic services as well. In practice, clinical psychologists often work in multidisciplinary teams with other professionals such as psychiatrists,
occupational therapistAn occupational therapist who is trained in the practice of occupational therapy. The role of an occupational therapist is to work with a client to help them achieve a fulfilled and satisfied state in life through the use of "purposeful activity or interventions designed to achieve functional...
s, and
social workSocial Work is both a profession and social science. It involves the application of social theory and research methods to study and improve the lives of people, groups, and societies...
ers to bring a multimodal approach to complex patient problems.
History
Although modern, scientific psychology is often dated at the 1879 opening of the first psychological laboratory by
Wilhelm WundtWilhelm Maximilian Wundt was a German medical doctor, 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
PatañjaliPatañjali is the compiler of the Yoga Sutras, an important collection of aphorisms on Yoga practice, and also the author of the Mahābhāṣya, a major commentary on Panini's Ashtadhyayi...
,
PadmasambhavaPadmasambhava , The Lotus Born, was an Indian sage Guru and is said to have transmitted Tantric Buddhism to Bhutan and Tibet in the 8th century. In those lands he is better known as Guru Rinpoche or Lopon Rinpoche, where followers of the Nyingma school regard him as the second Buddha...
, Rhazes,
Avicenna, known as Abū Alī Sīnā or Ibn Sīnā , and commonly known in English by his Latinized name Avicenna , was a Persian polymath and the foremost physician and philosopher of his time...
, and Rumi.
In the early 19th century, one could have his or her head examined, literally, using
phrenologyPhrenology is a hypothesis stating that the personality traits of a person can be derived from the shape of the skull. It is now considered a pseudoscience. Developed by German physician Franz Joseph Gall in 1796, the discipline was very popular in the 19th century...
, the study of personality by the shape of the skull. Other popular treatments included
physiognomyPhysiognomy 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
magnetA 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 and attracts or repels other magnets.A permanent magnet is an object made from a...
s.
SpiritualismSpiritualism is a monotheistic belief system or religion, postulating a belief in God, but the distinguishing feature is belief that spirits of the dead can be contacted, either by individuals or by gifted or trained "mediums", who can provide information about the afterlife.Spiritualism developed...
and
Phineas QuimbyPhineas Parkhurst Quimby , was a New England philosopher, magnetizer, mesmerist, healer, and inventor, who resided in Belfast, Maine, and had an office in Portland, Maine.-Inventor:...
'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
psychiatryPsychiatry is a medical specialty officially devoted to the treatment and study of mental disorders. The term was first coined by the German physician Johann Christian Reil in 1808....
and
neurologyNeurology 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
asylumA psychiatric hospital, sometimes known as an asylum, is a hospital specializing in the treatment of serious mental illness, usually for relatively long-term inpatients....
movement. It was not until the end of the 19th century, around the time when
Sigmund FreudSigmund Freud , Sigismund Schlomo Freud , was an Austrian neurologist who founded the psychoanalytic school of psychology...
was first developing his "
talking curePsychoanalysis is a body of ideas developed by Austrian physician Sigmund Freud and continued by others. It is primarily devoted to the study of human psychological functioning and behavior, although it also can be applied to societies.
...
" in
ViennaVienna is the capital of the Republic of Austria and also one of the nine states of Austria. Vienna is Austria's primary city, with a population of about 1.7 million , and is by far the largest city in Austria, as well as its cultural, economic, and political centre. It is the 10th largest city by...
, that the first scientifically clinical application of psychology began.
Early clinical psychology
By the second half of the 1800s, the scientific study of psychology was becoming well established in university laboratories. Although there were a few scattered voices calling for an applied psychology, the general field looked down upon this idea and insisted on "pure" science as the only respectable practice. This changed when
Lightner WitmerLightner Witmer is regarded as the inventor of the term "Clinical Psychology" and the co-founder of the world's first Psychological Clinic in 1896 at the University of Pennsylvania.-Biography:Dr...
(1867–1956), a past student of Wundt and head of the psychology department at the
University of PennsylvaniaThe University of Pennsylvania is a private research university located in Philadelphia, Pennsylvania, USA. Penn is the fourth-oldest institution of higher education in the United States, and is one of several institutions that claims to have been the first university in America...
, 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 disabilitiesLearning disability , is a disorder in which a person has a difficulty to learn effectively, caused by an unknown factor or factors. The unknown factor is the disorder that affects the brain's ability to receive and process information...
. Ten years later in 1907, Witmer was to found the first journal of this new field,
The Psychological Clinic, where he coined the term "clinical psychology," defined as "the study of individuals, by observation or experimentation, with the intention of promoting change". The field was slow to follow Witmer's example, but by 1914 there were 26 similar clinics in the U.S.
Even as clinical psychology was growing, working with issues of serious mental distress remained the domain of
psychiatristsPsychiatry is a medical specialty officially devoted to the treatment and study of mental disorders. The term was first coined by the German physician Johann Christian Reil in 1808....
and
neurologistsNeurology 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,...
