Clinical Psychology Research Paper
preferred specialization Clinical psychologists assess and treat mental, emotional, and behavioral disorders. These range from short-term crises, such as difficulties resulting from adolescent rebellion, to more severe, chronic conditions such as schizophrenia. Some clinical psychologists treat specific problems exclusively, such as phobias or clinical depression. Others focus on specific populations: youngsters, ethnic minority groups, gays and lesbians, and the elderly, for instance. They also consult with physicians on physical problems that have underlying psychological causes. Counseling psychologists help people recognize their strengths and resources to cope with their problems. Counseling psychologists do counseling/psychotherapy, teaching, and scientific research with individuals of all ages, families, and organizations (e.g., schools, hospitals, businesses). Counseling psychologists help people understand and take action on career and work problems. They pay attention to how problems and people differ across life stages. Counseling psychologists have great respect for the influence of differences among people (such as race, gender, sexual orientation, religion, disability status) on psychological well-being. They believe that behavior is affected by many things, including qualities of the individual
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(e.g., psychological, physical, or spiritual factors) and factors in the person 's environment (e.g., family, society, and cultural groups). Health psychologists specialize in how biological, psychological, and social factors affect health and illness. They study how patients handle illness; why some people don 't follow medical advice; and the most effective ways to control pain or to change poor health habits. They also develop health care strategies that foster emotional and physical well-being. Psychologists team up with medical personnel in private practice and in hospitals to provide patients with complete health care. They educate medical staff about psychological problems that arise from the pain and stress of illness and about symptoms that may seem to be physical in origin but actually have psychological causes. Health psychologists also investigate issues that affect a large segment of society, and develop and implement programs to deal with these problems. Examples are teenage pregnancy, substance abuse, risky sexual behaviors, smoking, lack of exercise, and poor diet. Social psychologists study how a person 's mental life and behavior are shaped by interactions with other people. They are interested in all aspects of interpersonal relationships, including both individual and group influences, and seek ways to improve such interactions. For example, their research helps us understand how people form attitudes toward others, and when these are harmful-as in the case of prejudice-suggests ways to change them. Social psychologists are found in a variety of settings, from academic institutions (where they teach and conduct research), to advertising agencies (where they study consumer attitudes and preferences), to businesses and government agencies (where they help with a variety of problems in organization and management). Clinical psychologists make up the single largest specialty area in psychology. Clinicians are psychologists who assess, diagnose and treat mental illnesses. They frequently work in mental health centers, private or group practices or hospitals. Within the area of clinical psychology, there are also a number of sub-specialty areas. Some professionals are generalists and work with a wide range of clients, while others specialize in treating certain types of psychological disorders or a certain age group. For example, some clinical psychologists might work in a hospital setting with individuals suffering from brain injuries or neurological conditions. Other clinical psychologists might work in a mental health center to counsel individuals or families coping with stress, mental illness, substance abuse or personal problems.
Clinical psychologists usually perform a wide range of tasks on a daily basis such as interviewing patients, conducting assessments, giving diagnostic tests, performing psychotherapy and administering programs. Work settings can vary based on the specific population that a clinician is working with. Common work settings include hospitals, schools, universities, prisons, mental health clinics and private practices.
There are also a number of different sub-specialty areas within clinical psychology, including health psychology, neuropsychology and geropsychology. Counseling psychologists make up another large specialty area in psychology. These professionals perform many of the same tasks that clinical psychologists do, but counseling psychologists tend to work with clients suffering from less severe forms of mental illness. Counseling psychology focuses on providing therapeutic treatments to clients who experience a wide variety of symptoms. The Society of Counseling Psychology describes the field as "a psychological specialty [that] facilitates personal and interpersonal functioning across the life span with a focus on emotional, social, vocational, educational, health-related, developmental and organizational concerns." • OOH HOME |
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Psychologists
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• Summary
• What They Do
• Work Environment
• How to Become One
• Pay
• Job Outlook
• Similar Occupations
• Contacts for More Info
What Psychologists Do About this section Industrial-organizational psychologists apply psychological research and methods to workplace issues.
Psychologists study mental processes and human behavior by observing, interpreting, and recording how people and other animals relate to one another and the environment.
Duties
Psychologists typically do the following:
• Conduct scientific studies to study behavior and brain function
• Collect information through observations, interviews, surveys, tests, and other methods
• Find patterns that will help them understand and predict behavior
• Use their knowledge to increase understanding among individuals and groups
• Develop programs that improve schools and workplaces by addressing psychological issues
• Work with individuals, couples, and families to help them make desired changes to behaviors
• Identify and diagnose mental, behavioral, or emotional disorders
• Develop and carry out treatment plans
• Collaborate with physicians or social workers to help treat patients
Psychology seeks to understand and explain thoughts, emotions, feelings, and behavior. Depending on the topic of study, psychologists use techniques such as observation, assessment, and experimentation to develop theories about the beliefs and feelings that influence a person’s actions.
Psychologists often gather information and evaluate behavior through controlled laboratory experiments, psychoanalysis, or psychotherapy. They also may administer personality, performance, aptitude, or intelligence tests. They look for patterns of behavior or cause-and-effect relationships between events, and use this information when testing theories in their research or treating patients.
The following are common occupational specialties:
Clinical psychologists assess, diagnose, and treat mental, emotional, and behavioral disorders. Clinical psychologists help people deal with problems ranging from short-term personal issues to severe, chronic conditions.
Clinical psychologists are trained to use a variety of approaches to help individuals. Although strategies generally differ by specialty, psychologists often interview patients, give diagnostic tests, and provide individual, family, or group psychotherapy. They also design behavior modification programs and help patients implement their particular program.
Some clinical psychologists focus on certain populations, such as children or the elderly, or certain specialties, such as the following:
• Health psychologists study how psychological factors affect health and illness. They educate both patients and medical staff about psychological issues, and promote healthy-living strategies. They also investigate health issues, such as substance abuse or teenage pregnancy, and develop programs to address the problems.
• Neuropsychologists study the relation between the brain and behavior. They typically work with patients who have sustained a brain injury.
Clinical psychologists often consult with other medical personnel regarding the best treatment for patients, especially treatment that includes medication. Two states, Louisiana and New Mexico, currently allow clinical psychologists to prescribe medication to patients. In most states, however, only psychiatrists and medical doctors may prescribe medication for treatment. For more information, see the profile on physicians and surgeons.
