THE SKILLS & ACTIVITIES OF A CLINICAL PSYCHOLOGIST:THE INTERNSHIP

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Clinical Psychology (PSY401)

LESSON 02

THE SKILLS & ACTIVITIES OF A CLINICAL PSYCHOLOGIST

WHO IS A CLINICAL PSYCHOLOGIST?

A clinical psychologist is a professional who applies principles and procedures to understand, predict

and alleviate intellectual, emotional, psychological and behavioral problems"

(American Psychological Association).

PROFESSIONAL SKILLS / ACTIVITIES OF A CLINICAL PSYCHOLOGIST

The fundamental skill areas that are essential for competent functioning as a clinical psychologist within

the areas of mental health include the following:

Assessment & Diagnosis

Intervention & Therapy

Teaching

Clinical Supervision

Research

Consultation

Program Development

Administration

1. ASSESSMENT & DIAGNOSIS

ASSESSMENT

Assessment has long been a critical part of the clinical psychologist's role. Clinical psychologists most

commonly administer psychological tests for the purposes of assessing a person's mental health.

Assessment, whether through observation, testing or interviewing, is a way of gathering information so

that an important question can be solved. Assessment of an individual's development, behavior,

intellect, interests, personality, cognitive processes, emotional functioning, and social functioning are

performed by clinical psychologists, as are assessment activities directed toward couples, families, and

groups.

Interpretation of assessment results, and integration of these results with other information available, in

a way that is sensitive to the client, and particularly clients of special populations, is an essential skill of

clinical psychologists. The process of assessment is very important as it leads to the diagnosis of the

client's problem(s).

All practicing clinicians engage in assessment of one form or another. Take, for example, the following

cases:

A child who is failing the fourth grade is administered an intelligence test to check if there is an

intellectual deficit; a student with an undesirable behavior in class is administered a personality test to

check the presence of anti-social personality traits.

Clinical psychologists also conduct detailed interviews with patients, asking questions intended to

reveal signs of a psychological problem. At times, it is difficult to determine whether someone should

be identified as having a psychological disorder. According to the American Psychiatric Association, a

pattern of behavior or thinking is considered a psychological disorder only if

(1) The person is experiencing significant distress or impairment,

Clinical Psychology (PSY401)

(2) The source of the problem resides within the person and is not a normal response to negative life

events, and

(3) The problem is not a deliberate reaction to conditions such as poverty, prejudice, or conflicts with

society.

DIAGNOSIS

To formulate an effective method of treatment, clinical psychologists must not only determine that there

is a problem but also must make a specific diagnosis. That is, they must identify the specific disorder or

problem affecting the patient. Clinical psychologists are trained to assess, and make functional

diagnoses regarding intellectual level, cognitive, emotional, social, and behavioral functioning, as well

as mental and psychological disorders. For this purpose, the most widely used diagnostic scheme in the

United States is the Diagnostic and Statistical Manual of Mental Disorders, a reference book published

by the American Psychiatric Association. This manual contains a complete list of psychological

disorders classified into 16 broad categories.

For example, panic disorder, post-traumatic stress disorder, obsessive-compulsive disorder, and phobias

are grouped under the category of anxiety disorders. The manual describes the main symptoms for each

disorder in concrete behavioral terms. It also gives the prevalence rates for men and women in the

population; a list of predisposing factors; the normal age of onset; and the prognosis, or expected

outcome.

In clinical settings, diagnoses may be made formally, using widely accepted criteria, such as the DSM

IV, or informally, such as diagnosis of family dynamics using a particular theoretical model.

2. INTERVENTION & THERAPY

A major activity of clinical psychologists is intervention or treatment. Many clinical psychologists work

directly with people who have a mental illness or psychological disorder. By choosing an appropriate

treatment, clinical psychologists can help such people overcome their problem or, at minimum, manage

their symptoms. All psychological intervention rests on the ability to develop and maintain functional

therapeutic relationships with clients.

Intervention is an important skill, as clients seen by clinical psychologists are often highly distressed

and sensitive. The major purpose of intervention is to empower individuals to make adaptive choices

and to gain healthy control of their own lives.

All interventions require skill in the following tasks: conceptualization of the problem; formulation of a

treatment plan; implementation of the treatment plan; and evaluation of the accuracy and completeness

of the above mentioned tasks, as well as outcome of the intervention.

