Clinical psychology is an integration of science,
theory, and clinical knowledge for the purpose
of understanding, preventing, and relieving
psychologically-based distress or dysfunction
and to promote subjective well-being and personal
development.
Central to its practice are psychological
assessment, clinical formulation, and psychotherapy,
although clinical psychologists also engage
in research, teaching, consultation, forensic
testimony, and program development and administration.
In many countries, clinical psychology is
a regulated mental health profession.
The field is generally considered to have
begun in 1896 with the opening of the first
psychological clinic at the University of
Pennsylvania by Lightner Witmer.
In the first half of the 20th century, clinical
psychology was focused on psychological assessment,
with little attention given to treatment.
This changed after the 1940s when World War
II resulted in the need for a large increase
in the number of trained clinicians.
Since that time, three main educational models
have developed in the USA—the Ph.D. Clinical
Science model (heavily focused on research),
the Ph.D. science-practitioner model (integrating
research and practice), and the Psy.D. practitioner-scholar
model (focusing on clinical practice).
In the UK and the Republic of Ireland the
Clinical Psychology Doctorate falls between
the latter two of these models, whilst in
much of mainland Europe the training is at
masters level and predominantly psychotherapeutic.
Clinical psychologists are expert in providing
psychotherapy, and generally train within
four primary theoretical orientations—psychodynamic,
humanistic, cognitive behavioral therapy (CBT),
and systems or family therapy.
== History ==
The earliest recorded approaches to assess
and treat mental distress were a combination
of religious, magical and/or medical perspectives.
Early examples of such physicians included
Patañjali, Padmasambhava, Rhazes, Avicenna,
and Rumi.
In the early 19th century, one approach to
study mental conditions and behavior was using
phrenology, the study of personality by examining
the shape of the skull.
Other popular treatments at that time included
the study of the shape of the face (physiognomy)
and Mesmer's treatment for mental conditions
using magnets (mesmerism).
Spiritualism and Phineas Quimby's "mental
healing" were also popular.While the scientific
community eventually came to reject all of
these methods for treating mental illness,
academic psychologists also were not concerned
with serious forms of mental illness.
The study of mental illness was already being
done in the developing fields of psychiatry
and neurology within the asylum movement.
It was not until the end of the 19th century,
around the time when Sigmund Freud was first
developing his "talking cure" in Vienna, that
the first scientific application of clinical
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 Witmer (1867–1956),
a past student of Wundt and head of the psychology
department at the University of Pennsylvania,
agreed to treat a young boy who had trouble
with spelling.
His successful treatment was soon to lead
to Witmer's opening of the first psychological
clinic at Penn in 1896, dedicated to helping
children with learning disabilities.
Ten years later in 1907, Witmer was to found
the first journal of this new field, The Psychological
Clinic, where he coined the term "clinical
psychology", defined as "the study of individuals,
by observation or experimentation, with the
intention of promoting change".
The field was slow to follow Witmer's example,
but by 1914, there were 26 similar clinics
in the U.S.Even as clinical psychology was
growing, working with issues of serious mental
distress remained the domain of psychiatrists
and neurologists.
However, clinical psychologists continued
to make inroads into this area due to their
increasing skill at psychological assessment.
Psychologists' reputation as assessment experts
became solidified during World War I with
the development of two intelligence tests,
Army Alpha and Army Beta (testing verbal and
nonverbal skills, respectively), which could
be used with large groups of recruits.
Due in large part to the success of these
tests, assessment was to become the core discipline
of clinical psychology for the next quarter
century, when another war would propel the
field into treatment.
=== Early professional organizations ===
The field began to organize under the name
"clinical psychology" in 1917 with the founding
of the American Association of Clinical Psychology.
This only lasted until 1919, after which the
American Psychological Association (founded
by G. Stanley Hall in 1892) developed a section
on Clinical Psychology, which offered certification
until 1927.
Growth in the field was slow for the next
few years when various unconnected psychological
organizations came together as the American
Association of Applied Psychology in 1930,
which would act as the primary forum for psychologists
until after World War II when the APA reorganized.
