Clinical psychology

From The Book of THoTH (Leaves of Wisdom)

Clinical psychology is the application of psychology to problematic mental distress in a health and social care context. Clinical Psychologists assess mental health problems; conduct and use scientific research to understand mental health problems; develop, provide and evaluate psychological care and interventions (psychotherapy). In America, they normally hold a Ph.D. or a Psy.D. graduate degree, and often have postgraduate work experience. The term was introduced in a 1907 paper by the American psychologist Lightner Witmer (1867-1956), who specifically defined it as the study of individuals, by observation or experimentation, with the intention of promoting change(Compass & Gotlib, 2002, p.5). The American Psychological Association offers a more modern definition of Clinical Psychology:

The field of Clinical Psychology integrates science, theory, and practice to understand, predict, and alleviate maladjustment, disability, and discomfort as well as to promote human adaptation, adjustment, and personal development. Clinical Psychology focuses on the intellectual, emotional, biological, psychological, social, and behavioral aspects of human functioning across the life span, in varying cultures, and at all socioeconomic levels(American Psychological Association, Division 12, About Clinical Psychology).

1 Professional practice
2 The Big Three perspectives
3 History
4 See also
- 4.1 Related lists
5 References
6 External links

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Professional practice

Clinical psychologists typically undergo many hours of postgraduate training under supervision in order to gain demonstrable competence and experience. In practice, they may work with individuals, couples, families, or groups in a variety of settings, including private offices, hospitals, private and public mental health organizations, schools, businesses, and non-profit agencies. Many also are active in academia, teaching, conducting research, or both. Clinical psychologists may specialize in a particular field (although not all do), including, but not limited to, mood disorders (depression), eating disorders (anorexia or bulimia), learning disorders, neuropsychological disorders (brain injury), or substance abuse. Many clinical psychologists diagnose their patients (or clients) based on criteria described in the DSM or ICD, although many clinical psychologists do not use a medical or categorical approach. Clinical psychologists do not usually prescribe medication, although there is a growing movement for psychologists to have prescribing privileges. Such privileges would require additional, supervised training and education.

Clinical psychologists evaluate patients (clients) and provide therapy. There are a wide variety of therapeutic techniques and perspectives that guide practitioners, although most fall into the major categories of Psychodynamic, Cognitive Behavioral, Humanistic, Systems (e.g. family or couples therapy), Gestalt, Existential and Transpersonal. A current trend is the use of an "eclectic" approach, by which a clinical psychologist may combine or adapt one or more techniques or theories in order to offer the best technique for any given client or situation.

Today, about half of Clinical Psychologists are being trained in the Scientist-Practitioner Model of Clinical Psychology (Ph.D.)—a model that emphasizes research—which is usually housed in universities. The other half are being trained within a Practitioner-Professional Model of Clinical Psychology (Psy.D.), which has slightly more focus on practice (similar to professional schools for medicine and law)(Norcross, J. & Castle, P. (2002)). Both models envision practicing Clinical Psychology in a research-based, scientifically valid manner. The American Psychological Association, among many English-speaking Psychological Societies, supports both models and accredits Ph.D. and Psy.D. programs that meet its academic standards.

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The Big Three perspectives

The field generally recognizes three major perspectives regarding the practice of clinical psychology: Psychodynamic, Cognitive Behavioral, and Humanistic (while a growing debate exists about including the Transpersonal perspective).

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Psychodynamic

The Psychodynamic perspective developed out of the Psychoanalysis of Sigmund Freud. The core object of Psychoanalysis is to make the unconscious conscious—to make the client aware of his or her own primal drives (namely those relating to sex and aggression) and the various defenses used to keep them in check. The essential tools of the psychoanalytic process are the use of free association and an examination of the client's transference towards the therapist, defined as the tendency to take unconscious thoughts or emotions about a significant person (e.g. a parent) and apply them to another person who is similar in some way.

Many theorists built upon Freud's fundamental ideas, including Anna Freud, Alfred Adler, Carl Jung, Heinz Hartmann, Karen Horney, Erik Erikson, Ronald Fairbairn, Otto Kernberg, Melanie Klein, Heinz Kohut, Margaret Mahler, David Rapaport, Donald Winnicott, and Harry Stack Sullivan. Major variations on Freudian psychoanalysis include Self Psychology, Ego Psychology, and Object Relations Theory. However, there are still common themes that appear within psychodynamic psychology, 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.

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Cognitive Behavioral

Cognitive Behavioral Therapy (CBT) developed out of the two branches, Cognitive psychology and Behaviorism. Behaviorism operates from the perspective that how people behave is largely (if not completely) determined by a combination of forces comprising genetic factors and the environment, either through association or reinforcement. In its most radical form, it has even denied that inner mental states exist at all, as espoused by famous behaviorists like B.F. Skinner and John B. Watson. Cognitive psychology, on the other hand, is the psychological science that studies cognition, the mental processes that underlie behavior, including thinking, reasoning, decision making, and to some extent motivation and emotion.

In the 1950s and '60s, theorists Albert Ellis and Aaron T. Beck began combining the two perspectives to create CBT. Essentially, it is based on the idea that how we think (cognition), how we feel (emotion), and how we act (behavior) all interact together. Specifically, our thoughts determine our feelings and our behavior. Therefore negative thoughts can cause us distress and result in problems. The object of CBT is to discover the biased and irrational thinking that leads to emotional problems and to help the client take control over his or her thinking processes in such a way that will lead to increased well-being. There are various approaches along the lines of CBT, such as Rational Emotive Behavior Therapy and Dialectic Behavior Therapy, both of which have been shown to be effective in treating certain conditions, such as depression and phobias.

These theories most closely ally with the Scientist-Practitioner Model of Clinical Psychology, in which clinical practice and research is informed by a scientific perspective; clear operationalization of the "problem" or "issue;" an emphasis on measurement (and measurable changes in cognition and behavior); and measurable goal-attainment.

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Humanistic

Humanistic psychology was developed in the 1950s largely as a 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 only three things a client needed from a therapist to become self-actualized—congruence, unconditional positive regard, and empathetic understanding. The aim of much humanistic therapy is to give a holistic description of the person. By using phenomenological, intersubjective and first-person categories, the humanistic psychologist hopes to get a glimpse of the whole person and not just the fragmented parts of the personality(Rowan, 2001). This aspect of holism links up with another aim of humanistic 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 point the individual in the direction of these resources.

It is arguable that Humanistic psychology is more of an outlook than a set of techniques. Even so, there are several therapeutic approaches that could be called Humanistic, including Gestalt Therapy, Existential therapy, Experiential psychotherapy, Psychodrama, and Transpersonal therapy.

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History

Clinical psychology developed partly as a result of a need for additional clinicians to treat mental health problems, and partly as psychological science advanced to the stage where the fruits of psychological research could be successfully applied in clinical settings.

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References

Compass & Gotlib. (2002). Introduction to Clinical Psychology. Boston : McGraw Hill. ISBN 007124914
American Psychological Association, Division 12, About Clinical Psychology
Rowan, John. (2001). Ordinary ecstasy : the dialectics of humanistic psychology. Hove: Brunner-Routledge.
Norcross, J. & Castle, P. (2002). Appreciating the PsyD: The Facts. Eye on Psi Chi, 7(1), 22-26.

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