. 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 IWorld War I , also known as the First World War, the Great War, and the War to End All Wars, was a global military conflict which involved most of the world's great powers, assembled in two opposing alliances: the Triple Entente and the Triple Alliance...
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 AssociationThe American Psychological Association is a professional organization representing psychologists in the U.S., with around 150,000 members and an annual budget of around $70m...
(founded by
G. Stanley HallGranville 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 APA created what is now called Division 12, its division of clinical psychology, which remains a leading organization in the field. Psychological societies and associations in other English-speaking countries developed similar divisions, including in Britain, Canada, Australia and New Zealand.
World War II and the integration of treatment
When
World War IIWorld War II, or the Second World War , was a global military conflict which involved a majority of the world's nations, including all great powers, organized into 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 in the U.S. made an enormous investment to set up programs to train doctoral-level clinical psychologists to help treat the thousands of veterans needing care. As a consequence, the U.S. went from having no formal university programs in clinical psychology in 1946 to over half of all PhDs in psychology in 1950 being awarded in clinical psychology.
WWII helped bring dramatic changes to clinical psychology, not just in America but internationally as well. Graduate education in psychology began adding psychotherapy to the science and research focus based on the 1947
scientist-practitioner modelThe scientist–practitioner model, also called the Boulder model, is a training model for graduate programs that focuses on creating a foundation of research and scientific practice. It was developed primarily to train clinical psychologists but has been adapted by other specialty programs...
, known today as the
Boulder Model, for PhD programs in clinical psychology. Clinical psychology in
BritainThe United Kingdom of Great Britain and Northern Ireland is a sovereign state located off the northwestern coast of continental Europe. It is an island country, spanning an archipelago including Great Britain, the northeastern part of Ireland, and many small islands...
developed much like in the U.S. after WWII, specifically within the context of the
National Health ServiceThe National Health Service is the name commonly used to refer to the publicly-funded health care services in Great Britain. In England the name National Health Service is used without further qualification whereas the services in Scotland and Wales are known as NHS Scotland and NHS Wales...
with qualifications, standards, and salaries managed by the
British Psychological SocietyThe British Psychological Society is the representative body for psychologists and psychology in the United Kingdom. The BPS is a 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 PhD educational model did not offer the necessary training for those interested in practice rather than research. There was a growing argument that said the field of psychology in the U.S. had developed to a degree warranting explicit training in clinical practice. The concept of a practice-oriented degree was debated in 1965 and narrowly gained approval for a pilot program at the 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 ModelThe practitioner-scholar model, often called the Vail model, is a training model for graduate programs that is focused on clinical practice. It was developed primarily to train clinical psychologists but may be adapted by other specialty programs...
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, The State University of New Jersey , is the largest institution for higher education in the state of New Jersey. It was originally chartered as Queen's College in 1766 and is the eighth-oldest college in the United States...
. 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 U.S. 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 careThe term managed care is used to describe a variety of techniques intended to reduce the cost of providing health benefits and improve the quality of care for organizations that use those techniques or provide them as services to other organizations , or to describe systems of financing and...
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.
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 adolescent
Child 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...
- Family
Family therapy, also referred to as couple and family therapy and family systems therapy, 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 interaction between family...
and relationship 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...
- Forensic
Forensic 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...
- Health
Health psychology is concerned with understanding how biology, behavior, and social context influence health and illness. Health psychologists work alongside other medical professionals in clinical settings, work on behaviour change in public health promotion, teach at universities, and conduct...
- Neuropsychological disorders
Clinical neuropsychology is a sub-specialty of clinical psychology that specializes in the diagnostic assessment and treatment of patients with brain injury or neurocognitive deficits....
- Organization and business
Industrial and Organizational Psychology applies psychology to organizations and the workplace...
- School
Educational psychology is the study of how humans learn in educational settings, the effectiveness of educational interventions, the psychology of teaching, and the social psychology of schools as organizations. Educational psychology is concerned with how students learn and develop, often focusing...
- Specific disorders
A mental disorder or mental illness is a psychological or behavioral pattern that occurs in an individual and is thought to cause distress or disability that is not expected as part of normal development or culture. The recognition and understanding of mental disorders has changed over time and...
(e.g. traumaPsychological trauma is a type of damage to the psyche that occurs as a result of a traumatic event. When that trauma leads to posttraumatic stress disorder, damage may involve physical changes inside the brain and to brain chemistry, which damage the person's ability to adequately cope with...
, addictionThe term "addiction" is used in many contexts to describe an obsession, compulsion, or excessive psychological dependence, such as: drug addiction The term "addiction" is used in many contexts to describe an obsession, compulsion, or excessive psychological dependence, such as: drug addiction The...
, eatingAn eating disorder is a condition which affects an individuals eating habits, either as a result of their own doing , or as a bodily reaction to the consumption of food. Eating disorders can range from mild mental anguish to life-threatening conditions, and can affect every aspect of an...
, sleepA sleep disorder 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 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.-Categories:...
