Clinical psychology

From Wikipedia, the free encyclopedia

Clinical psychology is the application of psychology in a clinical setting, including researching and treating psychological distress, dysfunction or disorder. In many countries it is a regulated mental health profession.^[1] Central to the practice of clinical psychology is assessment of the issues and needs of clients, and provision of psycho-education or psychotherapy to improve subjective well-being, mental health, and life functioning.

The term Clinical Psychology was introduced in 1907 by Lightner Witmer. A recognised field and profession developed through the 20th century, drawing initially on various strands of experimental and psychotherapy (initially behavioral and psychoanalytic), and later from numerous branches of psychology as well from other fields such as neuroscience and sociology.

Different countries require various educational and professional qualifications to practice clinical psychology, traditionally at the doctoral level but sometimes at the masters level. The scope of the field has varied but has been said to include intellectual, emotional, biological, psychological, social, and behavioral aspects of human functioning across the life span, in varying cultures, at different socioeconomic levels.^[2] Clinical psychologists may not necessarily see an individual's distress or disorder as a problem within the client, even if the client experiences it in that way, but may see it as based within the wider familial, social or cultural environment. A common theme of those seeking assistance from clinical psychology is suffering, for example, from coping with chronic bodily pain from injury or illness.

Practitioners of clinical psychology can work with individuals, couples, children, older adults, families or small groups. They may work in psychiatric hospitals, general practice, psychological clinics, or academic centers. They may work individually or in multi-disciplinary teams involving other professionals, commonly with licensed psychologists, social workers, psychiatric nurses and psychiatrists and they themselves may be a licensed psychologist, a social worker, a therapist, a counselor, a psychiatric nurse, or a psychiatrist.

Contents 1 History 2 Training, professional practice and licensing 3 Assessment 3.1 Diagnostic impressions 4 Theories and interventions 4.1 Four main perspectives 4.1.1 Cognitive Behavioral 4.1.2 Humanistic 4.1.3 Psychodynamic 4.1.4 Transpersonal 4.2 Other major therapeutic orientations 4.3 Integration 4.4 Other perspectives 5 Comparison with other mental health professions 5.1 Psychiatry 5.2 Counseling psychology 5.3 Abnormal psychology 5.4 School psychology 5.5 Social Workers 6 Clinical psychology journals 7 Major influences 8 Criticisms and controversies 9 See also 9.1 Related lists 10 References 11 External links

[edit] History

See also: History of psychology and History of psychotherapy

Psychology had been applied to individual psychological problems for millenia, in both Eastern and Western traditions. The earliest recorded approaches were a combination of religious, magical and medical perspectives.

Main article: Clinical Psychology - Eastern & Middle Eastern Influences

Selfhood, or the idea of an autonomous self, was developed in and is unique to western psychology. The developing field of psychiatry dominated mental healthcare using physical treatments based in asylums. In the 19th century, the Mental hygiene and moral treatment movements gave impetus to public health and psychosocial approaches to "madness". At the turn of the 20th Century, experimental psychology and psychoanalysis were developing. A recognized practice of clinical psychology developed as these psychological methods and theories were applied in clinics. The American Lightner Witmer, who had studied under Wilhelm Wundt in Germany, coined the term "clinical psychology" in 1907 to describe the practice of a clinic for children established in 1896 at the University of Pennsylvania.^[3] Witmer specifically defined it as the study of individuals, by observation or experimentation, with the intention of promoting change.^[4] He also founded the first journal of clinical psychology, Psychological Clinic. Witmer's call for clinical involvement by psychologists was slow to gain acceptance, but there were twenty-six more psycho-education clinics in the U.S. by 1914.^[5] While Witmer focused on children with intellectual delays and deficits, other clinics developed which focused on those in mental distress, and clinical psychology was developing in mental hospitals as psychologists gained staff positions, often working alongside psychiatrists.^[6] The applied psychologists of this time did not generally engage in psychotherapy — a practice that was mainly limited to psychiatrists (i.e. those with a medical degree). Rather, they focused mostly on psychological assessment, and this aspect of early clinical psychology came fully into its own as a result of an increasing focus during World War I when the U.S. military required clinical psychologists to assess thousands of new soldiers.^[3]

