Clinical psychology

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Clinical psychology is the application of psychology to relieve 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, clinical psychology is most often practiced by licensed professionals with an advanced degree. Most licenses require extensive, supervised postgraduate work experience as well. Individuals may be licensed as psychotherapists, counselors (generally requiring an M.A. degree), or licensed psychologists (which requires a Ph.D. or Psy.D. degree). 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. <ref>Compass & Gotlib, 2002, p.5</ref> 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. <ref>American Psychological Association, Division 12, "About Clinical Psychology"</ref>


[edit] 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.

[edit] 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, eating disorders, learning disorders, neuropsychological disorders, or substance abuse. Many clinical psychologists provide diagnostic impressions of their patients (or clients) based on criteria described in the DSM or ICD, although some 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 require additional, supervised training and education. To date, psychologists who obtain additional training in clinical psychopharmacology may prescribe psychotropic medications in Guam, New Mexico, and Louisiana.

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, in America, about half of the licensed 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-Scholar Model of Clinical Psychology (Psy.D.), which has slightly more focus on practice (similar to professional schools for medicine and law).<ref>Norcross, J. & Castle, P. (2002).</ref> 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 encourages accreditation of Ph.D. and Psy.D. programs that meet its strict academic standards. Psychotherapy counselors require training at the Masters level, which also has more of a focus on treatment rather than research.

In Britain, Clinical Psychologists used to obtain an MSc or MPhil degree, but now undertake a DClinPsy (or similar) which is a taught doctorate with both clinical and research components. This is done after a three year undergraduate degree and some form of experience in either a National Health Service setting as an Assistant Psychologist or academia as a Research Assistant. Previously a few did a PhD before getting onto a clinical master's programme, and others went onto further academic study afterwards. British Clinical Psychologists do not tend to diagnose, but rather they use 'formulation' as an assessment tool. This is an individualized 'map' of the difficulties that the patient or client faces, encompassing predisposing, precipitating and perpetuating (maintaining) factors.

[edit] 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).

[edit] 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.

[edit] 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, memory, reasoning, decision making, sensory processes, 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. In this hypothesis, certain thoughts or ways of interpreting the world (called schemas) can cause emotional distress or result in behavioral 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 are informed by a scientific, empirical perspective; clear operationalization of the "problem" or "issue;" an emphasis on measurement (and measurable changes in cognition and behavior); and measurable goal-attainment.

[edit] Humanistic

Main article: Humanistic psychology

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 Phenomenology, Intersubjectivity 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.<ref>(Rowan, 2001)</ref> 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.

[edit] Other scientific perspectives

Positive psychology is the scientific study of human happiness, which started to gain momentum in the scientific arena due to the call of Martin Seligman in 2000, then head of the American Psychological Association. 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 is on developing positive character strengths and virtues rather than focusing on negative personality traits such as mental disorders, even though the main point may be combating the latter.

[edit] Notes


[edit] See also

[edit] Related lists

[edit] 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.

[edit] External links

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ca:Psicologia clínica da:Klinisk psykologi de:Klinische Psychologie fa:روان‌شناسی بالینی fr:Psychologie clinique ja:臨床心理学 pt:Psicologia clínica ru:Клиническая психология sl:Klinična psihologija sr:Клиничка психологија

Clinical psychology

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