, clinical depressionMajor depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and loss of interest or pleasure in normally enjoyable activities...
, anxietyAnxiety is a psychological and physiological state characterized by cognitive, somatic, emotional, and behavioral components. These components combine to create an unpleasant feeling that is typically associated with uneasiness, fear, or worry....
, or phobiaA phobia , is an irrational, intense, persistent fear of certain situations, activities, things, or people. The main symptom of this disorder is the excessive, unreasonable desire to avoid the feared subject...
s)
- Sport
Sport psychology is the scientific study of people and their behaviors in sport contexts and the practical application of that knowledge. Sport psychologists identify principles and guidelines that professionals can use to help adults and children participate in and benefit from sport and exercise...
Training and certification to practice
Clinical psychologists undergo many hours of graduate training—usually four to six years post-Bachelors—in order to gain demonstrable competence and experience. About half of all clinical psychology graduate students are being trained in
Ph.D.The scientist–practitioner model, also called the Boulder model, is a training model for graduate programs that focuses on creating a foundation of research and scientific practice. It was developed primarily to train clinical psychologists but has been adapted by other specialty programs...
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 AssociationThe American Psychological Association is a professional organization representing psychologists in the U.S., with around 150,000 members and an annual budget of around $70m...
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.
In the U.K., clinical psychologists nearly always undertake a D.Clin.Psychol./Clin.Psy.D, which is a practitioner
doctorateA doctorate is an academic degree or professional degree that in most countries represents the highest level of formal study or research in a given field. In some countries it also refers to a class of degrees which qualify the holder to practice in a specific profession . The best-known example...
with both clinical and research components. This is a three-year full-time salaried program sponsored by the
National Health ServiceThe National Health Service is the name commonly used to refer to the publicly-funded health care services in Great Britain. In England the name National Health Service is used without further qualification whereas the services in Scotland and Wales are known as NHS Scotland and NHS Wales...
(N.H.S.) and based in universities and the N.H.S. Entry into these programs is highly competitive, and requires at least a three-year undergraduate degree in psychology approved by the
British Psychological SocietyThe British Psychological Society is the representative body for psychologists and psychology in the United Kingdom. The BPS is a charity and, along with advantages, this also imposes certain constraints on what the society can and cannot do...
or an approved conversion course, plus some form of experience, usually in either the NHS as an Assistant Psychologist or in academia as a Research Assistant. It is not unusual for applicants to apply several times before being accepted onto a training course as only about one-fifth of applicants are accepted each year.
The practice of clinical psychology requires a license in the United States, Canada, the United Kingdom, and many other countries. Although each of the U.S. states is somewhat different in terms of requirements and licenses, there are three common elements:
-
- Graduation from an accredited school with the appropriate degree
- Completion of supervised clinical experience or internship
- Passing a written examination and, in some states, an oral examination
All US states and Canada province licensing boards are members of the Association of State and Provincial Psychology Boards (ASPPB) which created and maintains the Examination for Professional Practice in Psychology (EPPP). Many states require other examinations in addition to the EPPP, such as a jurisprudence (i.e. mental health law) examination and/or an oral examination. Most states also require a certain number of continuing education credits per year in order to renew a license, which can be obtained though various means, such as taking audited classes and attending approved workshops. Clinical psychologists require the Psychologist license to practice, although licenses can be obtained with a masters-level degree, such as Marriage and Family Therapist (MFT),
Licensed Professional CounselorLicensed 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 is due to become statutory in summer 2009 and will be administered by the
HPCThe Health Professions Council is a UK health regulator. It was created by the Health Professions Order 2001 to protect the public by setting and maintaining standards for the professions it regulates...
. Previously there has been a voluntary scheme through which the
BPSThe British Psychological Society is the representative body for psychologists and psychology in the United Kingdom. The BPS is a charity and, along with advantages, this also imposes certain constraints on what the society can and cannot do...
award practicing certificates to qualified Clinical Psychologists who have completed sufficient continuing professional development activities and agree to abide by their professional Code of Conduct.
Assessment
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:
- Intelligence & achievement tests. These tests are designed to measure certain specific kinds of cognitive functioning (often referred to as IQ
An intelligence quotient, or IQ, is a score derived from one of several different standardized tests designed to assess intelligence. The term "IQ", from the German Intelligenz-Quotient, was coined by the German psychologist William Stern in 1912 as a proposed method of scoring early modern...
) in comparison to a norming-group. These tests, such as the WISC-IVThe Wechsler Intelligence Scale for Children , developed by David Wechsler, is an intelligence test for children between the ages of 6 and 16 inclusive that can be completed without reading or writing. The WISC generates an IQ score.-History:...
, 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 personality
A personality test aims to describe aspects of a person's character that remain stable throughout that person's lifetime, the individual's character pattern of behavior, thoughts, and feelings. An early model of personality was posited by Greek philosopher/physician Hippocrates...
aim to describe patterns of behavior, thoughts, and feelings. They generally fall within two categories: objectiveObjective tests are psychological tests that measure 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 projectiveA projective test, in psychology, 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 MMPIThe 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 testThe Rorschach test is a psychological test in which subjects' perceptions of inkblots are recorded and then analyzed using psychological interpretation, complex scientifically derived algorithms, or both...
