1887 – Wolfgang Köhler, German psychologist and phenomenologist (d. 1967).
Wolfgang Kohler
Wolfgang Köhler (21 January 1887 to 11 June 1967) was a German psychologist and phenomenologist who, like Max Wertheimer and Kurt Koffka, contributed to the creation of Gestalt psychology.
During the Nazi regime in Germany, he protested against the dismissal of Jewish professors from universities, as well as the requirement that professors give a Nazi salute at the beginning of their classes. In 1935 he left the country for the United States, where Swarthmore College in Pennsylvania offered him a professorship. He taught with its faculty for 20 years, and did continuing research. A Review of General Psychology survey, published in 2002, ranked Köhler as the 50th most cited psychologist of the 20th century.
1952 – Nikos Sideris, Greek psychiatrist and poet.
People (Deaths)
1944 – James McKeen Cattell, American psychologist and academic (b. 1860).
2012 – Alejandro Rodriguez, Venezuelan-American paediatrician and psychiatrist (b. 1918).
Nikos Sideris
Nikos Sideris (Greek: Νίκος Σιδέρης; born 20 January 1952), is a Greek psychiatrist, translator, poet and writer.
Sideris studied medicine at the University of Athens. He then settled in Paris for his postgraduate studies (specializing in Psychiatry, History and Neuropsychology-Neurolinguistics). He is a PhD of Panteion University Psychology Department and teaching psychoanalyst, member of the Strasbourg School of Psychoanalysis (E.P.S.) and the European Federation of Psychoanalysis and Psychoanalytic School of Strasburg (FEDEPSY). He works as a psychiatrist, psychoanalyst and family therapist in Athens.
His book “Children do not need psychologists. They need parents!” (Τα παιδιά δεν θέλουν ψυχολόγο. Γονείς θέλουν) became a non-fiction best-seller in Greece.
James McKeen Cattell
James McKeen Cattell (25 May 1860 to 20 January 1944), American psychologist, was the first professor of psychology in the United States, teaching at the University of Pennsylvania, and long-time editor and publisher of scientific journals and publications, most notably the journal Science. He also served on the board of trustees for Science Service, now known as Society for Science & the Public (or SSP), from 1921-1944.
At the beginning of Cattell’s career, many scientists regarded psychology as, at best, a minor field of study, or at worst a pseudoscience such as phrenology. Perhaps more than any of his contemporaries, Cattell helped establish psychology as a legitimate science, worthy of study at the highest levels of the academy. At the time of his death, The New York Times hailed him as “the dean of American science.” Yet Cattell may be best remembered for his uncompromising opposition to American involvement in World War I. His public opposition to the draft led to his dismissal from his position at Columbia University, a move that later led many American universities to establish tenure as a means of protecting unpopular beliefs.
Alejandro Rodriguez
Alejandro Rodriguez (February 1918 to 20 January 2012) was a Venezuelan-American paediatrician and psychiatrist, known for his pioneering work in child psychiatry. He was the director of the division of child psychiatry at the Johns Hopkins University School of Medicine, and conducted pivotal studies on autism and other developmental disorders in children.
1987 – Lawrence Kohlberg, American psychologist and academic (b. 1927).
Lawrence Kohlberg
Lawrence Kohlberg (25 October 1927 to 19 January 1987) was an American psychologist best known for his theory of stages of moral development.
He served as a professor in the Psychology Department at the University of Chicago and at the Graduate School of Education at Harvard University. Even though it was considered unusual in his era, he decided to study the topic of moral judgment, extending Jean Piaget’s account of children’s moral development from twenty-five years earlier. In fact, it took Kohlberg five years before he was able to publish an article based on his views. Kohlberg’s work reflected and extended not only Piaget’s findings but also the theories of philosophers George Herbert Mead and James Mark Baldwin. At the same time he was creating a new field within psychology: “moral development”.
In an empirical study using six criteria, such as citations and recognition, Kohlberg was found to be the 30th most eminent psychologist of the 20th century.
Kohlberg’s first academic appointment was at Yale University, as an assistant professor of psychology, 1958-1961. In 1955 while beginning his dissertation, he had married Lucille Stigberg, and the couple had two sons, David and Steven. Kohlberg spent a year at the Centre for Advanced Study in the Behavioural Sciences, in Palo Alto, California, 1961-1962, and then joined the Psychology Department of the University of Chicago as assistant, then associate professor of psychology and human development, 1962-1967. He held a visiting appointment at the Harvard Graduate School of Education, 1967-1968, and then was appointed Professor of Education and Social Psychology there, beginning 1968, where he remained until his death.
1932 – Robert Anton Wilson, American psychologist, author, poet, and playwright (d. 2007).
Robert Anton Wilson
Robert Anton Wilson (born Robert Edward Wilson; 18 January 1932 to 11 January 2007) was an American author, futurist and self-described agnostic mystic. Recognised by Discordianism as a Pope and saint, Wilson helped publicise the group through his writings and interviews.
Wilson described his work as an “attempt to break down conditioned associations, to look at the world in a new way, with many models recognised as models or maps, and no one model elevated to the truth”. His goal being “to try to get people into a state of generalised agnosticism, not agnosticism about God alone but agnosticism about everything.”
Following a journalistic career, Wilson emerged as a major countercultural figure in the mid-1970s, comparable to one of his coauthors, Timothy Leary, as well as Terence McKenna.
1881 – Harry Price, English psychologist and author (d. 1948).
1887 – Ola Raknes, Norwegian psychoanalyst and philologist (d. 1975).
1945 – Anne Cutler, Australian psychologist and academic.
Harry Price
Harry Price (17 January 1881 to 29 March 1948) was a British psychic researcher and author, who gained public prominence for his investigations into psychical phenomena and his exposing fraudulent spiritualist mediums. He is best known for his well-publicised investigation of the purportedly haunted Borley Rectory in Essex, England.
Ola Raknes
Ola Raknes (17 January 1887 to 28 January 1975) was a Norwegian psychologist, philologist and non-fiction writer. Born in Bergen, Norway, he was internationally known as a psychoanalyst in the Reichian tradition. He has been described as someone who spent his entire life working with the conveying of ideas through many languages and between different epistemological systems of reference, science and religion (Dannevig, 1975). For large portions of his life he was actively contributing to the public discourse in Norway. He has also been credited for his contributions to strengthening and enriching the Nynorsk language and its use in the public sphere.
Raknes was known as a thorough philologist and a controversial therapist. Internationally he was known as one of Wilhelm Reich’s closest students and defenders.
Anne Cutler
(Elizabeth) Anne Cutler (1945 to Present) FRS is a Research Professor at the MARCS Institute for Brain, Behaviour and Development, Western Sydney University and Emeritus Director of the Max Planck Institute for Psycholinguistics in Nijmegen.
The degree of Doctor of Clinical Psychology (DClinPsy/DClinPsych/ClinPsyD) is a professional doctorate in clinical psychology, awarded mainly in the United Kingdom and Ireland.
The degree has both clinical and research components, and qualifies the holder to practice as a clinical psychologist in Britain’s National Health Service and other clinical settings.
It bears some similarities to the Doctor of Psychology degree in the United States.
Background
In Denmark the corresponding degree is called “specialpsykolog” (Special Psychologist) or “specialist i **” (Specialist Psychologist in **).
In the Netherlands the corresponding degree is “gezondheidszorgpsycholoog” (Healthcare Psychologist).
In Spain, the postgraduate training in Clinical Psychology is carried out as 4 years intern residence within the National Health System and the title obtained is “Especialista en Psicología Clínica [Specialist in Clinical Psychology]”, usually abbreviated “EPC”.
In Italy, postgraduate training leading to the professional licence to practice as a psychotherapist is carried out as a 5-year programme involving 400 hours of theoretical training and 400 hours of clinical practicum every year. Trainees are attached to clinical units of the Italian national health system and are required to spend part of their training carrying out research and defend their specialization thesis before an academic board, which will consider the conferment of the title of “specialista” in psychotherapy. Four different specialist degrees lead to the license as a psychotherapist: Specialist in Clinical Psychology, Specialist in Health Psychology, Specialist in Lifespan Psychology and Specialist in Neuropsychology.
In Ireland doctoral programmes in Clinical Psychology are accredited by the Psychological Society of Ireland. Irish universities offering professional doctoral programmes in Clinical Psychology include Trinity College Dublin, University College Dublin, and University College Cork,
In the United Kingdom, doctoral programmes in Clinical Psychology are accredited by the British Psychological Society and approved by the Health and Care Professions Council, the statutory regulator for practitioner psychologists and courses in the UK. The doctorate in clinical psychology programme normally lasts three years, and funding is provided by the National Health Service. A Doctorate in Clinical Psychology is necessary to register as a practitioner clinical psychologist with the Health and Care Professions Council.
