Clinical Psychology

The application of psychological principles to diagnosing and treating persons with emotional and behavioral problems.

Clinical psychologists apply research findings in the fields of mental and physical health to explain dysfunctional behavior in terms of normal processes. The problems they address are diverse and include mental illness, mental retardation, marital and family issues, criminal behavior, and chemical dependency. The clinical psychologist may also address less serious problems of adjustment similar to those encountered by the counseling psychologist.

Approximately one-third of the psychologists working in the United States today are clinical psychologists. A number of clinical psychologists are in private practice, either alone or in group practice with other mental health professionals. Others may practice in a variety of settings, including community mental-health centers, university medical schools, social work departments, centers for the mentally and physically handicapped, prisons, state institutions and hospitals, juvenile courts, and probation offices. Clinical psychologists use psychological assessment and other means to diagnose psychological disorders and may apply psychotherapy to treat clients individually or in groups. In the United States, they are governed by a code of professional practice drawn up by the American Psychological Association.

Individuals consult clinical psychologists for treatment when their behaviors or attitudes are harmful to themselves or others. Many different treatment types and methods are employed by psychologists, depending on the setting in which they work and their theoretical orientation. The major types of therapy include psychodynamic therapies, based on uncovering unconscious processes and motivations, of which the most well known is Freudian psychoanalysis; phenomenological, or humanistic, therapies (including the Rogerian and Gestalt methods) which view psychotherapy as an encounter between equals, abandoning the traditional doctor-patient relationship; and behavior-oriented therapies geared toward helping clients see their problems as learned behaviors that can be modified without looking for unconscious motivations or hidden meanings. These therapies, derived from the work of Ivan Pavlov and B.F. Skinner, include methods such as behavior modification and cognitive-behavior therapy, which may be used to alter not only overt behavior but also the thought patterns that drive it.

The work of the clinical psychologist is often compared with that of the psychiatrist, and although there is overlap in what these professionals do, there are also specific distinctions between them. As of 1996, clinical psychologists cannot prescribe drugs to treat psychological disorders, and must work in conjunction with a psychiatrist or other M.D. who is authorized to administer controlled substances. However, a movement is under-way for prescription privileges for psychologists. The clinical psychologist has extensive training in research methods and in techniques for diagnosing, treating, and preventing various disorders. Most psychologists earn a Ph.D. degree in the field, which requires completion of a four- to six-year program offered by a university psychology department. The course of study includes a broad overview of the field (including courses in such areas as statistics, personality theory, and psychotherapy), as well as specialization in a particular subfield and completion of a practicum, internship, and dissertation.

A new training program for psychologists was developed and introduced at the University of Illinois, which offered the first Psychology Doctorate (Psy.D.) in 1968. This degree program is geared exclusively toward the training of clinicians rather than researchers. It stresses course work in applied methods of assessment and intervention and eliminates the dissertation requirement. The number of Psy.D. programs in the United States has grown since 1968, with some programs offered at universities and others at independent, "freestanding" professional schools of psychology.

Assessment plays a prominent role among the functions of clinical psychology. The term "clinical psychology" itself was first used at the end of the nineteenth century in connection with the testing of mentally retarded and physically handicapped children. The discipline soon expanded with the growing interest in the application of assessment techniques to the general population following Robert Yerkes's revision of the Stanford Binet Intelligence scales in 1915, creating a widely used point scale for the measurement of human mental ability. Clinical psychologists must be familiar with a variety of techniques of assessing patients through interviews, observation, tests, and various forms of play. Assessment may be used to compare an individual with others in a reliable way using standardized norms; determine the type and circumstances of symptomatic behaviors; understand how a person functions in a given area (cognition, social skills, emotion); or match a patient to a particular diagnostic category for further treatment.

While the clinical psychologist does not specialize in research, the two disciplines often overlap. With their varied experiences, clinicians are qualified to participate in research on, for example, cost effectiveness in health care, design of facilities, doctor-patient communication, or studies of various treatment methods. Clinical psychologists routinely contribute to the training of mental health professionals and those in other areas of health care, serving on the faculties of universities and independent institutes of psychology, where they teach courses, supervise practicums and internships, and oversee dissertation research. They also carry out administrative appointments which call for them to assist in the planning and implementation of health care services and are represented in international groups such as the World Health Organization.