Clinical Psychology: Definition & History

• Clinical psychology addresses psychological problems or disorders.

Original Definition

• Lightner Witmer coined the term "clinical psychology" in 1907 and established the first psychological clinic.
• Witmer envisioned clinical psychology as a discipline akin to medicine, education, and sociology, focusing on treatment, education, and interpersonal issues.
• Witmer's initial clients were children with behavioral or educational problems, and he anticipated applicability to all ages and problems.

Challenges in Defining Clinical Psychology Today

• Growth of the Field: Significant expansion in various directions since Witmer's time makes it difficult to capture the field's entirety with simple definitions.
• Contemporary Practice: Clinical psychologists engage in diverse activities with different goals for varied populations.

Recent Definitions

• Clinical psychology studies, assesses, and treats individuals with psychological problems or disorders and these definitions fail to encompass the full range of clinical psychologists' work, methods, and client demographics.

Comprehensive Definition by APA

• APA Division 12 (2022) defines clinical psychology as the field involving research, teaching, and services relevant to the applications of principles, methods, and procedures for understanding, predicting, and alleviating intellectual, emotional, biological, psychological, social, and behavioral maladjustment, disability, and discomfort, applied to a wide range of client populations.
• This definition illustrates the rich and varied growth of the field since Witmer's identification.

Current Understanding of Clinical Psychology

• Norcross & Sayette (2022) note that the field and its practitioners continue to outgrow classic definitions.
• Textbook definition: Clinical psychology involves rigorous study and applied practice aimed at understanding and improving the psychological facets of human experience and addressing issues related to behavior, emotions, or intellect.

Overview of Clinical Psychology Training

• Understanding clinical psychology involves examining the education and training of clinical psychologists.
• Basic components of training are consistent across programs.

Educational Requirements

• Aspiring clinical psychologists must obtain a doctoral degree in clinical psychology and approximately 3,000 doctoral degrees are awarded annually
• Most students enter doctoral programs with a bachelor's degree, while some enter with a master's degree, often from a terminal master's program in clinical psychology.
• Terminal master's graduates may pursue doctoral degrees or enter the workforce

Training Structure

• Training typically involves at least 4 years of full-time coursework, followed by a 1-year predoctoral internship.
• Key subjects include psychotherapy, assessment, statistics, research design and methodology, biological bases of behavior, cognitive-affective bases of behavior, social bases of behavior, and individual differences/diversity
• Other requirements include a master's thesis and doctoral dissertation, as well as practicum for supervised clinical experience.
• After completing coursework, students undertake a 1-year predoctoral internship for greater clinical responsibilities and full-time supervised experience, followed by a postdoctoral internship after the doctoral degree.

Diverse Paths to Clinical Psychology

• There is no single pathway to becoming a clinical psychologist; multiple routes exist.
• Over half of APA-accredited doctoral programs offer training in specialty tracks such as clinical child psychology, clinical health psychology, forensic psychology, family psychology, and clinical neuropsychology.

Training Models

• Practitioner-Scholar (Vail) Model: Focuses on the application of clinical skills and knowledge, with less emphasis on research.
• Scientist-Practitioner (Boulder) Model: Emphasizes the integration of scientific research and clinical practice.
• Clinical Scientist Model: Prioritizes scientific research and evidence-based practice in clinical training.

Leaning Toward the Practice: Practitioner-Scholar (Vail) Model

• Vail Conference (1973): A pivotal conference on clinical psychology training was held in Vail, Colorado.
• Dissatisfaction with the Boulder Model: Prior to the conference, there was growing discontent with the Boulder or scientist-practitioner model of training as many clinical psychologists questioned the necessity of extensive research training when their primary goal was to practice.