Counseling psychologists advise people on how to deal with their problems. They help patients understand their problems, including issues in the home, workplace, or community. Through counseling, they work with patients to identify the strengths or resources they can use to manage problems. For information on similar workers, see the profiles on mental health counselors and marriage and family therapists, substance abuse and behavioral disorder counselors, and social workers.
Developmental psychologists study the psychological progress and development that takes place throughout life. Many focus on children and adolescents. Development psychologists also increasingly study aging and problems faced by the elderly.
Forensic psychologists use psychological principles in the legal and criminal justice system to help judges, attorneys, and other legal specialists understand the psychological findings of a particular case. They often appear in court as expert witnesses. They typically specialize in family court, civil court, or criminal court.
Industrial-organizational psychologists apply psychology to the workplace by using psychological principles and research methods to solve problems and improve the quality of work life. They study issues such as workplace productivity, management or employee working styles, and morale. They also work with management on matters such as policy planning, employee screening or training, and organizational development.
School psychologists apply psychological principles and techniques to education-related issues. For example, they may address students’ learning and behavioral problems, evaluate students’ performances, and counsel students and families. They also may consult with other school-based professionals to suggest improvements to teaching, learning, and administrative strategies.
Social psychologists study how people’s mindsets and behavior are shaped by social interactions. They examine both individual and group interactions and may investigate ways to improve negative interactions.
Some psychologists become professors or combine research with teaching. For more information, see the profiles on postsecondary teachers and high school teachers. Suggested citation:
Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2012-13 Edition, Psychologists
Purpose
The field of clinical psychology was established in the 1890s and has undergone substantial transformation during the past 120 years. By learning about the historical roots of clinical psychology, we can better understand current developments and gain insight into how the field may continue to develop.
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Commentary
Welcome to the study of clinical psychology! You may ask, "What is clinical psychology?" As a discipline, clinical psychology is hardly more than a century old. Despite its relatively young age, clinical psychology has changed dramatically since its inception in the late nineteenth century. If you were to travel back in time to the beginnings of the field, you would have a very different opinion about what a clinical psychologist does than we do today. For example, it may surprise you to learn that until World War II, clinical psychologists were rarely allowed to perform a duty that is now considered to be an integral part of their work: providing psychological interventions to individuals in distress or with psychiatric symptoms.
As members of a rapidly evolving discipline, clinical psychologists have often found themselves at odds with other medical and mental health care providers and even with one another. Past battles over the ability to provide psychological interventions have faded into memory, only to be revisited today as some clinical psychologists fight for the right to prescribe psychopharmacological medications alongside medical doctors, psychiatrists, and psychiatric nurses. At times, it seems that even clinical psychologists themselves cannot agree on what clinical psychology is. For example, there is currently a great debate about whether psychological interventions are a branch of science or a form of art. If they are an art, should we subject them to the rigors of empirical study? If they are a science, should we be allowed to continue a practice that has no research support? As you progress through this course, you may find that there are no clear-cut answers to these questions.
This is an exciting time in the field of clinical psychology. Now, as in the past, clinical psychology is in a period of turmoil, change, and growth. In order to understand how modern clinical psychology has developed and to lay a groundwork for understanding future developments in the field, we must first look at the beginnings of this ever-changing discipline.
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What Is a Clinical Psychologist?
Psychology, like many disciplines, consists of a dizzying array of subgroups and specialties. In addition to clinical psychologists, there are counseling psychologists, school psychologists, developmental psychologists, cognitive psychologists, social psychologists, personality psychologists, and so on. While we will look at some of these subgroups shortly, we will focus on clinical psychologists during this course. Image 1.1. Group therapy is an activity that many associate with clinical psychologists. However, it is just one of several professional activities clinical psychologists typically engage in.
When people are asked to describe what a psychologist does, they often mention activities that are familiar to most clinical psychologists: performing individual or group therapy, asking questions about psychiatric symptoms, measuring intelligence, or assessing personality. While some clinical psychologists spend most of their time on these clinical activities, others spend relatively little time on them.
You may wonder, "If clinical psychologists are not conducting therapy or performing assessments, what are they doing?" In addition to clinical work, the scientific study of mental health disorders is an important area for many clinical psychologists. Clinical psychologists employed by universities often work as researchers who develop and test interventions designed to prevent or treat mental health disorders. Other clinical psychologists work as instructors or professors and teach a variety of topics within the field of psychology to undergraduate and graduate students.
Regardless of their professional duties, all clinical psychologists have completed a doctoral degree and earned the title doctor of philosophy (PhD) or doctor of psychology (PsyD). In the next lesson, we will learn more about the different training models in clinical psychology and the relationship between training and professional activities.
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What Is a Mental Health Professional? A mental health professional can be defined as a trained professional who provides some form of assessment or intervention with the intent of identifying and relieving distress or psychiatric symptoms. Clinical psychologists can be generally described as mental health professionals, but not all mental health professionals are clinical psychologists. In fact, a number of related health disciplines are similar to clinical psychology in terms of the services they provide and the client populations they treat. Counseling psychologists, school psychologists, psychiatrists, and social workers are all mental health professionals who are similar to clinical psychologists but who belong to distinct disciplines.
Counseling Psychology
Like clinical psychologists, counseling psychologists are required to complete a doctoral degree before they can provide therapy and assessment. However, counseling psychologists may complete either a doctorate in philosophy (PhD) or a doctorate in education (EdD). Traditionally, counseling psychologists work with individuals who have less severe problems (e.g., school- or work-related stress), while clinical psychologists treat individuals with severe psychiatric symptoms (e.g., depression or personality disorder). Counseling psychologists typically work in educational settings (e.g., university counseling clinics), while clinical psychologists work in hospital or psychiatric inpatient settings.
School Psychology
School psychologists complete a doctorate in philosophy (PhD) and often work in a school setting with other educators to promote intellectual, social, and emotional growth in students. School psychologists may recommend services for children with special needs, conduct intelligence tests, or help develop or implement school-based intervention programs.
Psychiatry
Psychiatrists are medical doctors who have completed additional training in the treatment of mental health disorders. Psychiatrists typically complete a doctorate in medicine (MD), which reflects their extensive training in physiological and biochemical systems. Compared to clinical psychologists, however, psychiatrists have relatively little training in psychological functioning or research methods. Psychiatry is rooted in the field of medicine, so it is not surprising that psychopharmacological treatment is a primary approach to the treatment of mental health disorders among members of this discipline. Psychiatrists are allowed to prescribe medication, while psychologists (including clinical psychologists) are not. This is an area of controversy in the field of clinical psychology that we will talk more about later in this course.