, 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 brain
The brain is the center of the nervous system in all vertebrate, and most invertebrate, animals. Some primitive animals such as jellyfish and starfish have a decentralized nervous system without a brain, while sponges lack any nervous system at all...
structure or pathway. They are typically used to assess impairment after an injury or illness known to affect neurocognitiveNeurocognitive is a term used to describe cognitive functions closely linked to the function of particular areas, neural pathways, or cortical networks in the brain...
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 examination
The mental status examination 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
diagnosticIn medicine, diagnosis is a label given for a medical condition or disease identified by its signs, symptoms, and from the results of various diagnostic procedures...
impression. Many countries use the
International Statistical Classification of Diseases and Related Health Problems (ICD-10) while the U.S. most often uses the
Diagnostic and Statistical Manual of Mental DisordersThe Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides diagnostic criteria for 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 modelIn contemporary psychology, the "Big Five" factors of personality are five broad domains or dimensions of personality which have been scientifically discovered to define human personality at the highest level of organization...
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
formulationA 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 associationFree association may refer to:*Free association , a clinical technique of psychoanalysis devised by Sigmund Freud*Free Association, David Holmes group for the Code 46 soundtrack...
, while a psychologist trained in
GestaltGestalt psychology or gestaltism of the Berlin School is a theory of mind and brain positing that the operational principle of the brain is holistic, parallel, and analog, with self-organizing tendencies, or that the whole is different from the sum of its parts...
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 Therapy
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. In brief therapy, the therapist takes responsibility for working more pro-actively with the client...
, 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 perspectives
The field is dominated in terms of training and practice by essentially four major perspectives:
PsychodynamicPsychodynamic 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, but psychodynamic therapy tends to be briefer and less...
,
HumanisticHumanistic psychology is a school of psychology that emerged in the 1950s in reaction to both behaviorism and psychoanalysis. It is explicitly concerned with the human dimension of psychology and the human context for the development of psychological theory....
, Cognitive Behavioral, and
Systems or Family therapyFamily therapy, also referred to as couple and family therapy and family systems therapy, 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 interaction between family...
.
Psychodynamic
The Psychodynamic perspective developed out of the
psychoanalysisPsychoanalysis is a body of ideas developed by Austrian physician Sigmund Freud and continued by others. It is primarily devoted to the study of human psychological functioning and behavior, although it also can be applied to societies.
...
of
Sigmund FreudSigmund Freud , Sigismund Schlomo Freud , was an Austrian neurologist who founded the psychoanalytic school of psychology...
. 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 associationFree association is a technique used in psychoanalysis, first developed by Sigmund Freud.In free association, psychoanalytic patients are invited to relate whatever comes into their minds during the analytic session, and not to censor their thoughts...
and an examination of the client's
transferenceTransference is a phenomenon in psychoanalysis characterized by unconscious redirection of feelings for 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 PsychologySelf 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 PsychologyEgo 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 TheoryObject 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. The "objects" of the theory are both real others in one's world, and one's internalized images of others...
. 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 therapyPerson-centered therapy is also known as person-centered psychotherapy, client-centered therapy and Rogerian psychotherapy....
of
Carl RogersCarl 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 MayRollo May was an American existential psychologist. He authored the influential book Love and Will during 1969....
. 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
phenomenologyIn psychology, phenomenology is used to refer to subjective experiences or their study. The experiencing subject can be considered to be the person or self, for purposes of convenience. In phenomenological philosophy 'experience' is a considerably more complex concept than it is usually taken to...
, intersubjectivity and first-person categories, the humanistic approach seeks to get a glimpse of the whole person and not just the fragmented parts of the personality. This aspect of holism links up with another common aim of humanistic practice in clinical psychology, which is to seek an integration of the whole person, also called
self-actualization. According to humanistic thinking, each individual person already has inbuilt potentials and resources that might help them to build a stronger personality and self-concept. The mission of the humanistic psychologist is to help the individual employ these resources via the therapeutic relationship.
Cognitive Behavioral
Cognitive Behavioral Therapy (CBT) developed from the combination of
Cognitive TherapyCognitive behavioral therapy is a psychotherapeutic approach that aims to solve problems concerning dysfunctional emotions, behaviors and cognitions through a goal-oriented, systematic procedure...
and
Rational Emotive Behavior TherapyRational 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 psychologyCognitive psychology is a discipline within psychology that investigates the internal mental processes of thought such as visual processing, memory, problem solving, and language....
and
BehaviorismBehaviorism , also called the learning perspective , is a philosophy of psychology based on the proposition that all things which organisms do — including acting, thinking and feeling — can and should be regarded as behaviors...
