Introduction
Since the beginning of the twentieth century, there has been a growing concern about mental health. Studies have indicated that approximately one out of every five persons in the United States will experience a psychological disorder severe enough to warrant professional help. Given the magnitude of this problem, the question emerges as to who will provide the kind and amount of treatment needed for this large number of individuals.
Mental health practitioners have emerged from different fields of endeavor. The field of medicine produced psychiatrists; the field of psychology produced clinical psychologists and counseling psychologists; and the field of social work produced psychiatric social workers. In some states, such as California, legislation created special mental health practitioners called marriage, family, and child counselors to fulfill the needs that were not met by these large professional groups.
Types of Practitioners
Psychiatrists
are those individuals who have completed four years of college and four years of medical school, including one year of internship. After completion, they continue their studies in a residency in psychiatry for approximately three years and learn the skills of a practicing psychiatrist. This is generally done in a mental hospital or clinic, under the supervision of other psychiatrists. On completion, they may choose to take an examination that will award them the status of being certified. This status recognizes that a psychiatrist has demonstrated a level of competence that meets professional standards.
As a physician, the psychiatrist can perform all the medical functions that any physician can perform. In terms of the mental health setting, this means that the psychiatrist’s activities can involve the administration of different types of drugs that are designed to alter the way a patient feels, thinks, or behaves. The psychiatrist conducts psychotherapy and is concerned about any physical conditions that might make the patient’s psychological disposition more serious. The psychiatrist may use other biological treatments, such as electroshock therapy, in the treatment of severe depression and is qualified to supervise the care of patients requiring long-term hospitalization.
The clinical psychologist
emerges from the tradition of psychology rather than that of medicine, with a background in theories of behavior and the ways in which behavior may be changed. After completing four years of undergraduate study—usually, but not necessarily, in psychology—the student studies two more years to obtain a master’s degree in psychology and completes a master’s thesis, which provides evidence of research capabilities. This is followed by three more years working toward a PhD degree and the completion of an internship in a mental health setting. After completion of these academic requirements, a psychologist is eligible to take the state licensing examination, which usually requires an oral and a written test. In some states, such as California, the psychologist is required to complete an additional year of supervised experience after receiving a PhD before becoming eligible for the licensing examination. After passing the examination for licensing, the psychologist is then able to offer services to the public for a fee. Many clinical psychologists choose to go into private practice, that is, to provide services to private patients in their own offices. About a quarter of all psychologists in the United States list private practice as their primary setting of employment. Other clinical psychologists work in settings such as hospitals, mental health clinics, university counseling centers, and other human service agencies.
After five years of clinical experience, the psychologist may apply for certification by the
American Psychological Association. Obtaining certification requires passing written and oral tests as well as an on-site peer examination of clinical skills. Those who succeed are awarded the title of Diplomate in Clinical Psychology. This same award is given in other areas, such as counseling psychology, school psychology, industrial and organizational psychology, and neuropsychology. Board certification clarifies for the general public that the psychologist has demonstrated better-than-average clinical skills and is recognized as such by his or her professional peers. Fewer than 10 percent of all clinical psychologists have been awarded the status of diplomate. This is a useful guide, therefore, for persons who are uncertain about whom to see for therapy or assistance. Most telephone directories will designate the diplomate status of individuals, since the American Psychological Association requires that they identify themselves as such.
The counseling psychologist, much like the clinical psychologist, is required to obtain a PhD and complete an internship in counseling psychology. Counseling psychologists work in the mental health profession by providing services to those individuals, or couples, who are under stress or crisis but who continue to be functional. These are individuals who have functioned well in their lives but are meeting particularly difficult situations and require professional help to adjust to or overcome the stresses of the moment. These situations could involve loss of job, marital conflict, divorce, separation, parent-child or other family conflicts, prolonged physical illnesses, or academic difficulties. Counseling psychologists may either be in private practice or be employed by a university counseling center, where they provide services exclusively to college students.
A fourth type of mental health worker is the psychiatric social worker.
This person completes four years of undergraduate study in the social or behavioral sciences, then completes two additional years of study in a school of social work. Social workers may choose different areas of specialty; the mental health worker usually concentrates in psychiatric social work. This involves recognizing the social environment of the patient and altering it in ways that will reduce stress and help maintain the gains that the patient may have achieved in treatment. The social worker becomes involved with issues such as vocational placements, career choice, and family stresses and is the link between the patient and the outside world. Social workers who are licensed may have their own private practices and may offer counseling and psychotherapy as a form of treatment.
Typical Activities
Surveys conducted by the American Psychological Association indicate that clinical psychologists spend most of their professional time with therapy, diagnosis and assessment, and teaching and administration. These categories constitute approximately 70 percent of their daily activity. Additional activities involve research and consultation with other agencies or professionals. Forty percent of their daily activity, however, is devoted to providing direct clinical services to patients either through psychotherapy or psychological testing.