British universities offering professional doctoral programmes in Clinical Psychology include the University of Edinburgh, University of Glasgow, University of Hertfordshire, Lancaster University, University of East London, University of Sheffield, University of Liverpool, University College London, Newcastle University, Queen’s University Belfast, and the University of Oxford. There is a central clearinghouse for applications to Doctor of Clinical Psychology programmes, hosted by the University of Leeds. Information and discussion about the UK system of training in clinical psychology, the typical requirements needed to gain a place on a doctoral training course, and what the doctorate allows graduates to do can be found on the ClinPsy website and forum.
The Doctor of Psychology (Psy.D) is a professional doctoral degree intended to prepare graduates for careers that apply scientific knowledge of psychology and deliver empirically based service to individuals, groups and organisations.
Earning the degree was originally completed through one of two established training models for clinical psychology. However, Psy.D. programmes are no longer limited to Clinical Psychology as several universities and professional schools have begun to award professional doctorates in Business Psychology, Organisational Development, Forensic Psychology, Counselling Psychology, and School Psychology.
The initial guidelines for the education and training of clinical psychologists were established in 1949 at an American Psychological Association (APA)-sponsored Conference on Training in Clinical Psychology in Boulder, Colorado. Students would be prepared both to conduct experimental research and apply knowledge for clinical practice. This approach became known as the scientist-practitioner model, although it is often referred to as the Boulder model since the conference was held in Boulder, Colorado.
The difficulty integrating the education and training for both research and practice within the same degree has been long recognised. While the scientist-practitioner model ostensibly included clinical training, many argued that preparation for practice was often neglected. Some also argued that in trying to train students in both research and practice, not enough emphasis was placed on either. In regard to research, the most common number of publications by graduates of PhD. programmes was zero. In regard to practice, students were not being trained effectively for the needs of people seeking services.
While the scientist-practitioner model “stood intransigent and impervious through the 1950s and 60s”, the APA attempted to respond to pressure for more and better clinical training by forming the Committee on the Scientific and Professional Aims of Psychology in 1963. The Committee concluded that the scientist-practitioner model failed to do either of the jobs for which it was designed and recommended several important changes, including: establishing separate practice-oriented programmes, potentially in locations other than university psychology departments; developing a practice-oriented training model; and using the Doctor of Psychology (Psy.D) degree to designate preparation for clinical practice. The Committee’s conclusions and recommendations met with controversy. In particular, opponents said a different degree would impact the field’s prestige and ignore science. Proponents, however, argued it would be informed by science and that other practice-oriented healthcare disciplines, such as medicine, had well-respected professional degrees.
In 1973, the APA sponsored the Conference on Levels and Patterns of Training in Vail, Colorado. Conference members concluded that psychological knowledge had matured sufficiently to warrant creating distinct practice-oriented programmes. Members also concluded that if the education and training for practice differs from research, then different degrees should reflect that: when emphasis is on preparing students for providing clinical services, the Doctor of Psychology (Psy.D) degree should be awarded; when the focus is on preparing students for conducting experimental research, the Doctor of Philosophy (PhD) degree should be awarded. This approach became known as the practitioner-scholar model, also known as the Vail model. Graduates of both training models would be eligible for licensure in all jurisdictions in the United States, and the licensing exams and renewal requirements would be the same for both degrees.
With the creation of the Doctor of Psychology degree, the APA confirmed that the Psy.D. is a credential that certifies attainment of the knowledge and skill required to establish clinical psychology as a profession. Furthermore, it follows the policies of both the Association of American Universities, and the Council of Graduate Schools: a professional doctorate (e.g., M.D., DDS, DVM) is awarded in recognition of preparation for professional practice, whereas the PhD. is awarded in recognition of preparation for research.
Education and Clinical Training
The practice of clinical psychology is based on an understanding of the scientific method and behavioural science. The focus of the Doctor of Psychology training model is on the application of this knowledge for direct clinical intervention. This includes the diagnosis and treatment of mental illness, as well as cognitive and emotional impairments in which psychological approaches may be of use. Compared to PhD., the doctor of psychology is focused toward more clinical work as opposed to the research focus of a doctor of philosophy in psychology.
Doctor of Psychology programmes take four to seven years to complete. Students in these programmes receive a broad and general education in scientific psychology and evidence-based treatment. Course work includes: Biological bases of behaviour; cognitive-affective bases of behaviour; social-cultural bases of behaviour; lifespan development; assessment and diagnosis; treatment and intervention; research methods and statistics; and ethical and professional standards. Specialised training (e.g. neuropsychology, forensic psychology, psychodynamic psychology) is also available in some programmes.
Students in doctoral psychology programmes receive extensive clinical training through placements in various settings (e.g. community mental health centres, hospitals, juvenile hall, college counselling centres). These placements provide direct patient contact that is supervised by a licensed psychologist. Clinical training culminates in a 1,750-2,000 hour (1-year full-time or 2-year half-time) supervised internship.
In order to complete the Psy.D. degree, students typically must demonstrate several competencies:
Knowledge mastery through passing comprehensive exams;
Clinical skill through successful completion of a pre-doctoral internship; and
Scholarship through a doctoral research project.
Regional accreditation is available to doctoral programmes in clinical psychology.
The doctoral degree allows for a broader range of career options in schools, private or independent practice, clinics, hospitals, or research/academia. Individuals with doctoral degrees may experience greater eligibility for various credentials.
As stated above, there are three different doctoral degrees for school psychology, PhD., Psy.D., and Ed.D. Career options for those with a PhD. may include being a school psychologist with a license at any level (preschool, primary, secondary or after), a professor for school psychology graduate students and/or screening for possible recruits for a school psychology programme or a postdoctoral resident. Overall, those with a PhD. have more opportunities for leadership positions. Those with this degree can work in settings other than schools. Those with a PhD. are more likely to create student development workgroups and review proposals for conventions. They have been known to become editors for Best Practices, work with the editors in chief of journals, members of the NASP Communique Editorial Board, reviewers for the National School Psychology Certification Board and part of NASP’s Social Justice Committee. Some school psychologists choose to continue practicing in a K-12 setting but encourage more trained school staff for professional development, i.e. for functional behavioural assessments and behaviour intervention plans. Those who have obtained a PhD. have a greater opportunity to conduct comprehensive neuropsychological evaluations for educational and forensic purposes, review medical/legal records for forensic evaluations, and see clients for therapy. These individuals may even develop new rating scales to the field. Those with this degree have the opportunity to be recognised as a member of the American Psychological Association.
Career options for those who attain an Ed.D. may include becoming a university professor, creating school policy, focusing on administration, educational technology and district-wide leadership, and assisting in adult education, curriculum and instruction. Overall these areas can be broken up into three subgroups; research and academia, management and influence. If the individual chose to be involved in research and academia they could teach at public/private universities and conduct/publish research. The knowledge and experience gained through the doctorate program is imperative in having a successful career in academia. A doctorate is not required for management in some school districts; however, the degree, experience, and education can help in competitive positions. All of the experience and knowledge acquired helps with understanding education from a different perspective.
Psy.D. training has a clinical emphasis compared to PhD., and focusing on delivering psychological services directly to individuals or groups. This allows school psychologists to learn more about mental health. This degree usually takes four to six years to attain. Once the Psy.D. is earned the school psychologist becomes eligible for licensure as a psychologist from an APA approved programme. Psy.D. career options may include private practice, working in university based settings (undergraduate teaching or other practitioner scholar Psy.D programmes), working in community based mental health centres (i.e. behavioural health, disorders), working in outpatient settings- clinics for individual or group therapy, or working for juvenile justice programmes (work with incarcerated youth). It is recommended to work in the field before pursuing a school psychology doctoral degree.
Doctoral training programmes may be approved by NASP and/or accredited by the American Psychological Association. In 2007, approximately 125 programmes were approved by NASP, and 58 programmes were accredited by APA. Another 11 APA-accredited programmes were combined (clinical/counselling/school, clinical/school, or counselling/school).
Licensing
A license to practice as a clinical psychologist is required in the United States. While specific requirements vary by jurisdiction, every state mandates:
Successful completion of either a 1-year full-time or 2-year half-time supervised clinical internship totalling 1,750-2,000 hours; and
Passing the national and state licensing exams.
Most states also require an additional postdoctoral year of supervised training after earning the doctorate, in order to become eligible to take the national and state licensing exams.