. 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 desensitizationSystematic 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 questioningSocratic 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 Dialectic Behavior Therapy and
Mindfulness-based Cognitive TherapyMindfulness-based cognitive therapy is a method of psychotherapy which blends features of cognitive therapy with mindfulness techniques. MBCT involves accepting thoughts and feelings without judgement rather than trying to push them out of consciousness, with a goal of correcting cognitive...
.
Systems or Family Therapy
Systems or
Family therapyFamily therapy, also referred to as couple and family therapy and family systems therapy, 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 interaction between family...
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, Ph.D. is known for his work on marital stability and relationship analysis through scientific direct observations published in peer-reviewed literature...
,
Jay HaleyJay Douglas Haley was a psychotherapist. He was one of the founding figures of brief and family therapy and a teacher, supervisor, and author in these disciplines.-Life and works:...
,
Susan JohnsonSusan Johnson may refer to:*Susan Johnson , also known as Susan Johnson-Kehn *Susan Johnson , National Bishop of the Evangelical Lutheran Church in Canada...
, and
Virginia SatirVirginia Satir was a noted 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
Existential psychotherapy is partly based on the existential belief that human beings are alone in the world. This feeling of aloneness leads to feelings of meaninglessness which can be overcome only by creating one's own values and meanings...
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 May was an American existential psychologist. He authored the influential book Love and Will during 1969....
, Victor Frankl, James BugentalJames 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 TherapyGestalt therapy is an existential and experiential psychotherapy that focuses on the individual's experience in the present moment, the therapist-client relationship, the environmental and social contexts in which these things take place, and the self-regulating adjustments people make as a result...
, primarily founded by Fritz PerlsFriedrich 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 Therapy
Narrative 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 TherapySolution focused brief therapy , often referred to as simply 'solution focused therapy' or 'brief therapy', is a type of talking therapy that is based upon social constructionist philosophy. It focuses on what clients want to achieve through therapy rather than on the problem that made them to seek...
, and Coherence 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 perspective
Transpersonal psychology is a school of psychology that studies the transpersonal, self-transcendent or spiritual aspects of the human experience....
places a stronger focus on the spiritualSpirituality is relating to, consisting of, or having the nature of spirit; not tangible or material. Synonyms include immaterialism, dualism, incorporeality and eternity....
facet of human experience. It is not a set of techniques so much as a willingness to help a client explore spirituality and/or transcendentIn religion, transcendence is a condition or state of being that surpasses physical existence and in one form is also independent of it. It is affirmed in the concept of the divine in the major religious traditions, and contrasts with the notion of God, or the Absolute, existing exclusively in the...
states of consciousness. It also is concerned with helping clients achieve their highest potential. Important writers in this area include Ken WilberKenneth Earl Wilber II is an American philosopher who has written about adult development, developmental psychology, philosophy, worldcentrism , ecology, and Stages of Faith. His work formulates what he calls Integral Theory. In 1998, he founded the Integral Institute, for teaching and...
, Abraham MaslowAbraham Harold Maslow was an American psychologist. He is noted for his conceptualization of a "hierarchy of human needs", and is considered the founder of humanistic psychology.-Biography:...
, Stanislav GrofStanislav Grof is one of the founders of the field of transpersonal psychology and a pioneering researcher into the use of altered states of consciousness for purposes of analysing, healing, and obtaining growth and insight into the human psyche...
, John 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 Brazier is a British author and psychotherapist known for his writings on Zen Buddhism and psychotherapy. He is the leader of the Amida Trust.-Bibliography:* Beyond Carl Rogers: Towards a Psychotherapy for the 21st Century. ISBN 0094726108...
and Roberto AssagioliRoberto Assagioli was an Italian psychiatrist who was the founder of the psychological movement known as Psychosynthesis.An humanist, Assagioli differed from Freud...
.
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 acculturation
Acculturation is the exchange of cultural features that results when groups of individuals having different cultures come into continuous first hand contact; the original cultural patterns of either or both groups may be altered, but the groups remain distinct...
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 therapy
Feminist 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 psychology
Positive psychology is a recent branch of psychology that "studies the strengths and virtues that enable individuals and communities to thrive"...
is the scientific study of human happiness and well-being, which started to gain momentum in 1998 due to the call of Martin SeligmanMartin E. P. Seligman is an American psychologist and author of self-help books. A world-renowned authority on depression and abnormal psychology, he is known for his work on the theory of "learned helplessness", and according to The Daily Pennsylvanian is considered the father of positive...
, then president of the APA. The history 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 1879, when psychology developed as an independent scientific discipline in Germany...
shows that the field has been primarily dedicated to addressing mental illnessA mental disorder or mental illness is a psychological or behavioral pattern that occurs in an individual and is thought to cause distress or disability that is not expected as part of normal development or culture. The recognition and understanding of mental disorders has changed over time and...
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 is the scientific study of the nervous system. Such studies span the structure, function, evolutionary history, development, genetics, biochemistry, physiology, pharmacology, informatics, computational neuroscience and pathology of the nervous system.The International Brain Research...
