Tag: Mental Health Education

Introduction

A psychologist is a person who studies normal and abnormal mental states, perceptual, cognitive, emotional, and social processes and behaviour by experimenting with, and observing, interpreting, and recording how individuals relate to one another and to their environments.

Applied Psychology in the United States

Applied psychology applies theory to solve problems in human and animal behaviour. Clinical psychology is a field of applied psychology that focus on therapeutic methods. Other applied fields include counselling psychology and school psychology. Licensing and regulations can vary by country, state, and profession.

Clinical Psychology

Education and Training

In the United States and Canada, full membership in the American Psychological Association requires doctoral training (except in some Canadian provinces, such as Alberta, where a master’s degree is sufficient). The minimal requirement for full membership can be waived in circumstances where there is evidence that significant contribution or performance in the field of psychology has been made. Associate membership requires at least two years of postgraduate studies in psychology or an approved related discipline.

Some US schools offer accredited programmes in clinical psychology resulting in a master’s degree. Such programmes can range from forty-eight to eighty-four units, most often taking two to three years to complete after the undergraduate degree. Training usually emphasizes theory and treatment over research, quite often with a focus on school, or couples and family counselling. Similar to doctoral programs, master’s level students usually must fulfil time in a clinical practicum under supervision; some programmes also require a minimum amount of personal psychotherapy. While many graduates from master’s level training go on to doctoral psychology programmes, a large number also go directly into practice – often as a licensed professional counsellor (LPC), marriage and family therapist (MFT), or other similar licensed practice (see below).

There is stiff competition to gain acceptance into clinical psychology doctoral programs (acceptance rates of 2-5% are not uncommon). Clinical psychologists in the US undergo many years of graduate training – usually five to seven years after the bachelor’s degree – to gain demonstrable competence and experience. Licensure as a psychologist takes an additional one to two years post Ph.D./Psy.D. (licensure requires 3,000 hours of supervised training), depending on the state. Today in America, about half of all clinical psychology graduate students are being trained in Ph.D. programmes that emphasize research and are conducted by universities – with the other half in Psy.D. programmes, which have more focus on practice (similar to professional degrees for medicine and law). Both types of doctoral programmes (Ph.D. and Psy.D.) envision practicing clinical psychology in a research-based, scientifically valid manner, and most are accredited by the American Psychological Association (APA).

APA accreditation is very important for US clinical, counselling, and school psychology programmes because graduating from a non-accredited doctoral programme may adversely affect employment prospects and present a hurdle for becoming licensed in some jurisdictions.

It should be noted that APA membership is not a requirement for licensure in any of the 50 states. This fact should not be confused with APA accreditation of graduate psychology programmes and clinical internships.

Doctorate (Ph.D. and Psy.D.) programmes usually involve some variation on the following 5 to 7 year, 90-120 unit curriculum:

• Bases of behaviour: biological, cognitive-affective and cultural-social.
• Individual differences: personality, lifespan development, psychopathology.
• History and systems: development of psychological theories, practices and scientific knowledge.
• Clinical practice: diagnostics, psychological assessment, psychotherapeutic interventions, psychopharmacology, ethical and legal issues.
• Coursework in statistics and research design.
• Clinical experience:
  • Practicum: usually three or four years of working with clients under supervision in a clinical setting. Most practicum placements begin in either the first or second year of doctoral training.
  • Doctoral internship: usually an intensive one or two-year placement in a clinical setting.
• Dissertation: Ph.D. programmes usually require original quantitative empirical research, while Psy.D. dissertations involve original quantitative or qualitative research, theoretical scholarship, program evaluation or development, critical literature analysis or clinical application and analysis. The dissertation typically takes 2-3 years to complete.
• Specialized electives: many programmes offer sets of elective courses for specialisations, such as health, child, family, community or neuropsychology.
• Personal psychotherapy: many programmes require students to undertake a certain number of hours of personal psychotherapy (with a non-faculty therapist) although in recent years this requirement has become less frequent.
• Comprehensive exams or master’s thesis: A thesis can involve original data collection and is distinct from a dissertation.

Psychologists can be seen as practicing within two general categories of psychology: applied psychology which includes “practitioners” or “professionals”, and research-orientated psychology which includes “scientists”, or “scholars”. The training models endorsed by the American Psychological Association (APA) require that applied psychologists be trained as both researchers and practitioners, and that they possess advanced degrees.

Psychologists typically have one of two degrees: PsyD or PhD. The PsyD programme prepares the student only for clinical practice (e.g., testing, psychotherapy). Depending on the specialty (industrial/organisational, social, clinical, school, etc.), a PhD may be trained in clinical practice as well as in scientific methodology, to prepare for a career in academia or research. Both the PsyD and PhD programmes prepare students to take state licensing exams.