Shift in Focus

• A minority of clinical psychologists pursued careers in academia or research; the majority favored clinical practice.
• Aspiring clinical psychologists sought doctoral degrees that emphasized applied clinical skills

Emergence of the Practitioner-Scholar Model

• The practitioner-scholar model was created to address the needs of those focused on clinical practice.
• This model introduced a new type of doctoral degree: the PsyD (Doctor of Psychology)

Growth of PsyD Programs

• Curriculum Differences: PsyD programs typically include more coursework directly related to clinical practice and fewer courses focused on research and statistics compared to PhD programs
• Current Trends: Approximately half of the doctoral degrees awarded in clinical psychology are PsyD degrees, but although there are fewer PsyD programs than PhD programs, PsyD programs tend to accept and graduate a larger number of students.

Variability

• There is considerable variation within both PhD and PsyD programs
• Research Emphasis: PsyD programs place less emphasis on research-related training and more on clinically relevant training.
• Admissions: PsyD programs accept a larger percentage and number of applicants, are typically housed in independent or university-affiliated professional schools rather than psychology departments, and accept students with lower Graduate Record Examination (GRE) scores and undergraduate GPAs.
• Funding: PsyD programs offer significantly less funding to enrolled students.
• Master's Degree Holders: A higher percentage of PsyD students have already earned a master's degree.
• Internship Placement: PsyD students have lower rates of success in placing students in APA-accredited predoctoral internships.
• Licensing Exam Performance: PsyD graduates tend to score lower on the national licensing exam (EPPP).
• Graduation Timeline: PsyD students graduate approximately 1.5 years sooner than PhD students.
• Career Paths: PsyD graduates are more likely to pursue practice-related careers rather than academic or research-related careers, and a slightly higher percentage of faculty in PsyD programs subscribe to psychodynamic approaches compared to cognitive-behavioral approaches.

Balancing Practice and Science - The Scientist-Practitioner (Boulder) Model

• The first conference on graduate training in clinical psychology was held in Boulder, Colorado in 1949
• A consensus was reached that training in clinical psychology should emphasize both practice and research, and graduate students must demonstrate competence in clinical methods (e.g., assessment, psychotherapy) and research methods necessary for scientific study and evaluation of the field.

Curriculum Structure

• Programs should include classes that reflect the dual emphasis - clinical courses such as psychotherapy and assessment, and research courses such as statistics and research methods.
• Graduate students are expected to conduct both clinical work and empirical research (thesis and dissertation) under supervision.
• Clinical psychology graduate programs are typically housed in departments of psychology at universities, and graduates are awarded the PhD degree with the approach labeled the scientist-practitioner model, also known as the Boulder model.
• Dominance of the Boulder Model: For decades, the scientist-practitioner model dominated clinical psychology training, and more programs continue to subscribe to the Boulder model than any other training approach
• Shifts Over Time: As time progressed, the field saw developments that led to a wider range of training options as the balance between practice and research shifted toward one extreme or the other, reflecting changes in the profession's needs and priorities.

Leaning Towards Science—The Clinical Scientist Model

• Following the establishment of the Boulder model in the late 1940s and the Vail model in the 1970s, a movement emerged advocating for a more research-focused training model in clinical psychology.
• In the 1990s, a push for increased empiricism led to the development of the clinical scientist model, which emphasized the scientific and research-oriented aspects of clinical psychology more strongly than the Boulder model.

Philosophy of the Clinical Scientist Model

• Proponents argued that science should be the foundation of clinical psychology, advocating for a model that prioritizes empirical research and evidence-based clinical methods.
• Unlike the Vail model, the clinical scientist model does not propose a different degree; it still awards the PhD, similar to Boulder model programs, and a PhD from a clinical scientist program indicates a strong emphasis on scientific research and evidence-based practices.

Key Events in the Clinical Scientist Movement

• Richard McFall published a pivotal article titled "Manifesto for a Science of Clinical Psychology," asserting that scientific clinical psychology is the only legitimate form of the discipline and questioned the reliance on intuition and unscientific methods, advocating for a rigorous scientific approach.
• Following a conference at Indiana University, the Academy was established to promote clinical science and McFall served as its first president, and the Academy has since grown to include numerous graduate programs and internships, some of which have rebranded to reflect their focus on science.