In 1945, the APA created what is now called
Division 12, its division of clinical psychology,
which remains a leading organization in the
field.
Psychological societies and associations in
other English-speaking countries developed
similar divisions, including in Britain, Canada,
Australia and New Zealand.
=== World War II and the integration of treatment
===
When World War II broke out, the military
once again called upon clinical psychologists.
As soldiers began to return from combat, psychologists
started to notice symptoms of psychological
trauma labeled "shell shock" (eventually to
be termed posttraumatic stress disorder) that
were best treated as soon as possible.
Because physicians (including psychiatrists)
were over-extended in treating bodily injuries,
psychologists were called to help treat this
condition.
At the same time, female psychologists (who
were excluded from the war effort) formed
the National Council of Women Psychologists
with the purpose of helping communities deal
with the stresses of war and giving young
mothers advice on child rearing.
After the war, the Veterans Administration
in the 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 Ph.D.s
in psychology in 1950 being awarded in clinical
psychology.WWII helped bring dramatic changes
to clinical psychology, not just in America
but internationally as well.
Graduate education in psychology began adding
psychotherapy to the science and research
focus based on the 1947 scientist-practitioner
model, known today as the Boulder Model, for
Ph.D. programs in clinical psychology.
Clinical psychology in Britain developed much
like in the U.S. after WWII, specifically
within the context of the National Health
Service with qualifications, standards, and
salaries managed by the British Psychological
Society.
=== Development of the Doctor of Psychology
degree ===
By the 1960s, psychotherapy had become embedded
within clinical psychology, but for many the
Ph.D. educational model did not offer the
necessary training for those interested in
practice rather than research.
There was a growing argument that said the
field of psychology in the U.S. had developed
to a degree warranting explicit training in
clinical practice.
The concept of a practice-oriented degree
was debated in 1965 and narrowly gained approval
for a pilot program at the University of Illinois
starting in 1968.
Several other similar programs were instituted
soon after, and in 1973, at the Vail Conference
on Professional Training in Psychology, the
practitioner–scholar model of clinical psychology—or
Vail Model—resulting in the Doctor of Psychology
(Psy.D.) degree was recognized.
Although training would continue to include
research skills and a scientific understanding
of psychology, the intent would be to produce
highly trained professionals, similar to programs
in medicine, dentistry, and law.
The first program explicitly based on the
Psy.D. model was instituted at Rutgers University.
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 care 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 engage in a wide range
of activities.
Some focus solely on research into the assessment,
treatment, or cause of mental illness and
related conditions.
Some teach, whether in a medical school or
hospital setting, or in an academic department
(e.g., psychology department) at an institution
of higher education.
The majority of clinical psychologists engage
in some form of clinical practice, with professional
services including psychological assessment,
provision of psychotherapy, development and
administration of clinical programs, and forensics
(e.g., providing expert testimony in a legal
proceeding).In clinical 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.
Clinical psychologists who provide clinical
services may also choose to specialize.
Some specializations are codified and credentialed
by regulatory agencies within the country
of practice.
In the United States such specializations
are credentialed by the American Board of
Professional Psychology (ABPP).
== Training and certification to practice
==
Clinical psychologists study a generalist
program in psychology plus postgraduate training
and/or clinical placement and supervision.
The length of training differs across the
world, ranging from four years plus post-Bachelors
supervised practice to a doctorate of three
to six years which combines clinical placement.
In the USA, about half of all clinical psychology
graduate students are being trained in Ph.D.
programs—a model that emphasizes research—with
the other half in Psy.D. programs, which has
more focus on practice (similar to professional
degrees for medicine and law).
Both models are accredited by the American
Psychological Association and many other English-speaking
psychological societies.
A smaller number of schools offer accredited
programs in clinical psychology resulting
in a Masters degree, which usually take two
to three years post-Bachelors.
In the U.K., clinical psychologists undertake
a Doctor of Clinical Psychology (D.Clin.Psych.),
which is a practitioner doctorate with both
clinical and research components.
This is a three-year full-time salaried program
sponsored by the National Health Service (NHS)
and based in universities and the NHS.
