The definition, history, and diverse applications of clinical psychology

Clinical Psychology
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Broadly speaking, clinical psychology is a practice in the field of medicine that applies “principles, methods, and procedures to reduce or alleviate maladjustment, disability, and discomfort in a wide range of client populations” (Kramer, Bernstein & Phares, 2014, p. 37). Specifically, clinical psychology is the branch of psychology that focuses on assessing and treating individuals suffering from mental or psychology illness or disabilities. This branch includes behavioral health care along with mental health care. Practitioners in the field can use a variety of approaches when treating clients. Approaches can include cognitive, behavioral, cognitive behavioral, humanistic, socio-cultural, biological, and other methods.
Clinical psychology involves a great deal of research so that therapists and counselors can better understand their patients. They must engage in assessment, study, consultation, and teaching in various sectors: workplace settings, health care settings, school settings, sport facility settings, and so on. Clinical psychology has a broad range of applications, as everyone everywhere has a need for mental health. Psychologists work with clients dealing with addiction, struggling with relationship issues, families, people who have suffered some trauma such as veterans or abuse survivors. They help people who want to overcome some challenge, whether behavioral or mental.
Clinical psychology is thus a field that is very diverse and can be used for diverse populations. Clinical psychologists essentially use a map of the mind along with the DSM-V to help assess and treat patients and get them to a healthy place mentally and behaviorally so that they can achieve the goals they have for themselves. They are like tune-up technicians of the mind.
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The empirical tradition of clinical psychology focused on exploring the mind as a physical space and collecting facts and data about nerve impulses and mental processes as physical functions. Weber, Wundt and Witmer were some of the major players here, and Witmer is credited with getting psychology going in the right direction, though he did not adjust his approach as the field began to develop. He was the one who began to insist that clinical psychology be based on scientific principles.
The psychometric tradition focused on measuring knowledge through practices such as phrenology and even way back in ancient times through use of astrology and zodiac signs. Knowledge, abilities, attitudes and personality are all areas that have been studied under this tradition. Comparing individuals and populations is also something that has come under scrutiny in psychometric studies—for example, the differences in brain size and behavior between races and genders. Galton was one who proposed a systematic way of measuring people’s behaviors, dreams, attitudes and so on. The measurement of mental functioning became a primary focus in the psychometric tradition and is responsible for the numerous psychological tests that are around today, Galton-Cattell sensorimotor tests.
The Clinical tradition is really the comprehensive school of healing the mind and body that goes back to ancient times, when people from all cultures used a range of approaches to treat people with mental and behavioral health issues. In ancient times, maladies were often blamed on humors, bile or something of the sort. Today, psychologists like Freud and Festinger have helped to show how the mind works so that therapists can treat issues more appropriately—by helping patients to see what their unconscious mind is trying to tell them, as Freud pointed out, or seeing how they are coping with cognitive dissonance, as Festinger showed.
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Client and therapist variables that are considered essential to a good therapeutic relationship and ultimately better therapy outcomes are: 1) trust, 2) communication, 3) honesty and openness, 4) integrity, 5) accountability, and 6) alignment in terms of how to approach the issues. These variables are all interrelated and overlap with one another, so one may naturally feed into another. Trust for instance is important because if the client does not trust the therapist, the therapy will not yield positive results, and if the therapist does not trust the client is being honest, the therapist will not be able to help much. Communication fosters trust and allows for honesty to be possible. Integrity is essential because without it, there is nothing propelling either the therapist or the client to be honest and open about what is going on. Integrity fosters accountability so that both the client and the therapist will hold themselves accountable for the sessions and the progress they make and the need to strive towards the goals they agree upon.
One of the most important variables, however, is alignment between the client and the therapist in terms of how the therapy is approached. If there is no agreement between the two about how the mental health issue should be treated, the relationship will break down and the therapy outcome will be negative. For example, if the client wants a Christian-based approach to therapy to be used and the therapist only wants to apply a psychoanalytical approach, the two will not be on the same page and there will be no progress made. This is why it is important for a client to have a therapist whose outlook is at the very least accepting of the client’s outlook.
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Psychoanalytic theory continues to influence most approaches to psychotherapy today because it highlights the nature of the mind in the most applicable terms: there is the conscious mind and the unconscious mind and the need to bridge the two. Basically it is the idea that the individual needs to be more reflective and in tune with what is going on in his own heart and mind so that he can understand and amend his behaviors so that they produce better outcomes for himself. For example, depression is a major problem and one of the most common that people have who seek therapy. They do not know why they are depressed because they do not know how to navigate and interpret the thoughts and feelings inside of them. They do not know which thoughts and feelings that they focus on or neglect to focus on are dragging them down into depression.
The psychologist, thanks to the work that Freud and others have done in the field of psychoanalysis, can help the client to identify the thoughts, feelings and experiences that may be negatively impacting the client’s mood, attitude, beliefs and behaviors and together they can either address them together or else adopt a cognitive-behavioral therapeutic approach and simply identify alternative patterns of behavior to implement whenever one of the “trigger” thoughts or feelings arises. Even in this approach, even though it does not aim to understand the underlying issues behind the negative thoughts and feelings but simply attempts to help the client to avoid them and maintain a healthier mental and emotional lifestyle by focusing on positive thoughts and feelings instead, owes its development to psychoanalysis and the perceived limitations of that branch, as it looks to build on what is uncovered and point the client in a new direction.
