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Clinical Psychology is the study of human behavior and its associated thinking and emotions, and how these are associated with our brains. Clinical Psychologists know a lot about how brains work, and therefore know about how people think and feel. We also know a lot about how people interact with their environments and why they do the things they do. We study human behavior in all its strengths and vulnerabilities. These vulnerabilities range from everyday problems to severe mental illness. As Clinical Psychology grew from its formal beginnings in the late 1940s , it became strongly influenced first by the treatment principles of psychoanalysis, then by behaviourism, and more recently by cognitive psychology and cognitive neuroscience.
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Clinical Psychologists work directly with individuals at all developmental levels (infants to the elderly), as well as groups (families, people with similar psychopathology, and organizations), using a wide range of assessment and treatment methods to promote mental health and to alleviate discomfort and maladjustment.
Clinical Psychologists are also involved in research, teaching and supervision, program development and evaluation, consultation, public policy, professional practice, and other activities that promote psychological health in individuals, families, groups, and organizations. Their work can range from prevention and early intervention of minor problems of adjustment to dealing with the adjustment and maladjustment of individuals whose disturbance requires them to be hospitalised.
Researchers study the theory and practice of Clinical Psychology, and through their publications, document the empirical base of Clinical Psychology. Consultants, Teachers, and Clinical Supervisors share the Clinical Psychology knowledge base with students, other professionals, and non-professionals. Clinical Psychologists also engage in program development, evaluate Clinical Psychology service delivery systems, and analyze, develop, and implement public policy on all areas relevant to the field of Clinical Psychology. Many Clinical Psychologists combine these activities.
Assessment in Clinical Psychology involves determining the nature, causes, and potential effects of personal distress; of personal, social, and work dysfunctions; and the psychological factors associated with physical, behavioral, emotional, nervous, and mental disorders. Examples of assessment procedures are interviews, behavioral assessments, and the administration and interpretation of tests of intellectual abilities, aptitudes, personal characteristics, and other aspects of human experience and behavior relative to disturbance.
Treatment or interventions in Clinical Psychology are directed at preventing, treating, and correcting emotional conflicts, personality disturbances, problematic behaviors, psychopathology, and the skill deficits underlying human distress or dysfunction. Examples of intervention techniques include psychotherapy, counselling, cognitive behavior therapy, couple and family therapy, group therapy, biofeedback, cognitive retraining and rehabilitation, and social learning approaches.
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Although there are many similarities between Clinical Psychology and the related professions of Psychiatry and Counselling, there are also substantial differences.
Psychiatry is a medical specialty, in the same way that Cardiology, Paediatrics, and Orthopaedic Surgery are medical specialties. Psychiatry is the medical specialty that deals with mental illness. In New Zealand a major difference in the training of Psychiatrists and Clinical Psychologists centres on the use of medication for treatment. Because Psychiatrists are medical practitioners they prescribe medications, which Clinical Psychologists do not. Some Psychiatrists have a strong interest in psychological therapy and may give much emphasis to this in their training and practice. In practice, Psychiatrists and Clinical Psychologists often work with similar clients, and often work together.
The concept of counselling has actually been around for a long time, and it reflects the need for one person to seek out help or advice from another person. Counselling as a professional occupation arose not from the clinic but from more social settings such as church organizations and social work. It focuses on helping people resolve problems or role issues related to work or school or family matters. Here are some general characteristics of counselling:
- It is primarily concerned with everyday problems rather than concentrating on mental health or illness
- It is concerned with role functioning, with choices to be made, and with actions to be taken to solve the everyday problems of living, without referring to the underlying working of the brain
- It is more concerned with present events than with past events
Counselling in New Zealand has not traditionally been associated with qualifications in psychology, or with any particular form of training. This is changing, with various courses in counselling now on offer, including ones with tertiary degree status. There is no official registration process for counsellors. Importantly, all Clinical Psychologists are trained in the skills of counselling.
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In order to be registered in the Clinical Scope of Practice with the New Zealand Psychologists Board, a psychologist must have a minimum of a Masters Degree in Psychology plus a Postgraduate Diploma in Clinical Psychology plus a minimum of 1500 hours of supervised practice as a Clinical Psychologist.
The university qualification that is the basis of Clinical Psychology training in New Zealand is the Postgraduate Diploma in Clinical Psychology. This postgraduate diploma involves three years of study and 1500 hours of supervised practical experience in addition to a Master’s degree in psychology.
In other countries, there are equivalent Clinical Psychology qualifications, such as a Masters degree in Clinical Psychology or a professional doctorate in Clinical Psychology, a PsyD.
Some Clinical Psychologists in New Zealand or abroad have also completed a PhD, which involves three years of full-time research in a clinical area.
Some universities use different names for their Clinical Psychology qualification, such as “M.A. (Applied)”, and some are now developing Doctoral programmes.
Regardless of the type of degree, a person registered in the Clinical Scope of Practice will be considered to have both theoretical training and supervised, practical training in the assessment and treatment of the full range of psychological problems that people experience – from everyday difficulties to serious mental disorders.