Entry into these programs is highly competitive,
and requires at least a three-year undergraduate
degree in psychology plus some form of experience,
usually in either the NHS as an Assistant
Psychologist or in academia as a Research
Assistant.
It is not unusual for applicants to apply
several times before being accepted onto a
training course as only about one-fifth of
applicants are accepted each year.
These clinical psychology doctoral degrees
are accredited by the British Psychological
Society and the Health Professions Council
(HPC).
The HPC is the statutory regulator for practitioner
psychologists in the UK.
Those who successfully complete clinical psychology
doctoral degrees are eligible to apply for
registration with the HPC as a clinical psychologist.
The practice of clinical psychology requires
a license in the United States, Canada, the
United Kingdom, and many other countries.
Although each of the 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 examinationAll U.S. state
and Canadian province licensing boards are
members of the Association of State and Provincial
Psychology Boards (ASPPB) which created and
maintains the Examination for Professional
Practice in Psychology (EPPP).
Many states require other examinations in
addition to the EPPP, such as a jurisprudence
(i.e. mental health law) examination and/or
an oral examination.
Most states also require a certain number
of continuing education credits per year in
order to renew a license, which can be obtained
though various means, such as taking audited
classes and attending approved workshops.
Clinical psychologists require the Psychologist
license to practice, although licenses can
be obtained with a masters-level degree, such
as Marriage and Family Therapist (MFT), Licensed
Professional Counselor (LPC), and Licensed
Psychological Associate (LPA).In the U.K.
registration as a clinical psychologist with
the Health Professions Council (HPC) is necessary.
The HPC is the statutory regulator for practitioner
psychologists in the U.K.
In the U.K. the following titles are restricted
by law "registered psychologist" and "practitioner
psychologist"; in addition the specialist
title "clinical psychologist" is also restricted
by law.
== 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.
=== Measurement domains ===
There exist 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) in comparison to a norming-group.
These tests, such as the WISC-IV, 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
aim to describe patterns of behavior, thoughts,
and feelings.
They generally fall within two categories:
objective and projective.
Objective measures, such as the MMPI, 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
test, allow for open-ended answers, often
based on ambiguous stimuli.
Neuropsychological tests – Neuropsychological
tests consist of specifically designed tasks
used to measure psychological functions known
to be linked to a particular brain structure
or pathway.
They are typically used to assess impairment
after an injury or illness known to affect
neurocognitive 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, which is
often used in psychiatry as a screening tool
for treatment or further testing.
=== Diagnostic impressions ===
After assessment, clinical psychologists may
provide a diagnostic 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 Disorders.
Both are nosological systems that largely
assume categorical disorders diagnosed through
the application of sets of criteria including
symptoms and signs.Several new models are
being discussed, including a "dimensional
model" based on empirically validated models
of human differences (such as the five factor
model of personality) and a "psychosocial
model", which would take changing, intersubjective
states into greater account.
The proponents of these models claim that
they would offer greater diagnostic flexibility
and clinical utility without depending on
the medical concept of illness.
However, they also admit that these models
are not yet robust enough to gain widespread
use, and should continue to be developed.Clinical
psychologists do not tend to diagnose, but
rather use formulation—an individualized
map of the difficulties that the patient or
client faces, encompassing predisposing, precipitating
and perpetuating (maintaining) factors.
=== Clinical v. mechanical prediction ===
Clinical assessment can be characterized as
a prediction problem where the purpose of
assessment is to make inferences (predictions)
about past, present, or future behavior.
For example, many therapy decisions are made
on the basis of what a clinician expects will
help a patient make therapeutic gains.
Once observations have been collected (e.g.,
psychological test results, diagnostic impressions,
clinical history, X-ray, etc.), there are
two mutually exclusive ways to combine those
sources of information to arrive at a decision,
diagnosis, or prediction.
One way is to combine the data in an algorithmic,
or "mechanical" fashion.
Mechanical prediction methods are simply a
mode of combination of data to arrive at a
decision/prediction of behavior (e.g., treatment
response).