Current Landscape of Clinical Psychology Training

• The field now includes three primary training models: Boulder Model (balanced approach emphasizing both practice and research), Vail Model (focused on clinical skills and practice), and Clinical Scientist Model (strong emphasis on empirical research).
• The experience of clinical psychology graduate students can vary significantly based on the training model of their program with The Insider's Guide to Graduate Programs rates programs on a scale from "practice-oriented" to "research-oriented"
• Shifts in Theoretical Orientation: A study indicated a shift toward cognitive/cognitive-behavioral orientations and away from psychodynamic approaches and there has been an increase in the percentage of doctoral students who are female and from racial or ethnic minorities.
• The Clinical Scientist Model represents a significant shift toward emphasizing empirical research in clinical psychology training, and this model, alongside the Boulder and Vail models, contributes to a diverse educational landscape, reflecting varying priorities in practice and research
• Technology plays an increasing role in training, with students using webcams and computer-based methods for supervision and assessment, and emphasis on specific competencies ensures graduates can apply their knowledge in real-world settings
• Training can be rewarding but also stressful due to intense academic demands, clinical responsibilities, and research pressures and a study found that over 20% of clinical psychology graduate students reported moderate to severe anxiety or depression, with higher rates among LGBTQ+ students, and potential sources of support include faculty, classmates, friends, family, and mental health professionals.

Resources for Aspiring Clinical Psychology Students

• Competitive Admission Rates: PhD programs have a 7% to 16% acceptance rate and PsyD programs have a 40% to 50% acceptance rate.
• Applicants typically apply to 10-12 programs.
• Requirements for Licensure: Completion of graduate coursework, predoctoral internship, and postdoctoral internship, and passing the Examination for Professional Practice in Psychology (EPPP) and a state-specific exam on laws and ethics with many states requiring licensed psychologists to complete CEUs to maintain licensure.

Preparation Strategies for Applicants

• Know Your Professional Options: Research various paths to becoming a clinical psychologist and related professions to make informed decisions.
• Undergraduate Coursework: Focus on relevant courses to enhance graduate school readiness:
• Required: Statistics, research methods, psychopathology, biopsychology, personality.
• Electives: Classes with clinical relevance, such as field studies or internships.
• Build Relationships with Professors: Strong letters of recommendation are crucial; develop meaningful relationships with professors through research or advising.
• Gain Research Experience: Conduct research with faculty to gain empirical experience and potentially co-author publications or presentations.
• Obtain Clinically Relevant Experience: Seek opportunities in community mental health centers, psychiatric hospitals, crisis hotlines, and similar settings to demonstrate commitment to the field.
• Maximize GRE Scores: Prepare thoroughly for the GRE, as scores are significant factors in admissions decisions.
• Research Graduate Programs: Understand the training model (Boulder, Vail, or clinical scientist), faculty orientations, and available clinical opportunities.
• Write Effective Personal Statements: Clearly articulate career aspirations, research interests, and relevant experiences while maintaining professionalism.
• Prepare for Admissions Interviews: Dress professionally and demonstrate knowledge of the program, including specific faculty interests and research areas.
• Consider Long-Term Goals: Reflect on career aspirations, theoretical orientations, and financial considerations to ensure a good fit with the program.
• Core Components Valued by Programs: Undergraduate GPA, GRE scores, letters of recommendation, personal statement, curriculum vitae, and interview performance.
• Differences Between PhD and PsyD Programs: PhD programs emphasize student-mentor research matches and research experience, while PsyD programs are more likely to admit applicants with a master's degree.
• Assess Compatibility: Consider personal comfort, faculty personalities, program climate, and quality-of-life factors when choosing a program.
• Predoctoral Internship: A full year of supervised clinical experience in settings like hospitals, counseling centers, or community mental health centers and is considered a transition from student to professional with APA accreditation is important for internship credibility.
• Postdoctoral Internship: Typically lasts 1 to 2 years and involves more responsibilities than a predoctoral internship, and provides specialized training and is often required for licensure.
• Requirements for Licensure: Completion of graduate coursework, predoctoral internship, and postdoctoral internship, and, also, passing the Examination for Professional Practice in Psychology (EPPP) and a state-specific exam on laws and ethics.

