MODULE – I: INTRODUCTION TO CLINICAL PSYCHOLOGY

1.0 Learning objectives

1.1 Introduction
1.2 Nature, scope, role, history and current status
1.3 Professional issues, training, ethical standards
1.4 Clinical psychology in India.
1.5 Summary
1.6 Keywords
1.7 Learning Activity
1.8 Unit End Questions
1.9 References

1.0 LEARNING OBJECTIVES

After studying this unit, you will be able to:

 Explain the concept, history and current status of Clinical psychology

 Describe the various issues and ethics of Clinical psychology

 Explain the concept of Clinical psychology in India

1.1 INTRODUCTION

Clinical psychology is a subfield of the broader discipline of psychology, as its name implies.
Clinical psychology is the study of behavior and mental processes. Clinical psychologists, like
other psychologists, conduct studies on human behavior, strive to apply the findings of that
research, and conduct individual evaluations. Clinical psychologists, like members of other
professions, assist persons who require aid with psychological issues. The ever-expanding scope
and shifting orientations of clinical psychology are challenging to describe in a line or two.
Clinical psychology has the potential to make significant contributions to the health of
individuals, families, and society in the twenty-first century.

Some facts about mental health:

● More than 450 million people have mental disorders.
● Many more have mental health problems.
● About half of all mental disorders begin before people reach age 14.
● Worldwide, 877,000 people commit suicide every year.
● In emergencies, the number of people who have mental disorders is estimated to increase
by 6–11%.
● Mental disorders increase the risk for physical disorders.
● Many health conditions increase the risk of mental disorders.
● Stigma prevents many people from seeking mental health care.
● There are great inequities in the availability of mental health professionals around the
world.
Adapted from World Health Organization (2007)

Mental health disorders are more common in particular groups than in the general population,
possibly due to the stress of living and/or working situations. The Depression Report, published
by the London School of Economics' Centre for Economic Performance's Mental Health Policy
Group in 2006, translated epidemiological data into economic terms. Despite the fact that one in
every three families is thought to be impacted by depression or anxiety, just 2% of NHS
expenditures in the United Kingdom (UK) were committed to treating these diseases. The
breadth of mental health disorders across countries is illustrated by data from the World Health
Organization. Hundreds of millions of individuals suffer from mental illnesses around the world.
However, the majority of mental problems go undiagnosed or misdiagnosed, and only a small
number of those who suffer from them ever obtain treatment. Even if individuals receive
treatment for other health issues, mental health issues are frequently overlooked, regardless of
the affluence or level of development of the country in which they live. Mental diseases are
responsible for around 8 million fatalities worldwide each year (Walker, McGee, &Druss, 2015).
This is especially concerning because most of these illnesses have excellent, very inexpensive
therapies (psychological and/or pharmaceutical). Aside from the severe issues faced by mental
illnesses, there is growing evidence that lifestyle and psychosocial variables are linked to many
of the causes of disability and death in Western countries. Aside from the severe issues faced by
mental illnesses, there is growing evidence that lifestyle and psychosocial variables are linked to
many of the causes of disability and death in Western countries.

Clinical psychologists have become well-known in many nations (Swierc& Routh, 2003).
Clinical practice appears to be psychologists' most common activity these days. Individuals,
groups, and families are treated using psychotherapy or other interventions. They conduct many
types of clinical evaluations of mental and behavioral elements of health issues. Many work in
clinics and hospitals as consultants or cooperate with other health professionals. Clinical
psychologists commonly participate in educational activities, such as teaching in colleges or
universities, and many also do research.

The largest subfield of psychology is clinical psychology. Clinical psychology graduate

programmes draw more applications than graduate programmes in any other area of psychology,
and clinical and associated health care provider areas give significantly more doctoral degrees
than other areas of psychology (Kohout&Wicherski, 2011). The popularity of clinical
psychology explains why the terms "psychologist" and "clinical psychologist" are almost
interchangeable in public discourse.
The attraction of clinical psychology is reflected in the composition of the American
Psychological Association, the biggest organization of psychologists in the United States. The
clinical psychology divisions (Division 12—Clinical Psychology, Division 40—Clinical
Neuropsychology, and Division 42—Psychologists in Independent Practice) make up the
majority of the APA's 56 divisions. Of course, prominence brings competition for clinical
psychology students, especially for graduate school slots. Indeed, some freestanding PsyD
schools take closer to 50% of applications, while stronger, research-oriented PhD programmes
accept as few as 7% of applicants, whose students often score the highest on the Examination for
Professional Practice in Psychology (Norcross, Ellis, & Sayette, 2010). Despite the competition,
clinical psychologists have a bright future ahead of them.
Many portrayals of clinical psychologists and their disturbed clients in movies, television, and
other media demonstrate the field's popularity. It's a double-edged sword having such a high
level of popularity. On the one hand, accurate portrayals can aid public mental health literacy, or
a thorough awareness of psychological diseases and their remedies (Jorm, 2000). Inaccurate
portrayals, on the other hand, can lower mental health literacy and lead to stereotyped attitudes
of the profession. Unfortunately, the latter appears to be the more common outcome. Clinical
psychologists are frequently depicted as oracles, social compliance agents, or wounded healers,
and the procedures by which they assist clients are rarely appropriately depicted (Orchowski,
Spickard, & McNamara, 2006).

1.1 NATURE, SCOPE, ROLE, HISTORY AND CURRENT STATUS

Lightner Witmer was the first to use the term clinical psychology in print in 1907. In addition,
Witmer was the first to open a psychological clinic. Clinical psychology, according to Witmer, is
a science that is similar to a number of other professions, including medicine, education, and
sociology. As a result, a clinical psychologist was someone who worked with people on therapy,
education, and interpersonal concerns. The first patients at his clinic were children with
behavioral or educational issues. Witmer envisaged clinical psychology as applicable to people
of all ages and with a variety of presenting difficulties as early as his books.
Clinical psychology is more difficult to define today than it was in Witmer's time. Most basic,
brief descriptions fall short of describing the field in its whole due to its rapid expansion in a
wide number of ways. Clinical psychologists today do a wide range of things, with a wide range
of goals, for a wide range of people.
Some have attempted to develop "quick" definitions of clinical psychology in order to give a
sense of what the field encompasses. Clinical psychology, for example, is essentially the area of
psychology that investigates, assesses, and treats people with psychological issues or disorders,
according to many introductory psychology textbooks and dictionaries of psychology. Although
such a definition appears acceptable, it is not without flaws. It doesn't show everything clinical
psychologists do, how they do it, or who they help.
Clinical psychology would need to be more inclusive and descriptive in order to be accurate,
thorough, and current. Clinical psychology is defined as follows by the American Psychological
Association's Division of Clinical Psychology:
The field of Clinical Psychology involves research, teaching and services relevant to the
applications of principles, methods, and procedures for understanding, predicting, and alleviating
intellectual, emotional, biological, psychological, social and behavioral maladjustment, disability
and discomfort, applied to a wide range of client populations. In theory, training, and practice,
Clinical Psychology strives to recognize the importance of diversity and strives to understand the
roles of gender, culture, ethnicity, race, sexual orientation, emotional, biological, psychological,
social and behavioral maladjustment, disability and discomfort, applied to a wide range of
clients.
The enormous scope of this definition shows the field's rich and varied evolution in the century
since Witmer first defined it. As you can see, the definition emphasizes the integration of
science and practice, as well as the application of this integrated knowledge across varied human
groups with the goal of reducing human suffering and increasing health.

According to British Psychological Society:

Clinical psychology aims to reduce psychological distress and to enhance the promotion of
psychological well-being. Clinical psychologists deal with a wide range of mental and physical
health problems including addiction, anxiety, depression, learning difficulties and relationship
issues. They may undertake a clinical assessment to investigate a clients’ situation. There are a
variety of methods available including psychometric tests, interviews and direct observation of
behavior. Assessment may lead to advice, counselling or therapy.
When we consider the pain and suffering that people with mental and physical health problems
go through, the interpersonal effects of their distress on their family, friends, and coworkers, and
the tragedy of untimely death, we can see how important it is to have effective services in place
to identify and address these issues. It is unavoidable that each of us will be affected by the
emotional misery of psychiatric diseases at some point in our life, either directly or indirectly.
Clinical psychology is a discipline of psychology that focuses on establishing assessment tools
and interventions to deal with the painful experiences that everyone encounters in their lives.
Clinical psychology's nature and definition have moved, extended, and evolved over the years.
Clinical psychology's only certainty is that it will continue to evolve, given the field's ever-
changing nature. Time will tell whether this evolution leads to a decreased focus on traditional
face-to-face assessment and treatment (as predicted by some experts), an increased focus on the
use of psychopharmacological agents to treat mental illness and mental health problems (as
promoted by some psychologists and psychological associations), or the adoption of universal
prevention programmes designed to enhance our protection from risk (as promoted by some
psychologists and psychological associations). Clinical psychology has expanded its scope from
its basic concentration on assessment, evaluation, and diagnosis. Individuals, couples, and
families can now benefit from a variety of intervention and prevention services provided by
clinical psychology.
Clinical psychology also encompasses indirect services that do not entail direct interaction with
people who are suffering from mental illnesses, such as consulting, research, programme
development, programme assessment, supervision of other mental health practitioners, and
health-care administration. Clinical psychology, according to the criteria we gave, is primarily
concerned with the application of psychological knowledge in the assessment, prevention, and/or
intervention of issues involving ideas, behaviors, and feelings. Of course, many clinical
psychologists undertake psychological research and offer essential knowledge to the field of
psychology in addition to delivering psychological therapies. Nonetheless, clinical psychology
research aims to generate knowledge that may be utilized to drive the development and
implementation of psychological therapies.
Many of the research methods, statistical analytic procedures, and measuring strategies used in
other areas of psychology are also used in clinical psychology. Many fields of psychology, such
as cognitive, developmental, learning, personality, physiological, and social psychology, provide
research that has direct or indirect clinical psychology applications. The primary goal of research
in these other areas of psychology is to develop basic knowledge about human functioning and,
in general, to improve our understanding of people. Its secondary importance is that part of this
knowledge can be utilized to assess and treat dysfunction and therefore improve human
functioning. Many psychologists use their skills in a variety of settings. Health psychologists,
forensic psychologists, and neuropsychologists are professionals that have received clinical
psychology training as well as specialized training in their fields of research and practice.
Counseling psychology and school psychology are two more disciplines of applied psychology
that provide vital mental health services to the general public. Although they have certain
training and methods in common with clinical psychologists, these psychologists specialize in
the assessment, prevention, and treatment of mental health issues.