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The main goals of cognitive therapy are 1) to promote self-awareness with the client, 2) to help the client to see how certain “triggers” contribute to the problematic thoughts, feelings, attitudes, and behaviors the client is suffering from, 3) to provide relief by addressing current issues that the client is facing in his or her life, 4) to teach the client how to engage in self-control so that when “triggers” appear they do not threaten the equilibrium that has been achieved by the client, and 5) the freezing of these changes by helping the client to implement a change of core beliefs and values so that personal growth can be achieved and so that the unhelpful perspective, outlook, worldview and set of core beliefs and values that were causing so many problems and trigger-events for the client can be replaced with better ones.
Instead of trying to explore and process some trauma or hidden communication that the unconscious is harboring, the therapist who uses cognitive therapy focuses more on how the mind can be used to point the client in a more positive direction without having to process trauma or something of the sort. The cognitive approach looks more at what modes of thought and what attitudes and perspectives are dragging the client down into a mentally unhealthy place. It looks at how that perspective can be changed by using logic, argumentation, and evidence from the client’s own life to show the client why unhealthy attitudes and perspectives lead him or her to make bad decisions and fall into a funk.
By promoting alternative ways of thinking and helping the client to develop a new core set of values the therapist assists the client in becoming a better version of himself and in getting over the obstacles that were acting as mental blocks before. This approach aims to use the mind to better the client’s behavior overall. The goal is to get the client thinking about himself or herself and about others and life in general in the right way.
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Cognitive distortions are biases that people possess in their thought processes. Schemas are ways that people construct their views: they are “the organized knowledge structures that influence how we perceive, interpret, and recall information” (Kramer et al., 2014, p. 571). Schemas like cognitive distortions can lead to the creation of biases and stereotypes, wrong ways of thinking about things and life and reality. For instance, cognitive distortions and schemas can include or lead to mental filtering, jumping to conclusions, personalization, over-generalizations, black and white (either/or) thinking, labeling, emotional reasoning, magnification or minimization, and so on.
For example, a child may be taken to eat at a fast food restaurant. Not knowing that there are other options, he constructs a sense of reality around the schema that when one goes out to eat one goes to that same fast food restaurant all the time. The next day he is told his family is going out to eat—he remembers the fast food restaurant and assumes he is going to that one again and is happy because the food was good and the games were fun. However, the family goes to a different one. The child becomes upset and cries: he had built up an expectation of a reality in his mind that did not match the actual external reality of his environment. The same thing happens with cognitive distortions. For example, an individual has one bad experience with a certain type of person. From that point on he believes that all people of that gender and ethnicity are trouble, so he avoids them and thinks badly about them—this is a type of over-generalization that leads to bias formation and prejudice.
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Infant temperament is the temperament of the child as perceived in infancy. It is viewed as being genetically determined; however, there are arguments to be made that it is also environmentally shaped as well (Kramer et al., 2014). For instance, an infant’s temperament can be altered if the baby is never held and is neglected all day long—i.e., left in a crib without ever coming into any human contact. Children need love and affection and they also need cognitive and emotional stimulation so that they can properly develop through the various stages, as Erikson points out in his model of the stages of development. Genetics and biology only account for one aspect of the infant temperament. For example, an infant who receives all the natural supports and inputs needed to aid in development and growth will still have a particular personality that is unique—and this can come from biology and genes to some extent.
However, that personality will also be based on the environment, who is interacting with the child, what kind of stimuli the child is receiving and so on. This is essentially the way it goes for the life of the person. In other words it is both nature and nurture that impacts the development of the person through all stages of development and on into old age, as Erikson shows. Every stage of development is a process in which nature and nurture are working in the shaping of the person. The temperament will be formed throughout this process and will change in some ways and stay the same in other ways. The temperament, whether one is sanguine or choleric or phlegmatic or melancholic, will also change depending on one’s environment, who one is around, what one is experiencing, what is going on in one’s mental or emotional life, etc. Nature plays a part but so too does the extent to which one is nurtured by environment.
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Protective factors exist within the child, the family and the community. In the child they include “Good cognitive abilities, Effective behavioral and emotional regulation strategies, [and] Perceived efficacy and control” (Kramer et al., 2014, p. 764). In the family, they include a good or strong relationship with whoever cares for them, a parenting style that is appropriate (authoritative but also warm and affectionate), and faith which provides spiritual nourishment. In the community, protective factors can include good schools, good neighbors, quality neighborhoods (safe and playful), the promotion of values, and so on.
These protective factors help the child to regulate behavior by teaching the child about ability, self-control, and the need to live according to values and principles that guide one to be better. The child learns what is acceptable behavior, what is good to think and how to process feelings. The child is supported by these protective factors and without them the child’s development can be impaired.
To say a child is resilient means that a child is capable of bouncing back from some negative or overwhelming experience without being developmentally, emotionally or psychologically damaged from the experience. Children can endure a great many experiences so long as they have the protective factors in place that can provide them with the nurturing care, love and support they need to forget about negative or overwhelming experiences and make the child feel secure, loved and confident once more. As Maslow shows in his hierarchy of needs, the more a person has those basic needs met—such as love, security and esteem—the more the person will be resilient in life—i.e., self-actualizing.

References
Kramer, G., Bernstein, D. & Phares, V. (2014). Introduction to clinical psychology. NY: Pearson.