,
geneticsGenetics, , a discipline of biology, is the science of heredity and variation in living organisms. The fact that living things inherit traits from their parents has been used since prehistoric times to improve crop plants and animals through selective breeding...
,
evolutionary biologyEvolutionary biology is a sub-field of biology concerned with the origin of species from a common descent and descent of species, as well as their change, multiplication and diversity over time. Someone who studies evolutionary biology is known as an evolutionary biologist...
, and
psychopharmacologyPsychopharmacology is the study of drug-induced changes in 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 U.S., professional ethics are largely defined by the APA
Code of Conduct, which is often used by states to define licensing requirements. The APA Code generally sets a higher standard than that which is required by law as it is designed to guide responsible behavior, the protection of clients, and the improvement of individuals, organizations, and society. 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
Although clinical psychologists and
psychiatristA psychiatrist is a physician who specializes in psychiatry and is certified in treating mental disorders. All psychiatrists are trained in diagnostic evaluation and in psychotherapy...
s can be said to share a same fundamental aim—the alleviation of mental distress—their training, outlook, and methodologies are often quite different. Perhaps the most significant difference is that psychiatrists are licenced physicians. As such, psychiatrists often use the
medical modelMedical 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 medicationsA psychoactive drug, psychopharmaceutical or psychotropic substance is a chemical substance that acts primarily upon the central nervous system where it alters brain function, resulting in changes in perception, mood, consciousness and behavior...
as the chief method of addressing the illness—although many also employ
psychotherapyPsychotherapy or personal counseling with a psychotherapist, is an intentional interpersonal relationship used by trained psychotherapists to aid a client or patient in problems of living.It aims to increase the individual's sense of their own well-being...
as well. Psychiatrists and
medical psychologistsMedical Psychology refers to an emerging specialty of clinical psychological practice in which psychologists, who have undergone additional specialized education and training, may prescribe medications in the care and management of patients. In the United States, New Mexico and Louisiana, and...
(who are clinical psychologists that are also trained to prescribe) are able to conduct physical examinations, order and interpret laboratory tests and
EEGEEG 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
CTComputed tomography is a medical imaging method employing tomography created by computer processing. Digital geometry processing is used to generate a three-dimensional image of the inside of an object from a large series of two-dimensional X-ray images taken around a single axis of rotation.CT...
or
CATComputed tomography is a medical imaging method employing tomography created by computer processing. Digital geometry processing is used to generate a three-dimensional image of the inside of an object from a large series of two-dimensional X-ray images taken around a single axis of rotation.CT...
,
MRIMagnetic Resonance Imaging , or nuclear magnetic resonance imaging , is primarily a medical imaging technique most commonly used in radiology to visualize the internal structure and function of the body...
, and
PETPositron emission tomography is a nuclear medicine imaging technique which 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
prescribeA 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 limited
prescribing privilegesThe Prescriptive authority for psychologists movement is a political effort to give prescriptive authority to clinical psychologists, enabling them to prescribe psychotropic medications to treat mental and emotional disorders...
. These medical privileges require additional training and education. To date, medical psychologists may prescribe psychotropic medications in
GuamGuam is an island in the western Pacific Ocean and is an organized, unincorporated territory of the United States. It is one of five U.S. territories with an established civilian government. The island's capital is Hagåtña...
,
New MexicoNew Mexico is a state located in the southwestern region of the United States. Inhabited by Native American populations for many centuries, it has also been part of the Imperial Spanish viceroyalty of New Spain, part of Mexico, and a U.S. territory. Among U.S...
, and Louisiana and some Military psychologist].
Unless a psychiatrist voluntarily chooses to obtain extra training he or she will have less knowledge of psychological assessment and psychotherapy than will a licensed clinical psychologist.
Counseling psychology
Counseling psychologistsCounseling psychology is a psychological specialty that encompasses research and applied work in several broad domains: counseling process and outcome; supervision and training; career development and counseling; diversity and multiculturalism; and prevention and health...
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 primarily trained for, such as
dementiaDementia is a serious cognitive disorder. It may be static, the result of a unique global brain injury or progressive, resulting in long-term decline in cognitive function due to damage or disease in the body beyond what might be expected from normal aging...
or
psychosisPsychosis literally 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. There is considerable overlap between the two fields and distinctions between them continue to fade.
School psychology
School psychologistsSchool 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...
are primarily concerned with the academic, social, and emotional well-being of children and adolescents within a scholastic environment. In the U.K., they are known as 'educational psychologists'. Like clinical (and counseling) psychologists, school psychologists with doctoral degrees are eligible for licensure as health service psychologists, and many work in private practice. Unlike clinical psychologists, they receive much more training in education, child development and behavior, and the psychology of learning. Common degrees include the
Educational Specialist DegreeThe Education Specialist, also referred to as Educational Specialist, Specialist in Education, or Ed.S., is a terminal advanced academic degree in the U.S...