Counseling Psychology
Counseling psychologists have the most in common with clinical psychologists in terms of
training and services provided. Practitioners are trained in psychopathology, interviewing,
evaluation, counselling and psychotherapy, research, and other areas that overlap with clinical
psychologists' course work and supervised training. The training, research interests,
professional activities, and license requirements of these two subfields are sufficiently similar
that requests to unite them are frequently heard (Norcross, 2011). Despite this, there are some
key distinctions between clinical and counselling psychology.
The distinction between clinical and counselling psychology has traditionally been based on the
severity of the problems addressed. Clinical psychology has traditionally focused on the
assessment and treatment of psychopathology, which refers to anxiety, depression, and other
symptoms severe enough to earn a clinical diagnosis. Counseling psychologists, on the other
hand, helped people deal with common life issues including leaving home to work or attend
university or college, dealing with changes in work or interpersonal roles, and dealing with the
stress of academic or work expectations. Simply put, counselling psychologists worked with
people who were generally well adjusted, whereas clinical psychologists worked with persons
who were having serious issues in their lives and were unable to handle the emotional and
behavioral symptoms that resulted.
The type of environment in which the practitioners worked was another distinction between the
two professions. Counseling psychologists are most typically found in educational settings (such
as college or university counselling clinics) or in general community clinics that provide a
variety of social and psychological services. Clinical psychologists, on the other hand, were more
likely to work in hospital settings, including both general and psychiatric facilities. Due to
changes within both professions, the conventional differences between clinical and counselling
psychologists are eroding. Counseling psychologists assist people who are having trouble
functioning, such as university students with major depressive disorder, panic disorder, social
anxiety disorder, or eating disorders (Benton, Robertson, Tseng, Newton, & Benton, 2003;
Kettman et al., 2007).

Clinical psychologists have expanded their practice to include services such as couples therapy,
consulting, and treatment for persons suffering from chronic illness and stress-related disorders,
in addition to traditional mental health treatments. As a result, clinical psychologists established
treatments for people whose issues didn't fit into any of the psychopathological categories.
Clinical psychologists have also begun to develop programmes that aim to prevent issues from
arising in the first place. On one level, it's a risky decision to draw a line between counselling
and clinical psychology based on the potential distinctions between "normal" and "pathological"
degrees of discomfort. The same person may present with symptoms severe enough to meet
diagnostic criteria for a mental disorder or with less severe, subclinical symptoms depending on
when they seek care.

Personal, educational, vocational, and group adjustment are all goals of counselling psychology
(American Psychological Association Division 17, 2012). As a result, counselling psychologists
are more likely to deal with people's regular changes and adjustments. Counseling psychologists
may provide career counselling or other types of counselling relating to life changes or
developmental concerns in addition to psychotherapy. Clinical psychology, on the other hand,
was created with the goal of assessing and treating people with mental illnesses. Clinical
psychologists, as opposed to counselling psychologists, are more focused on the prevention,
diagnosis, and treatment of psychological problems, as well as related research. They also deal
with more severe pathology. As a result, the distinctions between clinical and counselling
psychology are mostly a question of emphasis. Despite these distinctions, the two professions
have a lot in common.

There is no distinction between clinical and counselling psychology in many nations. In some
cases, the distinction is becoming increasingly meaningless for practical purposes. Counseling
psychology, like clinical psychology, encourages the use of evidence-based interventions. This
desire to provide evidence-based treatments is expected to have significant ramifications for
counselling psychology training and practice. Clinical and counselling psychologists are
frequently trained in different academic environments and in different academic traditions, which
is the root of the differentiation between the two psychological professions in various countries.
Although clinical and counselling psychologists receive different training, it is worth noting that
students in both professional psychology programmes take more psychology and mental health
courses than trainees in any other mental health specialty (Murdoch, Gregory, &Eggleton, 2015).
School Psychology
School psychologists and clinical and counselling psychologists have a lot in common: they go
through a scientist-practitioner training model, have similar internship and licensure
requirements, conduct assessments, design interventions at the individual and system levels, and
evaluate programmes.
School psychologists work in a variety of settings in the United States, including schools, clinics,
and hospitals, as well as private practice. Traditionally, school psychology focused on services
relating to children's and adolescents' learning, such as intellectual functioning assessments,
learning challenges evaluations, and consultation with teachers, students, and parents about ways
for maximizing students' learning potential.
The treatment of a diagnosable mental condition was the emphasis of clinical child psychology.
In response to the needs of parents, educational systems, and governments, the scope of school
psychology has grown over time. Because of an increasing understanding of the negative impacts
of child and adolescent psychopathology, parental psychopathology, and stressful family
conditions on learning, school psychologists' work is now more generally focused on students'
mental health and life situations. School psychologists' responsibilities have evolved to
encompass the consideration of social, emotional, and medical variables in the context of
learning and development. These changes, combined with legal requirements that schools
provide the best possible education for all students, have led to school psychologists diagnosing
a variety of childhood and adolescent disorders, as well as developing school and/or family-
based programmes to help students learn to their full potential. School psychologists have also
played a key role in the development of school-based violence prevention programmes aimed at
improving social skills, reducing bullying, facilitating conflict resolution, and preventing
violence (Kratochwill, 2007).
The obvious difference is that school psychologists often have more schooling and child
development expertise, and they focus their treatments in school and other educational settings
on children, adolescents, adults, and their families. Despite the differences in emphasis, there are
more similarities than differences between clinical, especially clinical child psychology, and
counselling psychology (American Psychological Association Division 16, 2012; Cobb et al.,
2004).
Psychiatry
When students first start studying psychology, one of the first questions they ask is, "What's the
difference between a psychologist and a psychiatrist?" The contrast in training and practice
between the two professions seems to be the most comprehensive answer. Within the medical
field, psychiatry is a specialization. Psychiatrists are medical specialists who specialize in
treating psychiatric diseases, just as paediatricians specialise in children, ophthalmologists
specialize in eyes, and neurologists specialize in the brain and nervous system. Psychiatrists
often complete a psychiatric residency, during which they attend psychology courses and are
supervised by qualified psychiatrists while working with patients. This residency is usually done
in a hospital setting and so exposes you to more significant psychopathology, although it can also
be done in an outpatient setting. Psychotherapy is provided by many psychiatrists, but not all of
them. According to recent polls, the majority of doctors see patients for fewer than 25 minutes at
a time, with medication reviews being the most common reason (Kane, 2011). Psychiatrists order
or conduct other medical tests, educate, do research, work in administration, and perform other
jobs according to their level of expertise, in addition to providing therapy and prescribing
medicine. Clinical psychologists typically have more formal training in psychological
assessment and greater exposure to a variety of approaches to psychology than psychiatrists,
despite the fact that psychiatrists typically have more medical expertise.
Historically, there has been a separation between psychiatrists and clinical psychologists.
Perceived as representing the distinction between a biological (psychiatrists) and a psychosocial
(clinical psychologists) perspective on the origins of mental diseases. However, in recent years,
there has been more collaboration between the professions. Much of the shift can be ascribed to
the emerging knowledge that psychiatric problems are usually the result of a complex
combination of biological and psychological factors. As a result, clinical psychologists are being
hired more frequently in medical settings, where their psychological and research knowledge is
prized. On task forces devoted to the valid diagnosis and effective treatments, psychiatrists and
psychologists frequently collaborate. This is in line with a larger trend toward psychology being
a health professional rather than just a mental health one (Rozensky, 2011).
Only psychiatrists could administer medication in the past, which was a significant distinction
between clinical psychologists and psychiatrists. This is no longer the situation in certain
American jurisdictions. Psychologists can now be trained to administer psychoactive drugs
through programmes run by the federal Department of Defense and the Indian Health Service, as
well as several state legislatures.
Let's take a closer look at some of the activities that clinical psychologists engage in, the many
venues where they work, the range of clients and problems on which they focus their attention,
and the job's rewards. Although not all physicians are equally involved in all of the activities we
will discuss, our review should give you a clearer idea of the diverse alternatives available to
individuals who enter the field. It could also explain why so many students continue to be drawn
to the field. Around 95 percent of clinical psychologists spend their working careers doing some
combination of six activities: evaluation, treatment, research, teaching (including supervision),
consultation, and administration, according to the American Psychological Association.

