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FAKULTI SAINS SOSIAL GUNAAN (FASS)

JANUARY 2018

INTRODUCTION TO CLINICAL PSYCHOLOGY

BY
PADLYALPATTANI

padlyalpatanni@gmail.com

Abstract:
As its name implies, clinical psychology is a subfield of the larger discipline of
psychology. Like all psychologists, clinical psychologists are interested in behaviour
and mental processes. Clinical psychologists generate research about human
behaviour, seek to apply the results of that research, and engage in individual
assessment. Like the members of some other professions, clinical psychologists
provide assistance to those who need help with psychological problems. The
American Psychological Association defines clinical psychology as “a clinical
discipline that involves the provision of diagnostic, assessment, treatment plan,

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treatment, prevention, and consultative services to patients of an emergency room,

inpatient units, and clinics of hospitals”. Another definition given by the Canadian
Psychological Association sees it as a broad field of practice and research within the
discipline of psychology applying psychological principles to the assessment,
prevention, amelioration, and rehabilitation of psychological distress, disability,
dysfunctional behaviour, and health-risk behaviour, and to the enhancement of
psychological and physical well-being. As you can see, the definition focuses on the
integration of science and practice, the application of this integrated knowledge across
diverse human populations, and the purpose of alleviation human suffering and
promoting health.

Content:-

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1.0 Introduction.

2.0 Role of the clinical psychologist in his/her workplace.

3.0 A weekly routine of a clinal psychologist.

4.0 Challenges faced by the clinical psychologist in his/her workplace.

5.0 How do clinical psychologists maintain the balance of work and life?

6.0 The clinical psychologist’s perspective of the world in encountering much

negativity in his/her cases or workload.

7.0 Summary.

8.0 References.

1. Introduction.

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As its name implies, clinical psychology is a subfield of the larger discipline of

psychology. Like all psychologists, clinical psychologists are interested in behaviour
and mental processes. Clinical psychologists generate research about human
behaviour, seek to apply the results of that research, and engage in individual
assessment. Like the members of some other professions, clinical psychologists
provide assistance to those who need help with psychological problems. The
American Psychological Association defines clinical psychology as “a clinical
discipline that involves the provision of diagnostic, assessment, treatment plan,
treatment, prevention, and consultative services to patients of an emergency room,
inpatient units, and clinics of hospitals”. Another definition given by the Canadian
Psychological Association sees it as a broad field of practice and research within the
discipline of psychology applying psychological principles to the assessment,
prevention, amelioration, and rehabilitation of psychological distress, disability,
dysfunctional behaviour, and health-risk behaviour, and to the enhancement of
psychological and physical well-being. As you can see, the definition focuses on the
integration of science and practice, the application of this integrated knowledge across
diverse human populations, and the purpose of alleviation human suffering and
promoting health.

Clinical psychology is a field of study that has been well practised in Western
countries. However, in Malaysia, the government and the public have only begun to
recognise the growing needs for clinical psychology. It is a fairly new profession in
Malaysia, appearing in the mid-1980s in practice and academic training (Ng, Teoh, &
Haque, 2003). Being a fledgeling profession, there are many trials and tribulations in
its development, especially within the mental health arena. Some common issues for
clinical psychology include misunderstanding of its roles, the lack of training and
human resources, as well as its inclusion within the mainstream mental health services
(Ng,2007a). Parameshvara Deva (2004) reports that clinical psychologists, among
other mental health professionals, are severely lacking in Malaysia. A World Health
Organisation (WHO) report on mental health in Southeast Asia also states that
Malaysia has a ratio of only 0.05 psychologists per population count of 100,000
compared with Indonesia (0.3 per 100,000), the Philippines (0.9 per 100,000),

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Singapore (1.0 per 100,000), and Thailand (0.2 per 100,000) (Maramis, Nguyen, &
Minas, 2011). This shows how Malaysia is lagging behind its neighbour with regard
to clinical psychologists’ to the population. In Malaysia, the mental health scene has
been traditionally managed by psychiatrists. From the late 1990s onward, the
counselling profession has been made a complementary service to address mental
health issues. Haque (2005) clearly states that, in Malaysia, the mental health should
not be confined to psychiatry but must have a multifaceted approach that includes,
among others, clinical psychologists. Clinical psychology services are needed to fill
the gap that counsellors and psychiatrists are not able to fill. Clinical psychology
services include psychological assessments, diagnoses and psychological
interventions not just for psychiatric patients but also for other groups of patients from
other groups of patients from other medical and health departments. Rahmatullah
Khan (2008) highlights the roles and potentials of clinical psychologists apart from
being within the psychiatric setting in Malaysia. Some of the roles mentioned by
Khan include the application of clinical psychology within specialized health-care
departments such as paediatrics, oncology, and surgery. With regard to behaviour
management, clinical psychologists also play a significant role in behaviour
evaluation and modification for children as well as adults with or without special
needs. As identified by Ng et al. (2003), other needs for clinical psychologists are a
consultation for public health campaigns, research, academic programme evaluation
and development, as well as policymaking. Given their various roles and increased
demand in the country, there is also a great need to address the practical issues and
challenges that are facing the clinical psychology profession. From the author’s
experience, clinical psychologists are becoming more sought after for various
activities such as community service talks, multidisciplinary research projects,
employee assistance programme and consultancies for various government and non-
government agencies.