Within the two main categories are many further types of psychologists as reflected by the 56 professional classifications recognised by the APA, including clinical, counselling, and school psychologists. Such professionals work with persons in a variety of therapeutic contexts. People often think of the discipline as involving only such clinical or counselling psychologists. While counselling and psychotherapy are common activities for psychologists, these applied fields are just two branches in the larger domain of psychology. There are other classifications such as industrial, organisational and community psychologists, whose professionals mainly apply psychological research, theories, and techniques to “real-world” problems of business, industry, social benefit organisations, government, and academia.

Specialisations

• Specific disorders (e.g. trauma, addiction, eating and sleep disorders, sexual dysfunction, depression, anxiety, or phobias).
• Neuropsychological disorders.
• Child and adolescent psychology.
• Family and relationship counselling.
• Health psychology.
• Medical Psychology.
• Sport psychology.
• Forensic psychology.
• Industrial and organisational psychology.
• Educational psychology.

Clinical psychologists receive training in a number of psychological therapies, including behavioural, cognitive, humanistic, existential, psychodynamic, and systemic approaches, as well as in-depth training in psychological testing, and to some extent, neuropsychological testing.

Services

Clinical psychologists can offer a range of professional services, including:

• Psychological treatment (therapy).
• Administering and interpreting psychological assessment and testing.
• Conducting psychological research.
• Teaching.
• Developing prevention programmes.
• Consulting.
• Programme administration.
• Expert testimony.

In practice, clinical psychologists might work with individuals, couples, families, or groups in a variety of settings, including private practices, hospitals, mental health organisations, schools, businesses, and non-profit agencies.

Most clinical who engage in research and teaching do so within a college or university setting. Clinical psychologists may also choose to specialise in a particular field.

Prescription Privileges

Psychologists in the United States campaigned for legislative changes to enable specially trained psychologists to prescribe psychotropic medications. Legislation in Idaho, Iowa, Louisiana, New Mexico, and Illinois has granted those who complete an additional master’s degree program in psychopharmacology permission to prescribe medications for mental and emotional disorders. As of 2019, Louisiana is the only state where the licensing and regulation of the practice of psychology by medical psychologists (MPs) is regulated by a medical board (the Louisiana State Board of Medical Examiners) rather than a board of psychologists. While other states have pursued prescriptive privileges, they have not succeeded. Similar legislation in the states of Hawaii and Oregon passed through their respective legislative bodies, but in each case the legislation was vetoed by the state’s governor.

In 1989, the US Department of Defence was directed to create the Psychopharmacology Demonstration Project (PDP). By 1997, ten psychologists were trained in psychopharmacology and granted the ability to prescribe psychiatric medications.

Licensure

The practice of clinical psychology requires a license in the United States and Canada. Although each of the US states is different in terms of requirements and licenses, there are three common requirements:

• Graduation from an accredited school with the appropriate degree.
• Completion of supervised clinical experience.
• Passing a written and/or oral examination.

All US state, and Canada provincial, licensing boards are members of the Association of State and Provincial Psychology Boards (ASPPB) which created and maintains the Examination for Professional Practice in Psychology (EPPP). Many states require other examinations in addition to the EPPP, such as a jurisprudence (i.e. mental health law) examination or an oral examination. Most states also require a certain number of continuing education credits per year in order to renew a license. Licensees can obtain this through various means, such as taking audited classes and attending approved workshops.

There are professions whose scope of practice overlaps with the practice of psychology (particularly with respect to providing psychotherapy) and for which a license is required.

It should be noted that APA membership is not a requirement for licensure in any of the 50 states. This fact should not be confused with APA accreditation of graduate psychology programmes and clinical internships.

Ambiguity of Title

To practice with the title of “psychologist”, in almost all cases a doctorate degree is required (a PhD or PsyD in the US). Normally, after the degree, the practitioner must fulfil a certain number of supervised postdoctoral hours ranging from 1,500-3,000 (usually taking one to two years), and passing the EPPP and any other state or provincial exams. A professional in the US must hold a graduate degree in psychology (MA, Psy.D., Ed.D., or Ph.D.), or have a state license to use the title psychologist. Additional regulations vary from state to state.

Differences with Psychiatrists

Although clinical psychologists and psychiatrists share the same fundamental aim – the alleviation of mental distress – their training, outlook, and methodologies are often different. Perhaps the most significant difference is that psychiatrists are licensed physicians, and, as such, psychiatrists are apt to use the medical model to assess mental health problems and to also employ psychotropic medications as a method of addressing mental health problems.