Figure 1.2 depicts the findings of surveys conducted over the previous few decades to determine
how clinical psychologists spend their time.
 1) Assessments
Assessment is the process of gathering data on people, such as their behavior, issues, distinctive
qualities, abilities, and cognitive functioning. This information can be used to diagnose
problematic behavior, to advise a client toward an ideal career choice, to facilitate the selection
of job candidates, to describe a client's personality characteristics, to choose treatment methods,
to assist legal choices concerning the commitment of individuals to organizations, to provide a
more complete picture of a client's problems, to screen potential participants in psychological
research projects, to establish pretreatment criteria, and to provide a more complete picture of a
client's problems. Tests, interviews, and observations are the three main types of clinical
evaluation instruments.
Clinicians now have access to a variety of assessment choices that were previously unavailable
to them. Computers, for example, can administer assessment items, analyze findings, and
generate written reports in their entirety. Research on a number of biological elements linked to
human functioning is paving the way for a new frontier in psychological assessment. The
creation of new neurobiological assessments has resulted from research focusing on genetic,
neurochemical, hormonal, and neurological components in the brain over the previous two
decades. These advances, like computer-based assessment, have the potential to dramatically
improve physicians' assessment efforts, but they present a variety of procedural, logistical, and
ethical problems (Gazzaniga, 2011; Popma& Raine, 2006).

2) Treatment
Clinical psychologists provide services aimed at assisting patients in better understanding and
resolving painful psychological issues. Depending on the clinician's theoretical perspective, these
therapies are referred to as psychotherapy, behavior modification, psychological counseling, or
other titles. Client or therapist monologues, the meticulous development of new behavioral skills,
bouts of great emotional drama, or a variety of other activities ranging from the very structured
to the completely spontaneous can all be found in treatment sessions.

Individual psychotherapy has historically been the most common clinical activity (Kazdin,
2011), but psychologists can also treat two or more clients in couple, family, or group therapy.
To assist their clients, two or more professionals may work together in therapy teams. Treatment
might last as little as one session or as long as several years. Community psychologists work to
avoid psychological disorders by changing institutions, environmental stresses, or behavioral
skills of people at risk for the disorder (e.g., adolescent parents) or an entire community.
Psychological treatments normally provide good results, yet in certain circumstances, the change
may be minor, nonexistent, or even detrimental (Castonguay, Boswell, Constantino, Goldfried,
& Hill, 2010; Lilienfeld, 2007). Of course, improving the efficacy of therapies available to the
general public is a major purpose of research.

3) Research
Clinical psychologists are research-oriented by training and tradition. For the first half of its life,
the field was dominated more by research than by application (see Chapter 2). Although the
balance has shifted, clinical psychology continues to rely heavily on research.
Clinicians stand out among other helping professions because they engage in research, and we
feel this is where they can make the most impact. Theory and practice in the field of
psychotherapy, for example, were originally mostly dependent on case study evidence,
subjective evaluations of treatment efficacy, and poorly conducted research. This "prescientific"
age in the history of psychotherapy research has given way to an "experimental" era, in which
the quality of research has substantially improved and the conclusions we can draw about the
effects of therapy have become much stronger. Clinical psychologists' research has played a
significant role in this progress.
Clinical research is diverse in terms of its setting and scope. Some studies are carried out in
research labs, while others are carried out in more natural, but less controlled, settings outside the
lab. Some projects receive funding from the government or the private sector.
Grants that pay for research assistants, computers, and other expenses, but a lot of clinical
research is done by investigators with low budgets who rely on volunteer aid and their own
capacity to obtain space, equipment, and subjects.
Graduate school entrance standards generally stress applicants' grades in statistics or research
methods above marks in abnormal psychology or personality theory, reflecting clinical
psychology's research tradition. Many graduate psychology departments in the United States
consider research experience to be one of the top three admissions criteria, and graduates of
research-oriented clinical psychology programmes often outperform graduates of schools that
don't place as much emphasis on research (Norcross, Ellis, & Sayette, 2010; Pate, 2001). Despite
the fact that the majority of clinical psychologists do not pursue a research career and many
never publish a single piece of research, most clinical psychology graduate programmes dedicate
a large amount of time to empirical research training. Why?

At least four reasons exist. To begin, all physicians should be able to critically review published
research in order to decide which evaluation processes and therapeutic strategies are most likely
to be beneficial. Second, academic doctors are frequently responsible for supervising and
evaluating research projects done by their students. Third, research training can be highly useful
for psychologists working in community mental health centers or other service agencies who are
requested to assist administrators in evaluating the success of the agency's programmes. Finally,
research training can assist doctors in evaluating the efficacy of their own therapeutic work
objectively. Tracking client change might indicate the need for treatment modifications,
highlight the need for additional clinical training, and aid third-party initiatives (e.g., insurance
companies, clinical researchers) to document and understand aspects affecting therapeutic
success (Hatfield & Ogles, 2004).
4) Teaching
Many clinical psychologists devote a significant portion of their time to educational initiatives.
Clinical psychologists who work full- or part-time in academia typically teach undergraduate and
graduate courses in areas like personality, abnormal psychology, introductory clinical
psychology, psychotherapy, behavior modification, interviewing, psychological testing, research
design, and clinical assessment. They teach specialized graduate seminars on advanced themes
and supervise graduate students in practicum courses who are developing assessment and
therapeutic skills.
Clinical psychologists teach in a variety of ways, including research supervision. Students and
professors discuss research topics of mutual interest that are within the professor's area of
competence to begin this type of instruction. Most research supervisors assist students in
developing acceptable research questions, applying basic research design principles to answer
those questions, and introducing them to research skills relevant to the situation at hand.
Clinical psychologists also do a lot of teaching in the context of in-service (on-the-job) training
for psychological, medical, or other interns, social workers, nurses, institutional aides, ministers,
police officers, prison guards, teachers, administrators, business executives, day-care workers,
lawyers, probation officers, and many other groups whose vocational skills could be enhanced by
increased psychological sophistication. Clinicians can even teach while providing therapy,
especially if they use a behavioral approach in which the goal is to assist people develop more
adaptive behaviors.
Finally, a large number of full-time clinicians also teach part-time in colleges, universities, and
professional schools. Working as an adjunct faculty member gives an additional source of
money, but doctors frequently teach because it is a fun opportunity to share their professional
knowledge and stay current in their industry.
5) Consultation
Clinical psychologists frequently offer assistance to businesses on a number of issues.
Consultation is a type of activity that incorporates components of research, assessment,
treatment, and education. Maybe it's because of this mix of activities that some clinicians find
consultation gratifying and lucrative enough to do it full-time. Consultants help organizations of
all sizes and scopes, from one-person medical or legal firms to large government agencies and
international corporations. Neighborhood associations, walk-in treatment clinics, and a variety of
other community-based organizations may work with the consultant. Education (e.g.,
familiarizing staff with research relevant to their work), advise (e.g., concerning cases or
programmes), direct service (e.g., assessment, treatment, and evaluation), and the elimination of
intraorganizational conflict are all responsibilities that consultants conduct (e.g., eliminating
sources of trouble by altering personnel assignments).
When a clinician consults on a case, he or she concentrates on a specific client or organizational
problem and either solves it or advises on how to solve it. When a clinician consults on a
programme or administration, the clinician focuses on the problematic components of the
organization's operation or structure. The consultant may, for example, suggest and develop new
procedures for screening candidates for various jobs within an organization, establish criteria for
identifying profitable personnel, or lower staff turnover rates by raising administrators'
awareness of the psychological impact of their decisions on employees.
6) Administration
Many clinical psychologists find themselves managing or leading organization’s daily
operations. Clinical psychologists may hold administrative positions such as head of a college or
university psychology department, director of a graduate training programme in clinical
psychology, director of a student counseling centre, head of a consulting firm or testing centre,
superintendent of a school system, chief psychologist at a hospital or clinic, director of a mental
hospital, director of a community mental health centre, manager of a government agency, and
dialysis centre director. As clinicians advance in their professions, administrative responsibilities
become more typical.