Mechanical prediction does not preclude any
type of data from being combined; it can incorporate
clinical judgments, properly coded, in the
algorithm.
The defining characteristic is that, once
the data to be combined is given, the mechanical
approach will make a prediction that is 100%
reliable.
That is, it will make exactly the same prediction
for exactly the same data every time.
Clinical prediction, on the other hand, does
not guarantee this, as it depends on the decision-making
processes of the clinician making the judgment,
their current state of mind, and knowledge
base.What has come to be called the "clinical
versus statistical prediction" debate was
first described in detail in 1954 by Paul
Meehl, where he explored the claim that mechanical
(formal, algorithmic) methods of data combination
could outperform clinical (e.g., subjective,
informal, "in the clinician's head") methods
when such combinations are used to arrive
at a prediction of behavior.
Meehl concluded that mechanical modes of combination
performed as well or better than clinical
modes.
Subsequent meta-analyses of studies that directly
compare mechanical and clinical predictions
have born out Meehl's 1954 conclusions.
A 2009 survey of practicing clinical psychologists
found that clinicians almost exclusively use
their clinical judgment to make behavioral
predictions for their patients, including
diagnosis and prognosis.
== Intervention ==
Psychotherapy involves a formal relationship
between professional and client—usually
an individual, couple, family, or small group—that
employs a set of procedures intended to form
a therapeutic alliance, explore the nature
of psychological problems, and encourage new
ways of thinking, feeling, or behaving.Clinicians
have a wide range of individual interventions
to draw from, often guided by their training—for
example, a cognitive behavioral therapy (CBT)
clinician might use worksheets to record distressing
cognitions, a psychoanalyst might encourage
free association, while a psychologist trained
in Gestalt techniques might focus on immediate
interactions between client and therapist.
Clinical psychologists generally seek to base
their work on research evidence and outcome
studies as well as on trained clinical judgment.
Although there are literally dozens of recognized
therapeutic orientations, their differences
can often be categorized on two dimensions:
insight vs. action and in-session vs. out-session.
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, cognitive behavioral therapy)
In-session – interventions center on the
here-and-now interaction between client and
therapist (e.g. humanistic therapy, Gestalt
therapy)
Out-session – a large portion of therapeutic
work is intended to happen outside of session
(e.g. bibliotherapy, rational emotive behavior
therapy)The methods used are also different
in regards to the population being served
as well as the context and nature of the problem.
Therapy will look very different between,
say, a traumatized child, a depressed but
high-functioning adult, a group of people
recovering from substance dependence, and
a ward of the state suffering from terrifying
delusions.
Other elements that play a critical role in
the process of psychotherapy include the environment,
culture, age, cognitive functioning, motivation,
and duration (i.e. brief or long-term therapy).
=== Four main schools ===
Many clinical psychologists are integrative
or eclectic and draw from the evidence base
across different models of therapy in an integrative
way, rather than using a single specific model.
In the UK, clinical psychologists have to
show competence in at least two models of
therapy, including CBT, to gain their doctorate.
The British Psychological Society Division
of Clinical Psychology has been vocal about
the need to follow the evidence base rather
than being wedded to a single model of therapy.
In the USA, intervention applications and
research are dominated in training and practice
by essentially four major schools of practice:
psychodynamic, humanistic, behavioral/cognitive
behavioral, and systems or family therapy.
==== Psychodynamic ====
The psychodynamic perspective developed out
of the psychoanalysis of Sigmund Freud.
The core object of psychoanalysis is to make
the unconscious conscious—to make the client
aware of his or her own primal drives (namely
those relating to sex and aggression) and
the various defenses used to keep them in
check.
The essential tools of the psychoanalytic
process are the use of free association and
an examination of the client's transference
towards the therapist, defined as the tendency
to take unconscious thoughts or emotions about
a significant person (e.g. a parent) and "transfer"
them onto another person.
Major variations on Freudian psychoanalysis
practiced today include self psychology, ego
psychology, and object relations theory.
These general orientations now fall under
the umbrella term psychodynamic psychology,
with common themes including examination of
transference and defenses, an appreciation
of the power of the unconscious, and a focus
on how early developments in childhood have
shaped the client's current psychological
state.
