Clinical psychology

From Wikipedia, the free encyclopedia

Clinical psychology includes the scientific study and application of psychology for the purpose of understanding, preventing, and relieving psychologically-based distress or dysfunction and to promote subjective well-being and personal development.^[1][2] Central to its practice are psychological assessment and psychotherapy, although clinical psychologists also engage in research, teaching, consultation, forensic testimony, and program development and administration.^[3] In many countries it is a regulated mental health profession.

The field is often considered to have begun in 1896 with the opening of the first psychological clinic at the University of Pennsylvania by Lightner Witmer. In the first half of the 20th century, clinical psychology was focused on psychological assessment, with little attention given to treatment. This changed after the 1940s when World War II resulted in the need for a large increase in the number of trained clinicians. Since that time, two main educational models have developed—the Ph.D. (focusing on research) and the Psy.D. (focusing on practice). Clinical psychologists are now considered experts in providing psychotherapy, and generally train within four primary theoretical orientations—Psychodynamic, Humanistic, Cognitive Behavioral, and Systems or Family therapy.

Clinical psychology may be confused with psychiatry, which generally has similar goals (e.g. the alleviation of mental distress), but is unique in that psychiatrists are physicians. The most obvious difference is psychiatrists and, in some jusridictions, medical psychologists, an emerging specialty of psychology, are licensed to prescribe medication. In practice psychologists and psychiatrists often work closely together in multidisciplinary teams with other professionals such as occupational therapists and social workers to bring a multimodal approach to complex patient problems.

Contents 1 History 1.1 Early clinical psychology 1.2 Early professional organizations 1.3 World War II and the integration of treatment 1.4 Development of the Doctor of Psychology degree 1.5 A changing profession 2 Professional practice 3 Training and certification to practice 4 Assessment 4.1 Diagnostic impressions 5 Clinical theories and interventions 5.1 Four main perspectives 5.1.1 Psychodynamic 5.1.2 Humanistic 5.1.3 Cognitive behavioral 5.1.4 Systems or Family Therapy 5.2 Other major therapeutic orientations 5.3 Other perspectives 5.4 Integration 6 Professional ethics 7 Comparison with other mental health professions 7.1 Psychiatry 7.2 School psychology 7.3 Clinical social work 8 Clinical psychology journals 9 Major influences 10 Criticisms and controversies 11 See also 12 References 13 External links

[edit] History

Main articles: History of psychology and History of psychotherapy

Further information: Eastern philosophy and clinical psychology and Islamic psychology

Although modern, scientific psychology is often dated at the 1879 opening of the first psychological laboratory by Wilhelm Wundt, attempts to create methods for assessing and treating mental distress existed long before. The earliest recorded approaches were a combination of religious, magical and/or medical perspectives.^[4]

In the early 1800s, one could have his or her head examined, literally, using phrenology, the study of personality by the shape of the skull. Other popular treatments included physiognomy—the study of the shape of the face—and mesmerism, Mesmer's treatment by the use of magnets. Spiritualism and Phineas Quimby's "mental healing" were also popular.^[5]

While the scientific community eventually came to reject all of these methods, academic psychologists also were not concerned with serious forms of mental illness. That area was already being addressed by the developing fields of psychiatry and neurology within the asylum movement.^[4] It was not until the end of the 19th century, around the time when Sigmund Freud was first developing his "talking cure" in Vienna, that the first scientifically clinical application of psychology began.

[edit] 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.^[4] 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.^[6] 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."^[7] The field was slow to follow Witmer's example, but by 1914 there were 26 similar clinics in the U.S.^[8]

Even as clinical psychology was growing, working with issues of serious mental distress remained the domain of psychiatrists and neurologists.^[9] 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.^[5][6] 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.

[edit] 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.^[8] 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.^[10] In 1945 APA created what is now called Division 12, its division of clinical psychology, which remains a leading organization in the field. Psychological societies and associations in other English-speaking countries developed similar divisions, including in Britain, Canada, Australia and New Zealand.