Psychotherapy is the activity that most frequently engages the typical clinician's efforts and to which

the most time is devoted. The lay person often has an image of the therapy situation as one in which the

client lies on a couch while the therapist, bearded and mysterious, sits behind with notepad and

furrowed brow. Actually, therapy comes in many different sizes and shapes. A few therapists still use a

couch, but more often the client sits in a chair adjacent to the therapist's desk.

Most often therapy involves a one- to- one relationship, but today couple's therapy, family therapy and

group therapy are also very common. The therapist and client meet regularly, typically (but not

necessarily) in weekly sessions, to work out the solution of the client's problems until both agree that the

client has substantially improved and does not need further treatment. Although clinical psychologists

cannot prescribe medication, they often combine psychotherapy with drug treatment by working in

collaboration with the client's physician.

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There are many different approaches to the practice of psychotherapy. Each is based on different ideas

about the sources of personal problems. Most therapies can be classified as:

Psychodynamic

Humanistic

Behavioral,

Cognitive, or

Eclectic

This manual contains a complete list of psychological disorders classified into 16 broad categories.

For example, panic disorder, post-traumatic stress disorder, obsessive-compulsive disorder, and phobias

are grouped under the category of anxiety disorders. The manual describes the main symptoms for each

disorder in concrete behavioral terms. It also gives the prevalence rates for men and women in the

population; a list of predisposing factors; the normal age of onset; and the prognosis, or expected

outcome.

3. TEACHING

Clinical psychologists who have full or part- time academic appointments obviously devote a

considerable amount of time to teaching. Those, whose responsibilities are primarily in the area of

graduate education, teach courses in advanced psychopathology, psychological testing, interviewing,

intervention, personality theory and so on. Some also teach abnormal psychology, introduction to

clinical psychology. Much of this teaching is of the familiar class- room lecture type. But a considerable

amount of teaching is also done on a one- to- one, supervisory basis.

Clinical psychologists in clinical setting may also teach informal classes or do orientation works with

other mental health personnel, such as nurses, aides, social worker, occupational therapist and so on. In

some cases the clinician may go out into the community and lead workshops on various topics for police

officers, volunteers, ministers, probation officers and others.

4. CLINICAL SUPERVISION

This activity is another form of teaching. However, it typically involves more one- to- one teaching,

small group approaches, and other less formal, non class room varieties of instruction. Clinical

psychologists often spend significant portions of their time supervising students, interns and others.

Becoming skilled in the therapy and assessment techniques requires more than just reading textbooks. It

also involves seeing clients and then discussing their cases with a more experienced supervisor.

During supervision, clinical psychologists discuss the trainee's clinical cases in depth while providing

therapeutic guidance as they learn psychotherapy or psychological testing skills. In short one learns by

doing but under the controlled and secure conditions of a trainee- supervisor relationship.

5. RESEARCH

Clinical psychology has grown out of an academic research tradition. As a result, when clinical training

programs were first established after World War II, the scientist- practitioner model was adopted. This

meant that in contrast to other mental health workers such as psychiatrist or social worker, all clinicians

were to be trained both as scientist and as practitioner. Although this research emphasis may not be as

prominent in some training programs as it once was, the fact remains that clinical psychologists are in a

unique position both to evaluate research conducted by others and to conduct their own research.

Clinical psychology research can be both basic and applied. Among the health care professions, clinical

psychology is one of the few to provide extensive research training. Thus, clinical psychologists are

well suited to design, implement, and evaluate research and conduct program evaluation/quality

assurance programs as part of their activities.

Clinical Psychology (PSY401)

Research is an integral activity of clinical psychologists working in academic and clinical settings. The

range of research projects carried out by clinicians is enormous. Clinical studies include search for the

causes of mental disorders, development and validation of assessment devices, evaluation of therapy

techniques and so on. By virtue of their training in research, clinical psychologists have the ability both

to consume and produce new knowledge.

6. CONSULTATION

Consultation, regardless of the setting in which it occurs, or the particular purpose it has, is a significant

activity of many clinical psychologists. A growing number of clinical psychologists serve as

consultants. In consultation, the goal is to increase the effectiveness of those to whom one's efforts are

directed by imparting to them some degree of expertise. Consultation might involve an informal

discussion, a brief report, or a more ongoing and formal consultation arrangement. It takes innumerable

forms, in many different settings.