==== Humanistic ====
Humanistic psychology was developed in the
1950s in reaction to both behaviorism and
psychoanalysis, largely due to the person-centered
therapy of Carl Rogers (often referred to
as Rogerian Therapy) and existential psychology
developed by Viktor Frankl and Rollo May.
Rogers believed that a client needed only
three things from a clinician to experience
therapeutic improvement—congruence, unconditional
positive regard, and empathetic understanding.
By using phenomenology, intersubjectivity
and first-person categories, the humanistic
approach seeks to get a glimpse of the whole
person and not just the fragmented parts of
the personality.
This aspect of holism links up with another
common aim of humanistic practice in clinical
psychology, which is to seek an integration
of the whole person, also called self-actualization.
From 1980, Hans-Werner Gessmann integrated
the ideas of humanistic psychology into group
psychotherapy as humanistic psychodrama.
According to humanistic thinking, each individual
person already has inbuilt potentials and
resources that might help them to build a
stronger personality and self-concept.
The mission of the humanistic psychologist
is to help the individual employ these resources
via the therapeutic relationship.
==== Behavioral and cognitive behavioral ====
Cognitive behavioral therapy (CBT) developed
from the combination of cognitive therapy
and rational emotive behavior therapy, both
of which grew out of cognitive psychology
and behaviorism.
CBT is based on the theory that how we think
(cognition), how we feel (emotion), and how
we act (behavior) are related and interact
together in complex ways.
In this perspective, certain dysfunctional
ways of interpreting and appraising the world
(often through schemas or beliefs) can contribute
to emotional distress or result in behavioral
problems.
The object of many cognitive behavioral therapies
is to discover and identify the biased, dysfunctional
ways of relating or reacting and through different
methodologies help clients transcend these
in ways that will lead to increased well-being.
There are many techniques used, such as systematic
desensitization, socratic questioning, and
keeping a cognition observation log.
Modified approaches that fall into the category
of CBT have also developed, including dialectic
behavior therapy and mindfulness-based cognitive
therapy.Behavior therapy is a rich tradition.
It is well researched with a strong evidence
base.
Its roots are in behaviorism.
In behavior therapy, environmental events
predict the way we think and feel.
Our behavior sets up conditions for the environment
to feedback back on it.
Sometimes the feedback leads the behavior
to increase- reinforcement and sometimes the
behavior decreases- punishment.
Oftentimes behavior therapists are called
applied behavior analysts or behavioral health
counselors.
They have studied many areas from developmental
disabilities to depression and anxiety disorders.
In the area of mental health and addictions
a recent article looked at APA's list for
well established and promising practices and
found a considerable number of them based
on the principles of operant and respondent
conditioning.
Multiple assessment techniques have come from
this approach including functional analysis
(psychology), which has found a strong focus
in the school system.
In addition, multiple intervention programs
have come from this tradition including community
reinforcement approach for treating addictions,
acceptance and commitment therapy, functional
analytic psychotherapy, including dialectic
behavior therapy and behavioral activation.
In addition, specific techniques such as contingency
management and exposure therapy have come
from this tradition.
==== Systems or family therapy ====
Systems or family therapy works with couples
and families, and emphasizes family relationships
as an important factor in psychological health.
The central focus tends to be on interpersonal
dynamics, especially in terms of how change
in one person will affect the entire system.
Therapy is therefore conducted with as many
significant members of the "system" as possible.
Goals can include improving communication,
establishing healthy roles, creating alternative
narratives, and addressing problematic behaviors.
=== Other therapeutic perspectives ===
There exist dozens of recognized schools or
orientations of psychotherapy—the list below
represents a few influential orientations
not given above.
Although they all have some typical set of
techniques practitioners employ, they are
generally better known for providing a framework
of theory and philosophy that guides a therapist
in his or her working with a client.
Existential – Existential psychotherapy
postulates that people are largely free to
choose who we are and how we interpret and
interact with the world.
It intends to help the client find deeper
meaning in life and to accept responsibility
for living.
