Clinical Psychology

An Introduction

Alan Carr

• Publisher: Routledge
• Year: 2012
• ISBN:
  9781136223600
• Edition: 1
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

Clinical Psychology is for students studying clinical psychology as part of an undergraduate programme in psychology, nursing, sociology or social and behavioural sciences. Undergraduate students who wish to know if postgraduate study in clinical psychology would be of interest to them will find this book particularly useful.

The book will inform students about:

• the profession of clinical psychology
• how to get onto a clinical psychology postgraduate training programme
• the way clinical psychologists work with children, adolescents and adults with common psychological problems
• the main models of practice used by clinical psychologists, and
• the scientific evidence for the effectiveness of psychological interventions.

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There is a focus on both clinical case studies and relevant research, and the book includes summaries, revision questions, advice on further reading and a glossaryof key terms, all of which make it an excellent student-friendly introduction to an exceptionally interesting subject.

What is clinical psychology?

1

Learning objectives

After studying this chapter you will be able to:

• • outline the basic aspects of the profession of clinical psychology
• • give an account of the main features of professional clinical psychology training
• • plan your career so as to maximize your chances of getting a place on a clinical psychology programme
• • explain the difference between clinical psychology, other applied psychology specialties and related mental health professions
• • give a balanced view on the pros and cons of clinical psychology as a prospective career.

Introduction

This chapter will give an overview of the profession and discipline of clinical psychology. There will be a description of clinical psychology training. The selection procedures used by clinical psychology training programmes in the UK and Ireland will be discussed, and there will be guidance on how to get a place on a clinical psychology programme. A brief account will be given of clinical psychology training in the US and elsewhere. The factors that distinguish clinical psychology from other types of applied psychology and other mental health professions will be discussed. The chapter will close with a consideration of the pros and cons of clinical psychology as a career.

The profession and scientific discipline of clinical psychology

Clinical psychology is both a health care profession (like medicine, surgery or social work), and a health-related scientific discipline (like physiology or sociology).

The profession

The profession of clinical psychology involves using clinical judgement to apply knowledge from the scientific discipline of clinical psychology in clinical practice with clients and patients. Clinical practice refers to the assessment, treatment and prevention of psychological problems in a range of populations. For example, assessing a boy who is failing in school and defiant with parents and teachers; helping a woman with depression regulate her mood more effectively; or helping the family of a person whose psychotic symptoms have been reduced through using medication to develop a supportive style to prevent relapse.

Clinical judgement is developed through supervised clinical practice while undertaking professional training, and during post-qualification clinical experience. Psychologists who have worked with a wide variety of cases over an extended time period have a broader experiential base on which to draw when making clinical decisions than their less experienced colleagues. Scientific knowledge about clinical psychology is developed through initial academic training, ongoing continuing professional development (CPD) and research. Throughout their careers clinical psychologists keep up to date with recent developments through CPD and must show evidence of this periodically to retain practising certificates.

The scientific discipline

Within the scientific discipline of clinical psychology, research is conducted to find out about how best to understand, assess, treat and prevent psychological problems, and also to find out how widespread psychological problems are. The results of clinical psychology research provide information for planning services for whole populations, and evaluating and treating individual cases in an evidence-based way. For example, the results of epidemiological research indicate that depression and anxiety are the most common problems that need to be addressed by clinical psychologists in outpatient adult mental health services (Carr & McNulty, 2006). The results of research on intelligence testing show that people with IQs below 50 require considerable support in community settings to be able to sustain a reasonable quality of life (Carr et al., 2007). Psychotherapy research shows that family therapy is more effective than individual therapy in the treatment of anorexia nervosa in young adolescent girls (Carr, 2009a).

TABLE 1.1
Main elements of clinical psychologists’ roles

• Direct work with clients, patients, service users • Indirect work • Administration and management • Research • Continuing professional development

Clinical psychologists’ roles

The main elements of clinical psychologists roles are listed in Table 1.1. Clinical psychologists’ jobs typically involve both direct and indirect work with clients, patients or service users. (Throughout this book the terms client, patient and service user will be employed interchangeably, as there is not currently a consensus on the most appropriate term to use.) Clinical psychologists’ jobs also involve administration or management, research, and continuing professional development (CPD) (Carr, 2000; Hall & Llewelyn, 2006). Beinart et al.’s (2009)Clinical Psychology in Practice gives many detailed example of clinical psychologists’ roles from a UK perspective.

Direct work

With direct work, clinical psychologists meet with clients, patients or service users, and in some instances with their families. In these meetings they assess psychological problems and provide psychological interventions. Assessments may include interviews, psychological testing and observation. For most cases, psychologists interview clients (and in some instances members of their families) to find out about the history of the presenting problem, previous attempts to resolve the problem, the person’s personal and family history and any other relevant details. In some cases psychologists administer tests to assess patient’s intelligence, memory, personality, psychopathology, family relationships and other aspects of their functioning. The main benefit of psychological tests is that they measure constructs in a reliable and valid way, and yield scores that can be interpreted within the context of population norms. For example if a person returns an IQ score of 100, the norms indicate that this person is more intelligent than 50% of people of the same age within the normal population. With regard to intervention, the media typically associate individual psychotherapy with the practice of clinical psychology. However, clinical psychologists use many other interventions such as parent training to equip parents with skills to manage their children’s problems, training in meditation to help people regulate depressed mood or impulsivity, and family psycho-education to help families provide a supportive environment for family members with psychosis. Psychological interventions may be offered to individuals, groups with similar sorts of problems, couples and families. Increasingly clinical psychologists are supplementing direct face-to-face work with clients with bibliotherapy and computer-based interventions (Carr, 2009a). With bibliotherapy patients are invited to read specific self-help books that address their main presenting problems. For example, a person with panic disorder could be given a book that outlines how to manage panic attacks using evidence-based procedures. There are a growing number of computer-based interventions, but the best validated are structured cognitive behavioural programmes for managing depression. With these programmes clients work though a series of web-based mood management exercises over period of weeks.