Where Do Clinical Psychologists Work?

• Primary Employment Settings: Private practice is the most common setting, with 30% to 41% of clinical psychologists working here since the 1980s, with university psychology departments as the second most common setting, not exceeding 19%.
• Other settings include psychiatric hospitals, general hospitals, community mental health centers, medical schools, and Veterans Affairs medical centers.
• Global Perspective: High-Income Countries: Approximately 14.0 psychologists per 100,000 people, while low-Income Countries have Only 0.04 psychologists per 100,000 people
• In low-income areas, healthcare directors train non-psychology professionals (e.g., nurses, teachers) to deliver psychological services under supervision, which has shown substantial benefits

What Do Clinical Psychologists Do?

• Psychotherapy: Foremost activity, with 76% to 87% of clinical psychologists involved in it since the 1970s. Clinical psychologists spend 31% to 37% of their time on psychotherapy, with individual therapy being the most common and more than half are involved in diagnosis/assessment, teaching, supervision, research/writing, consultation and administration with diagnosis and assessment typically occupy more time than other activities.
• About half of clinical psychologists hold at least two professional positions, indicating a diverse engagement in various professional pursuits

What Characteristics Do Clinical Psychologists Have?

• Ethnicity: 83% non-Hispanic White, 3% Black, 4% Asian, 7% Latinx. Gender: 70% are women, a significant increase in recent decades.
• Disabilities: 5% have disabilities, and the Mean Age: 48.4 years old.
• Clinical psychologists tend to be less religious than the general population, with lower affiliation and participation in religious practices, and they generally hold more liberal social and political views compared to the general public.
• There is a rising trend in the endorsement of cognitive or cognitive-behavioral approaches, particularly among those trained in science-oriented graduate programs.

Counseling Psychologists

• Initially, counseling psychology and clinical psychology were distinct fields, however, Clinical psychologists typically worked with clients with more severe psychological disorders, while counseling psychologists focused on less severe issues
• Today, there is significant overlap between the two professions.
• Graduate students in both fields often apply for the same internship sites and may earn the same degree (PhD), and both professions typically obtain the same licensure status
• Clinical psychologists tend to work more with clients who have severe disorders and often complete internships in settings like hospitals and inpatient psychiatric units, while Counseling psychologists generally work with clients who have less severe disorders and are more likely to intern in university counseling centers. Differences inclue Clinical psychologists tend to favor behaviorism, Counseling psychologists are more inclined toward humanistic/client-centered approaches,
• Counseling psychologists often focus on vocational testing and career counseling, while Clinical psychologists are more interested in applying psychology within medical settings.
• Psychiatrists attend medical school and are licensed as physicians, they can prescribe medication, a significant distinction from clinical psychologists, typically focus on fixing the brain through medication, viewing pharmacological treatment as a primary intervention however Clinical psychologists view clients' problems as behavioral, cognitive, and emotional, emphasizing non-pharmacological methods such as psychotherapy as the first line of defense

Social Workers

• Connect clients with social services (e.g., welfare agencies, disability offices, job-training sites) and work alongside psychologists and psychiatrists, particularly in institutional settings, to facilitate clients' transitions to community living post-inpatient care.
• They typically earn a master's degree rather than a doctorate, training emphasizes supervised fieldwork but includes minimal focus on research methods, psychological testing, or physiological psychology and the theories of psychopathology and therapy emphasize social and environmental factors.

School Psychologists

• Primarily work in schools and their primary Functions enhance students' intellectual, emotional, social, and developmental well-being
• Professional Counselors are often referred to as licensed professional counselors (LPCs), earn a master's degree and typically complete training in about 2 years and their scope of work focuses on counseling individuals with problems in living or mild mental illness, rather than serious mental illness.
• There is Equal emphasis on empiricism and practice from a Scientist-Practitioner and Stronger emphasis on practice from a Practitioner-Scholar.