Maryland and Washington have removed the one year postdoctoral experience in place of requiring two years of supervised experience, both of which can be completed prior to graduation. In February 2006, the American Psychological Association Council of Representatives adopted a statement recommending that this change also be made to the licensing requirements of other states since the nature of training has changed dramatically in the last 50 years. Previously, doctoral-level students accrued most of their clinical hours during internship and postdoctoral fellowships. Now, students accrue most of their clinical hours in the course of their training and internship. Thus, they are ready to begin practice upon graduation. Next, there are considerably fewer positions available for recent graduates and providing the training before graduation facilitates early career psychologists.
Licensing Exam
In the United States, a doctoral degree from a programme acceptable to the licensing board is required, including the PhD., Psy.D., and Ed.D. are among the doctorate degrees that make individuals eligible to sit for the Examination for Professional Practice of Psychology (EPPP; CA Board of Psychology). The EPPP is the national licensing examination and its completion is required in order for one to obtain a license to practice psychology.
While there is an increasing number of university-based Psy.D. programmes, many Psy.D. programmes are at newer professional schools of psychology.
Counselling psychology is a psychological specialty that encompasses research and applied work in several broad domains: counselling process and outcome; supervision and training; career development and counselling; and prevention and health. Some unifying themes among counselling psychologists include a focus on assets and strengths, person-environment interactions, educational and career development, brief interactions, and a focus on intact personalities.
Brief History
The term “counselling” is of American origin, coined by Carl Rogers, who, lacking a medical qualification was prevented from calling his work psychotherapy. In the US, counselling psychology, like many modern psychology specialties, started as a result of World War II. During the war, the US military had a strong need for vocational placement and training. In the 1940s and 1950s, the Veterans Administration created a specialty called “counselling psychology”, and Division 17 (now known as the Society for Counselling Psychology) of the APA was formed. The Society of Counselling Psychology unites psychologists, students and professionals who are dedicated to promote education and training, practice, scientific investigation, diversity and public interest in the field of professional psychology. This fostered interest in counsellor training, and the creation of the first few counselling psychology PhD programmes. The first counselling psychology PhD programmes were at the University of Minnesota; Ohio State University; University of Maryland, College Park; University of Missouri; Teachers College, Columbia University; and University of Texas at Austin.
In recent decades, counselling psychology as a profession has expanded and is now represented in numerous countries around the world. Books describing the present international state of the field include the Handbook of Counselling and Psychotherapy in an International Context; the International Handbook of Cross-Cultural Counselling; and Counselling Around the World: An International Handbook. Taken together these volumes trace the global history of the field, explore divergent philosophical assumptions, counselling theories, processes, and trends in different countries, and review a variety of global counsellor education programmes. Moreover, traditional and indigenous treatment and healing methods that may predate modern counselling methods by hundreds of years remain of significance in many non-Western and Western countries.
Employment and Salary
Counselling psychologists are employed in a variety of settings depending on the services they provide and the client populations they serve. Some are employed in colleges and universities as teachers, supervisors, researchers, and service providers. Others are employed in independent practice providing counselling, psychotherapy, assessment, and consultation services to individuals, couples/families, groups, and organisations. Additional settings in which counselling psychologists practice include community mental health centres, Veterans Administration medical centres and other facilities, family services, health maintenance organisations, rehabilitation agencies, business and industrial organisations and consulting within firms.
The amount of training required for psychologists differs based on the country in which they are practicing. Typically, a psychologist completes an Undergraduate Degree followed by 5-6 years of further study and/or training, leading to the Ph.D. While both psychologists and psychiatrists offer counselling, psychiatrists must possess a medical degree and thus are able to prescribe medication where psychologists are not.
Process and Outcome
Counselling psychologists are interested in answering a variety of research questions about counselling process and outcome. Counselling process refers to how or why counselling happens and progresses. Counselling outcome addresses whether or not counselling is effective, under what conditions it is effective, and what outcomes are considered effective – such as symptom reduction, behaviour change, or quality of life improvement. Topics commonly explored in the study of counselling process and outcome include therapist variables, client variables, the counselling or therapeutic relationship, cultural variables, process and outcome measurement, mechanisms of change, and process and outcome research methods. Classic approaches appeared early in the US in the field of humanistic psychology by Carl Rogers who identified the mission of counselling interview as “to permit deeper expression that the client would ordinarily allow himself”
Therapist Variables
Therapist variables include characteristics of a counsellor or psychotherapist, as well as therapist technique, behaviour, theoretical orientation and training. In terms of therapist behaviour, technique and theoretical orientation, research on adherence to therapy models has found that adherence to a particular model of therapy can be helpful, detrimental, or neutral in terms of impact on outcome.
A recent meta-analysis of research on training and experience suggests that experience level is only slightly related to accuracy in clinical judgement, Higher therapist experience has been found to be related to less anxiety, but also less focus. This suggests that there is still work to be done in terms of training clinicians and measuring successful training.
Client Variables
Client characteristics such as help-seeking attitudes and attachment style have been found to be related to client use of counselling, as well as expectations and outcome. Stigma against mental illness can keep people from acknowledging problems and seeking help. Public stigma has been found to be related to self-stigma, attitudes towards counselling, and willingness to seek help.
In terms of attachment style, clients with avoidance styles have been found to perceive greater risks and fewer benefits to counselling, and are less likely to seek professional help, than securely attached clients. Those with anxious attachment styles perceive greater benefits as well as risks to counselling. Educating clients about expectations of counselling can improve client satisfaction, treatment duration and outcomes, and is an efficient and cost-effective intervention.
Counselling Relationship
The relationship between a counsellor and client is the feelings and attitudes that a client and therapist have towards one another, and the manner in which those feelings and attitudes are expressed. Some theorists have suggested that the relationship may be thought of in three parts: transference and countertransference, working alliance, and the real – or personal – relationship. Other theorists argue that the concepts of transference and countertransference are outdated and inadequate.
Transference can be described as the client’s distorted perceptions of the therapist. This can have a great effect on the therapeutic relationship. For instance, the therapist may have a facial feature that reminds the client of their parent. Because of this association, if the client has significant negative or positive feelings toward their parent, they may project these feelings onto the therapist. This can affect the therapeutic relationship in a few ways. For example, if the client has a very strong bond with their parent, they may see the therapist as a father or mother figure and have a strong connection with the therapist. This can be problematic because as a therapist, it is not ethical to have a more than “professional” relationship with a client. It can also be a good thing, because the client may open up greatly to the therapist. In another way, if the client has a very negative relationship with their parent, the client may feel negative feelings toward the therapist. This can then affect the therapeutic relationship as well. For example, the client may have trouble opening up to the therapist because they lack trust in their parent (projecting these feelings of distrust onto the therapist).
Another theory about the function of the counselling relationship is known as the secure-base hypothesis, which is related to attachment theory. This hypothesis proposes that the counsellor acts as a secure base from which clients can explore and then check in with. Secure attachment to one’s counsellor and secure attachment in general have been found to be related to client exploration. Insecure attachment styles have been found to be related to less session depth than securely attached clients.
Cultural Variables
Counselling psychologists are interested in how culture relates to help-seeking and counselling process and outcome. Standard surveys exploring the nature of counselling across cultures and various ethnic groups include Counselling Across Cultures by Paul B. Pedersen, Juris G. Draguns, Walter J. Lonner and Joseph E. Trimble, Handbook of Multicultural Counseling by Joseph G. Ponterotto, J. Manueal Casas, Lisa A. Suzuki and Charlene M. Alexander and Handbook of Culture, Therapy, and Healing by Uwe P. Gielen, Jefferson M. Fish and Juris G. Draguns. Janet E. Helms’ racial identity model can be useful for understanding how the relationship and counselling process might be affected by the client’s and counsellor’s racial identity. Recent research suggests that clients who are Black are at risk for experiencing racial micro-aggression from counsellors who are White.
Efficacy for working with clients who are lesbians, gay men, or bisexual might be related to therapist demographics, gender, sexual identity development, sexual orientation, and professional experience. Clients who have multiple oppressed identities might be especially at-risk for experiencing unhelpful situations with counsellors, so counsellors might need help with gaining expertise for working with clients who are transgender, lesbian, gay, bisexual, or transgender people of colour, and other oppressed populations.
Gender role socialisation can also present issues for clients and counsellors. Implications for practice include being aware of stereotypes and biases about male and female identity, roles and behaviour such as emotional expression. The APA guidelines for multicultural competence outline expectations for taking culture into account in practice and research.
Counselling Ethics and Regulation
Perceptions on ethical behaviours vary depending upon geographical location, but ethical mandates are similar throughout the global community. Ethical standards are created to help practitioners, clients and the community avoid any possible harm or potential for harm. The standard ethical behaviours are centred on “doing no harm” and preventing harm.