[edit] World War II and the integration of treatment

When World War II broke out, the military once again called upon clinical psychologists for their assessment expertise. As soldiers began to return from combat, psychologists started to notice symptoms of psychological trauma labeled "shell shock" (eventually to be termed Post-Traumatic Stress Disorder) that were best treated as soon as possible.^[6] Because physicians (including psychiatrists) were over-extended in treating bodily injuries, psychologists were called to help treat this condition.^[11] 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.^[7] After the war, the Veterans Administration in the U.S. made an enormous investment to set up programs to train doctoral-level clinical psychologists to help treat the thousands of veterans needing care. As a consequence, the U.S. went from having no formal university programs in clinical psychology in 1946 to over half of all PhDs in psychology in 1950 being awarded in clinical psychology.^[7]

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 PhD programs in clinical psychology.^[12] Clinical psychology in Britain developed much like in the U.S. after WWII, specifically within the context of the National Health Service^[13] with qualifications, standards, and salaries managed by the British Psychological Society.^[14]

[edit] Development of the Doctor of Psychology degree

By the 1960s, psychotherapy had become imbedded within clinical psychology, but for many the Ph.D. educational model did not offer the necessary training for those interested in practice rather than research. There was a growing argument that said the field of psychology in the 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.^[15] 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.^[16] 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.^[15] Today, about half of all graduate students in clinical psychology are enrolled in Psy.D. programs.^[16]

[edit] 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.^[17] Clinical psychologists are still experts in assessment and psychotherapy, and have expanded their focus to address issues of prevention, gerontology, and even sports and the criminal justice system. The fastest growing area appears to be health psychology, which is reflected in hospitals being the fastest-growing employment setting for clinical psychologists in the past decade.^[5] Other major changes include the impact of managed care on mental health care, an increasing understanding of the importance of multicultural knowledge, an emerging practice of medical psychology in which practitioners receive the extensive additional education and training necessary for them to safely and effectively prescribe medications used in the management of psychological disorders, and the shift in the majority of practitioners of psychotherapy now having masters-level training.

[edit] Professional practice

Clinical psychologists can offer a range of professional services, including:^[7]

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

In practice, clinical psychologists may work with individuals, couples, families, or groups in a variety of settings, including private practices, hospitals, mental health organizations, schools, businesses, and non-profit agencies. Most clinical psychologists who engage in research and teaching do so within a college or university setting. Clinical psychologists may also choose to specialize in a particular field—common areas of specialization, some of which can earn board certification,^[18] include:

• Specific disorders (e.g. trauma, addiction, eating, sleep, sex, clinical depression, anxiety, or phobias)
• Neuropsychological disorders
• Child and adolescent
• Family and relationship counseling
• Health
• Sport
• Forensic
• Organization and business
• School

[edit] Training and certification to practice

Main article: Training and licensing of clinical psychologists

Clinical psychologists undergo many hours of graduate training—usually 4 to 6 years post-Bachelors—in order to gain demonstrable competence and experience. About half of all clinical psychology graduate students are being trained in Ph.D. programs—a model that emphasizes research and is usually housed in universities—with the other half in Psy.D. programs, which has more focus on practice (similar to professional degrees for medicine and law).^[16] Both models are accredited by the American Psychological Association^[19] 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 2 to 3 years post-bachelors.

In the U.K., clinical psychologists nearly always undertake a D.Clin.Psychol./Clin.Psy.D, 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 (N.H.S.) and based in universities and the N.H.S. Entry into these programs is highly competitive, and requires at least a three-year undergraduate degree in psychology approved by the British Psychological 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. It is not unusual for applicants to apply several times before being accepted onto a training course as only about a fifth of applicants are accepted each year.^[20] More information about the path to training in the UK can be found at the central clearing house for clinical psychology training applications, and at www.ClinPsy.org.uk where questions can also be answered on the forum, which is run by qualified clinical psychologists.