For example, companies might consult with a clinical psychologist to help reduce co-worker conflicts or

provide stress management strategies for high stress employees such as business executives, fire

fighters, police officers, or prison guards. Consultation might involve helping a physician to better

manage patient non-compliance with unpleasant medical procedures. Consultation might also include

assessment, teaching, research, and brief psychotherapy activities.

Consultation can run the gamut from clinical cases to matter of business, personnel and profit. It can

deal with individuals or entire organizations. Sometimes it is remedial, other times it is oriented toward

prevention.

7. PROGRAM DEVELOPMENT

Clinical psychologists are often asked to contribute to the development of treatment/evaluation

programs, and should obtain appropriate supervised experience in such activities during their training.

They typically work with other professionals, either directly or indirectly, who are also providing

professional services to the client.

As such, clinical psychologists must be skilled in interacting with other professionals in a respectful and

helpful manner to develop successful programs.

8. ADMINISTRATION

Nearly every clinical psychologist spends time on administrative tasks. For example, client records must

be maintained, the clients' clinical reports must be maintained, the policies and procedures for clinical or

research operations are to be developed, etc.

Some clinicians become full- time administrators. It would be difficult to list all the sorts of

administrative posts held by clinical psychologists. However, here are a few examples:

Head of a university psychology department, director of a veterans administration clinic, vice president

of a consulting firm, director of the clinical training program, chief psychologist in the hospital etc.

To Summarize,

We can say that, CLINICAL PSYCHOLOGY is one of the largest and most popular fields in

psychology. Clinical psychologists assess and treat a wide range of psychological problems. These

problems range from short-term emotional crises, such as those due to family conflicts, to severe and

chronic mental illnesses, such as schizophrenia.

Clinical Psychology (PSY401)

Some clinical psychologists specialize in treating specific problems, such as phobias or depression.

Others specialize in treating specific populations, such as children, the elderly, or members of ethnic

minority groups.

Clinical psychologists usually seek to treat emotional and behavioral problems with psychotherapy, a

form of intervention that relies primarily on verbal communication between therapist and client. In

addition, many clinical psychologists study the normal human personality and the ways in which

individuals differ from one another in their patterns of thinking, feeling, behaving, and relating to

others.

Still other clinical psychologists administer and interpret various kinds of psychological tests. These

include personality tests, intelligence tests, and aptitude tests. These tests are routinely given in schools

and businesses to assess an individual's skills, interests, and emotional functioning.

Clinical psychologists also use psychological tests to diagnose possible mental disorders. By identifying

early signs of distress or mental disturbance, clinical

psychologists work to promote mental health and to prevent mental disorders.

EDUCATION AND TRAINING OF A CLINICAL PSYCHOLOGIST

The road to becoming a clinical psychologist is a long one divided by a number of distinct stages and

phases that include college, graduate school, clinical internship, post doctoral fellowship, licensure and

finally employment, continuing education and advanced certification.

EDUCATION

GRADUATE WORK

The typical clinical psychology student in the United States completes a bachelor's degree and then five

years of graduate work. It typically includes training in assessment, research, diagnosis and therapeutic

skills, along with an internship.

MASTERS DEGREE PROGRAM

There are also clinical psychology programs that award the master's degree. Because of contemporary

licensing laws that dictate who may practice independently as a psychologist, fewer individuals

graduating from master's programs can achieve in the way of professional independence. Past evidence

suggests that sub doctoral-level clinicians, are paid less, and are not perceived fully licensed to practice

independently. The American Psychological Association also accepts the doctoral degree alone as the

key to work as an independent professional.

PHD / PSY.D PROGRAM

A student interested in obtaining a doctorate degree in clinical psychology can choose between two

types of degrees; the traditional PhD (Doctorate of Philosophy) or Psy.D (Doctorate of Psychology).

Although the American Psychological Association recommends a core curriculum of courses and

activities (APA 1987b), each program maintain its own unique orientation based on the faculty and the

traditions of the programs.

In researching graduate programs, one will find that each program has its own unique balance on

emphasizing the roles of biological, psychological and social factors in human behavior.