Clinical psychologists began to organize under that name in 1917 with the founding of the American Association of Clinical Psychology. This only lasted until 1919, after which the American Psychological Association developed a Section on Clinical Psychology^[5] which certified clinical psychologists until 1927. Growth in the field was slow for the next few years as various unconnected psychological organizations came together as the American Association of Applied Psychology in 1930. Formal training for a distinct profession of clinical psychology began in the 1930s with the introduction in the US of approved internships and tentative plans for training curricula. In 1945 APA created what is now called Division 12, its division of clinical psychology. Psychological societies and associations in other English-speaking countries developed similar divisions, including in Britain, Canada, Australia and New Zealand. Different countries adapted clinical psychological practice and training to suit different cultural perceptions and needs. Clinical psychology in Japan developed in various and changing ways, moving towards a more integrative socially-orientated counseling methodology. Practice in India developed from both traditional metaphysical and ayurvedic systems and Western methodologies.^[7]

The assessment-only focus of clinical psychology changed during and after World War II in the US and UK, partly because the military gave greater recognition to the condition they termed "shell shock" (now called Post Traumatic Stress Disorder or PTSD),^[3] and military personnel needed psychological care.^[8] There was also increasing interest in the impact of stress on the efficiency of the industrial workforce. Some clinical psychologists practiced psychodyanamic therapy, which included various techniques based on Freud's psychoanalysis, particularly in the US and southern Europe. Others practiced behavior therapy, using techniques based on theories of operant conditioning, classical conditioning and social learning theory. Other approaches developed over the second half of the century, reflecting changing paradigms in psychology and therapy, notably cognitivism and humanistic therapy.^[8] Clinical psychology faced territorial boundary issues with psychiatry and later other professionals practising psychotherapy or counseling.

After WWII, the Veterans Administration in the US made an enormous investment to set up programs to train doctoral-level clinical psychologists. 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.^[4] As a result of this shift, a report was drafted in 1947 that led to the scientist/practitioner model of clinical psychology, known today as the Boulder Model. This model of graduate training in the US maintained the science and research-oriented focus of the field while adding training in psychotherapy.^[5] The process of professionalization in the UK was somewhat different, relating to the development of the National Health Service and with less emphasis on psychoanalysis.^[7] Similar organizational and theoretical developments took place in other countries in the 1950s, and the number of clinical psychologists proliferated.

In 1973 in the US, the Practitioner-Scholar Model of Clinical Psychology—or Vail Model—resulting in the Doctor of Psychology (PsyD) degree was recognized by the Vail Conference on models of training in clinical psychology.^[9] At this conference, it was argued that the field of psychology in the US had grown to a degree warranting training persons explicitly in the clinical practice of psychology. 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 pilot PsyD program was instituted at the University of Illinois in 1968^[10]

Cognitive and behavioral approaches were increasingly combined during the 1970s, and Cognitive behavioral therapy^[8] came in to widespread usage by clinical psychologists. Numerous other individual and group-based therapies, systems therapies and psychosocial approaches also developed. The range of associated theories and practices also proliferated, with some consensus towards a biopsychosocial model.^[7]

[edit] Training, professional practice and licensing

Main article: Clinical psychology - training & licensing

Clinical psychologists undergo many hours of graduate training in many countries—usually 4 to 6 years post-Bachelors—in order to gain demonstrable competence and experience. In USA and Australia there is an increasing move toward training clinical psychology graduate students in PhD programs. This is a model emphasizing research in universities. Others undertaking PsyD programs have more focus on practice (similar to professional degrees for medicine and law).^[9] Both models envision practicing Clinical Psychology in a research-based, scientifically valid manner, accredited by their national professional organisations. A number of schools offer accredited programs in clinical psychology resulting in a Masters degree.

In the U.K., clinical psychologists undertake a DClinPsy (or similar), which is a doctorate with both clinical and research components. This is a three-year full-time salaried program sponsored by the National Health Service (NHS). Entry into these programs is highly competitive, and requires at least a three-year undergraduate degree in psychology approved by the British Psychological Society or an approved conversion course, plus some form of experience, usually in either the NHS as an Assistant Psychologist or in academia as a Research Assistant.^[11]

Clinical psychologists can offer a range of professional services, including:^[4]

• Provide psychological treatment (psychotherapy)
• Administer and interpret psychological assessment and testing
• Conduct psychological research
• Teaching
• Development of prevention programs
• Consultation (especially with schools and businesses)
• Program administration
• Provide expert testimony (forensics)

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.