Psychologists generally do not prescribe medication, although in some jurisdictions they do have prescription privileges. In five US states (New Mexico, Louisiana, Illinois, Iowa, and Idaho), psychologists with post-doctoral clinical psychopharmacology training have been granted prescriptive authority for mental health disorders.

Clinical psychologists receive extensive training in psychological test administration, scoring, interpretation, and reporting, while psychiatrists are not trained in psychological testing. In addition, psychologists (particularly those from Ph.D. programmes) spend several years in graduate school being trained to conduct behavioural research; their training includes research design and advanced statistical analysis. While this training is available for physicians via dual MD/Ph.D. programmes, it is not typically included in standard medical education, although psychiatrists may develop research skills during their residency or a psychiatry fellowship (post-residency). Psychologists from Psy.D. programs tend to have more training and experience in clinical practice (e.g. psychotherapy, testing) than those from Ph.D. programmes.

Psychiatrists, as licensed physicians, have been trained more intensively in other areas, such as internal medicine and neurology, and may bring this knowledge to bear in identifying and treating medical or neurological conditions that present with primarily psychological symptoms such as depression, anxiety, or paranoia, e.g., hypothyroidism presenting with depressive symptoms, or pulmonary embolism with significant apprehension and anxiety.

Mental Health Professions (US)

Occupation	Degree	Common Licenses	Prescription Privilege
Clinical Psychologist	PhD/PsyD	Psychologist	Mostly No
Counselling Psychologist (Doctorate)	PhD/PsyD	Psychologist	No
Counselling Psychologist (Master’s)	Ma/MS/MC	MFT/LPC/LPA	No
School Psychologist	PhD/EdD	Psychologist	No
Psychiatrist	MD/DO	Psychiatrist	Yes
Clinical Social Worker	Phd/MSW	LCSW	No
Psychiatric Nurse	PhD/MSN/BSN	APRN/PMHN	No
Psychiatric and Mental Health Nurse Practitioner	DNP/MSN	MHNP	Yes (Varies by State)
Expressive/Art Therapist	MA	ATR	No

• Marriage and Family Therapist (MFT):
  • An MFT license requires a doctorate or master’s degree.
  • In addition, it usually involves two years of post-degree clinical experience under supervision, and licensure requires passing a written exam, commonly the National Examination for Marriage and Family Therapists, which is maintained by the American Association for Marriage and Family Therapy.
  • Further, most states require an oral exam. MFTs, as the title implies, work mostly with families and couples, addressing a wide range of common psychological problems.
  • Some jurisdictions have exemptions that let someone practice marriage and family therapy without meeting the requirements for a license.
  • That is, they offer a license but do not require that marriage and family therapists obtain one.
• Licensed Professional Counse;lor (LPC):
  • Similar to the MFT, the LPC license requires a master’s or doctorate degree, a minimum number of hours of supervised clinical experience in a pre-doc practicum, and the passing of the National Counsellor Exam.
  • Similar licenses are the Licensed Mental Health Counsellor (LMHC), Licensed Clinical Professional Counsellor (LCPC), and Clinical Counsellor in Mental Health (CCMH).
  • In some states, after passing the exam, a temporary LPC license is awarded and the clinician may begin the normal 3000-hour supervised internship leading to the full license allowing to practice as a counsellor or psychotherapist, usually under the supervision of a licensed psychologist.
  • Some jurisdictions have exemptions that allow counselling to practice without meeting the requirements for a license – That is, they offer a license but do not require that counsellors obtain one.
• Licensed Psychological Associate (LPA):
  • Twenty-six states offer a master’s-only license, a common one being the LPA, which allows for the therapist to either practice independently, or, more commonly, under the supervision of a licensed psychologist, depending on the state.
  • Common requirements are two to four years of post-master’s supervised clinical experience and passing a Psychological Associates Examination.
  • Other titles for this level of licensing include psychological technician (Alabama), psychological assistant (California), licensed clinical psychotherapist (Kansas), licensed psychological practitioner (Minnesota), licensed behavioural practitioner (Oklahoma), licensed psychological associate (North Carolina) or psychological examiner (Tennessee).
• Licensed Behaviour Analysts:
  • Licensed behaviour analysts are licensed in five states to provide services for clients with substance abuse, developmental disabilities, and mental illness.
  • This profession draws on the evidence base of applied behaviour analysis and the philosophy of behaviourism.
  • Behaviour analysts have at least a master’s degree in behaviour analysis or in a mental health related discipline, as well as having taken at least five core courses in applied behaviour analysis.
  • Many behaviour analysts have a doctorate.
  • Most programmes have a formalised internship programme, and several programmes are offered online.
  • Most practitioners have passed the examination offered by the Behaviour Analysis Certification Board.
  • The model licensing act for behaviour analysts can be found at the Association for Behaviour Analysis International’s website.