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:^[21]

1. Graduation from an accredited school with the appropriate degree
2. Completion of supervised clinical experience
3. Passing a written examination and, in some states, an oral examination

All U.S. state and Canada province licensing boards are members of the Association of State and Provincial Psychology Boards (ASPPB) which created and maintains the Examination for Professional Practice in Psychology (EPPP). Many states require other examinations in addition to the EPPP, such as a jurisprudence (i.e. mental health law) examination and/or an oral examination.^[21] 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 similar licenses can be obtained with a masters-level degree, such as Marriage and Family Therapist (MFT), Licensed Professional Counselor (LPC), and Licensed Psychological Associate (LPA).

In the UK, registration is only now becoming statutory and administered by the HPC. Previously there has been a voluntary scheme through which the BPS award practising certificates to qualified Clinical Psychologists who have completed sufficient continuing professional development activities and agree to abide by their professional Code of Conduct.

[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.^[22] 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.^[2]

There exist literally hundreds of various assessment tools, although only a few have been shown to have both high validity (i.e., test actually measures what it claims to measure) and reliability (i.e., consistency). These measures generally fall within one of several categories, including the following:

• Intelligence & achievement tests. These tests are designed to measure certain specific kinds of cognitive functioning (often referred to as IQ) 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/spacial perception. Several tests have been shown to predict accurately certain kinds of performance, especially scholastic.^[22]
• 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, presumably revealing non-conscious psychological dynamics.
• Neuropsychological tests. Neuropsychological tests consist of specifically designed tasks used to measure psychological functions known to be linked to a particular brain 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 common example of a formal interview is the mental status examination, which is often used as a screening tool for treatment or further testing.^[22]

[edit] Diagnostic impressions

See also: Mental disorder

After assessment, clinical psychologists often provide a diagnostic impression. Many countries use the International Statistical Classification of Diseases and Related Health Problems, while the U.S. uses the Diagnostic and Statistical Manual of Mental Disorders (the DSM version IV-TR). Both assume medical concepts and terms, and state that there are categorical disorders that can be diagnosed by set lists of descriptive criteria.^[23] Most American HMO and insurance companies require a diagnosis from the DSM before they will approve payment for treatment.

The DSM 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 self-reported symptoms, intensity, behaviors, duration, onset, et cetera. There is a growing awareness that this model is not the only way to understand or describe psychological impairment. Moreover, there is little empirical justification for the cutoff criteria, which are based on clinical consensus and are therefore essentially arbitrary.^[24] As such, there is a debate in the field regarding alternative methods of diagnosing psychological problems.

Several conceptual models are being discussed, including a "dimensional model" based on empirically validated models of human differences (such as the five factor model of personality^[24][23]) and a "psychosocial model", which would take changing, intersubjective states into greater account.^[25] 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.

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.^[26]

[edit] Clinical theories and interventions

Main article: Psychotherapy

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, feeling, or behaving.

Clinicians have a wide range of individual interventions to draw from, often guided by their training—for example, a CBT clinician might use worksheets to record distressing cognitions, a psychoanalyst might encourage free association, while an expressive therapist would employ forms of artistic expression. 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.^[7]

• 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).

[edit] Four main perspectives

The field can be seen as recognizing essentially four major perspectives: Psychodynamic, Humanistic, Cognitive Behavioral, and Systems or Family therapy.

[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.^[27] 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.^[27]

[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) and existential psychology developed by Victor Frankl and Rollo May.^[2] Rogers believed that a client needed only three things from a clinician to experience therapeutic improvement—congruence, unconditional positive regard, and empathetic understanding.^[28] 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.^[29] 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] 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.^[30] 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.^[31]

[edit] Systems or Family Therapy

Main article: 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.^[32] 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. Important contributors include John Gottman, Jay Haley, Susan Johnson, and Virginia Satir.

[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. 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.^[33] Important writers in existential therapy include Rollo May, Victor Frankl, James Bugental, 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".^[34]

• Postmodern. Postmodern psychology says that the experience of reality is a subjective construction built upon language, social context, and history, with no essential truths.^[35] 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.^[36] 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.^[37] 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. Important writers in this area include Ken Wilber, Abraham Maslow, Stanislav Grof, John Welwood, and David Brazier.

[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.^[38] 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.^[39] 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.