(Ed.S.),
Doctor of PhilosophyDoctor of Philosophy, abbreviated PhD , for the Latin , meaning "teacher of philosophy", or alternatively, DPhil, for the equivalent , is an advanced academic degree awarded by universities...
(Ph.D.), and
Doctor of EducationThe Doctor of Education degree is a discipline-based doctorate that prepares the student for academic, administrative, clinical or research positions in education. Like other doctorates, , the Ed.D./D.Ed...
(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 is both a profession and social science. It involves the application of social theory and research methods to study and improve the lives of people, groups, and societies...
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 U.S. is a two-year, sixty credit program that includes at least a one year practicum (two years for clinicians). Unlike the PhD, which is a third level academic degree, the MSW is considered a professional degree (a second level university degree) and is sufficient for basic licensure in most states.
Occupational therapy
Occupational therapyOccupational therapy, often abbreviated as "OT", incorporates meaningful and purposeful occupation to enable people with limitations or impairments to participate in everyday life. Occupational therapists work with individuals, families, groups and populations to facilitate health and well-being...
—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.
Criticisms and controversies
Clinical psychology is a diverse field and there have been recurring tensions over the degree to which clinical practice should be limited to treatments supported by empirical research. It is also unclear as to what exactly constitutes adequate evidence to qualify as "support". Despite some evidence showing that all the major therapeutic orientations are about of equal effectiveness, there remains much debate about the efficacy of various forms treatment in use in clinical psychology.
Clinical Psychology can be subject to similar criticisms leveled at
psychiatryPsychiatry is a medical specialty officially devoted to the treatment and study of mental disorders. The term was first coined by the German physician Johann Christian Reil in 1808....
, for example by the
anti-psychiatryAnti-psychiatry usually refers to a configuration of groups and theories that emerged in the 1960s hostile to most of the fundamental assumptions and practices of psychiatry. Its igniting influences were Michel Foucault, R. D. Laing, Thomas Szasz and, in Italy, Franco Basaglia. The term was first...
movement, especially when more aligned with a biomedical model or using psychiatric diagnostic categories such as in the
DSMThe Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides diagnostic criteria for mental disorders...
. Others may view this positively. It has been reported that clinical psychology has rarely allied itself with client groups and tends to individualize problems to the neglect of wider economic, political and social inequality issues that may not be the responsibility of the client. It has been argued that therapeutic practices are inevitably bound up with power inequalities, which can be used for good and bad. A
critical psychologyCritical psychology is a branch of psychology that 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 psychopathology...
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
The following represents an (incomplete) listing of significant journals in or related to the field of clinical psychology.
- American Journal of Psychotherapy
The American Journal of Psychotherapy is the official journal of the Association for the Advancement of Psychotherapy. It began publishing in 1939. It is published 4 times a year....
- 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 Psychology
- Clinical Psychology and Psychotherapy
- Clinical Psychology Review
- Clinical Psychology: Science and Practice
- In Session: Psychotherapy in Practice
- International Journal of Psychopathology,
Psychopharmacology, and Psychotherapy
- International Journal of Psychotherapy
- Journal of Abnormal Psychology
Journal of Abnormal Psychology is a scientific journal published by the American Psychological Association.It has previously been entitled Journal of Abnormal & Social Psychology...
- Journal of Affective Disorders
- Journal of Anxiety Disorders
- Journal of Child Psychotherapy
- Journal of Clinical Child Psychology
- Journal of Clinical Psychiatry
- Journal of Clinical Psychology
The Journal of Clinical Psychology, founded in 1945, is a peer-reviewed forum devoted to psychological research, assessment, and practice. Published eight times a year, the Journal includes research studies; articles on contemporary professional issues, single case research; brief reports ; notes...
- Journal of Clinical Psychology in Medical Settings
- Journal of Clinical Psychopharmacology
- Journal of Consulting and Clinical Psychology
The 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
- Psychopathology
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 Research
See also: a list of
empirical journals published by the APA
Major influences
- Aaron Beck
- Abraham Maslow
Abraham Harold Maslow was an American psychologist. He is noted for his conceptualization of a "hierarchy of human needs", and is considered the founder of humanistic psychology.-Biography:...
- Albert Bandura
Albert Bandura is a psychologist specializing in social cognitive theory and self-efficacy. He is most famous for his social learning theory.- Education and academic career :...
- Albert Ellis
Albert Ellis was an American psychologist who in 1955 developed rational emotive behavior therapy. He held M.A. and Ph.D. degrees in clinical psychology from Columbia University and founded and was the president and president emeritus of the New York City-based Albert Ellis Institute...
- Alfred Adler
Alfred Adler was an Austrian medical doctor, psychologist 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 Psychoanalytic...
- Anna Freud
Anna 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. With Melanie Klein, she is the cofounder of psychoanalytic child psychology...
- Carl Gustav Jung
- Carl Rogers
Carl Rogers was an influential American psychologist and among the founders of the humanistic approach to psychology...
- David Shakow
David 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...