Social Work
Unlike psychologists and psychiatrists, most social workers are allowed to provide therapy and assessment after completing a bachelor 's (BSW) or master 's (MSW) degree in social work. Social workers often focus on large social issues, such as legal problems, housing, or food assistance, and are more likely to provide treatment in a client 's home or another community setting compared to psychologists and psychiatrists.
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Historical Developments in Clinical Psychology
Early Origins
During the late 1800s and early 1900s, a number of important contributions were made that served as the foundation for a new discipline: clinical psychology. This period was characterized by increased interest in the scientific study of the human mind. Sir Francis Galton was among the first to formally study individual differences among people, and his work influenced other researchers to measure individual characteristics, such as aptitude and mental ability. Within a few years of each other, Wilhelm Wundt established the first psychology laboratory in Germany and William James established the first psychology laboratory in the United States. While initial efforts were crude, early systems of diagnosis and measuring mental ability began to develop. In 1896, Lightner Witmer established the first psychological clinic and coined the term "clinical psychology."
Sigmund Freud was one of the first to create a formal approach to psychotherapeutic treatment and is one of the founding fathers of psychoanalytic therapy.
Freud emphasized the importance of unconscious processes and drives, the importance of early childhood experiences, and the role of insight as a mechanism for therapeutic change. Freud inspired a number of his students, including Carl Jung and Alfred Adler, to make further contributions in the field of psychology. Later approaches to psychotherapy, such as behaviorism and client-centered therapy, were heavily influenced by the idea of psychoanalytic therapy, despite moving in radically different
directions.
World Wars I and II Image 1.2. In this photo c. 1942, U.S. Army Air Corps cadets take group tests that are psychologically weighted more heavily for pilots, navigators, and bombardiers.
The field of clinical psychology might not exist today without the need for psychological tests and mental health professionals that was created by the two world wars. When the United States entered World War I, there was a great need for an assessment tool to identify the mental fitness of soldiers. Two tests—Army Alpha and Army Beta—were developed and, with the success of early intelligence and personality tests developed during the 1920s and 1930s, the field of clinical psychology came to be based around the development, administration, scoring, and interpretation of psychological tests.
Prior to World War II, clinical psychologists were rarely given the opportunity to conduct psychotherapy, a professional activity that was almost exclusively carried out by psychiatrists. However, the large number of men returning from war with trauma-related psychological problems quickly overwhelmed the nation 's psychiatric resources, and clinical psychologists were called upon to step in and provide psychotherapy at a widespread level. While the addition of clinical psychologists as psychotherapists was intended to be temporary, they quickly established themselves as competent clinicians, forming a professional identity that would last for the next 40 years.
Postwar
After World War II, clinical psychologists continued to make important developments in the areas of assessment and intervention. Old versions of intelligence tests and personality inventories were revised, and new assessments were developed and tested. In the 1950s, psychiatrists published a comprehensive system of diagnosis called the Diagnostic and Statistical Manual for Mental Health Disorders (DSM) that was later adopted by clinical psychologists and most other mental health professions. The DSM has been revised several times over the years. The early editions were flawed because they included vague descriptions of symptoms, which led to misdiagnosis and disagreement between clinicians on whether symptoms were present or absent in a given patient. Later editions addressed that shortcoming, and as a result, mental health diagnoses can now be established with much greater reliability. As of the date of this course 's development (2011), the DSM is in its fourth edition with a fifth edition release anticipated in 2013. However, the DSM will continue to be re-evaluated in the years to come, and new editions may be released as updates become necessary.
After the world wars, new forms of psychotherapy began to develop, including the humanistic and behavioral approaches, which challenged the practices and assumptions of psychoanalytic psychotherapy. Critics such as Hans Eysenck questioned the effectiveness of psychotherapy. In 1952, Eysenck published data suggesting some patients in therapy received no more benefit than those who received no therapy at all. This finding shocked many clinical psychologists and spurred some researchers to demonstrate that psychotherapy did work for many patients. Mary Smith, Gene Glass, and T. I. Miller (1980) used a statistical technique called meta-analysis to summarize the results of 475 studies of psychotherapy and found that the average patient receiving therapy was better off compared to 80% of people with similar problems who did not receive treatment. This research established that there was a benefit to psychotherapy, and it inspired researchers to begin identifying which treatments were beneficial for whom and under what conditions.
Another major change in the field of clinical psychology began in the 1980s with the advent of managed health care organizations (HMOs and MCOs) and insurance regulations. In response to unchecked spending in the medical and mental health professions, insurance companies and managed care organizations began to tightly regulate reimbursement for services. In the field of clinical psychology, this meant limited reimbursement for lengthy assessment and psychotherapy procedures. Long-term therapies, such as psychoanalytic therapy, which requires patients to attend therapy three or four times a week for several years, might be reimbursed for only a few sessions but then require the patient to pay for any remaining services. Similarly, lengthy assessment procedures, such as intelligence and personality testing, were less likely to be reimbursed.
The cost-containment strategy of health care organizations was one of the factors that led toward the development of short-term treatments. Researchers began testing brief treatments designed for specific populations (e.g., depressed adults, anxious teenagers), and this led to the creation of the evidence-based practice (EBP) movement in psychology. The EBP movement maintains a psychological intervention must be tested empirically and shown to be superior to no treatment or equivalent to another well-established treatment before it is implemented.
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Evidence-Based Practice in Psychology
You may be asking, "How do we know when a psychological intervention is effective?" This is a question of great interest to clinical psychologists today, regardless of whether they are providing treatment or conducting research.
Let 's use the hypothetical examples below to help us think about the issue of effective treatment. Figure 1.1 shows the change in symptoms for a 24-year-old male with depression during a 15-week course of psychotherapy. The numbers on the y-axis indicate the severity of depression symptoms, with the larger numbers indicating more severe symptoms. On the x-axis, there are six time points at which the subject filled out a questionnaire about his symptoms for that week. What might we conclude from Figure 1.1? At the beginning of treatment, the subject had a depression severity score of 30, and at the end of treatment, he had a score of 18. Can we conclude it was the treatment that caused him to improve? Perhaps not. Neither can we rule out the possibility that the subject got better simply as a result of the passage of time. Research has shown that 90 percent of individuals with depression improve within two years of becoming depressed, even without receiving any type of treatment. So, even if the treatment in Figure 1.1 was completely ineffective, we would still expect the patient to improve slowly over time as his depression gradually remits.