The practice of clinical psychology requires a license in the United States, Canada, the United Kingdom, Australia and many other countries. 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. There are several licenses that allow one to practice clinical psychology, usually awarded in relation to one's educational degree.

In the U.K., many mental health titles, including "psychologist", are not protected—although statutory registration of all the mental health professions is planned in the near future to help the public know who is qualified to practice. Currently, protected titles include "clinical psychologist", "counselling psychologist", and "educational psychologist". One can also become "Chartered" by the British Psychological Society. The title of "Assistant Psychologist" is used by a psychology graduate under the supervision of a qualified clinical psychologist, and the title "Trainee Clinical Psychologist" is used during the three-year doctoral program.

[edit] Assessment

Main article: Psychological testing

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.^[12] 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.

There exists 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., test is consistent—internally, over time, and regardless of administrator). 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. Commonly used today are the Weschler tests (the WAIS-III for adults, the WISC-IV for children, and the WIAT-II achievement test), the Woodcock-Johnson-III, and the Stanford-Binet-5. These tests generally measure areas such as verbal skills (e.g. comprehension and vocabulary), memory (short and long term), attention span, arithmetic, and non-verbal performance (e.g. visual/spacial perception, hand-eye coordination, problem solving, and logical reasoning). These tests have been shown to accurately predict certain kinds of performance, especially scholastic.^[12]
• Personality tests. Tests of personality aim to describe characteristic patterns of behavior, thoughts, and feelings that remain relatively stable throughout a person's lifetime. They generally fall within two categories: objective (offering restricted, measured responses, such as yes/no, true/false, or a rating scale) and projective (which allow a person to respond to ambiguous stimuli, presumably revealing non-conscious psychological dynamics). Typical objective tests used today are the Minnesota Multiphasic Personality Inventory, the Millon Clinical Multiaxial Inventory-III, and the California Psychological Inventory. Common projective tests include the Rorschach inkblot test and the Thematic Apperception Test.
• 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. Examples include the Stroop test, the Bender-Gestalt Test, the Trail Making task, and finger tapping.
• 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 common example of a formal interview is the mental status examination, which is often used as a screening tool for treatment or further testing.^[12]

[edit] Diagnostic impressions

Main article - Mental disorder.

After assessment, clinical psychologists often provide a diagnostic impression. Many countries use the International Statistical Classification of Diseases and Related Health Problems. In the U.S., many psychologists use the Diagnostic and Statistical Manual of Mental Disorders (the DSM version IV-TR). In both case these are necessary when working with an HMO or insurance company or involving a legal matter. Both assume medical concepts and terms, and state that there are categorical disorders that can be diagnosed by set lists of descriptive criteria, which serve psychologists by providing a familiar frame of reference for discussing and understanding the clinical experience and for guiding treatment.^[13]

The DSM IV uses a categorical medical model and views psychological problems in terms of discrete illnesses that can be defined by a minimum set of criteria (such as presenting problems, intensity, behaviors, duration, onset, etc.). While convenient for prescribing medications, there is a growing awareness that this model is not the only way to understand psychological functioning and the various causes of mental distress. Moreover, there is little justification for the cutoff criteria, which, except for schizotypal and borderline diagnoses, are essentially arbitrary.^[14] As such, there are many debates in the field regarding alternative methods of diagnosing psychological problems.

One such debate is the position of adopting a dimensional model which could be based on empirically validated models of human differences, such as the five factor model of personality. A dimensional model would arguably have several major advantages, including—addressing quantitative variation and shifts (between various disorders as well as between what is considered normal and pathological); dealing with co-occurrence of multiple problems; and a more constructive way of looking at otherwise 'sub-threshold' conditions.^[14][13]

Another variation is called the psychosocial model, which could be more relevant for the practice of psychotherapy (as opposed to medicine).^[15] While the medical model of the DSM is based on assumptions of biology, stability of diagnosis, and objective traits, the psychosocial model is more psychological, intersubjective, and diagnostically flexible over the course of therapy.

