Clinical Psychology

A Modern Health Profession

Wolfgang Linden, Paul L. Hewitt

• Publisher: Routledge
• Year: 2018
• ISBN:
  9781351210386
• Edition: 2
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Clinical Psychology invites students to think like clinical psychologists and develop an integrated sense of how science, experience, ethical behavior, and intuition get woven into our professional identity. Built around typical psychologists and the problems they need to solve, it demonstrates that assessment is much more than testing, and explores how treatment rationales are tailored to the individual problems, histories, and environments of clients. Committed to training future professionals, this text navigates students through the career path of a clinical psychologist and provides guidance on evolving education and training models.

The text uniquely portrays clinical psychology as a modern health care profession that bridges physical and mental health and takes a holistic stance. It treats therapy as a dynamic process that benefits from the cross-fertilization of a range of different approaches. It also provides an international perspective, describing similarities and differences between how clinical psychology is practiced in different countries and contexts. It recognizes that clinical psychology changes as health care systems change, and stresses that training models and practice patterns need to match these changes.

This second edition has been fully revised and reflects DSM-5 and ICD-10-CM guidelines. New and enhanced features include:

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• Additional description of the continuing integration of therapy approaches

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• Additional evidence on how to make psychotherapy cost-effective

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• Upgrades on self-help and web-based treatment

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• An expanded chapter on psychopharmacology, offering more information on mechanisms

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• Expanded in-text pedagogy, offering more vignettes, ongoing considerations, key terms, and thinking questions
• Powerpoint slides and links to recommended resources.

1
Being a Clinical Psychologist

Chapter Objectives

The authors of this textbook strongly identify with the profession and the science of clinical psychology and have been ardent proponents and defenders of the idea that as a profession we are distinct. One objective of this first chapter is therefore to circumscribe this unique profession, make it come alive, and get you as excited as we are about clinical psychology even after decades of practice. The learning objectives for this chapter are:

• An appreciation of diverse types of problems that clinical psychologists face, the actual work being done, and the expertise needed to do this work competently.
• An understanding of the training that is involved in developing the identity and skills of a clinical psychologist.
• An appreciation for the blend of science, skill, intuition, and sometimes difficult ethical challenges that shape our professional lives.

Describing the Profession and Its History

Clinical psychologists see clients for formal assessments, conduct psychotherapy, do research, consult and educate. The claim for a “distinctness” of our profession, however, does take some explaining. Specialty areas within psychology are defined by certain subsets of questions or fields of inquiry. Developmental psychology, for example, is interested in growth and change, and biological psychology in the relationship of biology, physiology, and behavior. Of course, these two domains also inform other research domains and areas of practical application. Clinical psychology, on the other hand, denotes a profession that creates and applies knowledge from many subspecialties within psychology and uses these to solve everyday problems across all aspects of health care.

While the paragraph above describes what clinical psychologists do, it does not inform the reader how clinical psychologists think. Scientific training affects the view of a psychologist’s own profession and the world at large and also explains the habits and values of clinical psychologists. Three such overarching principles were first described by Galileo (yes, that Galileo), and training in these creates an enduring mindset that permeates our approaches to research and practice. Machado and Silva (2007) describe them as:

1. Observation/experimentation, which essentially reflects the activities, such as methodology, that are used to generate theories and test hypotheses;
2. Quantification/mathematization, which reflects the use of statistical procedures and mathematics to obtain and test data to determine relationships;
3. Theoretical/conceptual analysis, which reflects the clear explication and detailed specification of concepts, constructs, and ideas that derive from or are the focus of research.

Image 1.1 Psychologists on a Date

© Dan Piraro, Bizzaro.com. Reprinted with permission.

All three of these components are important to truly understanding the nature of relationships among psychological constructs; however, Machado and Silva (2007) argue that only the first two tend to be used in psychology research or taught in psychology training programs. For example, although there are courses and emphases in the field on methodological and statistical issues, the issues germane to conceptual analysis tend to be ignored (also see Machado, Lourenco, & Silva, 2000). Although you, as a student of psychology, know, already, a great deal about methodology and statistics from courses you have taken and even from sections of this book, you have likely not been taught about the importance or conduct of conceptual analysis. This means that the clarity and specification of concepts within the field is wanting, which creates incredible confusion. One of the better examples of this is the use of the term “stress,” which the literature refers to as nonspecific responses to events, the events themselves, or negative responses to events. Both authors of this text have experienced the problems with the lack of focus on conceptual analysis in their own respective research areas of perfectionism (e.g., Hewitt et al., 2003, 2008) and stress management (Ong, Linden, & Young, 2004). It is hoped that emphases on clear explications of theoretical concepts will be incorporated in both the training and the research in the field and it is one of the major objectives of this textbook to teach concept clarity.