As such, it addresses fundamental issues of
life, such as death, aloneness, and freedom.
The therapist emphasizes the client’s ability
to be self-aware, freely make choices in the
present, establish personal identity and social
relationships, create meaning, and cope with
the natural anxiety of living.
Gestalt - Gestalt therapy was primarily founded
by Fritz Perls in the 1950s.
This therapy is perhaps best known for using
techniques designed to increase self-awareness,
the best-known perhaps being the "empty chair
technique."
Such techniques are intended to explore resistance
to "authentic contact", resolve internal conflicts,
and help the client complete "unfinished business".
Postmodern – Postmodern psychology says
that the experience of reality is a subjective
construction built upon language, social context,
and history, with no essential truths.
Since "mental illness" and "mental health"
are not recognized as objective, definable
realities, the postmodern psychologist instead
sees the goal of therapy strictly as something
constructed by the client and therapist.
Forms of postmodern psychotherapy include
narrative therapy, solution-focused therapy,
and coherence therapy.
Transpersonal – The transpersonal perspective
places a stronger focus on the spiritual facet
of human experience.
It is not a set of techniques so much as a
willingness to help a client explore spirituality
and/or transcendent states of consciousness.
It also is concerned with helping clients
achieve their highest potential.
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 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 is an orientation
arising from the disparity between the origin
of most psychological theories (which have
male authors) and the majority of people seeking
counseling being female.
It focuses on societal, cultural, and political
causes and solutions to issues faced in the
counseling process.
It openly encourages the client to participate
in the world in a more social and political
way.
Positive psychology – Positive psychology
is the scientific study of human happiness
and well-being, which started to gain momentum
in 1998 due to the call of Martin Seligman,
then president of the APA.
The history of psychology shows that the field
has been primarily dedicated to addressing
mental illness rather than mental wellness.
Applied positive psychology's main focus,
therefore, is to increase one's positive experience
of life and ability to flourish by promoting
such things as optimism about the future,
a sense of flow in the present, and personal
traits like courage, perseverance, and altruism.
There is now preliminary empirical evidence
to show that by promoting Seligman's three
components of happiness—positive emotion
(the pleasant life), engagement (the engaged
life), and meaning (the meaningful life)—positive
therapy can decrease clinical depression.
=== Integration ===
In the last couple of decades, there has been
a growing movement to integrate the various
therapeutic approaches, especially with an
increased understanding of cultural, gender,
spiritual, and sexual-orientation issues.
Clinical psychologists are beginning to look
at the various strengths and weaknesses of
each orientation while also working with related
fields, such as neuroscience, behavioral genetics,
evolutionary biology, and psychopharmacology.
The result is a growing practice of eclecticism,
with psychologists learning various systems
and the most efficacious methods of therapy
with the intent to provide the best solution
for any given problem.
== Professional ethics ==
The field of clinical psychology in most countries
is strongly regulated by a code of ethics.
In the U.S., professional ethics are largely
defined by the APA Code of Conduct, which
is often used by states to define licensing
requirements.
The APA Code generally sets a higher standard
than that which is required by law as it 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.
In the UK the British Psychological Society
has published a Code of Conduct and Ethics
for clinical psychologists.
This has four key areas: Respect, Competence,
Responsibility and Integrity.
Other European professional organisations
have similar codes of conduct and ethics.
== Comparison with other mental health professions
==
=== 
Psychiatry ===
Although clinical psychologists and psychiatrists
can be said to share a same fundamental aim—the
alleviation of mental distress—their training,
outlook, and methodologies are often quite
different.
Perhaps the most significant difference is
that psychiatrists are licensed physicians.
As such, psychiatrists often use the medical
model to assess psychological problems (i.e.,
those they treat are seen as patients with
an illness) and rely on psychotropic medications
as the chief method of addressing the illness—although
many also employ psychotherapy as well.
Psychiatrists and medical psychologists (who
are clinical psychologists that are also licensed
to prescribe) are able to conduct physical
examinations, order and interpret laboratory
tests and EEGs, and may order brain imaging
studies such as CT or CAT, MRI, and PET scanning.