What, then, might we do to test the treatment more rigorously? We could randomly select a group of individuals to receive treatment for depression while another randomly selected group does not receive any treatment at all. This would allow us to test whether there is any direct benefit from treatment or whether individuals improve over time regardless of treatment or nontreatment.
This situation is shown below in Figure 1.2. The blue line indicates individuals in the treatment group, and the red line indicates individuals in the control group. What might we conclude from Figure 1.2? At the beginning of treatment, the people in the treatment group and the people in the control group report being equally depressed and have a severity score of 30. At Week 4, the treatment group is doing slightly better, but at Week 12, the control group is doing slightly better (remember, lower scores on the y-axis indicate less severity). By the end of Week 15, both groups have improved—but there appears to be no benefit to treatment. In this example, we have strong support that a reduction in depressive symptoms is due to the passing of time (which both groups experienced) rather than any specific effects of intervention (which only the treatment group experienced).
Figure 1.3 is the same as Figure 1.2 except that we see a change between the treatment and control groups. What might we conclude from Figure 1.3? As in the previous example, the treatment and control groups are equally depressed at the beginning of treatment and have a severity score of 30. Starting at Week 4, both groups report their symptoms have decreased, but the individuals in the treatment group report less severe symptoms than those in the control group. This trend continues until, at Week 15, we see a marked difference in the severity of symptoms in the groups. As in the previous example, there is some improvement in the control group. However, there is significantly more improvement among individuals in the treatment group. This provides strong support for the idea that treatment results in greater change than we might expect from the passing of time alone. These examples illustrate the basic ideas behind evidence-based practice in psychology. Evidence-based practice attempts to not only answer the question of "what treatments work?" but also the question of "what treatments work for whom and under which conditions?" The idea behind this approach is that we must scientifically test treatments in order to demonstrate they are effective. Of course, we not only want to test a treatment against no-treatment conditions but against other treatments that have already been developed. In this way, we can begin to identify those treatments that provide maximum benefit.
EBP is one of the most controversial topics in the field of psychology. Some clinicians argue that it is inappropriate to take data gathered from groups and apply it to an individual. Advocates of EBP argue that it represents the treatments that have been shown to work and that are the best treatments available. They also argue that we should use them over untested treatments. We will talk about EBP in greater detail later in the course.
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Works Cited
Eysenck, H. J. The effects of psychotherapy: An evaluation. Journal of Consulting Psychology 16:5 (1952): 319–324.
National Institute of Mental Health. The numbers count: Mental disorders in America. Retrieved on June 19, 2008, from http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america.shtml.
Ringel, Jeanne S. and Roland Sturm. National estimates of mental health utilization and expenditures for children in 1998. Journal of Behavioral Health Services and Research 28:3 (2001): 319–332.
Smith, Mary L., Gene V. Glass, and Thomas I. Miller. The benefits of psychotherapy. Baltimore: Johns Hopkins University Press, 1980.
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The History of Clinical Psychology
Clinical psychology uses clinical knowledge, science and theory to understand, prevent, treat and relieve distress or dysfunction that is psychologically based. In particular treatment works to promote well being and help with personal development. The two main practices of clinical psychology include psychotherapy and psychological assessment. However other aspects of the field include teaching, research, forensic testimony, administration and consultation.
Early Clinical Psychology
The field of clinical psychology originated in 1896 when the University of Pennsylvania opened up a psychological clinic though early clinical psychology has been used in university laboratories from 1850 to 1900. The first example of applied psychology being used to help those in trouble was when Lightner Witmer, a scientist at the University of Pennsylvania, successfully treated a boy that had difficulty with spelling. After this case the university was known for treating those with learning disabilities. The very first journal in clinical psychology was created by Witmer, 10 years later, called the Psychological clinic. Despite the fact that there were several psychology clinics up and running most mental illness and distress was treated by neurologists and psychiatrists.
Early Professional Organizations
The name “clinical psychology” originates from 1917 when the first professional organization was formed, known as the America Association of Clinical Psychology. This organization closed only two years later but in 1892, G. Stanley Hall founded the clinical psychology branch of the American Psychological Association (APA). The APA was the first professional organization to offer a certification in clinical psychology. Several psychological organizations joined together in 1930 and created the American Association of Applied Psychology, which was the main organization for psychologists after WWII, as the APA was going through reorganization. When the APA was back and functioning in 1945, clinical psychology was covered under Division 12. To this day Division 12 is the leading professional organization for clinical psychology in English speaking countries.
World War II and Integration of Treatment
The military turned to clinical psychologists when World War II broke out as psychologists developed two important tests used in World War I; the Army Alpha and Army Beta. Specifically these psychologists were used to treat those soldiers that were “shell shocked” or suffering from what is now known as post traumatic stress disorder, as soldiers improved dramatically when they were treated as soon as possible. Physicians and psychiatrists were dealing with treating injuries to the bodies, psychologists were asked to help treat those with shell shock. Additional the National Council of Women Psychologists was formed to help communities deal with the stress that war put on families. Besides changing the field of clinical psychology in the US the war also changed how the world used clinical psychology. A similar clinical psychology program was developed in Britain after the war that was modeled after the system in the US. Development of the Doctor of Psychology Degree
In order to become a clinical psychologist additional postgraduate training is required, normally a minimum of four years supervised practice or a doctorate with time spent in a clinical placement. However for a long time there were no doctoral programs in clinical psychology (Psy. D.). The development of the PhD in clinical psychology can be accredited to the Veterans Administration. They provided funding to universities to train clinical psychologists, as the veterans from WWII needed support. In a very short amount of time, four years, universities in the US went from having no clinical psychology programs to more than half of all psychology PhDs being awarded in this field. Despite the fact that many students were gaining doctorates in the field most doctoral programs did not have t raining for those that wanted to practice clinical psychology, as most dealt purely with research. One of the first practice-based programs was offered at the University of Illinois in 1968. The success of this program was the advent for several other practice based programs opened and in 1973 the Doctor of Psychology was a recognized degree. Rutgers university was the first to have a doctoral program that was based on the Psy.D. recognized in 1973.