- Donald Woods Winnicott
- Erich Fromm
Erich Seligmann Fromm was an internationally renowned social psychologist, psychoanalyst, humanistic philosopher, and democratic socialist. He was associated with what became known as the Frankfurt School of critical theory.-Punanni:Erich Fromm was born on 23 March 1900, at Frankfurt am Main, the...
- Erik H. Erikson
- Fritz Perls
Friedrich Salomon Perls , better known as Fritz Perls, was a noted German-born psychiatrist and psychotherapist of Jewish descent....
- George Kelly
George Kelly was an American psychologist, therapist and educator, best known for developing Personal Construct Psychology.- Biography :...
- Gordon Allport
Gordon 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 Eysenck
Hans Jürgen Eysenck was a British psychologist of German origin, best remembered for his work on intelligence and personality, though he worked in a wide range of areas...
- Harry Stack Sullivan
'Harry 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 Kohut
Heinz 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 Bugental
James 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 Bowlby
John Bowlby was a British psychiatrist and psychoanalyst, notable for his interest in child development and for his pioneering work in attachment theory.- Family background :...
- John Gottman
John Gottman, Ph.D. is known for his work on marital stability and relationship analysis through scientific direct observations published in peer-reviewed literature...
- Joseph Wolpe
Joseph Wolpe was a South African psychiatrist, born in a Jewish family from Johannesburg, South Africa in 1915, settled later in his life in the United States,. He is best known for developing what is now called systematic desensitization. This treatment developed as a result of his...
- Karen Horney
Karen Horney born Danielsen was a German psychoanalyst and psychiatrist of Norwegian and Dutch descent. 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 Witmer
Lightner Witmer is regarded as the inventor of the term "Clinical Psychology" and the co-founder of the world's first Psychological Clinic in 1896 at the University of Pennsylvania.-Biography:Dr...
- Milton H. Erickson
Milton Hyland Erickson, was an American psychiatrist specializing in medical hypnosis and family therapy...
- Otto F. Kernberg
Otto F. 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 Rank
Otto 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...
- Robert Yerkes
Robert Mearns Yerkes was an American psychologist, ethologist, and primatologist best known for his work in intelligence testing and in the field of comparative psychology. Yerkes was a pioneer in the study both of human and primate intelligence and of the social behavior of gorillas and...
- Rollo May
Rollo May was an American existential psychologist. He authored the influential book Love and Will during 1969....
- Ronald David Laing
Ronald David Laing , was a Scottish psychiatrist who wrote extensively on mental illnessin particular, the experience of psychosis...
- Sigmund Freud
Sigmund Freud , Sigismund Schlomo Freud , was an Austrian neurologist who founded the psychoanalytic school of psychology...
- Stanislav Grof
Stanislav Grof is one of the founders of the field of transpersonal psychology and a pioneering researcher into the use of altered states of consciousness for purposes of analysing, healing, and obtaining growth and insight into the human psyche...
- Marsha M. Linehan
Marsha 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 Seligman
Martin E. P. Seligman is an American psychologist and author of self-help books. A world-renowned authority on depression and abnormal psychology, he is known for his work on the theory of "learned helplessness", and according to The Daily Pennsylvanian is considered the father of positive...
- Mary Ainsworth
Mary D. Salter Ainsworth was an American 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 Klein
Melanie Klein was an Austrian-born British psychoanalyst who devised novel therapeutic techniques for children that had a significant impact on child psychology and contemporary psychoanalysis...
- Morita Shoma
Dr. Morita Masatake, also read as Morita Shoma Dr. Morita Masatake, also read as Morita Shoma Dr. Morita Masatake, 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 by Zen Buddhism...
- Viktor Frankl
Viktor 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 Reich
Wilhelm Reich was an Austrian-American psychiatrist and psychoanalyst, known as one of the most radical figures in the history of psychiatry...
See also
- Anti-psychiatry
Anti-psychiatry usually refers to a configuration of groups and theories that emerged in the 1960s hostile to most of the fundamental assumptions and practices of psychiatry. Its igniting influences were Michel Foucault, R. D. Laing, Thomas Szasz and, in Italy, Franco Basaglia. The term was first...
- Applied psychology
The 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)
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 neuropsychology
Clinical neuropsychology is a sub-specialty of clinical psychology that specializes in the diagnostic assessment and treatment of patients with brain injury or neurocognitive deficits....
- Clinical trial
Clinical trials are conducted to allow safety and efficacy data to be collected for new drugs or devices. These trials can only take place once satisfactory information has been gathered on the quality of the product and its non-clinical safety, and Health Authority/Ethics Committee approval is...
- List of Clinical Psychologists
- List of credentials in psychology
- List of psychology topics
- List of psychotherapies
- Psychiatric and mental health nursing
Psychiatric nursing or mental health nursing is the speciality of nursing that cares for people of all ages with mental illness or mental distress, such as schizophrenia, bipolar disorder, psychosis, depression or dementia...
- Psychoneuroimmunology
Psychoneuroimmunology is the study of the interaction between psychological processes and the nervous and immune systems of the human body...
External links