Clinical Psychology History, Approaches, and Careers

Clinical psychology specialty integrates the science of psychology with treating complex human problems. In addition to directing treating people for mental health concerns, the field of clinical psychology also supports communities, conducts research, and offers training to promote mental health for people of all ages and backgrounds.1

This article discusses what clinical psychologists do, the history of the discipline, and the different approaches used today in treating mental health conditions.

What Is Clinical Psychology?

Clinical psychology is the branch of psychology concerned with assessing and treating mental illness, abnormal behavior, and psychiatric problems. This psychology specialty area provides comprehensive care and treatment for complex mental health problems. In addition to treating individuals, clinical psychology also focuses on couples, families, and groups.

History of Clinical Psychology

Early influences on the field of clinical psychology include the work of the Austrian psychoanalyst Sigmund Freud. He was one of the first to focus on the idea that mental illness was something that could be treated by talking with the patient, and it was the development of his talk therapy approach that is often cited as the earliest scientific use of clinical psychology.

American psychologist Lightner Witmer opened the first psychological clinic in 1896 with a specific focus on helping children who had learning disabilities. It was also Witmer who first introduced the term “clinical psychology” in a 1907 paper.2

Witmer, a former student of Wilhelm Wundt, defined clinical psychology as “the study of individuals, by observation or experimentation, with the intention of promoting change.”3

By 1914, 26 other clinics devoted to clinical psychology had been established in the United States. Today, clinical psychology is one of the most popular subfields and the single largest employment area within psychology.

Evolution During the World Wars

Clinical psychology became more established during the period of World War I as practitioners demonstrated the usefulness of psychological assessments. In 1917, the American Association of Clinical Psychology was established, although it was replaced just two years later with the establishment of the American Psychological Association (APA).

During World War II, clinical psychologists were called upon to help treat what was then known as shell shock, now referred to as post-traumatic stress disorder (PTSD).

During the 1940s, the United States had no programs offering a formal clinical psychology degree. The U.S. Veterans Administration set up several doctoral-level training programs and by 1950 more than half of all the Doctor of Philosophy (PhD)-level degrees in psychology were awarded in the area of clinical psychology.4

Changes in Focus

While the early focus in clinical psychology had mainly been on science and research, graduate programs began adding additional emphasis on psychotherapy. In clinical psychology PhD programs, this approach is today referred to as the scientist-practitioner or Boulder Model.5

Later, the Doctor of Psychology (PsyD) degree option emerged, which emphasized professional practice more than research. This practice-oriented doctorate degree in clinical psychology is known as the practitioner-scholar or Vail model.6

Treatment Approaches in Clinical Psychology

Clinical psychologists who work as psychotherapists often utilize different treatment approaches when working with clients. While some clinicians focus on a very specific treatment outlook, many use what is referred to as an eclectic approach. This involves drawing on different theoretical methods to develop the best treatment plan for each individual client.

Some of the major theoretical perspectives within clinical psychology include:

Psychodynamic Approach

This perspective grew from Sigmund Freud’s work; he believed that the unconscious mind plays a vital role in our behavior. Psychologists who utilize psychoanalytic therapy may use techniques such as free association to investigate a client’s underlying unconscious motivations.8

Modern psychodynamic therapy utilizes talk therapy to help people gain insight, solve problems, and improve relationships. Research has found that this approach to treatment can be as effective as other therapy approaches.9

Cognitive Behavioral Approaches

This approach to clinical psychology developed from the behavioral and cognitive schools of thought. Clinical psychologists using this perspective will look at how a client’s feelings, behaviors, and thoughts interact.

Cognitive-behavioral therapy (CBT) often focuses on changing thoughts and behaviors contributing to psychological distress.10 Specific types of therapy that are rooted in CBT include:

• Acceptance and commitment therapy
• Cognitive processing therapy
• Dialectical behavior therapy
• Rational emotive behavior therapy
• Trauma-focused cognitive behavioral therapy
• Mindfulness-based cognitive therapy

Humanistic Approaches

This approach to clinical psychology grew from the work of humanist thinkers such as Abraham Maslow and Carl Rogers. This perspective looks at the client more holistically and is focused on such things as self-actualization.11

Some types of humanistic therapy that a clinical psychologist might practice include client-centered therapy, existential therapy, Gestalt therapy, narrative therapy, or logotherapy.

How to Become a Clinical Psychologist

In the United States, clinical psychologists usually have a doctorate in psychology and receive training in clinical settings. The educational requirements to work in clinical psychology are quite rigorous, and most clinical psychologists spend between four to six years in graduate school after earning a bachelor’s degree.12

Before choosing a clinical psychology program, you should always check to be sure that the program is accredited by the APA. After completing an accredited graduate training program, prospective clinical psychologists must also complete a period of supervised training and an examination.

Students in the United Kingdom can pursue a doctorate-level degree in clinical psychology (DClinPsychol or ClinPsyD) through programs sponsored by the National Health Service.13

These programs are generally very competitive and are focused on both research and practice. Students interested in enrolling in one of these programs must have an undergraduate degree in a psychology program approved by the British Psychological Society in addition to experience requirements.

Careers In Clinical Psychology

Clinical psychologists work in a variety of settings (hospitals, clinics, private practice, universities, schools, etc.) and in many capacities. All of them require these professionals to draw on their expertise in special ways and for different purposes.

Some of the job roles performed by those working in clinical psychology can include:

• Assessment and diagnosis of psychological disorders, such as in a medical setting
• Treatment of psychological disorders, including drug and alcohol addiction
• Offering testimony in legal settings
• Teaching, often at the university level
• Conducting research
• Creating and administering programs to treat and prevent social problems

Some clinical psychologists may focus on one of these or provide several of these services. For example, someone may work directly with clients who are admitted to a hospital for psychological disorders, while also running a private therapeutic office that offers short-term and long-term outpatient services to those who need help coping with psychological distress.