Employment

In the United States, of 170,200 jobs for psychologists, 152,000 are employed in clinical, counselling, and school positions; 2,300 are employed in industrial-organisational positions, and 15,900 are in “all other” positions.

The median salary in the US, in 2012, for clinical, counseling, and school psychologists was US$69,280 and the median salary for organisational psychologists was US$83,580.

Psychologists can work in applied or academic settings. Academic psychologists educate higher education students as well as conduct research, with graduate-level research being an important part of academic psychology. Academic positions can be tenured or non-tenured, with tenured positions being highly desirable.

International

To become a psychologist, a person often completes a degree in psychology, but in other jurisdictions the course of study may be different and the activities performed may be similar to those of other professionals.

Australia

In Australia, the psychology profession, and the use of the title “psychologist”, is regulated by an Act of Parliament, the Health Practitioner Regulation (Administrative Arrangements) National Law Act 2008, following an agreement between state and territorial governments. Under this national law, registration of psychologists is administered by the Psychology Board of Australia (PsyBA). Before July 2010, the professional registration of psychologists was governed by various state and territorial Psychology Registration Boards. The Australian Psychology Accreditation Council (APAC) oversees education standards for the profession.

The minimum requirements for general registration in psychology, including the right to use the title “psychologist”, are an APAC approved four-year degree in psychology followed by either a two-year master’s program or two years of practice supervised by a registered psychologist. However, AHPRA (Australian Health Practitioner Regulation Agency) is currently in the process of phasing out the 4 + 2 internship pathway. Once the 4 + 2 pathway is phased out, a master’s degree or PhD will be required to become a psychologist in Australia. This is because of concerns about public safety, and to reduce the burden of training on employers. There is also a ‘5 + 1’ registration pathway, including a four-year APAC approved degree followed by one year of postgraduate study and one year of supervised practice. Endorsement within a specific area of practice (e.g. clinical neuropsychology, clinical, community, counselling, educational and developmental, forensic, health, organisational or sport and exercise) requires additional qualifications. These notations are not “specialist” titles (Western Australian psychologists could use “specialist” in their titles during a three-year transitional period from 17 October 2010 to 17 October 2013).

Membership with Australian Psychological Society (APS) differs from registration as a psychologist. The standard route to full membership (MAPS) of the APS usually requires four years of APAC-accredited undergraduate study, plus a master’s or doctorate in psychology from an accredited institution. An alternate route is available for academics and practitioners who have gained appropriate experience and made a substantial contribution to the field of psychology.

Restrictions apply to all individuals using the title “psychologist” in all states and territories of Australia. However, the terms “psychotherapist”, “social worker”, and “counsellor” are currently self-regulated, with several organisations campaigning for government regulation.

Belgium

Since 1933, the title “psychologist” has been protected by law in Belgium. It can only be used by people who are on the National Government Commission list. The minimum requirement is the completion of five years of university training in psychology (master’s degree or equivalent). The title of “psychotherapist” is not legally protected. As of 2016, Belgian law recognises the clinical psychologist as an autonomous health profession. It reserves the practice of psychotherapy to medical doctors, clinical psychologists and clinical orthopedagogists.

Canada

A professional in the US or Canada must hold a graduate degree in psychology (MA, Psy.D., Ed.D., or Ph.D.), or have a state license to use the title psychologist.

Finland

In Finland, the title “psychologist” is protected by law. The restriction for psychologists (licensed professionals) is governed by National Supervisory Authority for Welfare and Health (Finland) (Valvira). It takes 330 ECTS-credits (about six years) to complete the university studies (master’s degree). There are about 6,200 licensed psychologists in Finland.

Germany

In Germany, the use of the title Diplom-Psychologe (Dipl.-Psych.) is restricted by law, and a practitioner is legally required to hold the corresponding academic title, which is comparable to a M.Sc. degree and requires at least five years of training at a university. Originally, a diploma degree in psychology awarded in Germany included the subject of clinical psychology. With the Bologna-reform, this degree was replaced by a master’s degree. The academic degree of Diplom-Psychologe or M.Sc. (Psychologie) does not include a psychotherapeutic qualification, which requires three to five years of additional training. The psychotherapeutic training combines in-depth theoretical knowledge with supervised patient care and self-reflection units. After having completed the training requirements, psychologists take a state-run exam, which, upon successful completion (Approbation), confers the official title of “psychological psychotherapist” (Psychologischer Psychotherapeut). After many years of inter-professional political controversy, non-physician psychotherapy was given an adequate legal foundation through the creation of two new academic healthcare professions.