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POST DOCTORATE

It requires 1-2 years of post doctoral training and supervision before one is eligible to take the national

licensing examination. It includes clinical work as well as research, teaching and other professional

activities.

Overall students interested in becoming clinical psychologists and gaining admission into quality

graduate programs must take their college experience very seriously. Completing courses in psychology,

research design and statistics as well as having excellent grades, GRE scores and clinical experience

during the college years are very important.

CLINICAL PSYCHOLOGY EDUCATION IN PAKISTAN

To be a clinical psychologist, students have to complete Masters in Psychology (M.Sc. Psychology)

from an HEC recognized university. After that they must take a specialization course in clinical

practice.

It is not necessary to take a GRE test to get admission to any of the specialized clinical training

programs offered within the country. An excellent GPA and a good score in entry test and interview,

however, is a must.

The following specializations are being offered in Pakistan:

Advanced Diploma in Clinical Psychology (ADCP) duration: 18 months.

Masters in Clinical Psychology (M.S. Clinical) duration: 2 years.

Doctorate in Clinical Psychology (D. Clinical) duration: 2 years (after M.S. Clinical) or 3 years (after

ADCP).

TRAINING OF A CLINICAL PSYCHOLOGIST

The process of training of a clinical psychologist is very long and intensive. There are disagreements

among clinicians as to how to train the psychologists and in what direction the field should move.

However it is useful to remember that clinical psychology is but a specialized application of the more

basic core of psychology.

Within the United States, two different models of training have developed, one leading to the doctor of

Philosophy (PhD). The other is the doctor of Psychology

(Psy.D) degree. The basic difference between the two lies in their relative emphasis on the importance

of psychological research in the training of doctoral level clinical psychologists. The predominant

training philosophy in clinical psychology today is the scientist-practitioner model (leading to PhD).

COURSEWORK

Clinical students normally must take a series of basic courses such as statistics and research design,

biological foundations of behavior, social psychology,

developmental psychology, and cognitive psychology.

The exact number and content of these courses will vary somewhat from program to program. The

intent is to give the student an understanding of the basics that underlie human behavior or that permit

us to investigate that behavior.

These courses provide a strong scientific foundation for the student's clinical training and give life to

the scientist-practitioner model in clinical psychology. Clinical students also enroll in several courses

Clinical Psychology (PSY401)

that teach the fundamentals of clinical practice or deal with clinical topics at an advanced level. For

example, there are often courses in psychopathology, theory and research in therapy, or principles of

cognitive-behavioral interventions, or seminars in such topics as schizophrenia, methods of family and

group therapy, community psychology, or neuropsychological assessment.

PRACTICUM WORK

Books and coursework are fine, but ultimately one must learn by doing. As a result, all programs seek to

build the student's clinical skills through exposure to clinical practice.

The dictionary defines a practicum as "work done by an advanced student that involves the practical

application of previously studies theory". Whatever the specific form or content of the practicum

experience, it is a major vehicle for the acquisition of specific clinical skills.

The student's practicum work is supervised by clinical faculty member or by clinicians in the

community who have special skills. Most psychology departments that have clinical training programs

also operate a psychological clinic.

RESEARCH

The implementation of the scientist-practitioner model requires that the student develop research

competency. This is accomplished through courses in statistics, computer methods, and research

methodology and also by active participation in research projects. There are differences among schools

as to the extent of their commitment to the scientist-practitioner approach to training. Programs that

emphasize the research commitment usually see to it that research experience is not confined to the

thesis and dissertation. In one department, for example, each clinical student joins the research "team"

of a faculty member.

THE INTERNSHIP

The internship is a vital part of any training program. It is the capstone of the student's previous

experience in clinical courses and practice and provides the experience that begins to consolidate the

scientist-practitioner role. It allows the student to work full-time in a professional setting, and also in

acquiring new skills.

An internship of one sort or another is required of all students in clinical programs accredited by the

APA. The internship most often seems to come at the end of graduate training.

To Summarize,

Clinical psychologist's training is an essential factor to warrant professional competence. Such training

is the starting point of psychologist's professional activity and has to be permanently updated. Training

has to be theoretical as well as practical and must use appropriate methodology according to specific

targets to be reached.

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