PSYCH481:

Introduction

In this lesson, we will explore the field of clinical psychology and what sets it apart from other mental health professions. You probably don’t know the differences among some mental health–related fields. Many people don’t. What makes this important is that the patient population (that is, people seeking mental health services) likely don’t know the differences among the fields either.

There are distinctions to be made among the helping professions. These distinctions are also important in the event that you consider pursuing higher education in order to get licensed or certified to provide mental health services. Which advanced degree makes the most sense for you? Are you interested in being a therapist? Are you interested in teaching and research? Are you interested in doing evaluations for competency? The field you study makes a big difference in the types of services you would be qualified to provide.

Trull and Prinstein (2013) give the following definition of the field we will be studying in this course: “Clinical psychology focuses on the intellectual, emotional, biological, psychological, social, and behavioral aspects of human functioning across the lifespan, in varying cultures, and at all economic levels."

The first part of this lesson will teach you about the different options in the mental health field, while the second will provide a historical overview of clinical psychology.

Lesson Objectives

After completing this lesson, you should be able to do the following things:

• recognize what a clinical psychologist is and does and be able to identify how clinical psychology differs from closely related mental health professions,
• identify how clinical psychologists are trained and the types of jobs available at varying levels of education, and
• recall significant historical events in various domains of clinical psychology (such as diagnosis and assessment, interventions, research, and the profession).

Lesson Readings and Activities

By the end of this lesson, make sure you have completed the readings and activities found in the Course Schedule.

Education and Training in Clinical Psychology

There are basic aspects of becoming a clinical psychologist that are common across graduate programs. Students who want to pursue clinical psychology as a profession must earn a doctorate in clinical psychology. Most clinical psychology programs are designed so that students enter with a bachelor's degree and earn their master's degree during the course of their doctoral studies. Some students might earn a master's before entering a doctoral program or after working for a few years, but many programs are designed so that students enter with a bachelor's degree and leave with both a master's and a doctorate.

Many clinical programs include training that consists of three to four years of intensive study and a one-year, full-time pre-doctoral internship. Students typically complete a master's thesis and then must pass comprehensive examinations before moving into their doctoral studies. Students must also complete a dissertation and practicum placements, where they begin to get clinical experience and work with patients while under the supervision of licensed psychologists.

While these primary elements are common to most programs, many programs include specialty tracks, such as child clinical psychology, health psychology, or neuropsychology.

Your textbook describes the three training models that graduate programs use (Pomerantz, 2024):

• The scientist-practitioner (Boulder) model dominated graduate training for many years. It is a two-pronged approach that assumes that clinical psychology training should emphasize both clinical and research skills. Graduates of related programs are well-trained clinicians who have completed rigorous research programs culminating in the completion of a doctoral dissertation.
• The practitioner-scholar (Vail) model emerged because many felt that there should be options for those who primarily wanted to be clinicians, who were not interested in academia. Furthermore, some in the profession worried that there weren't enough well-trained clinicians to serve the needs of the population. This led to the evolution of the PsyD program (practitioner-scholar), which is primarily geared toward clinical training and less focused on research.
• The clinical scientist model grew out of a movement in the 1990s that placed primary importance on empirical research. A PhD from a clinical scientist program emphasizes evidence-based clinical methods.

Graduate School and Beyond

The author of your textbook states that APA-accredited PhD programs admit only 7% to 16% of applicants, while APA-accredited PsyD programs admit between 40% and 50% (Pomerantz, 2024). The textbook gives a list of ways to be prepared so that you can have a competitive edge (Pomerantz, 2024. pp. 12–15):

• Know your professional options.
• Take, and earn high grades in, the appropriate undergraduate courses.
• Get to know your professors.
• Get research experience.
• Get clinically relevant experience.
• Maximize your GRE score.
• Select graduate programs wisely.
• Write effective personal statements.
• Prepare well for admissions interviews.
• Consider your long-term goals.

All students who complete a doctoral program in clinical psychology also complete a one-year pre-doctoral internship, in which they are placed into a clinical setting under the supervision of one or more licensed clinical psychologists. These internships are very competitive, and the application process can be a bit intimidating, but most students find a placement, which is the final phase before being awarded a PhD or PsyD (Pomerantz, 2024).

After a PhD or PsyD has been earned, most states require a postdoctoral internship ("postdoc") before they will administer a license. This typically involves another year of supervised experience before sitting for the licensure exam, called the Examination for Professional Practice in Psychology (EPPP, sometimes called the "E triple P"). You must sit for this exam and pass it, along with whatever other tests your individual state requires (usually a state exam on laws and ethics; Pomerantz, 2024).

Other Helping Professions

Clinical psychologists engage in a wide array of professional activities, but differ from some other mental health professions in the following ways.

Counseling Psychologists

While both clinical and counseling psychologists complete doctoral programs, their primary difference is in the populations with whom they work. Clinical psychologists tend to work with more seriously disturbed patients in hospitals and inpatient settings, while counseling psychologists tend to work with higher-functioning patients in counseling centers. They would be more likely to administer vocational tests, rather than the psychological tests often used by clinical psychologists to diagnose and treat patients (Pomerantz, 2024).