Although some clinical psychologists only do one or two of the six actions we've discussed, the
majority does more, and some even do all six. One of the most appealing parts of clinical
practice for many clinicians is the ability to divide their time between multiple responsibilities.
History of Clinical Psychology
When thinking about the history of clinical psychology, consider interwoven threads such as the
history of assessment and intervention within clinical psychology, the history of clinical
psychology as a profession, the history of mental illness treatment, the history of prevention, and
the history of psychology itself. We shall present an outline of essential features of clinical
psychology's history in the remainder of the chapter.
We can't do justice to the number of significant events that have formed, and continue to shape,
clinical psychology around the world since it has developed in different ways and at different
rates in different nations. In this section, we highlight significant events that have shaped the
current state of clinical psychology in most English-speaking nations. We were unable to include
all significant events that contributed to the development and implementation of clinical
psychology in non-English-speaking nations due to space limits.
Clinical psychology was moulded by three sets of social and historical influences that continue to
impact it. These elements include:
(a) The empirical tradition of using scientific research methods,
(b) The psychometric tradition of measuring individual variations, and
(c) The clinical tradition of classifying and treating behavioral problems
The roots of clinical psychology may be traced back to advancements in philosophy, medicine,
and a variety of other sciences, even before the field of psychology was called. A number of
these roots are particularly significant since they converged and, while in embryonic form,
produced the area of clinical psychology.
Clinical Psychology's Beginnings
Early proponents of the concept that mental problems were produced by natural reasons rather
than demonic possession are described in numerous scholarly publications on the history of
psychopathology and its treatment. Hippocrates (commonly referred to as the father of medicine)
stressed what is now recognized as a biopsychosocial approach to addressing both physical and
psychological diseases among early Greek intellectuals between 500 and 300 B.C. (i.e., that
biological, psychological, and social influences on health and illness must be considered).
Hippocrates' "bodily fluid" theory, according to which abnormalities in the levels of blood, black
bile, yellow bile, and phlegm are responsible for emotional disturbances, is covered in abnormal
psychology and personality textbooks. Plato and Aristotle, both philosophers, are credited with
promoting some of Hippocrates' views, but in different ways. Plato stressed societal causes and
psychological demands in the genesis and relief of mental diseases, whereas Aristotle
emphasized biological determinants.
St. Vincent de Paul proposed in the late 1500s that mental and physical disorders were produced
by natural forces, and that psychotic behavior and other extreme manifestations of mental
abnormalities were not caused by witchcraft or satanic possession. Unfortunately, throughout the
centuries that followed, the prevalent approach to the treatment of mental disease in Europe and
North America was anything but humanitarian. Those suffering from serious mental illness were
institutionalized in asylums, the majority of which were not favorable to mental health
promotion. Many stories of these institutions depict suffering, despair, and desolation. The
patients' living quarters were often filthy, and the more aggressive ones were shackled to the
walls. Bleeding with knives or leeches (which was thought to lessen excitation owing to an
excess of blood) or immersion in freezing water were used to calm excessive behavior.
During the Enlightenment, which began in the second part of the 1700s in Europe and North
America, a new world view evolved in which issues could be investigated, understood, and
addressed, and scientific methods could be applied to all natural phenomena, including human
experience. This philosophical approach had a huge impact on how people with mental illnesses
were treated. In the late 1700s, reformer Philippe Pinel, the head of a prominent asylum in Paris,
ordered that all mental patients be released from their chains and treated humanely. In England,
about the same period, William Tuke advocated for the development of hospitals based on
modern ideals of appropriate care and established a country retreat where patients might live and
work. Benjamin Rush advocated for the use of moral therapy with mentally ill people in the
United States (a treatment philosophy that encouraged the use of compassion and patience rather
than physical punishment or restraints)
Around this time, the specialty of neurology was quickly increasing in European medicine. With
more attention paid to mental illnesses, it became clear that some ailments, such as hysteria
(excessive, dramatic, and often strange behavior, including limb paralysis), could not be
explained solely by biological factors. In France, Jean-Martin Charcot is recognized as being the
founder of clinical neurology. As his celebrity grew, so did his focus on psychological elements
in hysteria. Many physicians and medical students were first intrigued by Charcot's use of
suggestion and hypnosis to treat this illness. Pierre Janet and Sigmund Freud were notable
members of this group, who originally adopted Charcot's beliefs and his use of hypnosis, but
eventually developed their own hypotheses to explain hysteria.
The Empirical Tradition
In the year 1879, when Wilhelm Wundt created the first laboratory devoted to researching
mental processes in Leipzig, Germany, is considered by historians to represent the birth of
contemporary psychology. Wundt believed that, like biology, physics, and other sciences,
psychology should seek knowledge through empirical study methods. He and others after him
were adamant about studying human behavior using science's two most potent tools: observation
and experimentation.
Wundt's laboratory was not the only place where the new discipline had its start. Others in the
fields of physiology and medicine had been working on issues that were mostly psychological.
Johannes Müller and his student Herman Helmholtz, for example, discovered and studied the
neurological connections for vision and hearing, answering the riddle of how physical energy
created mental experiences. People's perceptual experiences altered in mathematically
predictable ways as stimuli (such as weight or brightness) changed, implying that mind and body
were essentially related, according to Ernst Weber and Gustav Fechner (Hunt, 1993). Wundt is
still considered as the father of psychology since the establishment of his laboratory so clearly
declared psychology as a discipline, and he trained many students who went on to build
psychology programmes in European and American colleges.
Lightner Witmer, an American, was one of Wundt's classmates. Witmer studied on his PhD in
psychology with Wundt at the University of Leipzig after graduating from the University of
Pennsylvania in 1888. Witmer was named director of the University of Pennsylvania psychology
laboratory after receiving his doctorate in 1892. Margaret Maguire, a local schoolteacher, asked
Witmer to assist one of her students, Charles Gilman, who she characterized as a "chronic lousy
speller," in March 1896. Witmer, a former schoolteacher, accepted the case, becoming the
world's first clinical psychologist and founding the world's first psychological clinic at the same
time (Benjamin, 2005; Routh, 1994).