Counsellors cannot share any confidential information that is obtained through the counselling process without specific written consent by the client or legal guardian except to prevent clear, imminent danger to the client or others, or when required to do so by a court order. Insurance companies or government programmes will also be notified of certain information about your diagnosis and treatment to determine if your care is covered. Those companies and government programmes are bound by HIPAA to keep that information strictly confidential.
Counsellors are held to a higher standard than most professionals because of the intimacy of their therapeutic delivery. Counsellors are not only to avoid fraternising with their clients. They should avoid dual relationships, and never engage in sexual relationships.
Counsellors are to avoid receiving gifts, favours, or trade for therapy. In some communities, it may be avoidable given the economic standing of that community. In cases of children, children and the mentally handicapped, they may feel personally rejected if an offering is something such as a “cookie”. As counsellors, a judgement call must be made, but in a majority of cases, avoiding gifts, favours, and trade can be maintained.
The National Board for Certified Counsellors states that counsellors “shall discuss important considerations to avoid exploitation before entering into a non-counselling relationship with a former client. Important considerations to be discussed include amount of time since counselling service termination, duration of counselling, nature and circumstances of client’s counselling, the likelihood that the client will want to resume counselling at some time in the future; circumstances of service termination and possible negative effects or outcomes.”
Outcome Measurement
Counselling outcome measures might look at a general overview of symptoms, symptoms of specific disorders, or positive outcomes, such as subjective well-being or quality of life. The Outcome Questionnaire-45 is a 45-item self-report measure of psychological distress. An example of disorder-specific measure is the Beck Depression Inventory. The Quality of Life Inventory is a 17-item self-report life satisfaction measure.
Process and Outcome Research Methods
Research about the counselling process and outcome uses a variety of research methodologies to answer questions about if, how, and why counselling works. Quantitative methods include randomly controlled clinical trials, correlation studies over the course of counselling, or laboratory studies about specific counselling process and outcome variables. Qualitative research methods can involve conducting, transcribing and coding interviews; transcribing and/or coding therapy sessions; or fine-grain analysis of single counselling sessions or counselling cases.
Training and Supervision
Professional Training Process
Counselling psychologists are trained in graduate programmes. Almost all programmes grant a PhD, but a few grant a Psy.D. or Ed.D. Most doctoral programmes take 5-6 years to complete. Graduate work in counselling psychology includes coursework in general psychology and statistics, counselling practice, and research. Students must complete an original dissertation at the end of their graduate training. Students must also complete a one-year full-time internship at an accredited site before earning their doctorate. In order to be licensed to practice, counselling psychologists must gain clinical experience under supervision, and pass a standardised exam.
Australia
In Australia, counselling psychology programmes are accredited by the Australian Psychology Accreditation Council (APAC). To become registered as a counselling psychologist, one must meet the criteria for the area of practice endorsement. This includes an undergraduate degree in the science of psychology, an Honours degree or Postgraduate Diploma in Psychology, and a Master’s or Doctorate degree in counselling psychology. Graduates must then complete a registrar programme to obtain an area of practice endorsement and use the title counselling psychologist. A substantial component of this master’s degree is dedicated to individual psychotherapy, family and couples therapy, group therapy, developmental theory and psychopathology.
Training Models and Research
Counselling psychology includes the study and practice of counsellor training and counsellor supervision. As researchers, counselling psychologists may investigate what makes training and supervision effective. As practitioners, counselling psychologists may supervise and train a variety of clinicians. Counsellor training tends to occur in formal classes and training programmes. Part of counsellor training may involve counselling clients under the supervision of a licensed clinician. Supervision can also occur between licensed clinicians, as a way to improve clinicians’ quality of work and competence with various types of counselling clients.
As the field of counselling psychology formed in the mid-20th century, initial training models included Robert Carkuff’s human relations training model, Norman Kagan’s Interpersonal Process Recall, and Allen Ivey’s micro-counselling skills. Modern training models include Gerard Egan’s skilled helper model, and Clara E. Hill’s three-stage model (exploration, insight, and action). A recent analysis of studies on counsellor training found that modelling, instruction, and feedback are common to most training models, and seem to have medium to large effects on trainees.
Supervision Models and Research
Like the models of how clients and therapists interact, there are also models of the interactions between therapists and their supervisors. Edward S. Bordin proposed a model of supervision working alliance similar to his model of therapeutic working alliance. The Integrated Development Model considers the level of a client’s motivation/anxiety, autonomy, and self and other awareness. The Systems Approach to Supervision views the relationship between supervisor and supervised as most important, in addition to characteristics of the supervisor’s personal characteristics, counselling clients, training setting, as well as the tasks and functions of supervision. The Critical Events in Supervision model focuses on important moments that occur between the supervisor and supervised.
Problems can arise in supervision and training. First, supervisors are liable for malpractice. Also, questions have arisen as far as a supervisor’s need for formal training to be a competent supervisor. Recent research suggests that conflicting, multiple relationships can occur between supervisors and clients, such as that of the client, instructor, and clinical supervisor. The occurrence of racial micro-aggression against Black clients suggests potential problems with racial bias in supervision. In general, conflicts between a counsellor and his or her own supervisor can arise when supervisors demonstrate disrespect, lack of support, and blaming.
Vocational Development and Career Counselling
Vocational Theories
There are several types of theories of vocational choice and development. These types include trait and factor theories, social cognitive theories, and developmental theories. Two examples of trait and factor theories, also known as person-environment fit, are Holland’s theory and the Theory of Work Adjustment.
John Holland hypothesized six vocational personality/interest types and six work environment types:
Realistic;
Investigative;
Artistic;
Social;
Enterprising; and
Conventional.
When a person’s vocational interests match his or her work environment types, this is considered congruence. Congruence has been found to predict occupation and college major.
The Theory of Work Adjustment (TWA), as developed by René Dawis and Lloyd Lofquist, hypothesizes that the correspondence between a worker’s needs and the reinforced systems predicts job satisfaction, and that the correspondence between a worker’s skills and a job’s skill requirements predicts job satisfaction. Job satisfaction and personal satisfaction together should determine how long one remains at a job. When there is a discrepancy between a worker’s needs or skills and the job’s needs or skills, then change needs to occur either in the worker or the job environment.
Social Cognitive Career Theory (SCCT) has been proposed by Robert D. Lent, Steven D. Brown and Gail Hackett. The theory takes Albert Bandura’s work on self-efficacy and expands it to interest development, choice making, and performance. Person variables in SCCT include self-efficacy beliefs, outcome expectations and personal goals. The model also includes demographics, ability, values, and environment. Efficacy and outcome expectations are theorised to interrelate and influence interest development, which in turn influences choice of goals, and then actions. Environmental supports and barriers also affect goals and actions. Actions lead to performance and choice stability over time.
Career development theories propose vocational models that include changes throughout the lifespan. Donald Super’s model proposes a lifelong five-stage career development process. The stages are growth, exploration, establishment, maintenance, and disengagement. Throughout life, people have many roles that may differ in terms of importance and meaning. Super also theorised that career development is an implementation of self-concept. Gottfredson also proposed a cognitive career decision-making process that develops through the lifespan. The initial stage of career development is hypothesized to be the development of self-image in childhood, as the range of possible roles narrows using criteria such as sex-type, social class, and prestige. During and after adolescence, people take abstract concepts into consideration, such as interests.
Career Counselling
Career counselling may include provision of occupational information, modelling skills, written exercises, and exploration of career goals and plans. Career counselling can also involve the use of personality or career interest assessments, such as the Myers-Briggs Type Indicator, which is based on Carl Jung’s theory of psychological type, or the Strong Interest Inventory, which makes use of Holland’s theory. Assessments of skills, abilities, and values are also commonly assessed in career counselling.
Professional Journals
In the United States, the premier scholarly journals of the profession are the Journal of Counselling Psychology and The Counselling Psychologist.
In Australia, counselling psychology articles are published in the counselling psychology section of the Australian Psychologist.
In Europe, the scholarly journals of the profession include the European Journal of Counselling Psychology (under the auspices of the European Association of Counselling Psychology) and the Counselling Psychology Review (under the auspices of the British Psychological Society). Counselling Psychology Quarterly is an international interdisciplinary publication of Routledge (part of the Taylor & Francis Group).
1842 – Josef Breuer, Austrian physician and psychiatrist (d. 1925).
1877 – Lewis Terman, American psychologist, eugenicist, and academic (d. 1956).