A Changing Profession
Today clinical psychology is a robust academic and professional field, as it continued to grow and develop since 1970. The number of clinical psychologists practicing today is more than triple than the amount of practicing psychologists in 1970. Besides learning disabilities and war related problems the field has grown to include problems found in the criminal justice system, sports, gerontology and health. Other changes that have benefited this field include use of managed care, understanding of cultural differences and the availability of
(e.g., psychological, physical, or spiritual factors) and factors in the person 's environment (e.g., family, society, and cultural groups). Health psychologists specialize in how biological, psychological, and social factors affect health and illness. They study how patients handle illness; why some people don 't follow medical advice; and the most effective ways to control pain or to change poor health habits. They also develop health care strategies that foster emotional and physical well-being. Psychologists team up with medical personnel in private practice and in hospitals to provide patients with complete health care. They educate medical staff about psychological problems that arise from the pain and stress of illness and about symptoms that may seem to be physical in origin but actually have psychological causes. Health psychologists also investigate issues that affect a large segment of society, and develop and implement programs to deal with these problems. Examples are teenage pregnancy, substance abuse, risky sexual behaviors, smoking, lack of exercise, and poor diet. Social psychologists study how a person 's mental life and behavior are shaped by interactions with other people. They are interested in all aspects of interpersonal relationships, including both individual and group influences, and seek ways to improve such interactions. For example, their research helps us understand how people form attitudes toward others, and when these are harmful-as in the case of prejudice-suggests ways to change them. Social psychologists are found in a variety of settings, from academic institutions (where they teach and conduct research), to advertising agencies (where they study consumer attitudes and preferences), to businesses and government agencies (where they help with a variety of problems in organization and management). Clinical psychologists make up the single largest specialty area in psychology. Clinicians are psychologists who assess, diagnose and treat mental illnesses. They frequently work in mental health centers, private or group practices or hospitals. Within the area of clinical psychology, there are also a number of sub-specialty areas. Some professionals are generalists and work with a wide range of clients, while others specialize in treating certain types of psychological disorders or a certain age group. For example, some clinical psychologists might work in a hospital setting with individuals suffering from brain injuries or neurological conditions. Other clinical psychologists might work in a mental health center to counsel individuals or families coping with stress, mental illness, substance abuse or personal problems.
Clinical psychologists usually perform a wide range of tasks on a daily basis such as interviewing patients, conducting assessments, giving diagnostic tests, performing psychotherapy and administering programs. Work settings can vary based on the specific population that a clinician is working with. Common work settings include hospitals, schools, universities, prisons, mental health clinics and private practices.
There are also a number of different sub-specialty areas within clinical psychology, including health psychology, neuropsychology and geropsychology. Counseling psychologists make up another large specialty area in psychology. These professionals perform many of the same tasks that clinical psychologists do, but counseling psychologists tend to work with clients suffering from less severe forms of mental illness. Counseling psychology focuses on providing therapeutic treatments to clients who experience a wide variety of symptoms. The Society of Counseling Psychology describes the field as "a psychological specialty [that] facilitates personal and interpersonal functioning across the life span with a focus on emotional, social, vocational, educational, health-related, developmental and organizational concerns." • OOH HOME |
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Psychologists
FONT SIZE: PRINTER-FRIENDLY
• Summary
• What They Do
• Work Environment
• How to Become One
• Pay
• Job Outlook
• Similar Occupations
• Contacts for More Info
What Psychologists Do About this section Industrial-organizational psychologists apply psychological research and methods to workplace issues.
Psychologists study mental processes and human behavior by observing, interpreting, and recording how people and other animals relate to one another and the environment.
Duties
Psychologists typically do the following:
• Conduct scientific studies to study behavior and brain function
• Collect information through observations, interviews, surveys, tests, and other methods
• Find patterns that will help them understand and predict behavior
• Use their knowledge to increase understanding among individuals and groups
• Develop programs that improve schools and workplaces by addressing psychological issues
• Work with individuals, couples, and families to help them make desired changes to behaviors
• Identify and diagnose mental, behavioral, or emotional disorders
• Develop and carry out treatment plans
• Collaborate with physicians or social workers to help treat patients
Psychology seeks to understand and explain thoughts, emotions, feelings, and behavior. Depending on the topic of study, psychologists use techniques such as observation, assessment, and experimentation to develop theories about the beliefs and feelings that influence a person’s actions.
Psychologists often gather information and evaluate behavior through controlled laboratory experiments, psychoanalysis, or psychotherapy. They also may administer personality, performance, aptitude, or intelligence tests. They look for patterns of behavior or cause-and-effect relationships between events, and use this information when testing theories in their research or treating patients.
The following are common occupational specialties:
Clinical psychologists assess, diagnose, and treat mental, emotional, and behavioral disorders. Clinical psychologists help people deal with problems ranging from short-term personal issues to severe, chronic conditions.
Clinical psychologists are trained to use a variety of approaches to help individuals. Although strategies generally differ by specialty, psychologists often interview patients, give diagnostic tests, and provide individual, family, or group psychotherapy. They also design behavior modification programs and help patients implement their particular program.
Some clinical psychologists focus on certain populations, such as children or the elderly, or certain specialties, such as the following:
• Health psychologists study how psychological factors affect health and illness. They educate both patients and medical staff about psychological issues, and promote healthy-living strategies. They also investigate health issues, such as substance abuse or teenage pregnancy, and develop programs to address the problems.
• Neuropsychologists study the relation between the brain and behavior. They typically work with patients who have sustained a brain injury.
Clinical psychologists often consult with other medical personnel regarding the best treatment for patients, especially treatment that includes medication. Two states, Louisiana and New Mexico, currently allow clinical psychologists to prescribe medication to patients. In most states, however, only psychiatrists and medical doctors may prescribe medication for treatment. For more information, see the profile on physicians and surgeons.
Counseling psychologists advise people on how to deal with their problems. They help patients understand their problems, including issues in the home, workplace, or community. Through counseling, they work with patients to identify the strengths or resources they can use to manage problems. For information on similar workers, see the profiles on mental health counselors and marriage and family therapists, substance abuse and behavioral disorder counselors, and social workers.
Developmental psychologists study the psychological progress and development that takes place throughout life. Many focus on children and adolescents. Development psychologists also increasingly study aging and problems faced by the elderly.