Greece

Since 1979, the title “psychologist” has been protected by law in Greece. It can only be used by people who hold a relevant license or certificate, which is issued by the Greek authorities, to practice as a psychologist. The minimum requirement is the completion of university training in psychology at a Greek university, or at a university recognised by the Greek authorities. Psychologists in Greece are legally required to abide by the Code of Conduct of Psychologists (2019). Psychologists in Greece are not required to register with any psychology body in the country in order to legally practice the profession.

India

In India, “clinical psychologist” is specifically defined in the Mental Health Act, 2017. An MPhil degree of two years duration recognized by the Rehabilitation Council of India is required to apply for registration as a clinical psychologist. This procedure has been criticised by some stakeholders since clinical psychology is not limited to the area of rehabilitation. Titles such as “counsellor” or “psychotherapist” are not protected at present. In other words, an individual may call themselves a “psychotherapist” or “counsellor” without having earned a graduate degree in clinical psychology or another mental health field, and without having to register with the Rehabilitation Council of India.

New Zealand

In New Zealand, the use of the title “psychologist” is restricted by law. Prior to 2004, only the title “registered psychologist” was restricted to people qualified and registered as such. However, with the proclamation of the Health Practitioners Competence Assurance Act, in 2003, the use of the title “psychologist” was limited to practitioners registered with the New Zealand Psychologists Board. The titles “clinical psychologist”, “counselling psychologist”, “educational psychologist”, “intern psychologist”, and “trainee psychologist” are similarly protected. This is to protect the public by providing assurance that the title-holder is registered and therefore qualified and competent to practice, and can be held accountable. The legislation does not include an exemption clause for any class of practitioner (e.g., academics, or government employees).

Norway

In Norway, the title “psychologist” is restricted by law and can only be obtained by completing a 6 year integrated programme, leading to the Candidate of Psychology degree. Psychologists are considered health personnel, and their work is regulated through the “health personnel act”.

South Africa

In South Africa, psychologists are qualified in either clinical, counselling, educational, organisational, or research psychology. To become qualified, one must complete a recognised master’s degree in Psychology, an appropriate practicum at a recognised training institution, and take an examination set by the Professional Board for Psychology. Registration with the Health Professions Council of South Africa (HPCSA) is required and includes a Continuing Professional Development component. The practicum usually involves a full year internship, and in some specialisations, the HPCSA requires completion of an additional year of community service. The master’s programme consists of a seminar, coursework-based theoretical and practical training, a dissertation of limited scope, and is (in most cases) two years in duration. Prior to enrolling in the master’s programme, the student studies psychology for three years as an undergraduate (B.A. or B.Sc., and, for organisational psychology, also B.Com.), followed by an additional postgraduate honours degree in psychology. Qualification thus requires at least five years of study and at least one internship. The undergraduate B.Psyc. is a four-year programme integrating theory and practical training, and – with the required examination set by the Professional Board for Psychology – is sufficient for practice as a psychometrist or counsellor.

United Kingdom

In the UK, “registered psychologist” and “practitioner psychologist” are protected titles. The title of “neuropsychologist” is not protected. In addition, the following specialist titles are also protected by law: “clinical psychologist”, “counselling psychologist”, “educational psychologist”, “forensic psychologist”, “health psychologist”, “occupational psychologist” and “sport and exercise psychologist”. The Health and Care Professions Council (HCPC) is the statutory regulator for practitioner psychologists in the UK. In the UK, the use of the title “chartered psychologist” is also protected by statutory regulation, but that title simply means that the psychologist is a chartered member of the British Psychological Society, but is not necessarily registered with the HCPC. However, it is an offense for someone who is not in the appropriate section of the HCPC register to provide psychological services. The requirement to register as a clinical, counselling, or educational psychologist is a professional doctorate (and in the case of the latter two the British Psychological Society’s Professional Qualification, which meets the standards of a professional doctorate). The title of “psychologist”, by itself, is not protected. The British Psychological Society is working with the HCPC to ensure that the title of “neuropsychologist” is regulated as a specialist title for practitioner psychologists.

Employment (UK)

As of December 2012, in the United Kingdom, there are 19,000 practitioner psychologists registered across seven categories: clinical psychologist, counselling psychologist, educational psychologist, forensic psychologist, health psychologist, occupational psychologist, sport and exercise psychologist. At least 9,500 of these are clinical psychologists, which is the largest group of psychologists in clinical settings such as the NHS. Around 2,000 are educational psychologists.