1958 – Boris Tadić, Serbian psychologist and politician, 16th President of Serbia
Josef Breuer
Josef Breuer (15 January 1842 to 20 June 1925) was a distinguished physician who made key discoveries in neurophysiology, and whose work in the 1880s with his patient Bertha Pappenheim, known as Anna O., developed the talking cure (cathartic method) and laid the foundation to psychoanalysis as developed by his protégé Sigmund Freud.
He graduated from the Akademisches Gymnasium of Vienna in 1858 and then studied at the university for one year before enrolling in the medical school of the University of Vienna. He passed his medical exams in 1867 and went to work as assistant to the internist Johann Oppolzer at the university.
Breuer, working under Ewald Hering at the military medical school in Vienna, was the first to demonstrate the role of the vagus nerve in the reflex nature of respiration. This was a departure from previous physiological understanding, and changed the way scientists viewed the relationship of the lungs to the nervous system. The mechanism is now known as the Hering–Breuer reflex.
Independent of each other in 1873, Breuer and the physicist and mathematician Ernst Mach discovered how the sense of balance (i.e. the perception of the head’s imbalance) functions: that it is managed by information the brain receives from the movement of a fluid in the semicircular canals of the inner ear. That the sense of balance depends on the three semicircular canals was discovered in 1870 by the physiologist Friedrich Goltz, but Goltz did not discover how the balance-sensing apparatus functions.
Lewis Terman
Lewis Madison Terman (15 January 1877 to 21 December 1956) was an American psychologist and author. He was noted as a pioneer in educational psychology in the early 20th century at the Stanford Graduate School of Education. He is best known for his revision of the Stanford-Binet Intelligence Scales and for initiating the longitudinal study of children with high IQs called the Genetic Studies of Genius. He was a prominent eugenicist and was a member of the Human Betterment Foundation. He also served as president of the American Psychological Association. A Review of General Psychology survey, published in 2002, ranked Terman as the 72nd most cited psychologist of the 20th century, in a tie with G. Stanley Hall.
Boris Tadic
Boris Tadić (15 January 1958 to Present) is a Serbian politician who served as President of Serbia from 2004 to 2012. He was elected to his first term on 27 June 2004, when Serbia was part of Serbia and Montenegro, and re-elected for a second term on 03 February 2008, this time as president of independent Serbia. He resigned on 05 April 2012 in order to trigger an early election. Prior to his presidency, Tadić served as the last Minister of Telecommunications of the Federal Republic of Yugoslavia and as the first Minister of Defence of Serbia and Montenegro. He is a psychologist by profession.
Tadić finished Pera Popović Aga (today Mika Petrović Alas) elementary school and matriculated at the First Belgrade Gymnasium in Dorćol. During his teenage years he played water polo for VK Partizan, but had to quit due to injuries. He graduated from the University of Belgrade Faculty of Philosophy with a degree in psychology, specifically social psychology in the department of clinical psychology.
He was arrested during his studies in July 1982 for protesting the arrest of a group of students, arrested for protesting against martial law in Poland and in support of the Solidarity movement. Tadić spent one month in penal labour prison in Padinska Skela.
He worked as a journalist, military clinical psychologist and as a teacher of psychology at the First Belgrade Gymnasium. Until 2003, Tadić also worked at the Faculty of Dramatic Arts at the University of Arts in Belgrade as a lecturer of political advertising. He is a Senior Network Member at the European Leadership Network (ELN).
A mental health professional is a health care practitioner or social and human services provider who offers services for the purpose of improving an individual’s mental health or to treat mental disorders.
This broad category was developed as a name for community personnel who worked in the new community mental health agencies begun in the 1970s to assist individuals moving from state hospitals, to prevent admissions, and to provide support in homes, jobs, education, and community. These individuals (i.e. state office personnel, private sector personnel, and non-profit, and now voluntary sector personnel) were the forefront brigade to develop the community programmes, which today may be referred to by names such as supported housing, psychiatric rehabilitation, supported or transitional employment, sheltered workshops, supported education, daily living skills, affirmative industries, dual diagnosis treatment, individual and family psychoeducation, adult day care, foster care, family services and mental health counselling.
Psychiatrists also are working in clinical fields with psychologists including in sociobehavioural, neurological, person-centred and clinical approaches (often office-based), and studies of the “brain disease” (which came from the community fields and community management and are taught at the MA to PhD level in education). For example, Nat Raskin (at Northwestern University Medical School) who worked with the illustrious Carl Rogers, published on person-centred approaches and therapy in 2004. The term counsellors often refers to office-based professionals who offer therapy sessions to their clients, operated by organisations such as pastoral counselling (which may or may not work with long term services clients) and family counsellors. Mental health counsellors may refer to counsellors working in residential services in the field of mental health in community programmes.
As Community Professionals
As Dr. William Anthony, father of psychiatric rehabilitation, described, psychiatric nurses (RNMH, RMN, CPN), clinical psychologists (PsyD or PhD), clinical social workers (MSW or MSSW), mental health counselors (MA or MS), professional counselors, pharmacists, as well as many other professionals are often educated in “psychiatric fields” or conversely, educated in a generic community approach (e.g. human services programmes or health and human services in 2013). However, his primary concern is education that leads to a willingness to work with “long-term services and supports” community support in the community to lead to better life quality for the individual, the families and the community.
The community support framework in the US of the 1970s is taken-for-granted as the base for new treatment developments (e.g. eating disorders, drug addiction programmes) which tend to be free-standing clinics for specific “disorders”. Typically, the term “mental health professional” does not refer to other categorical disability areas, such as intellectual and developmental disability (which trains its own professionals and maintains its own journals, and US state systems and institutions). Psychiatric rehabilitation has also been reintroduced into the transfer to behavioural health care systems.
As Certified and Licensed (Across Institutions and Communities)
These professionals often deal with the same illnesses, disorders, conditions, and issues (though may separate on-site locations, such as hospital or community for the same clientele); however, their scope of practice differs and more particularly, their positions and roles in the fields of mental health services and systems. The most significant difference between mental health professionals are the laws regarding required education and training across the various professions. However, the most significant change has been the Supreme Court Olmstead Decision on the most integrated setting which should further reduce state hospital utilisation; yet with new professionals seeking right for community treatment orders and rights to administer medications (original community programmes, residents taught to self-administer medications, 1970s).
In 2013, new mental health practitioners are licensed or certified in the community (e.g., PhD, education in private clinical practice) by states, degrees and certifications are offered in fields such as psychiatric rehabilitation (MS, PhD), BA psychology (liberal arts, experimental/clinical/existential/community) to MA licensing is now more popular, BA (to PhD) mid-level programme management, qualified civil service professionals, and social workers remain the mainstay of community admissions procedures (licensed by state, often generic training) in the US. Surprisingly, state direction has moved from psychiatry or clinical psychology to community leadership and professionalisation of community services management.
Entry level recruitment and training remain a primary concern (since the 1970s, then often competing with fast food positions), and the US Direct Support Workforce includes an emphasis on also training of psychiatric aides, behavioural aides, and addictions aides to work in homes and communities. The Centres for Medicaid and Medicare have new provisions for “self-direction” in services and new options are in place for individual plans for better life outcomes. Community programs are increasingly using health care financing, such as Medicaid, and Mental Health Parity is now law in the US.
Currently, psychologists may prescribe in US five states: Iowa, Idaho, Illinois, New Mexico, and Louisiana, as well as in the Public Health Service, the Indian Health Service, the US military, and Guam.
Includes licensed dual inclusion educators, behaviour analyst, substance abuse and behavioural disorders, “inclusion educator”.
Treatment Diversity and Community Mental Health
Mental health professionals exist to improve the mental health of individuals, couples, families and the community-at-large (In this generic use, mental health is available to the entire population, similar to the use by mental health associations). Because mental health covers a wide range of elements, the scope of practice greatly varies between professionals. Some professionals may enhance relationships while others treat specific mental disorders and illness; still, others work on population-based health promotion or prevention activities. Often, as with the case of psychiatrists and psychologists, the scope of practice may overlap often due to common hiring and promotion practices by employers.
As indicated earlier, community mental health professionals have been involved in the beginning and operating community programmes which include ongoing efforts to improve life outcomes, originally through long term services and supports (LTSS). Termed functional or competency-based programmes, this service also stressed decision making and self-determination or empowerment as critical aspects. Community mental health professionals may also serve children who have different needs, as do families, including family therapy, financial assistance and support services. Community mental health professionals serve people of all ages from young children with autism, to children with emotional (or behavioural) needs, to grandma who has Alzheimer’s or dementia and is living at home after dad passes away.
