What is Clinical Psychology?

overview

Clinical psychology is a field that applies psychological research and techniques in “clinical” settings. According to one simple clinical psychology definition, it’s “the study of individuals, by observation or experimentation, with the intention of promoting change.” Their field is “clinical” because it involves observing and working directly with patients in clinics and related settings. However, the practitioners may also work as part of a team of other health or social workers. Clinical psychologists meet with individuals, families and other groups in places like counseling centers, schools and hospitals. They practice in community health clinics and veteran service centers.

Most clients seek psychological services on their own accord. But clinical psychologists are sometimes appointed by courts or insurance companies to perform psychological assessment and evaluations that inform legal judgments. So clinical psychologists assess the mental health of inmates in prisons. Whatever the situation, they must be good listeners, highly skilled, and able to recognize mental and psychological disorders,  and offer treatments. They must also be organized, as collecting data and maintaining accurate records of client sessions is part of the job.

History

Early influences on the field of clinical psychology include the work of the Austrian psychoanalyst Sigmund Freud. He was one of the first to focus on the idea that mental illness was something that could be treated by talking with the patient, and it was the development of his talk therapy approach that is often cited as the earliest scientific use of clinical psychology.

American psychologist Lightner Witmer opened the first psychological clinic in 1896 with a specific focus on helping children who had learning disabilities. It was also Witmer who first introduced the term “clinical psychology” in a 1907 paper. Witmer, a former student of Wilhelm Wundt, defined clinical psychology as “the study of individuals, by observation or experimentation, with the intention of promoting change.”¹

By 1914, 26 other clinics devoted to the practice of clinical psychology had been established in the United States. Today, clinical psychology is one of the most popular subfields and the single largest employment area within psychology.

Evolution During the World Wars

Clinical psychology became more established during the period of World War I as practitioners demonstrated the usefulness of psychological assessments. In 1917, the American Association of Clinical Psychology was established, although it was replaced just two years later with the establishment of the American Psychological Association (APA).

During World War II, clinical psychologists were called upon to help treat what was then known as shell shock, now referred to as post-traumatic stress disorder (PTSD).

The demand for professionals to treat the many returning veterans in need of care contributed to the growth of clinical psychology during this period.

During the 1940s, the United States had no programs that offered a formal degree in clinical psychology. The U.S. Veterans Administration set up a number of doctoral-level training programs, and by 1950 more than half of all the Doctor of Philosophy (Ph.D.)-level degrees in psychology were awarded in the area of clinical psychology.

What Does Clinical Psychology Focus On?

Clinical psychology provides mental health services for people of all ages and from all walks of life. Methods and techniques may vary from practice to practice. But the focus of clinical psychology is on assessing clients’ mental health through psychological assessment and testing, and providing appropriate interventions. In addition to these primary activities, clinical psychologists sometimes conduct research and act as consultants. Here is a closer look at the primary functions of a clinical psychologist:

Assessing. In helping restore mental health, clinical psychologists follow much the same progression that medical doctors follow in restoring physical health. They must first find out what the problem is and what’s causing it. So the clinical psychologist assesses the client in order to diagnose the mental health issue. This is done in multiple ways.

• In a diagnostic interview, the clinical psychologist asks questions that give the client opportunities to talk about himself or herself. These questions probe into what the client is thinking, feeling and doing, and how the past influences the present.
• A behavioral assessment allows a clinical psychologist to observe and evaluate a client’s behavior. This assessment may reveal a pattern of behavior that indicates the presence of mental disorder and illness.
• Standardized psychological tests may be given in order to measure a mental disorder. These are formal tests often given in the form of checklists and questionnaires.

Intervening. Based on what the assessments reveal, the practitioner will recommend a psychological intervention, or treatment. There are different approaches to treatment. Some clinical psychologists favor one method over the others, but multiple approaches may be employed in treating a client. Regardless of which approach is used, treatments require multiple sessions. Occasional follow-up visits are often part of mental health maintenance plans after treatments have concluded.

• The cognitive behavioral approach holds that many mental disorders stem from a person’s negative thoughts and behaviors. These are often exposed through “talk therapy,” which involves confronting potentially uncomfortable and painful past topics through honest dialogue. The goal is to help the client recognize emotional triggers and teach them how to respond to them in a positive way. 
• The psychodynamic approach also helps the client become aware of negative thoughts, but emphasizes the unconscious mind. Through psychoanalysis, the clinical psychologist helps the client explore and sort out hidden conflicts from the past. 
• The humanistic approach is also known as “client-centered therapy.” It promotes acceptance, empathy and the idea that the client knows himself or herself better than anyone else. It also holds that focusing on the present is more important than digging up events from one’s past.