Almost all practicing clinical psychologists engage in some type of diagnosis or assessment. These assessments usually involve the administration of psychological tests, which include intelligence tests, vocational tests, personality tests, attitude tests, and behavioral repertoires. The purpose of the testing is to assess the patient’s current status, to determine any disabling conditions, to assess the patient’s psychological strengths that can be used in therapy, and to determine treatment recommendations that are specific to the patient’s particular problem. Usually these results are discussed with the patient, and a plan of treatment or therapy is recommended by the psychologist and agreed on by the patient.
Because there are more than two hundred forms of psychotherapy or behavioral interventions, it is the responsibility of the psychologist to determine which of these procedures is best for the patient, taking into consideration the patient’s age, physical status, psychological and emotional condition, and the length of time the disorder has been present. Psychologists should have a good knowledge of the research literature, which would tell them which of these many therapeutic approaches is best for the particular clients with whom they are working at the time.
In the course of private clinical work, the clinical psychologist is likely to meet a variety of different types of cases. These clients may be referred for treatment by other mental health workers, hospitals, insurance plans, ministers, or prior patients.
Clients vary as to the severity of their disorders. Some are very seriously disturbed, such as schizophrenic adults who are not receiving treatment in the community and are homeless. They often require hospitalization that provides a complete plan of treatment. Clients with drug or alcohol problems who have had long-standing difficulties with these substances may also require partial hospitalization. The clinical psychologist often acts as the principal or cooperating therapist who plans and participates in the treatment program. Because many clinical psychologists have hospital privileges that allow them to admit their patients to a hospital facility, this procedure is used with severely disturbed persons who are a danger to themselves or to others.
Those psychologists who work principally in private practice tend to see clients who have problems adjusting but who do not require hospitalization. These clients often seek therapy to reduce excessive symptoms of anxiety, depression, or intrusive thoughts that affect their daily lives. Other clients seek help in relationships with others to solve marital, parent-child, employee-supervisor, or sexual conflicts. The clinical psychologist in private practice meets the needs of these clients by providing the best means of resolving these conflicts.
Because psychologists deal with human behavior, they are often involved in many other facets of human activity that require their expertise. For example, psychologists are called on to testify in court on questions of sanity, in custody cases, and, occasionally, as expert witnesses in criminal cases. Other psychologists are involved in sports psychology, helping athletes to develop the best psychological and emotional conditions for maximum performance. Still others work in the area of neuropsychology, which deals with patients who have experienced head injuries. Psychologists are asked to assess the extent of the injury and to find those areas that could be used to help the patient recover lost skills. Other psychologists specialize in treating of children who have been sexually or physically abused, in providing drug or alcohol counseling, in working in prisons with juvenile delinquents, or in working with patients who have geriatric disorders.
Some psychologists are involved in full- or part-time teaching at a university. These clinical psychologists not only continue their own clinical practices but also help prepare undergraduate and graduate students through direct classroom instruction or through supervision of their intern or field experiences.
Developments in the Field
The field of psychology that deals mainly with emotional and psychological adjustment is called clinical psychology. This field began to take root during World War I, when psychologists were asked to screen military recruits for emotional problems and to assess intellectual abilities so that recruits could be placed in appropriate military positions. During World War II, clinical psychologists assumed an even greater role by developing psychological tests that were used in the selection of undercover agents. They were also asked to provide psychotherapy for soldiers who had emotional or neurological disorders.
Following World War II, clinical psychologists became heavily involved in the development and construction of psychological tests to measure intelligence, interest, personality, and brain dysfunction. Psychologists also became more involved in providing psychotherapy. Today, more psychologists spend their time providing psychotherapy than performing any other single activity.
Clinical psychology today regards itself as an independent profession, separate from the field of psychiatry, and sees itself rooted in the discipline of general psychology with the added clinical skills that make its practitioners uniquely capable of providing services to the general public. It is likely that clinical psychologists will continue to move in the direction of independent practice, focusing on new areas such as behavioral medicine, neuropsychology, forensic psychology, and pharmacotherapy. The latter trend is seen in the states of New Mexico and Louisiana, which allow psychologists with appropriate training to prescribe psychotropic drugs. Other states are actively considering legislation in this area.
Bibliography
American Psychological Association. Graduate Study in Psychology, 2013. Washington: Author, 2013. Print.
American Psychological Association. Psychology as a Health Care Profession. Washington: Author, 1980. Print.
Gerig, Mark S. Foundations for Clinical Mental Health Counseling: An Introduction to the Profession. 2nd ed. Upper Saddle River: Pearson, 2014. Print.
Linden, Wolfgang, and Paul L. Hewitt. Clinical Psychology: A Modern Health Profession. Boston: Prentice, 2012. Print.
Saccuzzo, Dennis P., and Robert M. Kaplan. Clinical Psychology. Boston: Allyn, 1984. Print.
Sternberg, Robert J., ed. Career Paths in Psychology: Where Your Degree Can Take You. 2nd ed. Washington: APA, 2007. Print.
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