What is Clinical Psychology?

For my post this week, I thought I would talk a bit about something that I get asked at least once a day. Clients, especially in my NHS job, always want to know exactly what it is that I do, and what it means to be a clinical psychologist. If I'm honest, I often struggle to answer them - it's hard to distill down exactly what I do into a snappy sound-bite, because psychology is quite complicated. But just for you, I'm going to try to explain what it is that clinical psychologists do, to give you more of an idea of what you might get from seeing a psychologist. This is by no means an exhaustive post, but it's a start.

Sometimes the best way to explain something is with a good old definition! Wikipedia defines clinical psychology as:
"...an integration of science, theory and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically-based distress or dysfunction and to promote subjective well-being and personal development."

Let's break that down a bit. Clinical psychologists would usually define themselves as "scientist-practitioners," which means that they take the things we know about the human brain and mind and apply them in real-world settings. The reason that they do this is to try to understand why people experience things like anxiety, depression, and other experiences that people find distressing, and to try to help them to manage these experiences so that they feel better or more able to manage their distress.

So far, so good. How would a clinical psychologist go about doing this though? Let's ask Wikipedia again:
"Central to (clinical psychology) are psychological assessment, clinical formulation, and psychotherapy, although clinical psychologists also engage in research, teaching, consultation, forensic testimony, and program development and administration."

Whew, there's a lot going on in that sentence! Clinical psychologists use assessment (we ask some specific questions to try to work out what's going on), formulation (kind of like a map that details some of the particular patterns of difficulty that a person might end up in) and psychotherapy (or CBT, or ACT, or any type of evidence-based therapy that they might have been trained in) to help people to manage distress.  In the UK, clinical psychologists work in a variety of different areas including mental health services (with children, adults or older adults), services for people with learning disabilities, physical health settings and forensic units, as well as many others I'm sure I've forgotten to list. Clinical psychologists also do research, helping to advance the field of psychology, and we also teach and train both our non-psychologist colleagues and trainee clinical psychologists. 

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Let's have a think about some of the differences between clinical psychology and other areas of healthcare:

Clinical psychologists are not psychiatrists
This distinction is one of the easier ones to make, and the one most people end up getting confused by. A psychiatrist is a medical doctor who has done specific training in mental health difficulties. They can prescribe medication. A clinical psychologist is not a medical doctor - they have a doctorate, but it isn't the same as being a medic so they cannot prescribe medication. As I said, this is often the one that confuses people (including, memorably, a psychologist friend's father who referred to her as a psychiatrist in his "father of the bride" speech at her wedding! If it can happen to family members, it's not surprising that it happens to most people!)

Clinical psychologists are not counsellors
This distinction is getting less clear over time. Traditionally, counsellors would offer non-directive listening skills to clients who were experiencing moderate difficulties in the face of fairly normal life events (e.g. anxiety or sadness relating to major life changes, grief, etc). This isn't really true any more and counsellors take on a lot of complex work. In the UK, 'counselling psychologist' is a protected title like 'clinical psychologist', which means that counselling psychologists go through extensive training and often specialise in particular areas. There is a much larger degree of overlap than there used to be, but it is important to note that "counsellor", like "therapist", is not a protected title. Counsellors are also less likely to do research, which is something that clinical psychologists (and counselling psychologists) are specifically trained to do.

Clinical psychologists are not life coaches
Generally speaking, clinical psychologists don't tell you exactly what to do with your life. They help you to think about your options, and will try to give you more of an understanding about your specific situation and what you might think about doing, but it's up to you to apply that to your life. I've always been sceptical of people who will tell you exactly what you should do with your life within an hour of meeting you, but I'm sure that's just the clinical psychologist in me!

A note on protected titles
In the UK, the HCPC regulates certain professions - people who are on the register can prove that they are trained to deliver the service they say they can deliver (click here to see which professions are protected). "Clinical Psychologist" is one of the psychological professions that is protected, which means that in the UK you cannot call yourself a clinical psychologist unless you are trained in a certain way, to do the things talked about above. There are other specific areas of psychology that are also protected, such as forensic and educational psychology.

 Yeah, okay but, what do you actually do?
Honestly, it depends! I have skills in CBT and other therapies such as ACT and PIT, in explaining to people what is happening in terms of their health condition and how that impacts on their mental health, and in thinking about how we might go about changing the things that they don't like (being anxious in groups, feeling low and not going out, not being able to spend time with family due to mood difficulties or relationship issues, etc). How I go about doing that will depend on the client I'm seeing. We'll probably start with a conversation about what they hope to get from coming to see me, and we'll work on these goals together. They will have work to do between sessions, and I'll be thinking about them between sessions as well. It should feel like we're working together, and not like I'm making them do things they don't want to do. Hopefully by the end of it, they will have a better understanding of their difficulties and they'll have ways to manage them that they didn't use before.  I might also work with people on meeting goals that aren't related to health conditions, such as financial or fitness-related goals, but I probably wouldn't be doing that in my NHS work. Check out this page for further information on what a clinical psychologist might be able to help you with.

Does this fit with your understanding of clinical psychology? Let me know in the comments!

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