Clinical psychologists generally do not prescribe
medication, although there is a growing movement
for psychologists to have prescribing privileges.
These medical privileges require additional
training and education.
To date, medical psychologists may prescribe
psychotropic medications in Guam, Iowa, Idaho,
Illinois, New Mexico, Louisiana, the Public
Health Service, the Indian Health Service,
and the United States Military.
=== Counseling psychology ===
Counseling psychologists undergo the same
level of rigor in study and use many of the
same interventions and tools as clinical psychologists,
including psychotherapy and assessment.
Traditionally, counseling psychologists helped
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.
However, that distinction has faded over time,
and of the counseling psychologists who do
not go into academia (which does not involve
treatment or diagnosis), the majority of counseling
psychologists treat mental illness alongside
clinical psychologists.
Many counseling psychologists also receive
specialized training in career assessment,
group therapy, and relationship counseling.
Counseling psychology as a field values multiculturalism
and social advocacy, often stimulating research
in multicultural issues.
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.
Counseling psychologists tend to be more frequently
employed in university counseling centers
compared to hospitals and private practice
for clinical psychologists.
However, counseling and clinical psychologists
can be employed in a variety of settings,
with a large degree of overlap (prisons, colleges,
community mental health, non-profits, corporations,
private practice, hospitals and Veterans Affairs).
Distinctions between the two fields continue
to fade.
=== School psychology ===
School psychologists are primarily concerned
with the academic, social, and emotional well-being
of children and adolescents within a scholastic
environment.
In the U.K., they 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
Degree (Ed.S.), Doctor of Philosophy (Ph.D.),
and Doctor of Education (Ed.D.).
Traditional job roles for school psychologists
employed in school settings have focused mainly
on assessment of students to determine their
eligibility for special education services
in schools, and on consultation with teachers
and other school professionals to design and
carry out interventions on behalf of students.
Other major roles also include offering individual
and group therapy with children and their
families, designing prevention programs (e.g.
for reducing dropout), evaluating school programs,
and working with teachers and administrators
to help maximize teaching efficacy, both in
the classroom and systemically.
=== Clinical social work ===
Social workers provide a variety of services,
generally concerned with social problems,
their causes, and their solutions.
With specific training, clinical social workers
may also provide psychological counseling
(in the U.S. 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).
=== Occupational therapy ===
Occupational therapy—often abbreviated OT—is
the "use of productive or creative activity
in the treatment or rehabilitation of physically,
cognitively, or emotionally disabled people."
Most commonly, occupational therapists work
with people with disabilities to enable them
to maximize their skills and abilities.
Occupational therapy practitioners are skilled
professionals whose education includes the
study of human growth and development with
specific emphasis on the physical, emotional,
psychological, sociocultural, cognitive and
environmental components of illness and injury.
They commonly work alongside clinical psychologists
in settings such as inpatient and outpatient
mental health, pain management clinics, eating
disorder clinics, and child development services.
OT's use support groups, individual counseling
sessions, and activity-based approaches to
address psychiatric symptoms and maximize
functioning in life activities.
== Criticisms and controversies ==
Clinical psychology is a diverse field and
there have been recurring tensions over the
degree to which clinical practice should be
limited to treatments supported by empirical
research.
Despite some evidence showing that all the
major therapeutic orientations are about of
equal effectiveness, there remains much debate
about the efficacy of various forms treatment
in use in clinical psychology.It has been
reported that clinical psychology has rarely
allied itself with client groups and tends
to individualize problems to the neglect of
wider economic, political and social inequality
issues that may not be the responsibility
of the client.
It has been argued that therapeutic practices
are inevitably bound up with power inequalities,
which can be used for good and bad.
A critical psychology movement has argued
that clinical psychology, and other professions
making up a "psy complex", often fail to consider
or address inequalities and power differences
and can play a part in the social and moral
control of disadvantage, deviance and unrest.An
October 2009 editorial in the journal Nature
suggests that a large number of clinical psychology
practitioners in the United States consider
scientific evidence to be "less important
than their personal – that is, subjective
– clinical experience."
== See also
