What Clinical Psychologists Do

What is Clinical Psychology?

  • Definition: Clinical psychology involves the application of psychological theories to understand, prevent, and alleviate distress.

  • Regulation: In the UK, the title of Clinical Psychologist is protected.

  • Requirements for Title: One must meet specific criteria to call oneself a clinical psychologist, including registration with the Health and Care Professions Council (HCPC).

Who do Clinical Psychologists Work With?

Clinical Psychologists (CPs) work with a variety of client groups, including but not limited to:

  • Working age adults

  • Children and families

  • People with learning disabilities

  • Individuals in forensic settings

  • Older individuals

What do Clinical Psychologists Do?

Clinical psychologists engage in various activities across multiple settings, including:

  • Psychological Therapy

  • Psychometric Assessment

    • Includes neuropsychological assessment

  • Team Working

    • Supporting colleagues in applying psychological knowledge

  • Understanding

    • Individuals and organizations from a psychological perspective

  • Supervision

    • Overseeing psychologists and other professionals

  • Writing Reports

  • Evaluating Work

  • Training and Professional Development

  • Research

Where do Clinical Psychologists Work?

  • Common Workplaces:

    • Hospitals

    • Community clinics

    • People’s homes

    • Care homes

    • Universities

    • Psychology departments

    • Inpatient units

    • Prisons

    • Cafes

Team Working in Clinical Psychology

  • Clinical psychologists frequently collaborate in multidisciplinary teams (MDTs) that may include:

    • Team Manager

    • Organizes and manages the team

    • Psychiatrists

    • Medical professionals specializing in mental health

    • Mental Health Nurses

    • Nurses specializing in mental health care

    • Social Workers

    • Focus on social care needs

    • Occupational Therapists

    • Specialize in occupational and daily living skills

    • Community Support Workers

    • Individuals without professional qualifications who support clients

    • Secretarial and Support Staff

    • Handle administrative tasks

    • Psychotherapists and Counsellors

    • Provide psychological therapy

    • Other Specialists

    • Physiotherapists, medical doctors, prison staff, etc.

Models of Practice in Clinical Psychology

Scientist Practitioner Model

  • Focuses on applying psychological science to clinical practice.

  • CPs are educated in research skills and critical appraisal of evidence.

  • Emphasizes scientific knowledge and research skills in training.

  • Historically recommended by the American Psychological Association (APA) in 1924 and endorsed at the Boulder Conference in 1949.

Reflective Practitioner Model

  • Involves the capacity to reflect on one’s work and oneself.

  • Reflection Types:

    • General reflection on work

    • Self-reflection on personal history, personality, and assumptions, and their impact on practice.

    • Adapted from Schön (1987).

Four Key Tasks of Clinical Psychology

  1. Evaluation

  2. Assessment

  3. Intervention

  4. Formulation

Methods of Assessment in Clinical Psychology

  • Client Assessment Methods:

    • Clinical interviews

    • Questionnaires (self and other-reports)

    • Standardized neuropsychological tests

    • Psychometrics

    • Diary sheets

    • Record forms for self-monitoring

    • Observations in school or residence settings

Formulation in Clinical Psychology

  • Definition: A psychological formulation is an understanding of the development and maintenance of an individual’s problems, informed by:

    • Individual History and Characteristics

    • Psychological Theory and Research

  • Model: Draws on the BioPsychoSocial model:

    • Social Factors: Relationships, family, culture, society

    • Psychological Factors: Thoughts, emotions, memories

    • Biological Factors: Genetics, physiology, neurology

Goals of Formulation

  1. Explain the problem in terms of:

    • Development: Understand how it began.

    • Maintenance: Identify what keeps it ongoing.

  2. Example:

    • "Ken is anxious about his exams because his parents were very critical of him, and we know that critical parenting is a risk factor for childhood anxiety."

  3. Nature of Formulations:

    • Tentative hypotheses that are subject to change as new information arises.

A Transtheoretical Formulation

  • Components:

    • Predisposing Factors

    • Precipitating Events

    • Protective Factors

    • Presenting Problems

    • Perpetuating (or Maintaining) Factors

Model Specific Formulation: Cognitive Behavioural Therapy (CBT)

  • Focus: Highlights the influence of cognitions (thoughts and beliefs) on mood, bodily sensations, and behavior.