Consulting. In addition to treating clients, clinical psychologists are sometimes contacted by other health professionals and organizations. They may be asked to collaborate on community health initiatives or provide expertise in some other way. 

Researching. Even though clinical psychologists spend most of their time with clients, they continuously draw on the latest research. They may also conduct original research based on data they have collected. 

Changes in Focus

While the early focus in clinical psychology had been largely on science and research, graduate programs began adding additional emphasis on psychotherapy. In clinical psychology Ph.D. programs, this approach is today referred to as the scientist-practitioner or Boulder Model. Later, the Doctor of Psychology (Psy.D.) degree option emerged, which placed a greater emphasis on professional practice rather than research. This practice-oriented doctorate degree in clinical psychology is known as the practitioner-scholar, or Vail model.²

The field has continued to grow tremendously, and the demand for clinical psychologists today remains strong.

What is the Difference Between Clinical Psychology and Psychiatry?

The fields of psychology and psychiatry are often confused, as both treat mental and emotional disorders. But the training and methods used in these disciplines are quite different. Psychologists treat clients whose mental illness may be the result of past emotional traumas or other negative influences. Treatments usually involve working through problems using talk therapy and other non-medical techniques. Psychologists are not medical doctors, but instead hold doctorate degrees in either psychology (PsyD) or philosophy (PhD).

When a client’s disorder is attributed to an imbalance in brain chemistry or some other physiological cause, that’s when a psychiatrist steps in. Psychiatrists generally have undergraduate degrees in psychology, and therefore know many of the cognitive-behavioral treatments that clinical psychologists use. They are medical doctors (MDs) who specialize in the medical treatment of mental illnesses. Whereas most psychologists cannot prescribe medications, psychiatrists can. 

Is Clinical Psychology the Same as Therapy or Counseling?

Many people use the terms clinical psychologist, therapist and counselor interchangeably. This is understandable, as professionals in those fields often perform similar roles. They work in similar settings – from schools and hospitals to private practices – and must be state-certified to practice. They hold clinical sessions with clients to resolve psychological and behavioral dysfunctions. They administer psychological tests, and prescribe appropriate cognitive therapies and coping strategies.

However, the educational requirements and clinical training are higher for clinical psychologists, as therapists are generally required to have only a master’s degree. And while therapists may treat patients who have mental illnesses with their master’s level degree, they often work with clients who don’t. People who are struggling with substance abuse, marital trouble or personal tragedy often seek out therapists over clinical psychologists. 

Education Requirements

In the United States, clinical psychologists usually have a doctorate in psychology and receive training in clinical settings. The educational requirements to work in clinical psychology are quite rigorous, and most clinical psychologists spend between four to six years in graduate school after earning a bachelor’s degree.

Generally speaking, Ph.D. programs are centered on research, while Psy.D. programs are practice-oriented. Students may also find some graduate programs that offer a terminal master’s degree in clinical psychology.

Before choosing a clinical psychology program, you should always check to be sure that the program is accredited by the APA. After completing an accredited graduate training program, prospective clinical psychologists must also complete a period of supervised training and an examination.

Specific licensure requirements vary by state, so you should check with your state’s licensing board to learn more.

Students in the United Kingdom can pursue a doctorate level degree in clinical psychology (D.Clin.Psychol. or Clin.Psy.D.) through programs sponsored by the National Health Service. These programs are generally very competitive and are focused on both research and practice. Students interested in enrolling in one of these programs must have an undergraduate degree in a psychology program approved by the British Psychological Society in addition to experience requirements.

Opportunities

Clinical psychologists work in a variety of settings (hospitals, clinics, private practice, universities, schools, etc.) and in many capacities. All of them require these professionals to draw on their expertise in special ways and for different purposes.

Some of the job roles performed by those working in clinical psychology can include:

• Assessment and diagnosis of psychological disorders, such as in a medical setting
• Treatment of psychological disorders, including drug and alcohol addiction
• Offering testimony in legal settings
• Teaching, often at the university level
• Conducting research
• Creating and administering programs to treat and prevent social problems

Some clinical psychologists may focus on one of these or provide several of these services. For example, someone may work directly with clients who are admitted to a hospital for psychological disorders, while also running a private therapeutic office that offers short-term and long-term outpatient services to those who need help coping with psychological distress.