Given the scientific training clinical psychologists actively research the questions they deal with in clinical practice, and vice versa; they use their clinical experience to feed new insights and ideas back to researchers. The most frequently used term to describe this twoway flow of ideas and actions is “Scientist-Practitioner.” Clinical psychology also can and needs to be defined by how it is different from related disciplines like Psychiatry and Social Work or Counseling Psychology (see Box 1.1) that describes the difference between clinical psychologist, psychiatrist, and social worker.

Box 1.1 What is a Clinical Psychologist?

Brace yourself. If you are a clinical psychologist, or graduate or even undergraduate student in Psychology, you are prone to be asked at family gatherings or other social events what the difference is between a psychiatrist and a psychologist. Aside from colloquially referring to both as “headshrinkers,” and to get that pesky questioner out of your hair, here are some standard definitions that you can supply:

A Psychologist is a scientist and/or clinician who studied psychology—the systematic investigation of the human mind, including behavior and cognition. Psychologists are usually categorized by their area of specialty. The most well recognized subgroup in the community is that of the “clinical psychologist,” who provides health care, conducts assessments, and provides psychological therapy.

In North America, the typical Clinical Psychologist holds a Doctor of Psychology (PsyD) degree if she was trained in a professional school, or a Doctor of Philosophy (PhD) if she was trained in a university-based psychology department. It typically takes 6–7 years above and beyond a Bachelor’s degree to become a clinical psychologist. What makes clinical psychologists stand apart from other mental health experts is the balance in their training requiring expertise in both science and practice (see Linden, Moseley, & Erskine, 2005; Linden, 2015 for a review). In much of Europe and Australia, clinical training is offered at the level of Master’s degrees and may require additional supervised training before graduates can become independent practitioners and/or are allowed to do third-party billing. The trend in North America is to move toward doctoral level training as a minimal standard although many long-term practitioners hold only a Master’s degree and there are still new MA and MSc psychologists getting licensed. When it comes to practice differences, Master’s level providers are less likely to work in hospitals, are less often involved in the care of patients with psychosis, and conduct fewer assessments (Hunsley, Ronson, & Cohen, 2013).

Counseling Psychologists are in many ways similar to clinical psychologists but are more likely to become service providers at the Master’s degree level (implying a total of 2–3 years of graduate training), have less training and expertise in formal psychodiagnostic assessments, and are less likely to work with populations that have psychoses or severe personality disorders.

Psychiatrists are physicians (and in North America usually doctors of medicine [MD]), who are certified in treating mental illness using a largely biologically based approach to mental disorders. Psychiatrists first complete regular medical school and then acquire specialty training through a 4-year residency during which they may also go through training to conduct psychotherapy. But it is their medical, biology-based training that allows them to prescribe medication and that differentiates them from other mental health professionals. In North America, it typically takes 8–9 years above and beyond a Bachelor’s degree to become a licensed psychiatrist.

The main tasks of Professional Social Workers are case management (linking clients with agencies and programs that will meet their financial and psychosocial needs), medical social work, counseling (psychotherapy), human services management, social welfare policy analysis, community organizing, advocacy, teaching (in schools of social work), and social science research. Some social workers, usually those with a graduate degree (MSW), also provide one-on-one clinical services, often in the area of child and family. The training background of social workers who function as psychotherapists can be quite heterogeneous.

The description of the different health professions does show existing overlap in areas of work but also draws boundaries between the different professions. Another way of highlighting these differences is to look at the total hours of training and clinical exposure various health professions have obtained. Murdoch, Gregory, and Eggleton (2015) have systematically compiled and compared the curricular and student training experiences of the professions described above and reveal the high level of preparedness for assessment and therapy that is imbued in doctoral level clinical and counseling psychologists.

Without going into excessive historical detail, the student of clinical psychology should be aware that the field really began to exist as a distinct specialty only after World War II. At this time, clinical psychologists made concerted efforts to define how the topic should be taught and w...