British clinical psychologists do not tend to diagnose, but rather use formulation—an individualized map of the difficulties that the patient or client faces, encompassing predisposing, precipitating and perpetuating (maintaining) factors.^[16]

[edit] Theories and interventions

There are different theories and models of psychological processes used in clinical psychology. Clinical psychologists generally seek to base their work on research evidence and outcome studies as well as on clinical judgement and empathy. They help to research and develop evidence-based theories and models of the psychological causes and mediators of mental health problems, which can be applied to individual clients. Clinical psychologists often provide psychotherapy (also known as "talking therapy"), using various techniques to change thoughts, feelings or behaviors in order to enhance well-being, mental health, and life functioning. Clinical psychologists often also provide social skills training or other skills-based or psycho-educational interventions, either to clients themselves and/or to family members or others in sigificant relations with the client.

Generally speaking, psychotherapy involves a formal relationship between professional and client—usually an individual, couple, family, or small group—that employs a set of procedures intended to form a therapeutic alliance, explore the nature of psychological problems, and encourage new ways of thinking or behaving. Although there are literally dozens of recognized therapeutic orientations, their differences could be categorized on two dimensions: insight vs. action and in-session vs. out-session.^[4]

• 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 Focussed Therapy, Cognitive Behavioral Therapy)
• In-session—interventions center on the here-and-now interactions between client and therapist (e.g. Humanistic therapy, Family Therapy)
• Out-session—although the importance of the relationship is recognized, therapy is geared towards helping the client make changes outside of the 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).

[edit] Four main perspectives

The field can be seen as recognizing essentially four major perspectives^{[citation needed]}: Psychodynamic, Cognitive Behavioral, Humanistic and transpersonal

[edit] Cognitive Behavioral

Main article: Cognitive behavioral therapy

Cognitive Behavioral Therapy (CBT) developed from the combination of Cognitive psychology and Behaviorism, and from more specific earlier therapies known as cognitive therapy and rational emotive behavior therapy. CBT is based on the theory that how we think (cognition), how we feel (emotion), and how we act (behavior) all interact together. In this perspective, certain thoughts or ways of interpreting the world (often called schemas) can cause emotional distress or result in behavioral problems. Certain behaviors, such as avoidance of feared situations, can also maintain distress. The object of CBT is to discover the biased or irrational thinking that leads to emotional problems and to help the client take control over his or her thinking processes and behaviors in such a way that will lead to increased well-being.^[17] There are several techniques used, including Systematic Desensitization. Modified approaches that fall into the category of CBT have also developed, including Dialectic Behavior Therapy and Mindfulness-based Cognitive Therapy^[18]

[edit] Humanistic

Main article: Humanistic psychology

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). Rogers believed that a client needed only three things from a clinician to experience therapeutic improvement—congruence, unconditional positive regard, and empathetic understanding.^[19] The aim of much humanistic therapy is to give a holistic description of the person. 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.^[20] 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.

[edit] Psychodynamic

Main article: Psychodynamic psychotherapy

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.^[21] 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.^[21].

[edit] Transpersonal

Main article: Transpersonal psychology

Transpersonal therapy places a stronger focus on spirituality in human experience.^[22] Similar to Existential therapy, it is not a set of techniques so much as a core orientation to spirit. It is concerned with assisting clients to reach for their highest potential.^[23] Important writers in this area include Ken Wilber, Abraham Maslow, Stanislav Grof, John Welwood, and David Brazier.

The transpersonal perspective grew out of the humanistic movement of the 1960's but first use of the term can be found in lecture notes, which William James prepared for a semester at Harvard University in 1905-6. In 1969, Abraham Maslow, Stanislav Grof and Anthony Sutich initiated publication of the first issue of the Journal of Transpersonal Psychology, the leading academic journal in the field. Research interest in the field include contributions to psychiatry and psychology of all spiritual traditions; Native American healing; aging and adult spiritual development; meditation research and clinical aspects of meditation.

[edit] Other major therapeutic orientations

See also: List of psychotherapies

There exist literally dozens of recognized schools or orientations of psychotherapy—the list below represents those that have been pivotal in the development of clinical psychology^{[citation needed]}. 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.

• 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.^[24] 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.

• 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.^[25] Important writers in existential therapy include Rollo May, Victor Frankl, and Irvin Yalom.

  One influential therapy that came out of Existential therapy is Gestalt Therapy, primarily founded by Fritz Perls in the 1950s. It is well-known for techniques designed to increase various kinds of self-awareness—the best-known perhaps being the empty chair technique—which are generally intended to explore resistance to authentic contact, resolve internal conflicts, and help the client complete "unfinished business".^[26]

• Postmodern. Postmodern psychology says that the experience of reality is a subjective construction built upon language, social context, and history, with no essential truths.^[27] 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.^[28] Forms of postmodern psychotherapy include Narrative Therapy, Solution-Focused Therapy, and Coherence Therapy.

