Understanding Clinical Psychology

Clinical Psychology Definition

• Clinical psychology is a broad field within psychology focusing on research and practice.
• It applies psychological principles to assess, prevent, ameliorate, and rehabilitate psychological distress, disability, dysfunctional behavior, and health-risk behavior.
• It also enhances psychological and physical well-being.
• Clinical psychology includes scientific research to identify general principles, clinical service to study and care for clients, and information exchange.
• Historically assessment, evaluation, and diagnosis were emphasized.
• Now, intervention and prevention are gaining importance, with a significant emphasis on research and evidence-based practice.
• Clinical psychology applies psychological knowledge to prevention, assessment, intervention, research, consultation, teaching, and supervision.
• Clinical psychologists work with diverse clients, like individuals, couples, families, groups, and organizations, across various settings and the lifespan.
• They work in areas like forensics, neuropsychology, health, and with children and adolescents.

Clinical Psychology Vs. Other Mental Health Professions

• There is minimal distinction between clinical and counseling psychology currently; differences may arise in populations, settings, and activities based on training opportunities.
• School psychologists operate at the intersection of psychology and education.
• Their role includes diagnosing childhood disorders and creating programs for schools/families, possibly requiring education degrees and/or child/adolescent experience.
• Psychiatrists must have a doctorate, clinical psychologists may practice with a master's.
• Psychiatry focuses on physiology and biological functions related to psychological abnormalities with pharmacology as a special area.
• Psychiatrists have less training in formal assessment, psychotherapy, and research.
• Clinical social work professionals may hold different degrees from clinical psychologists (BPsyc vs BSW).
• Clinical social work focuses on enhancing client well-being, involving policy development, social program planning, case management, counseling, and advocacy.

Cognitive Behavioral Therapy Dominance (CBT)

• CBT emphasizes the connection between thoughts, feelings, and behaviors.
• CBT has more empirical support compared to other psychotherapies like short-term psychodynamic psychotherapy.
• This increased support results in more resources for effectiveness research, including cross-cultural studies.
• A predominant focus on CBT can lead to a lack of diversity in mental health, limiting differing viewpoints.
• Clients may struggle to find therapists specializing outside of CBT.
• Therapies outside the CBT model receive less funding and research attention.

Diagnosing Clients: Benefits vs. Risks

• A clinical psychologist’s diagnostic expertise can lead to benefits for clients.
• One study suggests clinical psychologists are more aware of the side effects from psychopharmaceuticals like lorazepam.
• If prescriptions were allowed by clinical psychologists, it could create a more efficient and positive mental health system framework.
• General doctors typically see a high volume of patients.
• Allowing clinical psychologists to diagnose patients would shift the responsibility to more individuals and create better patient care.
• Risks include the fact that psychiatrists and other professionals with medical backgrounds tend to focus more on pharmaceuticals and their impact on the body.
• Clinical psychologists receive more therapeutic and counseling training; however, not all have scientific backgrounds.

Client Populations to Avoid

• Domestic violence perpetrators are a potential population to avoid.
• Ethically, individuals must set aside judgment and provide a fair, unbiased chance.
• The therapist should believe that their therapy can help.
• Personal bias against perpetrators of domestic violence, should be considered.

Psychotherapy Vs. Talking to a Friend

• Psychotherapy and informal discussions with friends differ in the following ways:
  • Conflict of interest
  • Personal investment
  • Bias due to emotional closeness
  • Absence of structure or mutually agreed goal
  • Psychological advice is provided without accountability.
  • "Talking to a friend" is not an empirically supported treatment approach.

Clinical Psychologist as Generalist

• It may be possible for clinical psychologists to be generalists, but specialists must be available for referral.
• General practitioners and family doctors operate similarly.
• Challenges for generalists include:
  • Extended, broad training to understand diverse populations
  • Potential to feel overwhelmed
  • Taking on work beyond capacity
  • Reduced opportunities for extensive practice in each specific therapy

Disillusioning a Potential Clinical Psychologist About the Field

• Masters programs in Alberta are not accredited; doctoral (PhD) programs are the standard.
• If unable to enter accredited PhD programs, individuals must ensure each graduate course is approved by the College of Alberta Psychologists.
• Accreditation standards for courses and previous degrees are demanding.
• Accredited programs have high entrance competition.
• You must find and often pay for your own supervision to practice.
• Applicants should be prepared to apply to multiple graduate programs and face potential rejection.
• Graduate programs require a bachelor's degree in addition to minimum applied research and publications experience.
• Expect to move for graduate programs, perhaps more than once if pursuing a doctorate.
• Personal applications for tri-council funding must be completed.
• Additional fees for licensure, study materials and time accrue after grad school.

Cognitive Behavioral Therapy (CBT)

• CBT is used to treat generalized anxiety disorder, OCD, and social anxiety disorder.
• Change Theory: CBT indicates that emotions and behaviors impact perception of events.
• Client experiences influence how they think.
• Psychologists utilize Socratic dialogue and probing questions.
• In this way core beliefs, assumptions, and thoughts are challenged.
• CBT has evidence showing improvements in clients, and it is structured, useful, accessible, and cost-effective for various diagnoses.
• CBT can be equally good as medication or to compliment it.
• CBT may not benefit some disorders as much as other therapies.
• It can also be too focused on the individual or may not always address underlying issues.

Collateral Information in Assessment

• Collateral information may be used in assessments to gain to a fuller understanding of the client’s behavior, relationships, and personal habits.
• Psychologists may consent to interview family and friends to gain insight regarding the client’s actions, emotions and behavior in familiar environments.
• Collateral information gathering occurs only on a case-by-case basis.
• It may be critical to include in assessments of children, during high stakes or forensic assessments, or when clients lack their own insight.
• Psychologists should be aware of common threads of informant’s reporting.
• They also may need to ask the client directly to gain further clarity.
• Differing information may be due to differences in environments, and unique experiences between individuals.

Interpersonal Therapy (IPT)

• IPT is suited for those who need to manage daily routines/social rhythms to prevent symptoms.
• It is used in Bipolar 1 and with Depression.
• Most clients may not need assistance regulating habits/routines that may be helpful for some but too severe for others.
• CBT has proven to be a more effective treatment for anxiety disorders.
• IPT depends on a strong level of trust between the patient and the counsellor.
• It utilizes psychoeducation (transdiagnostic), as well as the elements of goal-oriented therapy with behavioural therapy.
• For IPT to achieve the best results clients must track their progress daily.
• To be effective clients must actively engage in the therapy and make a long-term commitment.
• Some therapists may be biased, making them better suited for specific clients/therapy types.