Thus, Clinical Psychologists have studied psychology at University for seven or more years. They have specialised in understanding how the human brain works and therefore how a particular brain (with its feelings, actions, beliefs, experiences and culture) affects the way a particular individual interacts with the world. They have learned how human beings interact with their environments and how each affects the other. They have also learned how to listen to, and understand, people’s emotional and psychological problems, and how to help people make changes in their lives or overcome complex mental illness. Finally, they are trained to use therapies that have a sound evidence base, that is, have been shown to be effective.
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Only psychologists who are registered with the Psychologists Board under the Health Practitioners Competence Assurance Act 2003, within the Clinical Scope of Practice, may called themselves a “Registered Clinical Psychologist”. Some counsellors, psychotherapists, and psychologists try to treat problems for which they have not been specifically, or adequately, trained. To be confident about the quality of your care, you need to know what degree, what registration, and what training your psychologist or therapist has received. You should feel free to ask your psychologist (or any other health professional) whether they are registered, what their qualifications are, and to what professional body they belong.
All Clinical Psychologists should be in supervision. This means they will meet regularly with an experienced colleague(s) to discuss the work they are doing. They will keep any information that identifies you confidential, and the supervisor will also respect your privacy. Supervision allows the quality of the Clinical Psychologist’s work with you to be checked. It is a time when another Clinical Psychologist can ask questions that can help your therapist expand and deepen their understanding of your life and of working with you. Supervision helps to keep the standard of Clinical Psychology practice high.
Membership of a Professional body
In order to ensure high standards in the profession of Clinical Psychology in New Zealand, there are two professional bodies that provide an affiliation for Clinical Psychologists. The New Zealand College of Clinical Psychologists and The New Zealand Psychological Society (Institute of Clinical Psychology) provide practice guidelines for their members (including ethical guidelines), and monitor the supervision practices of their members. They also provide opportunities for their members to learn more about their work through training programmes and workshops. You can learn about the New Zealand College of Clinical Psychologists here.
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Many people have found relief from depression and other emotional difficulties through psychological therapy. This brief question-and-answer guide provides some basic information to help people take advantage of psychological therapy.
What does research show about the effectiveness of psychological therapy?
There is strong evidence that the right psychological therapy with a suitably qualified Clinical Psychologist can increase an individual’s wellbeing and performance. Research convincingly shows that certain kinds of therapy effectively treat a wide range of psychological problems such as depression, anxiety, and many other problems. Psychological therapy can also provide benefits for physical health, and research increasingly supports the idea that emotional and physical health are very closely linked and that therapy can improve a person’s overall health status. Psychological therapy with children is similar in effectiveness to psychological therapy with adults and is tailored to be age-appropriate. Your Clinical Psychologist will be able to tell you about the evidence for the treatments that they recommend.
How to gain the most from Psychological Therapy
All psychological therapy is a two-way process that works especially well when the client and the therapist communicate openly. Research has shown that the outcome of psychological therapy is improved when the therapist and client agree early about what the major problems are and how psychological therapy can help, and maintain a warm and trusting relationship. It is quite acceptable to contact a few Clinical Psychologists and have a brief conversation about your difficulties, and their approach to the work, and their qualifications and experience, so that you can get a “feel” for them. Then you can choose one to make an appointment with and see how you go. Obviously, if you don’t develop a positive relationship with that one, you can try another. We know that the quality of the relationship between the Clinical Psychologist and the client can account for up to 40% of the benefits of therapy, so it is important that you choose a Clinical Psychologist with whom you feel safe, understood, and in whom you have confidence.
You and your Clinical Psychologist both have responsibilities in establishing and maintaining a good working relationship. Be clear with your therapist about your expectations and share any concerns that may arise. Psychological therapy works best when you attend all scheduled sessions and give some forethought to what you want to discuss during each one.
How do I know if therapy is working well?
As you begin psychological therapy, you should establish clear goals with your Clinical Psychologist. Perhaps you want to overcome feelings of hopelessness associated with depression; maybe you would like to control a fear that disrupts your daily life; maybe you want to establish healthy lifestyle choices or stop a destructive eating pattern; or maybe you want to improve your relationships with others. Keep in mind that certain tasks require more time to accomplish than others. You may need to adjust your goals depending on how long you plan to be in psychological therapy.
After a few sessions, it’s a good sign if you feel the experience truly is a joint effort and that you and the therapist have a good rapport. On the other hand, you should be able to tell your therapist if you find yourself feeling ‘stuck’ or lacking direction once you’ve been in psychological therapy awhile.
People often feel a wide range of emotions during psychological therapy and these may be unsettling. It is important that you talk with your therapist about feelings that are unsettling, as it is these very reactions that indicate that you are working in an important area of your psychological makeup. When this happens, it can actually be a positive sign indicating that you are starting to explore your thoughts and behaviours.
Although there are other considerations affecting the duration of psychological therapy, success in reaching your primary goals should be a major factor in deciding when your psychological therapy should end.
Psychological therapy isn’t easy. But people who are willing to work in close partnership with their therapist often find relief from their emotional distress and begin to lead more productive and fulfilling lives.