Indirect work

With regard to indirect work, psychologists provide training, clinical supervision and consultation to colleagues in psychology, psychotherapy, social work, child care, medicine, nursing and other disciplines to empower them to provide services to patients. This is referred to as indirect work because psychologists influence patients indirectly through the actions of their colleagues. In the area of training, clinical psychologists may offer lectures or skills building programmes on particular topics relevant to specific groups, for example teaching foster parents about the psychology of attachment. In the area of clinical supervision, most senior psychologists in public health services provide placements of supervised clinical practice to clinical psychologists in training to help them develop the technical and self-reflective skills to practise professionally. Technical skills refer to those procedures used to evaluate and treat clients. Self-reflective skills refer to the capacity to monitor accurately the interactions between oneself, clients and colleagues, and the impact of these interactions on oneself. With regard to consultation, clinical psychologists may advise others how best to manage clients with specific problems. For example, in an intellectual disability service where a client engages in repeated challenging behaviour (such as aggression or self-harm), a clinical psychologist may advise staff in the service how to manage this on the basis of a thorough functional analysis. This type of assessment is used to establish the function of the challenging behaviour (for example, communicating to staff that they are stressed or bored) by carefully observing, recording and analysing the antecedents and consequences of the challenging behaviour.

Administration and management

Most clinical psychologists manage waiting lists, set appointment schedules, document clinical sessions by writing reports, and communicate with colleagues through correspondence, phone calls and meetings. As psychologists gain increasing managerial responsibility, they not only fulfil these functions for their own clinical work, but also support their more junior staff in doing so. Psychologists with managerial responsibilities also contribute to policy development and service planning for clinical psychology services, and in some instances for wider multidisciplinary teams in which clinical psychologists are involved.

Research

Clinical psychologists conduct a range of different types of research. They conduct literature searches to find out about recent developments in assessment and treatment, so that their practice with clients is informed by up-to-date research findings. Periodically they conduct service-based research projects to answer specific questions such as ‘What are the profiles and outcomes of referrals over a one-year period?’ or ‘What are the main reasons clients give for dropping out of therapy?’ Large specialist psychology services within university-affiliated agencies may have broad ongoing research programmes on specific themes such as eating disorders, drug abuse or attention deficit hyperactivity disorder (ADHD). Postgraduates on clinical psychology training programmes may conduct their doctoral research theses within these research programmes. In services without such research programmes, but which provide placements of supervised clinical practice, psychologists in clinical training may initiate smaller research projects to address questions of concern to the service, themselves and their university-based academic supervisors.

Continuing professional development

Clinical psychologists devote a proportion of their time each year to CPD. This is a requirement for remaining a registered practitioner. CPD includes regular participation in clinical supervision and journal clubs; attendance at professional short courses and conferences; and enrolment in advanced specialist training programmes, for example in psychotherapy or neuropsychology.

Populations and work settings

Clinical psychologists provide services to a wide range of people with diverse difficulties in an array of different work settings, as outlined in Table 1.2 (Carr, 2000; Hall & Llewelyn, 2006; Beinart et al., 2009).

Populations and problems

Clinical psychologists work with people across the life-span including children, adolescents, adults and older adults. They provide services to people with psychological disorders, intellectual and physical disabilities and psychological difficulties secondary to physical illnesses such as HIV/AIDS, heart disease or cancer. They also work with people experiencing significant stress associated with major life transitions and challenges such as infertility, child bearing, adoption, fostering, marital discord and bereavement.

Work settings

Clinical psychologists work in a wide variety of settings including primary care, community mental health teams, general and specialist adult and paediatric hospitals, disability services, services for older adults,

TABLE 1.2
Populations, problems and work settings

Populations	Children Adolescents Adults Older Adults
Problems	Mental health problems Adjustment of physical health problems Intellectual disability Physical disability Adjustment to major life transitions
Work settings	Primary care Community mental health teams Hospitals Disability services Older adult services Family services (e.g. fostering, adoption) Specialist services (e.g. addiction, chronic pain)

prisons, fostering and adoption services and hospices. They also work in a wide variety of specialist services for people with specific difficulties such as addiction, eating disorders, aggression, sexual offending, chronic pain and head injury. Most clinical psychologists in the UK and Ireland work mainly within the public health service, although some work in private practice. The following statements are first-hand accounts of a typical day’s work of psychologists working in a number of different settings.

Child and adolescent mental health

Martin, a clinical psychologist working on a child and adolescent mental health team, offered the following brief description of a typical day.

Today I saw two families in the morning; went to a case conference after lunch; made some calls to clients and colleagues after 4pm; and (finally) finished a report that I’d been working on for 2 weeks. The first family I saw this morning was a case of school refusal or separation anxiety. The little fellow was 8 and very anxious. So were his parents. We’ve met for three sessions, and worked today on the final elements of a return to school plan. The second case was a review of long-term client. This is a 16-year-old girl who came to our service first because she was cutting herself. I’ve seen her for nearly 2 years and she is doing much better now. This afternoon the case conference was about a chaotic family, where there are major child protection concerns. The report I finished was an assessment of need report on a 7-year-old boy with ADHD.

The child and adolescent mental health curriculum for the UCD clinical psychology programme is contained in the Handbook of Child and Adolescent Clinical Psychology (Carr, 2006a).

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