Most qualified mental health professionals will refer a patient or client to another professional if the specific type of treatment needed is outside of their scope of practice. The main community concern is “zero rejection” from community services for individuals who have been termed “hard to serve” in the population (think schizophrenia or dual diagnosis) or who have additional needs such as mobility and sensory impairments. Additionally, many mental health professionals may sometimes work together using a variety of treatment options such as concurrent psychiatric medication and psychotherapy and supported housing. Additionally, specific mental health professionals may be utilised based upon their cultural and religious background or experience, as part of a theory of both alternative medicines and of the nature of helping and ethnicity.
Primary care providers, such as internists, paediatricians, and family physicians, may provide initial components of mental health diagnosis and treatment for children and adults; however, family physicians in some states refuse to even prescribe a psychotropic medication deferring to separately funded “medication management” services. Community programmes in the categorical field of mental health were designed (1970s) to have a personal family physician for every client in their programmes, except for institutional settings and nursing facilities which have only one or two for a large facility.
In particular, family physicians are trained during residency in interviewing and diagnostic skills, and may be quite skilled in managing conditions such as attention deficit hyperactivity disorder (ADHD) in children and depression in adults. Likewise, many (but not all) paediatricians may be taught the basic components of ADHD diagnosis and treatment during residency. In many other circumstances, primary care physicians may receive additional training and experience in mental health diagnosis and treatment during their practice years.
Relative Effectiveness
Both primary care physicians/general practitioners (GP’s) and psychiatrist are just as effective (in terms of remission rates) for the treatment of depression. However, treatment resistant depression, suicidal, homicidal ideation, psychosis and catatonia should be handled by mental health specialists. Treatment-resistant depression (or treatment refractory depression) refers to depression which remains at large after at least two antidepressant medications have been trailed on their own.
Peer Workers
Some think that mental health professionals are less credible when they have personal experience of mental health. In fact, the mental health sector goes out of its way to hire people with mental illness experience. Those in the mental health workforce with personal experience of mental health are referred to as ‘peer (support) workers’. The balance of evidence appears to favour their employment: Randomised controlled trials consistently demonstrate peer staff produce outcomes on par with non-peer staff in ancillary roles, but they actually perform better in reducing hospitalisation rates, engaging clients who are difficult to reach, and cutting substance use. There is research that indicates peer workers cultivate a perception among service users that the service is more responsive to non-treatment things, increases their hope, family satisfaction, self-esteem and community belonging.
Psychiatrists are physicians and one of the few professionals in the mental health industry who specialize and are certified in treating mental illness using the biomedical approach to mental disorders including the use of medications. However, biological, genetic and social processes as part of pre-medicine have been the basis of education in fields such as BA psychology since the 1970s, and in 2013, such academic degrees also may include extensive work on the status of brain, DNA research and its applications. Clinical psychologists were hired by states and served in institutions in the US, and were involved in the transition to community systems.
Psychiatrists may also go through significant training to conduct psychotherapy and cognitive behavioural therapy;. The amount of training a psychiatrist holds in providing these types of therapies varies from program to program and also differs greatly based upon region (Cognitive therapy also stems from cognitive rehabilitation techniques, and may involve long-term community clients with brain injuries seeking jobs, education and community housing). In the 1970s, psychiatrists were considered to be hospital-based, assessment, and clinical education personnel which was not involved in establishing community programmes.
Specialties of Psychiatrists
As part of their evaluation of the patient, psychiatrists are one of only a few mental health professionals who may conduct physical examinations, order and interpret laboratory tests and EEGs, and may order brain imaging studies such as CT or CAT, MRI, and PET scanning. A medical professional must evaluate the patient for any medical problems or diseases that may be the cause of the mental illness.
Historically psychiatrists have been the only mental health professional with the power to prescribe medication to treat specific types of mental illness. Currently, physician assistants response to the psychiatrist (in lieu of and supervised) and advanced practice psychiatric nurses may prescribe medications, including psychiatric medications. Clinical psychologists have gained the ability to prescribe psychiatric medications on a limited basis in a few US states after completing additional training and passing an examination.
Educational Requirements for Psychiatrists
Typically the requirements to become a psychiatrist are substantial but differ from country to country. In general there is an initial period of several years of academic and clinical training and supervised work in different areas of medicine, in order to become a licensed medical doctor, followed by several years of supervised work and study in psychiatry, in order to become a licensed psychiatrist.
In the United States and Canada one must first complete a Bachelor’s degree. Students may typically decide any major subject of their choice, however they must enrol in specific courses, usually outlined in a pre-medical programme. One must then apply to and attend 4 years of medical school in order to earn their MD or DO and to complete their medical education. Psychiatrists must then pass three successive rigorous national board exams (United States Medical Licensing Exams “USMLE”, Steps 1, 2, and 3), which draws questions from all fields of medicine and surgery, before gaining an unrestricted license to practice medicine. Following this, the individual must complete a four-year residency in Psychiatry as a psychiatric resident and sit for annual national in-service exams. Psychiatry residents are required to complete at least four post-graduate months of internal medicine (paediatrics may be substituted for some or all of the internal medicine months for those planning to specialise in child and adolescent psychiatry) and two months of neurology, usually during the first year, but some programmes require more. Occasionally, some prospective psychiatry residents will choose to do a transitional year internship in medicine or general surgery, in which case they may complete the two months of neurology later in their residency. After completing their training, psychiatrists take written and then oral specialty board examinations. The total amount of time required to qualify in the field of psychiatry in the United States is typically 4 to 5 years after obtaining the MD or DO (or in total 8 to 9 years minimum). Many psychiatrists pursue an additional 1-2 years in subspecialty fellowships on top of this such as child psychiatry, geriatric psychiatry, and psychosomatic medicine.
In the United Kingdom, the Republic of Ireland, and most Commonwealth countries, the initial degree is the combined Bachelor of Medicine and Bachelor of Surgery, usually a single period of academic and clinical study lasting around five years. This degree is most often abbreviated ‘MBChB’, ‘MB BS’ or other variations, and is the equivalent of the American ‘MD’. Following this the individual must complete a two-year foundation programme that mainly consists of supervised paid work as a Foundation House Officer within different specialties of medicine. Upon completion the individual can apply for “core specialist training” in psychiatry, which mainly involves supervised paid work as a Specialty Registrar in different subspecialties of psychiatry. After three years there is an examination for Membership of the Royal College of Psychiatrists (abbreviated MRCPsych), with which an individual may then work as a “Staff grade” or “Associate Specialist” psychiatrist, or pursue an academic psychiatry route via a PhD. If, after the MRCPsych, an additional 3 years of specialisation known as “advanced specialist training” are taken (again mainly paid work), and a Certificate of Completion of Training is awarded, the individual can apply for a post taking independent clinical responsibility as a “consultant” psychiatrist.
Clinical Psychologists
A clinical psychologist studies and applies psychology for the purpose of understanding, preventing and relieving psychologically-based distress or dysfunction and to promote subjective well-being and personal development. In many countries it is a regulated profession that addresses moderate to more severe or chronic psychological problems, including diagnosable mental disorders. Clinical psychology includes a wide range of practices, such as research, psychological assessment, teaching, consultation, forensic testimony, and program development and administration. Central to clinical psychology is the practice of psychotherapy, which uses a wide range of techniques to change thoughts, feelings, or behaviours in service to enhancing subjective well-being, mental health, and life functioning. Unlike other mental health professionals, psychologists are trained to conduct psychological assessment. Clinical psychologists can work with individuals, couples, children, older adults, families, small groups, and communities.
Specialties of Clinical Psychologists
Clinical psychologists who focus on treating mental health specialises in evaluating patients and providing psychotherapy. They do not prescribe medication as this is a role of a psychiatrist (physician who specialises in psychiatry). There are a wide variety of therapeutic techniques and perspectives that guide practitioners, although most fall into the major categories of Psychodynamic, Cognitive Behavioural, Existential-Humanistic, and Systems Therapy (e.g. family or couples therapy).
In addition to therapy, clinical psychologists are also trained to administer and interpret psychological personality tests such as the MMPI and the Rorschach inkblot test, and various standardised tests of intelligence, memory, and neuropsychological functioning. Common areas of specialization include: specific disorders (e.g. trauma), neuropsychological disorders, child and adolescent, family and relationship counselling. Internationally, psychologists are generally not granted prescription privileges. In the US, prescriptive rights have been granted to appropriately trained psychologists only in the states of New Mexico and Louisiana, with some limited prescriptive rights in Indiana and the US territory of Guam.