[edit] Integration

Main article: Integrative Psychotherapy

In the last couple of decades, there has been a growing movement to integrate the various therapeutic approaches, especially with an increased understanding of cultural, gender, spiritual, and sexual-orientation issues. Clinical psychologists are beginning to look at the various strengths and weaknesses of each orientation while also working with related fields, such as neuroscience, genetics, evolutionary biology, and psychopharmacology. The result is a growing practice of eclecticism, with psychologists learning various systems and the most efficacious methods of therapy with the intent to provide the best solution for any given problem.^[29]

[edit] 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.^[30] 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 psychotherapeutic theory and practice.^[31] As such, more psychologists and training programs are integrating knowledge of various cultural groups in order to inform therapeutic practice in a more culturally sensitive and effective 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,^[32] 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 altrusism.^[33][34] 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.^[35]

• 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.^[36]

[edit] Comparison with other mental health professions

See also: Mental health professional

[edit] Psychiatry

Main article: 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 medical doctors with four years of medical school and another four years of residency in a medical setting where they may specialise in certain agegroups or specific conditions. Being medical doctors, they tend to use the medical model to assess psychological problems (i.e. those they treat are seen as patients with an illness) and often - at least in biopsychiatry rather than, say, social psychiatry, rely on psychotropic medications as the chief method of addressing them^[37]—although many also employ psychotherapy as well. Their medical training enables them 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 do not usually prescribe medication, although there is a growing movement for psychologists to have limited prescribing privileges.^[38] Such privileges require additional, supervised training and education, and would mostly be limited to psychotropic medications. To date, qualified psychologists may prescribe psychotropic medications in Guam, New Mexico, and Louisiana.^[39] In general, however, when medication is warranted many psychologists will work in cooperation with psychiatrists so that clients get all their therapeutic needs met.^[1]

Unless a psychiatrist voluntarily chooses to get extra training, such as in Cognitive behavioural therapy or at a psychoanalytic institute, they will have less training in the theory and practice of psychotherapy than will a licensed clinical psychologist.^[40] Even though many psychiatrists do seek out such training, the majority of them increasingly focus on medication management, possibly because insurance tends to pay far more for this service than for psychotherapy.^[41] Further, psychologists tend to have more training in psychological assessment.

[edit] Counseling psychology

Main article: Counseling Psychology

Counseling generally involves helping 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.^[1][4] As such, counseling psychologists often help people adjust to or cope with their environment or major events, although many also work with more serious problems as well. Clinical psychologists, by comparison, are trained to help with these kinds of issues but also more debilitating or chronic problems, such as forms of dementia or psychosis. Other differences include: there are fewer counseling psychology graduate programs, they are usually housed in departments of education (as opposed to psychology departments for clin-psy programs), counseling psychologists tend to conduct more vocational assessment and less projective or objective assessment, and they are more likely to work in public service or university clinics (compared with clinical psychologists who are more likely to work in hospitals or private practice).^[42] Despite these differences, there is considerable overlap between the two fields and distinctions between them continue to fade.

[edit] Abnormal psychology

Main article: Abnormal Psychology

Abnormal psychology is the branch of academic psychology concerned with identifying, classifying and understanding psychopathology and unusual behaviors. Theories from abnormal psychology may form a part of the education and research of clinical psychologists, but abnormal psychology is not in itself a clinical profession.

[edit] School psychology

Main article: School psychology

School psychologists, also known as educational psychologists, are primarily concerned with the academic, social, and emotional well-being of children within a scholastic environment. Unlike clinical psychologists, they receive much more training in education, child development and behavior, and the psychology of learning, often graduating with a post-Masters Educational Specialist Degree (EdS) or Doctor of Education (EdD) degree. Besides offering individual and group therapy with children and their families, school psychologists also evaluate school programs, provide cognitive assessment, help design prevention programs (e.g. reducing drops outs), and work with teachers and administrators to help maximize teaching efficacy, both in the classroom and systemically.^[43]

[edit] Social Workers

Main article: Social Work

Social Workers provide a variety of services, including psychology, in a clinical setting . This might be done on behalf of a mental health clinic, a private practice, in a school setting, a social welfare agency, a hospital or for a department of social services. For the most part, social workers are concerned with social problems, their causes, and their solutions, but many also work with clients as a psychotherapist or psychological counselor in addition to more traditional social work.