Witmer's strategy was to examine Charles's problem and then set up appropriate corrective
measures. Charles had a vision handicap, as well as reading and memory issues that Witmer
referred to as "visual verbal amnesia." These issues would almost certainly be identified as a
reading disorder today. Witmer suggested intense tutoring to assist the boy understand words
without having to learn how to spell them. This technique was successful in restoring Charles'
ability to read normally (McReynolds, 1987).
By 1900, a clinic staff of 11 members was serving three children each day, and Witmer
established a residential school for children with intellectual disabilities in 1907. He founded and
edited the first clinical magazine, The Psychological Clinic, in the same year, and wrote the first
piece, simply titled "Clinical Psychology." Witmer's facilities had seen over 450 patients by
1909. During the 1904–1905 academic year, the University of Pennsylvania began offering
official clinical psychology courses because to Witmer's influence. Clinical psychology was
approaching.
However, the initial response to this new venture was not enthusiastic. Witmer introduced his
new kind of psychology in a talk given at the four-year-old American Psychological
Association's annual meeting in 1896. "This is how his friend Joseph Collins described the scene:
"[Witmer] stated that clinical psychology is obtained from the findings of a one-on-one
examination of a large number of people, and that the analytic approach of discerning mental
abilities and faults generates an ordered classification of observed behavior through post analytic
generalizations." He claimed that the psychological clinic is a place of social and public service,
original research, and student training in psychological orthogenics, which comprises vocational,
educational, correctional, sanitary, industrial, and social counselling. The only reaction he got
from his audience was a few of the senior members raising their eyebrows slightly. Brotemarkle,
1947, p. 65) (Quoted in Brotemarkle, 1947, p. 65)
Given the following four facts that were common at the time, this lead-balloon reception is
understandable: For starters, most psychologists regarded themselves to be laboratory scientists,
and Witmer's description of their function was probably not relevant for them. Second, even if
they thought his ideas were great, few psychologists were trained or experienced enough to carry
out the functions he envisaged. Third, they were not about to sacrifice their scientific identity,
which was already delicate in those early years, by committing their profession to what they
considered to be premature applications. Fourth, Witmer had an unlucky knack for enraging his
coworkers (Reisman, 1976, p. 46). The reactions to Witmer's talk were the first indications that
there would be tensions between psychology as a science and psychology as an applied
profession, tensions that still exist today. For many years, certain characteristics of Witmer's
innovative clinic came to characterize following clinical work:
Witmer had been teaching a course on child psychology, had published his first papers in the
journal Pediatrics, and had caught the attention of instructors concerned about their students, so it
was only logical that the majority of his customers were youngsters.
• His suggestions for assisting individuals were preceded by a diagnostic evaluation.
• He did not work alone, but rather as part of a team that included members from diverse
fields consulting and cooperating on cases.
• He highlighted the importance of early diagnosis and correction in order to avoid future
problems.
• He highlighted that clinical psychology should be based on the concepts revealed in
general scientific psychology.
The final of these, that clinical practice should be based on empirical data, has remained a
cornerstone of clinical psychology. Other empirically trained psychologists followed Witmer's
lead and were interested in applying their expertise to challenges outside the laboratory. ”
As a result, clinical psychology's early history, like that of psychology in general, is essentially
one of experimental psychology.
Witmer got clinical psychology off the ground, but he had little say in how it developed. He lost
power largely as a result of his failure to notice advances that would subsequently become
pivotal in the area. Witmer, for example, relied on the psychological tests that were available at
the time, but he essentially overlooked the creation of new intelligence testing. This decision was
costly since, during the first half of the twentieth century, IQ testing characterized applied
psychology more than any other Endeavour (Benjamin, 2005). Witmer also overlooked early
forms of adult psychotherapy, which would come to dominate the field and, in the public's
perspective, define psychology. Of course, Witmer continued to work, but mostly with functions
and clients that are now more closely identified with school psychology, vocational counselling,
speech therapy, and remedial education than with clinical psychology (Fagan, 1996). Witmer's
contributions were considerable, but they cannot explain for the diversity and progress that
clinical psychology saw following his death. We'll have to go elsewhere for that.
The history of assessment in Clinical Psychology
Clinical psychology arose from psychology's concentration on measuring, characterizing, and
interpreting human behavior, and its early history is primarily the history of clinical assessment.
Clinical psychology was nearly entirely an assessment-based discipline until the middle of the
twentieth century, with a few outliers we'll address in the next section.
The German psychiatrist Emil Kraepelin and the French psychologist Alfred Binet are without a
doubt the most influential figures in the early work on evaluation in clinical psychology.
Kraepelin was convinced that all mental diseases were caused by biological reasons, and that
these biological causes could not be adequately treated using the very basic methods available in
the late 1800s and early 1900s. According to reports, he dedicated his career to the research and
categorization of mental diseases in the hopes of developing a scientifically sound classification
system with treatment implications. According to scientific definitions, a syndrome is a
combination of symptoms that regularly co-occur.
Examining how distinct symptoms covaried was an important component of Kraepelin's method
to classification throughout time. Kraepelin reasoned that examining the symptomatic behavior
of a large number of patients would reveal the kind of effect, thinking, and behavior disturbances
that commonly co-occurred. This, according to Kraepelin, would give insight into the nature of
mental diseases. These clusters of symptoms that commonly co-occurred were dubbed
syndromes by Kraepelin, and his classification system was based on determining how these
syndromes connected to and differentiated from one another. As a result, the presence of a single
symptom was thought to be of limited value in determining the nature of the patient's condition.
Kraepelin, on the other hand, believed that by examining the patient's whole range of symptoms,
the particular disease from which he or she was suffering could be identified. As his research
into symptoms and syndromes progressed, he discovered that there were constant variances
across disorders in terms of when symptoms first appeared (i.e., beginning of the disorder) and
how the disorder progressed after that (i.e., the course of the disorder). Kraepelin's classification
method was unrivaled, and one of his main achievements was the classification of what is now
recognized as schizophrenia. Despite the fact that some clinical psychologists question the utility
or validity of psychiatric diagnosis, Kraepelin has had a significant impact on modern psychiatry
and clinical psychology. Kraepelin's work influenced the nature and structure of current mental
disorder classification systems, such as the Diagnostic and Statistical Manual of the American
Psychiatric Association and the World Health Organization's International Classification of
Diseases (both of which are discussed in Chapter 3). From performing psychopathology research
to charging for psychological treatments, referring to these classification systems is a regular
aspect of professional life.
The contribution of Alfred Binet to clinical psychology is significantly different, but no less
significant. In the early twentieth century, the French government desired that all children get
schooling in order to maximize their learning and development potential. There was particular
concern about providing an education to youngsters with poor cognitive ability who would not
benefit from traditional teaching approaches. It was important to accurately identify youngsters
in need of special educational programmes before they could be introduced. Binet and his
colleague Theodore Simon were asked to devise a method for assessing mental abilities that
would provide information useful in identifying youngsters with intellectual disabilities. By
1908, the two collaborators had created the Binet-Simon IQ scale, which consisted of more than
50 tests of mental abilities that could be given to children aged 3 to 13. Binet and Simon amassed
a vast amount of data on a big number of youngsters in order to create norms. As we'll see in
further depth in Chapter 5, norms allow us to compare an individual's test scores to the range of
scores found in the general population or certain subgroups of the general population. Thus, the
degree of intelligence of a child could be assessed by comparing the child's intelligence test score
to norms for children of the same age. The Stanford-Binet Intelligence Measure, which was the
first widely available, scientifically based test of human intelligence, was published in 1916 by
Lewis Terman as a version of this scale for use in the United States. The relevance of
standardization in the construction of psychological tests, as well as references to normative data
in interpreting test results, was established by Binet's work.
Several approaches to clinical assessment flourished throughout the next two decades. Clinical
psychologists continued to place a high priority on measuring talents.
Current status
The rising costs of healthcare, as well as other recent trends, have elevated the importance of
health-care decisions, with decision-making authority frequently shifting from practitioners to
health economists, health plans, and insurers. Evidence that a treatment is efficacious, effective–
disseminable, cost-effective, and scientifically credible is increasingly used to guide health-care
decisions. Psychologists are losing the opportunity to play a leadership role in mental and
behavioral health care in these times of increased cost concerns and institutional–economic
decision making: Other sorts of practitioners are increasingly giving therapy, and the usage of
psychiatric drugs has skyrocketed in comparison to the provision of psychological interventions.
Numerous psychological therapies have been demonstrated to be efficacious, effective, and cost-
effective in studies. However, these interventions are used infrequently with patients who would
benefit from them, in part because clinical psychologists have not made a convincing case for
their use (e.g., by providing decision makers with the data they need to support implementation
of such interventions) and in part because clinical psychologists do not use these interventions
even when given the opportunity.
Clinical psychologists' failure to have a greater impact on clinical and public health can be traced
to their ambivalence about the role of science and a lack of adequate science training, which
leads them to value personal clinical experience over research evidence, use assessment practices
with questionable psychometric support, and not use the interventions for which the strongest
evidence of efficacy exists. Clinical psychology mimics medicine at a time when practitioners
were mostly prescientific in their practices. Prior to the early 1900s scientific reform of
medicine, many physicians shared the same beliefs as many clinical psychologists today, such as
prioritizing personal experience over scientific investigation. The American Medical Association
made a conscious effort to improve the science base of medical school instruction, which helped
to transform medicine. Many clinical psychology doctoral training programmes, particularly
PsyD and for-profit schools, feature large student–faculty ratios, deemphasize science in their
teaching, and produce students who are unable to use or generate scientific knowledge,
according to substantial evidence.
A new accreditation system that requires high-quality science instruction as a core part of clinical
psychology doctoral programme is a viable option for boosting the quality and clinical and
public health effect of clinical psychology. Increased training standards in clinical psychology
will improve health and mental health care in the same way that improved training standards in
medicine have improved health care quality. A system like this would (a) allow the public and
employers to identify scientifically trained psychologists; (b) stigmatize scientific training
programmes and practitioners; (c) produce aspirational effects, thereby improving overall
training quality; and (d) assist accredited programmes in improving their training in the
application and generation of science. These benefits should help to improve clinical and public
health by increasing the production, application, and distribution of experimentally supported
therapies. Experimentally based treatments are not only extremely effective, but also cost-
efficient when compared to other interventions; therefore they may be useful in reducing rising
health-care expenditures. The new Psychological Clinical Science Accreditation System
(PCSAS) aims to accredit clinical psychology training programmes that provide high-quality
science-centered education and training, resulting in graduates who can generate and use
scientific knowledge. Psychologists, institutions, and other stakeholders should strongly support
this new accreditation system as the surest path to a scientifically sound clinical psychology that
may significantly improve clinical and public health.

1.3 PROFESSIONAL ISSUES, TRAINING AND ETHICAL STANDARDS

Because it involves few facts, a few concepts, and a lot of uncertainty and occasional headaches,
defining ethical behavior and consistently acting on the underlying principles can be a difficult
area of clinical psychology to grasp (Keith-Spiegel &Koocher, 1985; Pope & Vasquez, 2016).
Nonetheless, clinical psychologists, like all other health professionals, must be concerned about
functioning ethically. Ethics awareness should function in the same manner that a virus-detection
programme does in the background of a computer. Clinical psychologists' decisions are
influenced by high expectations for professional competence and moral norms. Because the
context and circumstances are ever-changing and ethical dilemmas are not completely avoidable,
even by the most skilled and seasoned psychologist, ethical behavior and decision making is
rarely black and white, right or wrong, as opposed to most of what students learn in their
undergraduate training. When it comes to ethics, the first thing we teach students is that new
clinical psychologists must understand how to make ethical decisions and be conversant with the
ethical principles that guide this process. These are the critical tools clinical psychologists
require; we cannot afford to become complacent and rely just on our intuition. Even with these
skills, ethical practices in clinical psychology necessitate learning to live with some uncertainty.
Students who are new to the subject of ethics often want to skip ahead and ask the professor what
the correct response is.
Ethical principles are a collection of core concepts that guide psychologists in their work.
Respect for people, responsible service providing, maintaining integrity in professional
interactions, and professional duties to society are among these concepts. Clinical psychologists
must always ask themselves, "What is the evidence for what I am about to do?" in all of their
professional activities. And "What are the proportional risks and benefits of the course of action
I'm considering to people who are involved in my profession (patients, clients, students, research
participants)?
The majority of clinical psychologists feel that research evidence should inform professional
services. When the conversation shifts to how research should guide (or determine) practice and
what constitutes research evidence, disagreements emerge. Despite the vast corpus of
psychological knowledge, scientific findings cannot provide a solution to every problem that a
clinical psychologist encounters. An evidence-based strategy is a method of making clinical
service decisions. This frequently requires relying on research evidence. When no research
evidence is available to guide services, the clinical psychologist optimizes services by
determining the value of a psychological service through a systematic, questioning, and self-
critical approach, and then monitoring its effects to determine whether the outcome is primarily
beneficial or harmful. Lynn, Lilienfeld, and Lohr (2015) this, it's suggested, necessitates a
balance between excessive open-mindedness (i.e., "everything goes") and excessive scepticism
(i.e., "only proven services are accepted"). Science is a constantly growing collection of ideas,
theories, and facts, but it is also a process for generating and testing hypotheses.
The foundation of ethical decision-making is drawn from thousands of years of religious and
philosophical ideas centered on respect and dignity for others. The same philosophy inspired
early medical treatment, which was described as "above all, do no damage" (the Roman
physician Galen, mentioned on: www.medscape.com/viewarticle/543882), and psychology is no
exception.
It is critical for psychologists to be knowledgeable with their country's (or state or province)
laws, because what appears to be a tough ethical choice can be solved quickly if there is a
relevant statute or legal precedent. Unfortunately, there are few examples of possible ethical
difficulties that laws have resolved for us, but those that do exist have clear consequences.
Clinical psychologists must familiarize themselves with local legislation in order to earn a
licence.
The psychologist should also be aware of any confidentiality restrictions imposed by law. If a
client is involved in a trial, a judge can require a psychologist to submit his or her case files; this
includes literally every document that a psychologist has on this particular client (Committee on
Legal Issues, American Psychological Association, 2016). As a result, it's also a good idea to
inquire about the client's involvement in a current or pending court proceeding at the start of an
evaluation or treatment session. This understanding can and should influence how the
psychologist retains the client's records and selects words for a report, led by the question: "Is
this written material factually correct and full, and is it expressed in a constructive, nonoffending
language?”Given the similarity of many circumstances in professional training, research,
evaluation, and therapy, it is possible to spell out how to act in many of them. Such practice rules
are usually grouped together in a code of conduct, and practicing psychologists should be well-
versed in, or at least have easy access to, these guidelines, which can fill a large binder.
The following are the most basic, broad ideas behind the American Psychological Association's
codes of ethics:
1. The virtues of beneficence and non-maleficence (desire to help clients and prevent
harm)
2. Trustworthiness and accountability
3. Reliability
4. Honesty
5. Dignity and respect for people's rights