• 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.^[40]

• 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,^[41] 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.^[42][43] 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.^[44]

[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.^[45]

[edit] 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.^[46] 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.^[46] Detailed elements address how to resolve ethical issues, competence, human relations, privacy and confidentiality, advertising, record keeping, fees, training, research, publication, assessment, and therapy.

[edit] Comparison with other mental health professions

See also: Mental health professional

[edit] 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 physicians with four years of medical school and another four years of residency in a medical setting where they may specialize in certain age groups or specific conditions. Being physicians, tend to use the medical model to assess psychological problems (i.e. those they treat are seen as patients with an illness) and some rely on psychotropic medications as the chief method of addressing them^[47]— although many also employ psychotherapy as well. Psychiatrists and medical psychologists (who are clinical psychologists that are also trained to prescribe), 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 prescribe medication, although there is a growing movement for psychologists to have prescribing privileges.^[48] These medical privileges require extensive additional, supervised training and education. To date, medical psychologists may prescribe psychotropic medications in Guam, New Mexico, and Louisiana.^[49].

Unless a psychiatrist voluntarily chooses to get extra training beyond medical school—such as at a psychoanalytic institute or Cognitive Therapy studies —they will have less training in psychological assessment and psychotherapy than will a licensed clinical psychologist.^[50]

There are fewer counseling psychology graduate programs than those for clinical psychology and they are more often housed in departments of education rather than psychology. The two professions can be found working in all the same settings but counselors are more frequently employed in university counseling centers compared to hospitals and private practice for clinicians. ^[51] There is considerable overlap between the two fields and distinctions between them continue to fade.

[edit] 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. The majority of school psychologists possess a Professional Specialist training, Educational Specialist Degree (Ed.S.), with a minority holding the Doctor of Philosophy (Ph.D.) or Doctor of Education (Ed.D.) degree. 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.^[52][53]

[edit] 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 US and Canada), in addition to more traditional social work. The Masters in Social Work in the U.S. is a two-year, sixty credit program that usually includes at least a one year practicum. Unlike the PhD, which is a third level academic degree, the MSW is considered a professional degree (a second level university 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 [1] Annual Review of Psychology [2] British Journal of Psychotherapy British Journal of Clinical Psychology Clinical Psychology and Psychotherapy Clinical Psychology Review Clinical Psychology: Science and Practice In Session: Psychotherapy in Practice International Journal of Psychopathology, Psychopharmacology, and Psychotherapy International Journal of Psychotherapy Journal of Abnormal Psychology Journal of 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 Rational-Emotive and Cognitive Behaviour Therapy Journal of Social and Clinical Psychology Psychopathology Psychotherapy & Psychosomatics Psychotherapy Research

[edit] Major influences

Alfred Adler Mary Ainsworth Gordon Allport Albert Bandura Aaron Beck John Bowlby James Bugental Albert Ellis Erik H. Erikson Milton H. Erickson

Hans Eysenck 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 David Shakow Morita Shoma Harry Stack Sullivan Donald Woods Winnicott Lightner Witmer Joseph Wolpe Irvin Yalom Robert Yerkes

[edit] 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.^[54] It is also unclear as to what exactly constitutes adequate evidence to qualify as "support". Despite some evidence showing that all the major therapeutic orientations are about of equal effectiveness,^[55][56] there remains much debate about the efficacy of various forms of assessment and treatment in use in clinical psychology.^[57]

• 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.^[54] It has been argued that therapeutic practices are inevitably bound up with power inequalities, which can be used for good and bad.^[58] 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.^[59]

^[60]

[edit] See also

• Mental health professional
• Psychiatric and mental health nursing
• List of psychotherapies
• List of Clinical Psychologists
• List of credentials in psychology
• Anti-psychiatry
• Clinical neuropsychology
• Clinical Associate (Psychology)

[edit] References

[edit] External links

• APA Society of Clinical Psychology (Division 12)
• American Academy of Clinical Psychology
• American Board of Professional Psychology
• American Association for Marriage and Family Therapy
• Association of State and Provincial Psychology Boards (ASPPB)
• National Institute of Mental Health
• Info on the field of psychology form the U.S. Department of Labor, Bureau of Labor Statistics
• International Society of Clinical Psychology

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