The Master's in Social Work in the US is a two-year sixty credit program that usually includes at least a one year practicum. Unlike the Ph.D., which is an academic degree, the M.S.W. is considered a professional degree.

[edit] 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 Annual Review of Clinical Psychology (journal home) Annual Review of Psychology (journal home) British Journal of Psychotherapy British Journal of Social and 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 Affective Disorders Journal of Anxiety Disorders Journal of Child Psychotherapy

Journal of Clinical Child Psychology Journal of Clinical Psychology Journal of Clinical Psychology in Medical Settings Journal of Clinical Psychopharmacology Journal of Consulting and Clinical Psychology Journal of Contemporary Psychotherapy Journal of Family Psychotherapy Journal of Psychotherapy Integration Journal of Psychotherapy Praxis & Research Journal of Social and Clinical Psychology Psychopathology Psychotherapy & Psychosomatics Psychotherapy Research

[edit] Major influences

Alfred Adler Mary Ainsworth Gordon Allport Albert Bandura Aaron Beck Nathaniel Branden John Bowlby Albert Ellis Erik H. Erikson Milton H. Erickson Hans Eysenck Haim Ginott John Gottman Stanislav Grof Viktor Frankl Anna Freud Sigmund Freud Erich Fromm Karen Horney

Carl Gustav Jung Otto F. Kernberg Melanie Klein Heinz Kohut Ronald David Laing Marsha M. Linehan Abraham Maslow Rollo May Fritz Perls Otto Rank Wilhelm Reich Carl Rogers Martin Seligman Morita Shoma Harry Stack Sullivan Donald Woods Winnicott Lightner Witmer Joseph Wolpe Irvin Yalom

[edit] Criticisms and controversies

Clinical psychology is a diverse field and there have been recurring tensions over the degree to which clinical psychology should be based in empirical research and evidence-based practice or in self-reflection and clinical judgement. Trainees may undertake courses with different emphases in this respect and qualified professionals may register with different kinds of representative organizations.^[44]

Clinical Psychology can be subject to similar criticisms leveled at psychiatry, for example by the anti-psychiatry movement, especially when more aligned with a biomedical model or using psychiatric diagnostic categories such as in the DSM. 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^[44] It has been argued that therapeutic practices are inevitably bound up with power inequalities, which can be used for good and bad^[45] 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^[46]

Clinical Psychologists are sometimes criticized by psychiatrists for not having sufficient training or scientific knowledge in general medicine, genetics or medication. There has been controversy over attempts by clinical psychologists to obtain prescribing privileges.^[47]

Despite a growing evidence-base, there remains much debate about the efficacy of various forms of assessment and treatment in use in clinical psychology^[48]

[edit] See also

Psychologist Mental health Mental health professional Mental Health Counselor Mental illness Clinical neuropsychology Psychiatry

Social work Psychiatric and mental health nursing Anti-psychiatry Educational psychology School psychology Relationship counseling Health psychology

[edit] Related lists

• List of psychotherapies
• List of Clinical Psychologists
• List of credentials in psychology

[edit] References

[edit] External links

Organizations

• APA Society of Clinical Psychology (Division 12)
• American Academy of Clinical Psychology
• American Board of Professional Psychology
• American Counseling Association
• American Association for Marriage and Family Therapy
• Association of State and Provincial Psychology Boards (ASPPB)
• Society for the Exploration of Psychotherapy Integration
• National Institute of Mental Health
• The International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health

Information

• Info on the field of psychology form the U.S. Department of Labor, Bureau of Labor Statistics
• The Psychology Wiki
• Classics in the History of Psychology
• All About Psychotherapy

Career and Education

• Careers in Psychology
• Careers in Clinical and Counseling Psychology
• Graduate School Programs in Clinical Psychology
• APA Accredited Programs in Clinical Psychology
• Getting into Graduate School, APA

International

• International Society of Clinical Psychology
• International PSY Congresses
• Canadian Psychological Society
• British Psychological Society
• Psychology Societies Outside the U.S.

Finding a therapist

• Find A Psychologist, APA
• Find A Therapist, Psychology Today
• TherapistLocator.net, American Association for Marriage and Family Therapy