  • Treatment Approach:

    • Understanding and modifying unhelpful cognitions and behaviors

    • Structured, practical methods based on scientific models with strong evidence bases

    • One of the dominant approaches in NHS today.

CBT Formulation Focus Areas

  1. Cognitions:

    • Includes underlying beliefs and negative automatic thoughts, cognitive biases, and attentional biases.

  2. Behaviors:

    • Involves learned responses, reinforcement contingencies, and coping strategies.

  3. Emotions:

    • Encompasses moods and feelings.

  4. Physiology:

    • Includes bodily sensations and physical issues.

Example of CBT Formulation

  • Elements:

    • Physical: Racing heart, tension reactions

    • Situation: Exams in 2 weeks

    • Thoughts: "I'm going to fail!"

    • Behavior: Avoid studying

    • Emotional Response: Anxiety with negative moods and feelings.

Intervention in Clinical Psychology

  • Definition: Interventions are actions intended to help a person ‘get better’ based on theoretical views.

  • Nature of Interventions:

    • Psychological (not pharmacological or purely social measures)

    • Can include talking therapies, behavioral programs, self-help, activity scheduling, etc.

  • Foundation:

    • Interventions are derived from psychological theory and guided by the formulation.

    • Methods need to demonstrate efficacy through clinical trials.

Examples of Interventions

  • General Strategies:

    • Increasing pleasurable activity

    • Systematic desensitization

    • Bringing the unconscious into consciousness

    • Relaxation exercises

    • Reliving traumatic experiences

  • Other Possible Interventions:

    • Understanding and normalizing experiences

    • Providing relaxation and exercise strategies

    • Weighing evidence regarding likelihood and consequences

    • Reducing avoidance

    • Fostering connections with others

    • Learning from experiences.

Evaluation of Clinical Work

  • Significance: Clinical psychologists, as scientist practitioners, are required to evaluate their clinical work to assess efficacy, i.e., “Did this therapy work?”

  • Feedback Methods:

    • Verbal feedback from clients

    • Observational insights on efficacy

    • Use of questionnaires assessing client satisfaction, well-being, and symptom reduction.

  • Scope of Evaluation: Evaluations also inform wider funding decisions for mental health services and may highlight efficacy issues in therapies that do not focus on symptom reduction or the medical model.

Summary of Clinical Psychological Practice

  1. Assessment: Gather information to determine potential to help a person.

  2. Formulation: Use psychological theory to understand the development and maintenance of difficulties.

  3. Intervention: Apply psychological methods to facilitate improvement.

  4. Evaluation: Assess the effectiveness of the methods used.

Theoretical Orientations in Clinical Psychology

  • Clinical psychologists may be trained in two or more theoretical approaches, including but not limited to:

    • Psychodynamic Psychotherapy

    • Cognitive Behavioural Therapy (CBT)

    • Systemic Family Therapy

Psychodynamic Psychotherapy

  • Origin: Developed by Sigmund Freud (1856-1939).

  • Focus: Emphasizes the significance of conflicting motivational forces within the mind and highlights unconscious thoughts and feelings as potential causes of mental health problems.

Systemic Family Therapy

  • Origin: Developed by Gregory Bateson and colleagues in the 1950s.

  • Concept: Based on understanding individuals within their ecological contexts, acknowledging that behavior is meaningful in the context of relationships.

Lecture Summary

  • The Role of Clinical Psychologists in the NHS:

    • Different ways of working, varied client groups, team dynamics, evidence-based practices.

  • General Principles of Clinical Practice:

    • Encompasses assessment, formulation, intervention, and evaluation with emphasis on key therapeutic orientations.

Further Reading

  • Beinart, H., Kennedy, P., & Llewelyn, S. (2009). Clinical Psychology in Practice. Wiley-Blackwell.

  • Jones, F. (2023). Clinical psychology: training and development. In G. Davey (Ed.), Applied psychology (2nd ed.) (pp. 705-720). Oxford, UK: Wiley.

  • Jones, F., & Hartley, C. (2015). What does a clinical psychologist do? In G. Davey, N. Lake & A. Whittington (Eds.), Clinical psychology (2nd ed.) (pp. 3-18). Hove, UK: Routledge.

  • Llewelyn, S., & Murphy, D. J. (2014). What is Clinical Psychology? (5th Ed.). Oxford: OUP.

  • Llewelyn, S., & Aafjes-van Doorn, K. (2017). Clinical Psychology: A Very Short Introduction. Oxford: OUP.