Psychiatrists

Psychiatrists go to medical school, complete medical internships, and are licensed as physicians. And, although psychologists have gotten prescription privileges in a few places, psychiatrists primarily prescribe the psychotropic medications used to treat mental disorders. Additionally, psychiatrists are more likely to conceptualize mental illness as biologically based, although some go on to seek training in psychotherapy. Traditionally, psychologists focus more on psychotherapy to treat mental disorders.

Social Workers

Social workers receive master's degrees and, unlike psychologists, their graduate training is not as focused on research activities or learning how to do psychological testing.  Traditionally, social workers focused on activities like connecting patients to social service or welfare agencies.  More recently, their work activities have expanded and much of their work can look similar to psychologists as some social workers specialize in conducting therapy with patients.  However, their training in psychopathology tends to emphasize the role of social and environmental factors.

School Psychologists

School psychologists, as the name would suggest, work in school systems.  Depending on state requirements, some school psychologists obtain master's degrees, while other states require that school psycholoigsts earn doctorate degrees.  Their work often involves psychological testing and identifying learning problems or issues such as ADHD.  They work to make sure the educational and emotional needs of children are met within the school system.  They also interact with all the adults in children's lives:  parents, guardians, and other educators.  They may do counseling with students, but typically in a school setting and it can be limited in scope.

Professional Counselors

Professional counselors receive master's degrees and complete training within 2 years.  They receive licensing that allows them to work as Licensed Professional Counselors (or LPCs).  Their training focuses primarily on providing direct services to clients.  Their clients are more typically those living with mild mental health rather than working with people with more serious mental health challenges.

Marriage and Family Therapists

Marriage and Family Therapist (or MFTs) also earn master's degrees.  Their training is heavily focused on helping couples and families.  However,  they may also do therapy with other types of individuals, but the issues tend to be related to relationships (partners/spouses) and other issues related to family dynamics.  Most MFTs work in private practice, although they may also work in clinics and agencies.

History of the Field

It is difficult—if not impossible—to trace the beginning of the field of clinical psychology to one person or exact time frame.

Trull and Prinstein (2013) follow the lead of other researchers, who felt it was most useful to suggest that the roots of clinical psychology lie within the reform movement of the 19th century. It was during this time that the plight of the mentally ill patient came to the forefront, and humanitarian efforts began for the proper and humane treatment of these patients.

Prior to that time, mentally ill persons were stigmatized and mistreated. In the Western Hemisphere, many believed that they were possessed by demons or deserved their illness due to flaws in their character (Pomerantz, 2024).

The textbook gives a broad overview of the field in several core areas:

• Diagnosis and Assessment

  • Categorizing mental illness has been at the heart of the field of Clinical Psychology since the earliest inception of the field.  The field has evolved significantly; the earliest "diagnoses" included only two:  Neurosis and Psychosis.  The current Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) is over a1000 pages long!

• Intelligence Testing

  • Early psychological pioneers debated over over the nature of intelligence and how to measure it.  Intelligence testing emerged within the field, starting with the work of Alfred Binet in the early 1900s and his well known mathmatical algorithm used to determine IQ.

• Personality Assessment

  • Early attempts to understand the core elements of humanity led to the development of tests thought to tap into many aspects of personality.  Early tests sought to bypass psychological defenses and were known as "projective" tests. The most famous of these is the Rorschach (often referred to as the inkblot test).  Later tests were questionnaires that are collectively called "objective" personality tests.  Objective personality tests are typically more straightforward in their scoring and interpretation.

• Psychotherapy

  • The practice of psychotherapy lies at the heart of the field of Clinical Psychology.  Although most early psychologists were academic, by the middle of the 20th century, psychotherapy took on prominence within the field.  The primary therapeutic models that we will discuss in this course include Psychodynamic, Humanistic, Family Therapy, Group Therapy, and the Cognitive-Behavioral Approach.

• Development of the Profession

  • The lesson provides an interactive timeline to accompany the text in order to give an overview of the field's history. Highlights from the areas we are studying (diagnosis and assessment, interventions, and the profession) will be part of the timeline and should be studied in order to take the quiz at the end of the lesson.

Racism and Prejudice in the History of Clinical Psychology

It is important to acknowledge racism and prejudiced actions that are stains on the history of our field. Some of these acts have been committed by individual psychologists while others reflect the profession as an institution. Our field is working to both recognize and condemn these acts in order to promote more inclusive and equitable approaches by contemporary psychologists. 

In 2022, the American Psychological Association issued an apology to people of color and released recommendations for remedies for past wrongs that is detailed at the following page: Confronting Past Wrongs and Building and Equitable Future 

References

American Psychological Association. (2012). About clinical psychology. 

Pomerantz, A. M. (2020). Clinical psychology: Science, practice, and diversity (5th ed.). Thousand Oaks, CA: SAGE Publications

Pomerantz, A.M. (2024).  Clinical Psychology:  Science, practice, and diversity (6th ed.)  Thousand Oaks, CA: SAGE Publications.

Trull, T. J., & Prinstein, M. J. (2013). Clinical psychology (8th ed.). Belmont, CA: Wadsworth Cengage Learning.