Forensic psychologists use psychological principles in the legal and criminal justice system to help judges, attorneys, and other legal specialists understand the psychological findings of a particular case. They often appear in court as expert witnesses. They typically specialize in family court, civil court, or criminal court.
Industrial-organizational psychologists apply psychology to the workplace by using psychological principles and research methods to solve problems and improve the quality of work life. They study issues such as workplace productivity, management or employee working styles, and morale. They also work with management on matters such as policy planning, employee screening or training, and organizational development.
School psychologists apply psychological principles and techniques to education-related issues. For example, they may address students’ learning and behavioral problems, evaluate students’ performances, and counsel students and families. They also may consult with other school-based professionals to suggest improvements to teaching, learning, and administrative strategies.
Social psychologists study how people’s mindsets and behavior are shaped by social interactions. They examine both individual and group interactions and may investigate ways to improve negative interactions.
Some psychologists become professors or combine research with teaching. For more information, see the profiles on postsecondary teachers and high school teachers. Suggested citation:
Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2012-13 Edition, Psychologists
Purpose
The field of clinical psychology was established in the 1890s and has undergone substantial transformation during the past 120 years. By learning about the historical roots of clinical psychology, we can better understand current developments and gain insight into how the field may continue to develop.
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Commentary
Welcome to the study of clinical psychology! You may ask, "What is clinical psychology?" As a discipline, clinical psychology is hardly more than a century old. Despite its relatively young age, clinical psychology has changed dramatically since its inception in the late nineteenth century. If you were to travel back in time to the beginnings of the field, you would have a very different opinion about what a clinical psychologist does than we do today. For example, it may surprise you to learn that until World War II, clinical psychologists were rarely allowed to perform a duty that is now considered to be an integral part of their work: providing psychological interventions to individuals in distress or with psychiatric symptoms.
As members of a rapidly evolving discipline, clinical psychologists have often found themselves at odds with other medical and mental health care providers and even with one another. Past battles over the ability to provide psychological interventions have faded into memory, only to be revisited today as some clinical psychologists fight for the right to prescribe psychopharmacological medications alongside medical doctors, psychiatrists, and psychiatric nurses. At times, it seems that even clinical psychologists themselves cannot agree on what clinical psychology is. For example, there is currently a great debate about whether psychological interventions are a branch of science or a form of art. If they are an art, should we subject them to the rigors of empirical study? If they are a science, should we be allowed to continue a practice that has no research support? As you progress through this course, you may find that there are no clear-cut answers to these questions.
This is an exciting time in the field of clinical psychology. Now, as in the past, clinical psychology is in a period of turmoil, change, and growth. In order to understand how modern clinical psychology has developed and to lay a groundwork for understanding future developments in the field, we must first look at the beginnings of this ever-changing discipline.
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What Is a Clinical Psychologist?
Psychology, like many disciplines, consists of a dizzying array of subgroups and specialties. In addition to clinical psychologists, there are counseling psychologists, school psychologists, developmental psychologists, cognitive psychologists, social psychologists, personality psychologists, and so on. While we will look at some of these subgroups shortly, we will focus on clinical psychologists during this course. Image 1.1. Group therapy is an activity that many associate with clinical psychologists. However, it is just one of several professional activities clinical psychologists typically engage in.
When people are asked to describe what a psychologist does, they often mention activities that are familiar to most clinical psychologists: performing individual or group therapy, asking questions about psychiatric symptoms, measuring intelligence, or assessing personality. While some clinical psychologists spend most of their time on these clinical activities, others spend relatively little time on them.
You may wonder, "If clinical psychologists are not conducting therapy or performing assessments, what are they doing?" In addition to clinical work, the scientific study of mental health disorders is an important area for many clinical psychologists. Clinical psychologists employed by universities often work as researchers who develop and test interventions designed to prevent or treat mental health disorders. Other clinical psychologists work as instructors or professors and teach a variety of topics within the field of psychology to undergraduate and graduate students.
Regardless of their professional duties, all clinical psychologists have completed a doctoral degree and earned the title doctor of philosophy (PhD) or doctor of psychology (PsyD). In the next lesson, we will learn more about the different training models in clinical psychology and the relationship between training and professional activities.
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What Is a Mental Health Professional? A mental health professional can be defined as a trained professional who provides some form of assessment or intervention with the intent of identifying and relieving distress or psychiatric symptoms. Clinical psychologists can be generally described as mental health professionals, but not all mental health professionals are clinical psychologists. In fact, a number of related health disciplines are similar to clinical psychology in terms of the services they provide and the client populations they treat. Counseling psychologists, school psychologists, psychiatrists, and social workers are all mental health professionals who are similar to clinical psychologists but who belong to distinct disciplines.
Counseling Psychology
Like clinical psychologists, counseling psychologists are required to complete a doctoral degree before they can provide therapy and assessment. However, counseling psychologists may complete either a doctorate in philosophy (PhD) or a doctorate in education (EdD). Traditionally, counseling psychologists work with individuals who have less severe problems (e.g., school- or work-related stress), while clinical psychologists treat individuals with severe psychiatric symptoms (e.g., depression or personality disorder). Counseling psychologists typically work in educational settings (e.g., university counseling clinics), while clinical psychologists work in hospital or psychiatric inpatient settings.
School Psychology
School psychologists complete a doctorate in philosophy (PhD) and often work in a school setting with other educators to promote intellectual, social, and emotional growth in students. School psychologists may recommend services for children with special needs, conduct intelligence tests, or help develop or implement school-based intervention programs.
Psychiatry
Psychiatrists are medical doctors who have completed additional training in the treatment of mental health disorders. Psychiatrists typically complete a doctorate in medicine (MD), which reflects their extensive training in physiological and biochemical systems. Compared to clinical psychologists, however, psychiatrists have relatively little training in psychological functioning or research methods. Psychiatry is rooted in the field of medicine, so it is not surprising that psychopharmacological treatment is a primary approach to the treatment of mental health disorders among members of this discipline. Psychiatrists are allowed to prescribe medication, while psychologists (including clinical psychologists) are not. This is an area of controversy in the field of clinical psychology that we will talk more about later in this course.
Social Work
Unlike psychologists and psychiatrists, most social workers are allowed to provide therapy and assessment after completing a bachelor 's (BSW) or master 's (MSW) degree in social work. Social workers often focus on large social issues, such as legal problems, housing, or food assistance, and are more likely to provide treatment in a client 's home or another community setting compared to psychologists and psychiatrists.