The APA code of ethics' general principles

General Principles make up this section. The nature of General Principles is aspirational. Their
goal is to inspire and guide psychologists toward the profession's highest ethical principles. In
contrast to Ethical Standards, General Principles do not reflect requirements and should not be
used to justify imposing sanctions.
• Principle A: Beneficence and Non-maleficence
Psychologists want to help individuals with whom they work and avoid causing harm.
Psychologists strive to protect the welfare and rights of humans with whom they deal
professionally, as well as the welfare of animal subjects of research, in their professional
acts. When commitments or concerns of psychologists conflict, they seek to resolve the
disagreement in a responsible manner that avoids or minimizes harm. Because psychologists'
scientific and professional judgements and actions may have an impact on other people's
lives, they are aware of and vigilant against personal, economical, social, organizational, or
political variables that could lead to the abuse of their power. Psychologists attempt to be
mindful of how their own physical and mental health may affect their capacity to serve
individuals they work with.
• Principle B: Trustworthiness and Accountability
Psychologists build trusting relationships with the people they work with. They are conscious
of their professional and scientific obligations to society and the communities in which they
work. Psychologists adhere to ethical principles, define their professional roles and
responsibilities, accept responsibility for their actions, and avoid conflicts of interest that
could lead to exploitation or injury. To the degree necessary to serve the best interests of
persons with whom they engage, psychologists consult with, refer to, or collaborate with
other professions and institutions. They are concerned about their colleagues' scientific and
professional conduct being ethically compliant. Psychologists attempt to volunteer a portion
of their professional time for no or little pay or personal gain.
• Principle C: Integrity
In the science, education, and practice of psychology, psychologists strive for accuracy,
honesty, and truthfulness. Psychologists do not steal, cheat, or participate in deception,
subterfuge, or intentional misrepresentation of facts in these activities. Psychologists attempt
to maintain their pledges and avoid making reckless or ambiguous commitments. When
deception is ethically justifiable to maximize benefits while minimizing harm, psychologists
have a serious responsibility to consider the need for, the potential consequences of, and their
 responsibility to correct any resulting mistrust or other harmful affects that arise from the use
of such techniques.
• Principle D: Justice
Fairness and justice entitle all people to have access to and benefit from psychology's
contributions, as well as to equal quality in the processes, methods, and services provided by
psychologists. Psychologists use reasonable judgement and use caution to ensure that their
potential biases, competence boundaries, and expertise constraints do not lead to or condone
unjust actions.

• Principle E: Respect for People's Rights and Dignity

Psychologists value everyone's dignity and worth, as well as their right to privacy,
confidentiality, and self-determination. Psychologists are aware that extra precautions may be
required to protect the rights and welfare of individuals or groups whose vulnerabilities
impede their ability to make independent decisions. Psychologists recognize and respect
cultural, individual, and role differences, including those based on age, gender, gender
identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability,
language, and socioeconomic status, and take these factors into account when working with
members of these groups. Psychologists strive to eliminate the impact of biases based on
those characteristics on their work, and they do not knowingly participate in or condone acts
based on such prejudices by others.
Quoted from the American Psychological Association's Ethical Principles and Code of
Conduct, which can be found at www.apa.org/ethics/code/.
These broad principles are then applied to the ten ethical criteria listed below, which are divided
into specific areas of practice:
• Competence
• Human relations
• Privacy and secrecy
• Advertising and other public statements
• Fees and record-keeping
• Education and training
• Research and publication
• Assessment
The subject of ethical behavior is intriguing, vital to our profession's existence and public image,
and also frustrating. It's simple to understand and sympathize with the desire to do the right
thing, but there's rarely a flawless solution when it comes to ethics. Contexts change constantly
and should be taken into account, and many of our decisions are flawed even if they are the best
we can do. This begs the question of how we might come to terms with the fact that we will
always be in a state of uncertainty. At one extreme, laws spell out exactly what we should not do
and how we will be punished if we do them. Practice guidelines are intended to aid in more
normal practice decisions, but they cannot tell you what will happen if you break them. The
overall ethical standards are broad in scope and must be tailored to each unique scenario and
context.
Training in Clinical psychology
All universities and colleges offer psychology programmes, which are quite popular.
Clinical psychology has been the most popular field within graduate psychology programmes for
many years. Clinical psychology programmes receive significantly more applications and
graduate far more students than other graduate programmes in psychology. Clinical psychology
received 32 percent of doctorates in psychology in 2013, according to data from American
colleges. In comparison, counselling psychology received 12% of Ph.D.s that year, whereas
school psychology received 3% (www.nsf.gov/statistics/sed/2013/data/tab13.pdf).
Clinical Psychology Training Models
Clinical psychologists are educated using three models: the scientist-practitioner model, the
clinical scientist model, and the practitioner-scholar model (McFall, 2006). The scientist-
practitioner approach is endorsed by the majority of Ph.D. programmes in clinical psychology.
This training paradigm, known as the Boulder model, was initially endorsed by the American
Psychological Association during a training conference held in Boulder, Colorado (Raimy,
1950).
Graduate students learn and display competencies in research and psychological care providing
in the scientist-practitioner approach. Students demonstrate research competency by conducting
original research, which they write up in a dissertation and successfully defend in an oral
examination, just as they would in any other Ph.D. programme. Practicum training is used to
master clinical skills such as interviewing, test administration, assessment report writing,
psychotherapy, and clinical consulting. These abilities are honed and improved during the
internship year, when the student is hired full-time to provide psychological services in a
structured health-care setting under the supervision of licenced psychologists.
Clinical psychologists should be capable of doing research and employing empirical evidence to
guide their clinical services, according to the scientist-practitioner model's guiding principle.
There is a lot of variation among scientist-practitioner-oriented programmes when it comes to the
relative balance of science and practice in training and, more importantly, how students are
taught to integrate science and practice (Sayette, Norcross, &Dimoff, 2011). Some programmes
that place a heavy emphasis on research capabilities now refer to themselves as clinical scientist
programmes, in which the major purpose is to prepare students to contribute to the body of
knowledge in psychology and allied fields (McFall, Treat, & Simons, 2015).

Most Boulder model graduates were working in practice settings and providing therapeutic
services in the 1950s and 1960s. Following the completion of their doctoral dissertations, these
psychologists rarely undertook any research. Delegates at a training conference in Vail,
Colorado, voiced unhappiness with the way the scientist-practitioner model was being used in
many training programmes, and created a new model, the practitioner-scholar model, which was
modified at following conferences (Peterson et al., 1991).
The practitioner-scholar paradigm places a greater focus on clinical skills training and less on
research skills offered in Ph.D. schools. A distinct doctoral degree, the Psy.D. is offered by
programmes that support the practitioner-scholar approach. Nonetheless, several Psy.D.
Programmes demand students to complete a research project and have extensive research
training. Unlike research undertaken in Ph.D. programmes, which may incorporate experimental
designs and analyses of huge datasets, Psy.D. Research focuses more on naturalistic designs and
the evaluation of individual cases or service-oriented programmes. In general, Psy.D.
Programmes are meant to educate research consumers who are informed by science in their daily
activities but do not require research abilities. All Ph.D. programmes in professional psychology
are provided by universities in the United States and Canada. Psy.D. programmes can be
available at both universities and independent professional schools in the United States. The
growth of free-standing colleges has caused anxiety among many in the field. Larger class
numbers, decreased financial support, and an overreliance on part-time teachers with minimal
experience in research or teaching are all aspects critics point to as having a negative impact on
the quality of students' education (McFall, 2006).
The weightage given to science and practice is the fundamental difference between Ph.D. and
Psy.D. Training methods. Cherry, Messenger, and Jacoby (2000) discovered unique profiles
congruent with the nature of each paradigm using survey data from APA-accredited scientist-
practitioner and practitioner-scholar programmes. During their training, students in both types of
programmes did a fair amount of clinical service delivery, but students in scientist-practitioner
programmes did more research than students in practitioner-scholar programmes. Graduates of
both types of schools spent the majority of their professional time (about 60%) delivering clinical
services; however, graduates of scientist-practitioner programmes spent more time on research
than graduates of practitioner-scholar programmes (10 percent versus 2 percent ).