Educational Requirements for Clinical Psychologists
Clinical psychologists, having completed an undergraduate degree usually in psychology or other social science, generally undergo specialist postgraduate training lasting at least two years (e.g. Australia), three years (e.g. UK), or four to six years depending how much research activity is included in the course (e.g. US). In countries where the course is of shorter duration, there may be an informal requirement for applicants to have undertaken prior work experience supervised by a clinical psychologist, and a proportion of applicants may also undertake a separate PhD research degree.
Today, in the US, about half of licensed psychologists are trained in the Scientist-Practitioner Model of Clinical Psychology (PhD) – a model that emphasizes both research and clinical practice and is usually housed in universities. The other half are being trained within a Practitioner-Scholar Model of Clinical Psychology (PsyD), which focuses on practice (similar to professional degrees for medicine and law). A third training model called the Clinical Scientist Model emphasizes training in clinical psychology research. Outside of coursework, graduates of both programmes generally are required to have had 2 to 3 years of supervised clinical experience, a certain amount of personal psychotherapy, and the completion of a dissertation (PhD programmes usually require original quantitative empirical research, whereas the PsyD equivalent of dissertation research often consists of literature review and qualitative research, theoretical scholarship, programme evaluation or development, critical literature analysis, or clinical application and analysis).
Continuing Education Requirements for Clinical Psychologists
Most states in the US require clinical psychologists to obtain a certain number of continuing education credits in order to renew their license. This was established to ensure that psychologists stay current with information and practices in their fields. The license renewal cycle varies, but renewal is generally required every two years.
The number of continuing education credits required for clinical psychologists varies between states. In Nebraska, psychologists are required to obtain 24 hours of approved continuing education credits in the 24 months before their license renewal. In California, the requirement is for 36 hours of credits. New York State does not have any continuing education requirements for license renewal at this time (2014).
Activities that count towards continuing education credits generally include completing courses, publishing research papers, teaching classes, home study, and attending workshops. Some states require that a certain number of the education credits be in ethics. Most states allow psychologists to self-report their credits but randomly audit individual psychologists to ensure compliance.
Counselling Psychologist or Psychotherapist
Counselling generally involves helping people with what might be considered “normal” or “moderate” psychological problems, such as the feelings of anxiety or sadness resulting from major life changes or events. As such, counselling psychologists often help people adjust to or cope with their environment or major events, although many also work with more serious problems as well.
One may practice as a counselling psychologist with a PhD or EdD, and as a counselling psychotherapist with a master’s degree. Compared with clinical psychology, there are fewer counselling psychology graduate programs (which are commonly housed in departments of education), counsellors tend to conduct more vocational assessment and less projective or objective assessment, and they are more likely to work in public service or university clinics (rather than hospitals or private practice). Despite these differences, there is considerable overlap between the two fields and distinctions between them continue to fade.
Mental health counsellors and residential counsellors are also the name for another class of counsellors or mental health professionals who may work with long-term services and supports (LTSS) clients in the community. Such counsellors may be advanced or senior staff members in a community program, and may be involved in developing skill teaching, active listening (and similar psychological and educational methods), and community participation programmes. They also are often skilled in on-site intervention, redirection and emergency techniques. Supervisory personnel often advance from this class of workers in community programmes.
Behaviour Analysts and Community/Institutional Roles
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, behaviour therapy, and the philosophy of radical behaviourism. Behaviour analysts have at least a master’s degree in behaviour analysis or in a mental health related discipline as well as at least five core courses in applied behaviour analysis (narrow focus in psychological education). 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 or the examination in clinical behaviour therapy by the World Association for Behaviour Analysis. The model licensing act for behaviour analysts can be found at the Association for Behaviour Analysis International’s website.
Behaviour analysts (who grew from the definition of mental health as a behavioural problem) often use community situational activities, life events, functional teaching, community “reinforcers”, family and community staff as intervenors, and structured interventions as the base in which they may be called upon to provide skilled professional assistance. Approaches that are based upon person-centred approaches have been used to update the stricter, hospital based interventions used by behaviour analysts for applicability to community environments. Behavioural approaches have often been infused with efforts at client self-determination, have been aligned with community lifestyle planning, and have been criticised as “aversive technology” which was “outlawed” in the field of severe disabilities in the 1990s.
Certified Mental Health Professional
The Certified Mental Health Professional (CMHP) certification is designed to measure an individual’s competency in performing the following job tasks. The job tasks are a sampling of job tasks with a clinical emphasis, and represents a level of line staff in community programmes reporting to a community supervisor in a small site based programme. Personnel in community housing, nursing facilities, and institutional programmes may be covered by these kinds of certifications.
Maintain confidentiality of records relating to clients’ treatment (and daily affairs as desired by the person).
Encourage clients to express their feelings, discuss what is happening in their lives, and help them to develop insight into themselves and their relationships.
Guide clients in the development of skills and strategies for dealing with their problems (and desired life outcomes).
Prepare and maintain all required treatment (and/or community service) records and reports.
Counsel clients and patients, individually and in group sessions, to assist in overcoming dependencies (seeking new relationships), adjusting to life, and making changes.
Collect information about clients through interviews, observations, and tests (and most importantly, speaking with and planning with the person).
Act as the client’s advocate in order to coordinate required services or to resolve emergency problems in crisis situations (often first line of emergency response).
Develop and implement treatment (or “person-centred”) plans based on clinical (and community) experience and knowledge.
Collaborate with other staff members to perform clinical assessments (and health may be contracted for specific consultations) and develop treatment (service) plans.
Evaluate client’s physical or mental condition (plan, not condition) based on review of client information (Evaluate outcomes as planned with the client on a “quarterly basis”).
However, these position levels have undergone decades of academic field testing and recommendations with new competencies in development in 2011-2013 by the Centres for Medicaid and Medicare (at the categorical aide levels). New professionals were recommended with a community services coordinator (commonly known as “hands on” case management), together with services and personnel management, and community development and liaison roles for community participation.
School Psychologist and Inclusion Educators
School psychologists’ primary concern is with the academic, social, and emotional well-being of children within a scholastic environment. Unlike clinical psychologists, they receive much more training in education, child development and behaviour, and the psychology of learning, often graduating with a post-master’s educational specialist degree (EdS), EdD or Doctor of Philosophy (PhD) degree. Besides offering individual and group therapy with children and their families, school psychologists also evaluate school programmes, provide cognitive assessment, help design prevention programmes (e.g. reducing drops outs), and work with teachers and administrators to help maximise teaching efficacy, both in the classroom and systemically.
In today’s world, the school psychologist remains the responsible party in “mental health” regarding children with emotional and behavioural needs, and have not always met these needs in the regular school environment. Inclusion (special) educators support participation in local school programmes and after school programmes, including new initiatives such as Achieve my Plan by the Research and Training Centre on Family Support and Children’s Mental Health at Portland State University. Referrals to residential schools and certification of the personnel involved in the residential schools and campuses have been a multi-decade concern with counties often involved in national efforts to better support these children and youth in local schools, families, homes and communities.
Psychiatric Rehabilitation
Psychiatric rehabilitation, similar to cognitive rehabilitation, is a designated field in the rehabilitation often academically prepared in either Schools of Allied Health and Sciences (near the field of Physical Medicine and Rehabilitation) and as rehabilitation counselling in the School of Education. Both have been developed specifically as preparing community personnel (at the MA and PHD levels) and to aid in the transition to professionally competent and integrated community services. Psychiatric rehabilitation personnel have a community integration-related base, support recovery and skills-based model of mental health, and may be involved with community programmes based upon normalisation and social role valourisation throughout the US. Psychiatric rehabilitation personnel have been involved in upgrading the skills of staff in institutions in order to move clients into community settings. Most common in international fields are community rehabilitation personnel which traditionally come from the rehabilitation counselling or community fields. In the new “rehabilitation centres” (new campus buildings), designed similar to hospital “rehab” (physical and occupational therapy, sports medicine), often no designated personnel in the fields of mental health (now “senior behavioural services” or “residential treatment units”). Psychiatric rehabilitation textbooks are currently on the market describing the community services their personnel were involved within community development (commonly known as deinstitutionalisation).
Psychiatric rehabilitation professionals (and psychosocial services) are the mainstay of community programs in the US, and the national service providers association itself may certify mental health staff in these areas. Psychiatric interventions which vary from behavioural ones are described in a review on their use in “residential, vocational, social or educational role functioning” as a “preferred methods for helping individuals with serious psychiatric disabilities”. Other competencies in education may involve working with families, user-directed planning methods and financing, housing and support, personal assistance services, transitional or supported employment, Americans with Disabilities Act (ADA), supported housing, integrated approaches (e.g. substance use, or intellectual disabilities), and psychosocial interventions, among others. In addition, rehabilitation counsellors (PhD, MS) may also be educated “generically” (breadth and depth) or for all diagnostic groups, and can work in these fields; other personnel may have certifications in areas such as supported employment which has been verified for use in psychiatric, neurological, traumatic brain injury, and intellectual disabilities, among others.