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Historical Developments in Clinical Psychology
Early Origins
During the late 1800s and early 1900s, a number of important contributions were made that served as the foundation for a new discipline: clinical psychology. This period was characterized by increased interest in the scientific study of the human mind. Sir Francis Galton was among the first to formally study individual differences among people, and his work influenced other researchers to measure individual characteristics, such as aptitude and mental ability. Within a few years of each other, Wilhelm Wundt established the first psychology laboratory in Germany and William James established the first psychology laboratory in the United States. While initial efforts were crude, early systems of diagnosis and measuring mental ability began to develop. In 1896, Lightner Witmer established the first psychological clinic and coined the term "clinical psychology."
Sigmund Freud was one of the first to create a formal approach to psychotherapeutic treatment and is one of the founding fathers of psychoanalytic therapy.
Freud emphasized the importance of unconscious processes and drives, the importance of early childhood experiences, and the role of insight as a mechanism for therapeutic change. Freud inspired a number of his students, including Carl Jung and Alfred Adler, to make further contributions in the field of psychology. Later approaches to psychotherapy, such as behaviorism and client-centered therapy, were heavily influenced by the idea of psychoanalytic therapy, despite moving in radically different
directions.
World Wars I and II Image 1.2. In this photo c. 1942, U.S. Army Air Corps cadets take group tests that are psychologically weighted more heavily for pilots, navigators, and bombardiers.
The field of clinical psychology might not exist today without the need for psychological tests and mental health professionals that was created by the two world wars. When the United States entered World War I, there was a great need for an assessment tool to identify the mental fitness of soldiers. Two tests—Army Alpha and Army Beta—were developed and, with the success of early intelligence and personality tests developed during the 1920s and 1930s, the field of clinical psychology came to be based around the development, administration, scoring, and interpretation of psychological tests.
Prior to World War II, clinical psychologists were rarely given the opportunity to conduct psychotherapy, a professional activity that was almost exclusively carried out by psychiatrists. However, the large number of men returning from war with trauma-related psychological problems quickly overwhelmed the nation 's psychiatric resources, and clinical psychologists were called upon to step in and provide psychotherapy at a widespread level. While the addition of clinical psychologists as psychotherapists was intended to be temporary, they quickly established themselves as competent clinicians, forming a professional identity that would last for the next 40 years.
Postwar
After World War II, clinical psychologists continued to make important developments in the areas of assessment and intervention. Old versions of intelligence tests and personality inventories were revised, and new assessments were developed and tested. In the 1950s, psychiatrists published a comprehensive system of diagnosis called the Diagnostic and Statistical Manual for Mental Health Disorders (DSM) that was later adopted by clinical psychologists and most other mental health professions. The DSM has been revised several times over the years. The early editions were flawed because they included vague descriptions of symptoms, which led to misdiagnosis and disagreement between clinicians on whether symptoms were present or absent in a given patient. Later editions addressed that shortcoming, and as a result, mental health diagnoses can now be established with much greater reliability. As of the date of this course 's development (2011), the DSM is in its fourth edition with a fifth edition release anticipated in 2013. However, the DSM will continue to be re-evaluated in the years to come, and new editions may be released as updates become necessary.
After the world wars, new forms of psychotherapy began to develop, including the humanistic and behavioral approaches, which challenged the practices and assumptions of psychoanalytic psychotherapy. Critics such as Hans Eysenck questioned the effectiveness of psychotherapy. In 1952, Eysenck published data suggesting some patients in therapy received no more benefit than those who received no therapy at all. This finding shocked many clinical psychologists and spurred some researchers to demonstrate that psychotherapy did work for many patients. Mary Smith, Gene Glass, and T. I. Miller (1980) used a statistical technique called meta-analysis to summarize the results of 475 studies of psychotherapy and found that the average patient receiving therapy was better off compared to 80% of people with similar problems who did not receive treatment. This research established that there was a benefit to psychotherapy, and it inspired researchers to begin identifying which treatments were beneficial for whom and under what conditions.
Another major change in the field of clinical psychology began in the 1980s with the advent of managed health care organizations (HMOs and MCOs) and insurance regulations. In response to unchecked spending in the medical and mental health professions, insurance companies and managed care organizations began to tightly regulate reimbursement for services. In the field of clinical psychology, this meant limited reimbursement for lengthy assessment and psychotherapy procedures. Long-term therapies, such as psychoanalytic therapy, which requires patients to attend therapy three or four times a week for several years, might be reimbursed for only a few sessions but then require the patient to pay for any remaining services. Similarly, lengthy assessment procedures, such as intelligence and personality testing, were less likely to be reimbursed.
The cost-containment strategy of health care organizations was one of the factors that led toward the development of short-term treatments. Researchers began testing brief treatments designed for specific populations (e.g., depressed adults, anxious teenagers), and this led to the creation of the evidence-based practice (EBP) movement in psychology. The EBP movement maintains a psychological intervention must be tested empirically and shown to be superior to no treatment or equivalent to another well-established treatment before it is implemented.
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Evidence-Based Practice in Psychology
You may be asking, "How do we know when a psychological intervention is effective?" This is a question of great interest to clinical psychologists today, regardless of whether they are providing treatment or conducting research.
Let 's use the hypothetical examples below to help us think about the issue of effective treatment. Figure 1.1 shows the change in symptoms for a 24-year-old male with depression during a 15-week course of psychotherapy. The numbers on the y-axis indicate the severity of depression symptoms, with the larger numbers indicating more severe symptoms. On the x-axis, there are six time points at which the subject filled out a questionnaire about his symptoms for that week. What might we conclude from Figure 1.1? At the beginning of treatment, the subject had a depression severity score of 30, and at the end of treatment, he had a score of 18. Can we conclude it was the treatment that caused him to improve? Perhaps not. Neither can we rule out the possibility that the subject got better simply as a result of the passage of time. Research has shown that 90 percent of individuals with depression improve within two years of becoming depressed, even without receiving any type of treatment. So, even if the treatment in Figure 1.1 was completely ineffective, we would still expect the patient to improve slowly over time as his depression gradually remits.