However, there are a number of other significant elements to consider while choosing a training
programme. Norcross, Ellis, and Sayette (2010) analysed the characteristics of five types of
APA-accredited clinical psychology programmes on the practice-research continuum, ranging
from free-standing Psy.D. Programmes to university professional school programmes. Psy.D.
programmes to practice-oriented Ph.D. programmes, Ph.D. programmes with equal emphasis,
and Ph.D. programmes with a research focus. The overall acceptance rate into clinical
programmes was 17 percent, but it ranged from 50 percent in free-standing Psy.D. Programmes
to just 7 percent acceptance in research-oriented Ph.D. programmes across the practice-research
continuum.
If one is thinking about applying to clinical psychology graduate school, it’s good to know not
only about acceptance rates but also about the financial aid available in various schools (unless
you are very wealthy or have recently won the lottery).
A fee waiver, a fellowship or assistantship, or a combination of a fee waiver and an assistantship
or fellowship is all examples of financial support. Norcross and his colleagues discovered that
free-standing Psy.D. Programmes had the lowest likelihood of funding, with only 1% of entering
students receiving a waiver and assistantship or fellowship. Funding rose in a linear fashion
across the continuum, with research-oriented Ph.D. programmes receiving the most assistance,
with 89 percent of entering students receiving both a fee waiver and an assistantship or
fellowship. Students took an average of six years to finish clinical psychology studies, including
the internship. Students who earned a Psy.D. From a free-standing school took an average of 5
years to complete the programme, whereas students in Ph.D. programmes took an average of 6.3
years.
There are some distinct distinctions in programme theoretical perspective as well. Although
behavioral and cognitive-behavioral orientations are dominant in all clinical psychology
programmes, research-oriented Ph.D. programmes have the highest number of faculty endorsing
cognitive-behavioral orientations (74 percent versus 28 percent in free-standing Psy.D.
programs). Professors in free-standing professional schools are more likely to support
humanistic/phenomenological methods (18%) than faculty in research-oriented Ph.D.
programmes (6 percent).
The scope of problems addressed and people serviced differentiates Clinical Psychology as a
general practisespecialisation. Clinical psychology focuses on individual differences, abnormal
behavior, and mental disorders, as well as their prevention and lifestyle enhancement, in
research, teaching, training, and practice. However, the current two-year training is insufficient,
and it could be replaced by a three-year Psy.D. Programme in Clinical Psychology and/or a four-
year PhD in Clinical Psychology after completing a Masters in Psychology. This could help to
avoid brain drain while also ensuring equal employment opportunities for all professions. While
making modifications, effort must be taken to ensure that trained clinical psychologists are
encouraged to pursue research and teaching positions in universities that need a Ph.D. as a
minimum requirement for employment under current laws and regulations.
Ensure that students are prepared to provide psychological services to an increasingly diverse
community are a fundamental problem for all training programmes. Aside from culture and
language, clinical psychologists must be aware that diversity also includes age, income, sexual
orientation, handicap, family structure, and geographic location. Those wishing to provide
services in a rural setting, for example, should be aware of the unique stressors that people in
rural areas face (e.g., higher rates of unemployment and accidents), as well as the fact that rural
areas have a higher proportion of Indigenous people and people with a lower overall level of
education than urban areas (Barbopoulos& Clark, 2003; Helbok, Marinelli, & Walls, 2006).
Because of the many different ways in which a country's diversity manifests itself, it's doubtful
that all clinical psychologists will have specialized understanding of all the different types of
diversity they may face. What's more important (and more respectful of how diversity manifests
itself among a psychologist's clients) is for a psychologist to
(a) be aware of diversity issues,
(b) be open to discussing these issues with clients (when appropriate),
(c) Have the interpersonal skills to effectively communicate about these issues, and
(d) Have the research skills to interpret and design research that is sensitive to diversity factors
(cf. Hertzsprung & Dobson, 2000; Whaley & Davis, 2007). Diversity concerns necessitate a
delicate balancing act in which universal human norms, specific group norms, and individual
features are examined alongside the normal-abnormal behavior continuum.

1.5 CLINICAL PSYCHOLOGY IN INDIA

Clinical psychology was established as a separate discipline in 1955 at the All India Institute of
Medical Sciences' Department of Clinical Psychology (NIMHANS). The DMP (Diploma in
Medical [2] Psychology) programme was accredited by the Medical Council of India. In 1962, a
similar programme was launched at Ranchi's Central Institute of Psychiatry. This two-year
programme was known by many names until 1996, when it was renamed M.Phil in Clinical
Psychology. The Rehabilitation Council of India (RCI) began regulating this two-year regular,
full-time programme in 1997. Students must have a standard Masters in Psychology degree and
be accepted into the programme through an entrance examination. Following this, a number of
additional universities began to provide the curriculum, and there are now 11 centers around the
country that do so.
Major milestones:

● Under the guidance of Dr. N.N Sen Gupta (Dalal A. K &Misra A., 2010), the first
psychology department and first psychology laboratory in India were founded in 1916 at
Calcutta University.

● 1922- By his close contact with and backing of Sigmund Freud, Dr. Girindra Shekhar
Bose, who succeeded Dr. N.N Sengupta at Calcutta University, founded the Indian
Psychoanalytical Society in 1922.
● M. V. Gopalaswamy established the second oldest Department of Psychology at the
University of Mysore in 1924. Until 1998, the department offered a master's degree in
psychology.

● S.N Gupta's tireless efforts result in the establishment of the First Indian Psychological
Association in 1925.

● N.N Sen Gupta was the first official founding editor of the Indian magazine of
psychology, which was created in 1926.

● In the year 1944, "The Madras Psychology Society" was founded.

● The India Government Defense Ministry formed a psychological research wing in 1949
with the goal of including psychologists on research and selection committees.

● In the year 1950, the University of Pune founded an experimental psychology

department.

● The inaugural Journal of Psychological Researches was published in 1957 by the Madras
Psychology Society.

● The Indian Journal of Applied Psychology was first published in 1964 by the Madras
Psychology Society.

● 1955- Advanced clinical psychology training programmes were developed at the All
India Institute of Mental Health (now known as NIMHANS) in Bangalore, thanks to the
collaboration of Erikson and McClelland.

● 1975- By the end of 1975, psychology was offered at 51 of the 101 recognized
universities.
 ● The National Academy of Psychology (NAOP) of India was established in 1989.

● In 2009, the Indian School Psychology Association was founded with the goal of
promoting school psychology in India and around the world.
Psychology has European roots in India. However, Indian psychology is capable of standing on
its own two feet in the twenty-first century, with multiple colleges, notable psychologists, and
remarkable organizations anchored in psychological interventions. In India, there are already
seventy institutions with well-established psychology departments and institutes for both applied
research and public psychological services (Robert B Lawson, Jean E. Graham, Kristin M.
Baker, 2008). There has been a notable movement from experimental work to understanding the
psycho-cultural milieu using Indian traditional notions in research, establishing psychological
theories, developing psychological examinations, and applying psychology to all disciplines of
university studies and to national requirements.