Social Worker
Social workers in the area of mental health may assess, treat, develop treatment plans, provide case management and/or rights advocacy to individuals with mental health problems. They can work independently or within clinics/service agencies, usually in collaboration with other health care professionals.
In the US, they are often referred to as clinical social workers; each state specifies the responsibilities and limitations of this profession. State licensing boards and national certification boards require clinical social workers to have a master’s or doctoral degree (MSW or DSW/PhD) from a university. The doctorate in social work requires submission of a major original contribution to the field in order to be awarded the degree.
In the UK there is a now a standardised three-year undergraduate social work degree, or two-year postgraduate masters for those who already have an undergraduate social sciences degree or others and relevant work experience. These courses include mandatory supervised work experience in social work, which may include mental health services. Successful completion allows an individual to register and work as a qualified social worker. There are various additional optional courses for gaining qualifications specific to mental health, for example training in psychotherapy or, in England and Wales, for the role of Approved Mental Health Professional (two years’ training for a legal role in the assessment and detention of eligible mentally disordered people under the Mental Health Act (1983) as amended in 2007).
Social workers in England and Wales are now able to become Approved Clinicians under the Mental Health Act 2007 following a period of further training (likely at postgraduate degree/diploma or doctoral level). Historically, this role was reserved for psychiatrist medical doctors, but has now extended to registered mental health professionals, such as social workers, psychologists and mental health nurses.
In general, it is the psycho-social model rather than, or in addition to, the dominant medical model, that is the underlying rationale for mental health social work. This may include a focus on social causation, labelling, critical theory and social constructiveness. Many argue social workers need to work with medical and health colleagues to provide an effective service but they also need to be at the forefront of processes that include and empower service users.
Social workers also prepare social work administration and may hold positions in human services systems as administration or Executives to Administration in the US. Social workers, similar to psychiatric rehabilitation, updates its professional education programmes based upon current developments in the fields (e.g. support services) and serve a multicultural client base.
Educational Requirements for Social Workers
In the United States, the minimum requirement for social workers is generally a bachelor’s degree in social work, though a bachelor’s degree in a related field such as sociology or psychology may qualify an applicant for certain jobs. Higher-level jobs typically require a master’s degree in social work. Master’s programs in social work usually last two years and consist of at least 900 hours of supervised instruction in the field. Regulatory boards generally require that degrees be obtained from programmes that are accredited by the Council of Social Work Education (CSWE) or another nationally recognised accrediting agency for promotion and future collaboration.
Before social workers can practice, they are required to meet the licensing, certification, or registration requirements of the state. The requirements vary depending on the state but usually involve a minimum number of supervised hours in the field and passing of an exam. All states, except California, also require pre-licensure from the Association of Social Work Boards (ASWB).
The ASWB offers four categories of social work license. The lowest level is a Bachelors, for which a bachelor’s degree in social work is required. The next level up is a Masters and a master’s degree in social work is required. The Advanced Generalist category of social worker requires a master’s degree in social work and two years of supervised post-degree experience. The highest ASWB category is a Clinical Social Worker which requires a master’s degree in social work along with two years of post-master’s direct experience in social work.
Continuing Education Requirements for Social Workers
Most states require social workers to acquire a minimum number of continuing education credits per license, certification, or registration renewal period. The purpose of these requirements is to ensure that social workers stay up-to-date with information and practices in their professions. In most states, the renewal process occurs every two or three years. The number of continuing education credits that is required varies between states but is generally 20 to 45 hours during the two- or three-year period prior to renewal.
Courses and programs that are approved as continuing education for social workers generally must be relevant to the profession and contribute to the advancement of professional competence. They often include continuing education courses, seminars, training programs, community service, research, publishing articles, or serving on a panel. Many states enforce that a minimum amount of the credits be on topics such as ethics, HIV/AIDs, or domestic violence.
Psychiatric and Mental Health Nurse
Psychiatric Nurses or Mental Health Nurse Practitioners work with people with a large variety of mental health problems, often at the time of highest distress, and usually within hospital settings. These professionals work in primary care facilities, outpatient mental health clinics, as well as in hospitals and community health centres. MHNPs evaluate and provide care for patients who have anything from psychiatric disorders, medical mental conditions, to substance abuse problems. They are licensed to provide emergency psychiatric services, assess the psycho-social and physical state of their patients, create treatment plans, and continually manage their care. They may also serve as consultants or as educators for families and staff; however, the MHNP has a greater focus on psychiatric diagnosis (typically the province of the MD or PhD), including the differential diagnosis of medical disorders with psychiatric symptoms and on medication treatment for psychiatric disorders.
Educational Requirements for Psychiatric and Mental Health Nurses
Psychiatric and mental health nurses receive specialist education to work in this area. In some countries, it is required that a full course of general nurse training be completed prior to specialising as a psychiatric nurse. In other countries, such as the UK, an individual completes a specific nurse training course that determines their area of work. As with other areas of nursing, it is becoming usual for psychiatric nurses to be educated to degree level and beyond. Psychiatric aides, now being trained by educational psychology in 2014, are part of the entry-level workforce which is projected to be needed in communities in the US in the next decades.
In order to become a nurse practitioner in the US, at least six years of college education must be obtained. After earning the bachelor’s degree (usually in nursing, although there are master’s entry level nursing graduate programs intended for individuals with a bachelor’s degree outside of nursing) the test for a license as a registered nurse (the NCLEX-RN) must be passed. Next, the candidate must complete a state-approved master’s degree advanced nursing education program which includes at least 600 clinical hours. Several schools are now also offering further education and awarding a DNP (Doctor of Nursing Practice).
Individuals who choose a master’s entry level pathway will spend an extra year at the start of the programme taking classes necessary to pass the NCLEX-RN. Some schools will issue a BSN, others will issue a certificate. The student then continues with the normal MSN programme.
Mental Health Care Navigator
A mental health care navigator is an individual who assists patients and families to find appropriate mental health caregivers, facilities and services. Individuals who are care navigators are often also trained therapists and doctors. The need for mental health care navigators arises from the fragmentation of the mental health industry, which can often leave those in need with more questions than answers. Care navigators work closely with patients through discussion and collaboration to provide information on options and referrals to healthcare professionals, facilities, and organisations specialising in the patients’ needs. The difference between other mental health professionals and a care navigator is that a care navigator provides information and directs a patient to the best help rather than offering diagnosis, prescription of medications or treatment.
Many mental health organisations use “navigator” and “navigation” to describe the service of providing guidance through the health care industry. Care navigators are also sometimes referred to as “system navigators”. One type of care navigator is an “educational consultant.”
Workforce Shortage
Behavioural health disorders are prevalent in the United States, but accessing treatment can be challenging. Nearly 1 in 5 adults experience a mental health condition for which approximately only 43% received treatment. When asked about access to mental health treatment, two-thirds of primary care physicians reported that they were unable to secure outpatient mental health treatment for their patients. This is due, in part, to the workforce shortage in behavioural health. In rural areas, 55% of US counties have no practicing psychiatrist, psychologist, or social worker. Overall, 77% of counties have a severe shortage of mental health workers and 96% of counties had some unmet need. Some of the reasons for the workforce shortage include high turnover rates, high levels of work-related stress, and inadequate compensation. Annual turnover rate is 33% for clinicians and 23% for clinical supervisors. This is compared to an annual PCP turnover rate of 7.1%. Compensation in behavioural health field is notably low. The average licensed clinical social worker, a position that requires a master’s degree and 2,000 hours of post-graduate experience, earns $45,000/year. As a point of reference, the average physical therapist earns $75,000/year. Substance abuse counsellor earnings are even lower, with an average salary of $34,000/year. Job stress is another factor that may lead to the high turnover rates and workforce shortage. It is estimated that 21-67% of mental health workers experience high levels of burnout including symptoms of emotional exhaustion, high levels of depersonalisation and a reduced sense of personal accomplishment. Researchers have offered various recommendations to reduce the critical workforce gaps in behavioural health. Some of these recommendations include the following: expanding loan repayment programmes to incentivise mental health providers to work in underserved (often rural) areas, integrating mental health into primary care, and increasing reimbursement to health care professionals.
Social workers also tend to experience competing for work and family demands, which negatively affects their job well-being and subsequently their job satisfaction, resulting in high turnover in the profession.
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