What, then, might we do to test the treatment more rigorously? We could randomly select a group of individuals to receive treatment for depression while another randomly selected group does not receive any treatment at all. This would allow us to test whether there is any direct benefit from treatment or whether individuals improve over time regardless of treatment or nontreatment.
This situation is shown below in Figure 1.2. The blue line indicates individuals in the treatment group, and the red line indicates individuals in the control group. What might we conclude from Figure 1.2? At the beginning of treatment, the people in the treatment group and the people in the control group report being equally depressed and have a severity score of 30. At Week 4, the treatment group is doing slightly better, but at Week 12, the control group is doing slightly better (remember, lower scores on the y-axis indicate less severity). By the end of Week 15, both groups have improved—but there appears to be no benefit to treatment. In this example, we have strong support that a reduction in depressive symptoms is due to the passing of time (which both groups experienced) rather than any specific effects of intervention (which only the treatment group experienced).
Figure 1.3 is the same as Figure 1.2 except that we see a change between the treatment and control groups. What might we conclude from Figure 1.3? As in the previous example, the treatment and control groups are equally depressed at the beginning of treatment and have a severity score of 30. Starting at Week 4, both groups report their symptoms have decreased, but the individuals in the treatment group report less severe symptoms than those in the control group. This trend continues until, at Week 15, we see a marked difference in the severity of symptoms in the groups. As in the previous example, there is some improvement in the control group. However, there is significantly more improvement among individuals in the treatment group. This provides strong support for the idea that treatment results in greater change than we might expect from the passing of time alone. These examples illustrate the basic ideas behind evidence-based practice in psychology. Evidence-based practice attempts to not only answer the question of "what treatments work?" but also the question of "what treatments work for whom and under which conditions?" The idea behind this approach is that we must scientifically test treatments in order to demonstrate they are effective. Of course, we not only want to test a treatment against no-treatment conditions but against other treatments that have already been developed. In this way, we can begin to identify those treatments that provide maximum benefit.
EBP is one of the most controversial topics in the field of psychology. Some clinicians argue that it is inappropriate to take data gathered from groups and apply it to an individual. Advocates of EBP argue that it represents the treatments that have been shown to work and that are the best treatments available. They also argue that we should use them over untested treatments. We will talk about EBP in greater detail later in the course.
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Works Cited
Eysenck, H. J. The effects of psychotherapy: An evaluation. Journal of Consulting Psychology 16:5 (1952): 319–324.
National Institute of Mental Health. The numbers count: Mental disorders in America. Retrieved on June 19, 2008, from http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america.shtml.
Ringel, Jeanne S. and Roland Sturm. National estimates of mental health utilization and expenditures for children in 1998. Journal of Behavioral Health Services and Research 28:3 (2001): 319–332.
Smith, Mary L., Gene V. Glass, and Thomas I. Miller. The benefits of psychotherapy. Baltimore: Johns Hopkins University Press, 1980.
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The History of Clinical Psychology
Clinical psychology uses clinical knowledge, science and theory to understand, prevent, treat and relieve distress or dysfunction that is psychologically based. In particular treatment works to promote well being and help with personal development. The two main practices of clinical psychology include psychotherapy and psychological assessment. However other aspects of the field include teaching, research, forensic testimony, administration and consultation.
Early Clinical Psychology
The field of clinical psychology originated in 1896 when the University of Pennsylvania opened up a psychological clinic though early clinical psychology has been used in university laboratories from 1850 to 1900. The first example of applied psychology being used to help those in trouble was when Lightner Witmer, a scientist at the University of Pennsylvania, successfully treated a boy that had difficulty with spelling. After this case the university was known for treating those with learning disabilities. The very first journal in clinical psychology was created by Witmer, 10 years later, called the Psychological clinic. Despite the fact that there were several psychology clinics up and running most mental illness and distress was treated by neurologists and psychiatrists.
Early Professional Organizations
The name “clinical psychology” originates from 1917 when the first professional organization was formed, known as the America Association of Clinical Psychology. This organization closed only two years later but in 1892, G. Stanley Hall founded the clinical psychology branch of the American Psychological Association (APA). The APA was the first professional organization to offer a certification in clinical psychology. Several psychological organizations joined together in 1930 and created the American Association of Applied Psychology, which was the main organization for psychologists after WWII, as the APA was going through reorganization. When the APA was back and functioning in 1945, clinical psychology was covered under Division 12. To this day Division 12 is the leading professional organization for clinical psychology in English speaking countries.
World War II and Integration of Treatment
The military turned to clinical psychologists when World War II broke out as psychologists developed two important tests used in World War I; the Army Alpha and Army Beta. Specifically these psychologists were used to treat those soldiers that were “shell shocked” or suffering from what is now known as post traumatic stress disorder, as soldiers improved dramatically when they were treated as soon as possible. Physicians and psychiatrists were dealing with treating injuries to the bodies, psychologists were asked to help treat those with shell shock. Additional the National Council of Women Psychologists was formed to help communities deal with the stress that war put on families. Besides changing the field of clinical psychology in the US the war also changed how the world used clinical psychology. A similar clinical psychology program was developed in Britain after the war that was modeled after the system in the US. Development of the Doctor of Psychology Degree
In order to become a clinical psychologist additional postgraduate training is required, normally a minimum of four years supervised practice or a doctorate with time spent in a clinical placement. However for a long time there were no doctoral programs in clinical psychology (Psy. D.). The development of the PhD in clinical psychology can be accredited to the Veterans Administration. They provided funding to universities to train clinical psychologists, as the veterans from WWII needed support. In a very short amount of time, four years, universities in the US went from having no clinical psychology programs to more than half of all psychology PhDs being awarded in this field. Despite the fact that many students were gaining doctorates in the field most doctoral programs did not have t raining for those that wanted to practice clinical psychology, as most dealt purely with research. One of the first practice-based programs was offered at the University of Illinois in 1968. The success of this program was the advent for several other practice based programs opened and in 1973 the Doctor of Psychology was a recognized degree. Rutgers university was the first to have a doctoral program that was based on the Psy.D. recognized in 1973.
A Changing Profession
Today clinical psychology is a robust academic and professional field, as it continued to grow and develop since 1970. The number of clinical psychologists practicing today is more than triple than the amount of practicing psychologists in 1970. Besides learning disabilities and war related problems the field has grown to include problems found in the criminal justice system, sports, gerontology and health. Other changes that have benefited this field include use of managed care, understanding of cultural differences and the availability of