Clinical Psychology Training Models in INDIA

When comparing the many training programmes available in India, there are four main models
of clinical psychology training available.
1. Mental Hospital Model: This is the oldest model, which began in 1955 at the All India
Institute of Mental Health (now NIMHANS), a mental hospital. Students receive supervised
instruction while working with inpatients and outpatients at a psychiatric hospital, and their
training was later extended to Neurology Departments. It is currently followed in Ranchi's CIP,
Delhi's IHBAS, and Ranchi's RINPAS. In addition, the trainees receive rotatory supervised
training in a General Hospital setting, as per RCI's training guidelines. More centers have
expressed an interest in implementing this training concept in centers affiliated with mental
hospitals/institutes in Agra, Chandigarh, Chennai, and Hyderabad.
2. Super Specialty Model: This model was developed at Manipal University in 1999 and was
based on RCI recommendations. The degree is offered at the faculty of Allied Health Sciences'
separate department of clinical psychology, which works closely with other departments at the
medical college hospital, including the department of psychiatry. Students receive supervised
training in many disciplines such as Pediatrics, Cardiology, and Neurology. This concept is
followed by training programmes at RIMPS, Manipal, and Sri Ramachandra University,
Chennai. More institutions in the South, such as JSS University in Mysore, have taken the
initiative to launch programmes based on this concept.
3. Rehabilitation Institute Model: In 2005, a similar initiative was launched in Sweekar,
Secunderabad. The training takes place mostly at a rehabilitation centre, but it also includes
exposure to other fields of clinical psychology, as well as mandatory rotations in various medical
specialties, including psychiatry. More non-profits working in the fields of mental health and
disability could start similar programmes aimed primarily at the impaired community.
4. University Department Model: This is the most common model in the United States, often
known as the Boulder Model. It was previously suggested that this paradigm be tested in India
because it provides more opportunities for clinical psychologists to advance. However, it began
in 2006 at the University of Kolkata and afterwards at Amity University in Uttar Pradesh.
Despite being housed in a university department, the programme includes mandatory postings in
many medical specialties, including psychiatry, as mandated by the regulating authority, RCI.
This provides trainees with the opportunity to gain the skills necessary to provide assistance to
the entire student community through clinics set up on campus. We have yet to assess the various
training models. However, given the size and diversity of our country, we need to be more
creative in our training. It is possible to try out both a community-based and a school-based
concept. School psychology and community psychology, as distinct fields, may not arise in our
country anytime soon, as they have in industrialized countries. As a result, we may need to try
out different clinical psychology training approaches. Non-profit organizations that provide
clinical psychology services in rural areas and have the resources to give necessary training in a
hospital setting may begin the programme with a focus on rural mental health.
The Fields of Clinical Psychology and Emerging Fields
1. Clinical Child Psychologists who work with children and assist learning challenged
youngsters in their assessment as well as giving psychological support and remedial
training have already established themselves, similar to psychotherapists and those who
work in addiction treatment facilities. Other fields, on the other hand, are gaining traction
in our country.
2. Health Psychology in Clinical Practice The training programmes provided in the medical
college context have resulted in research on various health issues. Research in this area
 has aided in the development of specializations such as psycho oncology, psycho
nephrology, and cardiac rehabilitation, as well as programmes for modifying life styles in
cardiac patients and other medical disciplines. It has also promoted dental health research
and services.
3. Forensic Psychology in Clinical Practice Clinical psychologists' expert opinions are
sought by family courts, as well as other courts, including the High Courts. The branch of
clinical forensic psychology is growing as the usage of brain mapping and profiling
processes grows, as well as the development of numerous forensic psychological
investigative procedures. The stakes are high since domestic as well as international
terrorism is posing a threat to our country's citizens. Suspect interrogation must be done
with caution, and clinical forensic psychologists are trained in this area. Another style of
training is anticipated to emerge with the introduction of a clinical psychology
programme in a forensic environment in Gujrat.
4. Psychology of Rehabilitation Rehabilitation psychology is a discipline of psychology that
works with impaired people and focuses on assessing and caring for them. Despite the
fact that rehabilitation psychologists are trained by clinical psychologists, their education
takes place in the context where the intellectually challenged are served. However,
rehabilitation psychologists may take some time to focus on the chronically mentally ill
as well as those who require neuropsychological rehabilitation.
5. Neuropsychology in Clinical Practice From administering 'imported' neuropsychological
tests in the 1980s to developing alternative neuropsychological batteries in many
indigenous languages for various groups, we have progressed to a point where we can
measure the magnitude as well as the area of dysfunction. Clinical neuropsychologists
have a stronger stake in cognitive science because it is growing as a distinct discipline
with significant implications. Furthermore, advances in the field of neuropsychological
rehabilitation are extremely beneficial to a wide range of people.
Importance
According to the RCI's "Status of Disability in India- 2000" assessment, India required 20,000
clinical psychologists in 2000 to fulfil the sole needs of impaired people. By 2020, the number of
clinical psychologists required to handle the issues faced by impaired people, as anticipated in
this paper, might be doubled, to around 40,000. Clinical psychologists, on the other hand, do not
just work with the disabled. If clinical psychologists are expected to provide services as general
practitioners, the number required to address current demands is significantly greater than what
has been predicted.
So far, the country has trained roughly 2000 clinical psychologists. However, the number of
people available to provide service in the country is much smaller. In the second decade of this
century, clinical psychology education in India must make a significant leap forward. The
Government of India's Ministry of Health and Family Welfare is fully aware of the need to
increase the number of qualified mental health practitioners in the country. As a result, directions
have been issued for the establishment of clinical psychology training programmes in centers of
excellence around the country. To realize this at a faster rate, however, all mental health
specialists, as well as other health professionals, must be on board. The IACP has approximately
650 professional members and another 280 associate members, which include other professionals
such as psychologists who specialize in other areas such as counselling, education, and other
areas of clinical psychology, as well as psychiatrists, social workers, lawyers, and other
professionals interested in clinical psychology. As a non-governmental organization, it has
consultative status with a number of Indian government ministries, and as a result,
representatives from the organization are invited to participate in consultations. We expect that
the Rehabilitation Council of India, or another new body that will likely govern clinical
psychology training programmes in the future, would consult with IACP in shaping and fostering
the programme. We believe that the reforms in the works to restructure the councils will have the
desired effects, assisting the clinical psychology profession, as well as psychology in general, in
meeting the problems that this magnificent country presents.

1.5 SUMMARY
 The distinction between clinical and counselling psychology has traditionally been based
on the severity of the problems addressed.
 The obvious difference is that school psychologists often have more schooling and child
development expertise, and they focus their treatments in school and other educational
settings on children, adolescents, adults, and their families.
 Unfortunately, throughout the centuries that followed, the prevalent approach to the
treatment of mental disease in Europe and North America was anything but humanitarian.
 Witmer, a former schoolteacher, accepted the case, becoming the world's first clinical
psychologist and founding the world's first psychological clinic at the same time
(Benjamin, 2005; Routh, 1994).
 The reactions to Witmer's talk were the first indications that there would be tensions
between psychology as a science and psychology as an applied profession, tensions that
still exist today.
 When it comes to ethics, the first thing we teach students is that new clinical
psychologists must understand how to make ethical decisions and be conversant with the
ethical principles that guide this process.
 An evidence-based strategy is a method of making clinical service decisions.
 Clinical psychologists must familiarize themselves with local legislation in order to earn
a license.
 Such practice rules are usually grouped together in a code of conduct, and practicing
psychologists should be well-versed in, or at least have easy access to, these guidelines,
which can fill a large binder.
 Non-profit organizations that provide clinical psychology services in rural areas and have
the resources to give necessary training in a hospital setting may begin the programme
with a focus on rural mental health.
 The branch of clinical forensic psychology is growing as the usage of brain mapping and
profiling processes grows, as well as the development of numerous forensic
psychological investigative procedures.
 Despite the fact that rehabilitation psychologists are trained by clinical psychologists,
their education takes place in the context where the intellectually challenged are served.
 The Government of India's Ministry of Health and Family Welfare is fully aware of the
need to increase the number of qualified mental health practitioners in the country.
 We expect that the Rehabilitation Council of India, or another new body that will likely
govern clinical psychology training programmes in the future, would consult with IACP
in shaping and fostering the programme.
1.6 KEYWORD
 Rehabilitation -the action of restoring someone to health or normal life through training

and therapy after imprisonment, addiction, or illness.

 Counselling – give professional help and advice to (someone) to resolve personal or

psychological problems.
 Beneficence – the quality or state of doing or producing good

 Accountability– the fact or condition of being accountable; responsibility.

 Standardization – the process of making something conform to a standard.

 Monologues-a long speech by one actor in a play or film, or as part of a theatrical or

broadcast programme.

1.7 LEARNING ACTIVITY

1. List down the institutes which provide the major researches in clinical Psychology in
India.
______________________________________________________________________________
________________________________________________________________________
2. Draw a flow chart of the historical development of Clinical Psychology

1.8 UNIT END QUESTIONS

A. Descriptive Questions

Short Questions:
1. Give a comprehensive definition of clinical Psychology.
2. What are the distinctions between clinical and counselling Psychology?
3. Mention the APA code of ethics for clinical psychologists.
4. List down any 5 major milestones of clinical Psychology in India.
5. What are the emerging fields of clinical Psychology?

Long Questions:
1. What is the scope of clinical Psychology?
2. Enumerate some of the extensions in the practice of clinical Psychology.
3. Critically analyse the role of assessment in clinical Psychology.
4. Describe the contribution of Wundt in empirical clinical psychology.
5. Explain India’s training models in clinical Psychology.
B. Multiple Choice Questions
1. Who used the term clinical psychology in print for the first time
a. Lightner Witmer
b. Wilhelm Wundt
c. Freud
d. Alfred Adler

2. Psycho oncology studies are:

a. Treatment plan for cancer
b. psychological reactions to the experience of cancer
c. Behavioural components in cancer patients
d. Adaptation with the adverse physical conditions

3. India requires 40,000 clinical psychologists by the year 2020 was stated by
a. NIMHANS
b. RCI
c. APA
d. ICMR

4. Psychological Clinical Science Accreditation System aims to provide:

a. Assessment protocols
b. Different courses in clinical psychology
c. High quality science centred education and training
d. Code of ethics for clinical psychologists

5. Rehabilitation psychology is a discipline of psychology that works with

a. Impaired people and focuses on assessing and caring for them

b. People with addiction
c. Children
d. Depression

Answers
1-a, 2-b, 3-b, 4-c, 5-a
1.9 REFERENCES

References book
 Aiken (2009). Psychological Testing and Assessment. Pearson.
 J F Ter Laak (2013). Understanding Psychological assessment: A Primer on Global
Assessment of the Client’s Behaviour in Educational and Organisational Setting. Sage
India
 S K Mangal (1996).Abnormal Psychology. Sterling Publishers Pvt. Ltd.
 Korchin(2004). Modern Clinical Psychology. CBS.

Textbook references
 Robert Kaplan and Dennis P. Saccuzzo (2013). Psychological Assessment and Theory:
Creating and Using Psychological Test. Cengage
 Anne Anastasy (1982), Psychological Testing. Macmillan Publishing Co. INC.
 Kaplan and Sadock . (8th Ed.), Synopsis of Psychiatry. B.I. Waverly Pvt. Ltd.
 Janet R. Matthews and Barry S. Anton (2007), Introduction to Clinical Psychology.
Oxford University Press.

Website
 https://psychology.fandom.com/wiki/Introduction_to_clinical_psychology
 https://www.verywellmind.com/what-is-clinical-psychology-2795000
 https://www.researchgate.net/publication/324182518_INTRODUCTION_TO_CLINICA
L_PSYCHOLOGY
 https://dl.uswr.ac.ir/bitstream/Hannan/140735/1/9781848722224.pdf