2. Role of the clinical psychologists in his/her workplace.

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Let us consider in more detail some of the activities or roles that clinical psychologists
pursue, the variety of places in which they are employed, the array of clients and
problems on which they focus their attention, and the rewards of the job. About 95%
of all clinical psychologists spend their working lives engaged in some combination
of six activities: assessment, treatment, research, teaching (including supervision),
consultation, and administration.

(a) Provision of Assessment.

Clinical psychologists assess patients using a variety of method to collect

information about people. This information may be used to diagnose problematic
behaviour, to guide a client toward an optimal vocational choice, to facilitate
selection of job candidates, to describe a client’s personality characteristics, to
select treatment techniques, to guide legal decisions regarding the
commitment of individuals to institutions, to provide a more complete picture of a
client’s problem, to screen potential participants in psychological research
projects, to establish pre-treatment baseline levels of behaviour against which to
measure post-treatment, and for literally hundreds of other purposes.

(b) Provision of Treatment.

Clinical psychologists offer treatments designed to help people better understand

and solve distressing psychological problems. These interventions are known as
psychotherapy, behaviour modification, psychological counselling, or other
terms, depending on the theoretical orientation of the clinician.

(c) Conducting Research.

By training and by tradition, clinical psychologists are research oriented. For

most of the first half of its existence, the field was strongly dominated by research
rather than by application. Although that balance has changed, research continues
to play a vital role in clinical psychology. Examples of their research activities
include; the development and standardization of clinical tools for diagnostic
assessment tests and examination of their reliability and validity, adapting and
testing the efficacy of both psychological and biological interventions to promote

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health and overcome disorders, studies to reveal the cultural and cross-cultural
aspects of psychological abnormalities, ascertaining the impact of both positive
and negative human behaviour on the physical health, and supervising projects,
thesis and dissertations of candidates whose researchers have psychological
components.

(d) Provision of Teaching.

A considerable portion of many clinical psychologists’ time is spent in

educational activities. Clinicians who hold full-or part-time academic positions
typically teach undergraduate and graduate courses in areas such as personality,
abnormal psychology, introductory clinical psychology, psychotherapy,
behaviour modification, interviewing, psychological testing, research design, and
clinical assessment. Clinical psychologists also do a lot of teaching in the context
of in-service (on-the-job) training of psychological, medical, or other interns,
social workers, nurses, institutional aides, ministers, police officers, teachers,
administrators, and many other groups whose vocational skills might be enhanced
by increased psychological sophistication.

(e) Consultation.

Clinical psychologists often provide advice to organizations about a variety of

problems. These activities, known as consultation, combines aspects of research,
assessment, treatment, and teaching. Organizations that benefit from consultants’
expertise range in size and scope from one-person medical or law practices to
huge government agencies and multinational corporations.

(f) Administration.

Many clinical psychologists find themselves engaged in managing or running the

daily operations of organizations. For examples of the administrative posts held
by clinical psychologists include the head of a college or university psychology
department, director of a graduate training program in clinical psychology.
Director of a student counselling centre and many other positions. Administrative

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duties tend to become more common as clinicians move through their

professional careers.

3. The weekly routine of clinical psychologists day-to-day activities.

The work settings that clinical psychologists choose strongly influence how they
distribute their time across professional activities. But so do their training, individual
interests, and areas of expertise. In short, what clinicians do and where they do it has
always depended and always will depend on situational demands, cultural values,
changing political climates, and the pressing needs of the society in which they
function.

A week in the life of a qualified clinical psychologist.

An interview report.

Dr Daniel Seal (dan@psychologist.com.my) from the UK. Hold a Doctorate in

Clinical Psychology from University College London, a Masters in Mental Health
Services Research from King’s College London and an Honours degree in
Psychology. He lives and works in Kuala Lumpur, Malaysia. He has managed time
between private practice, supervising clinical work at a local university hospital and
running projects at UNHCR. From December 2013 until September 2017, he taught at
the University of Nottingham’s Malaysia Campus and currently, an Honorary
Assistant Professor at the university. What he does on a day-to-day basis can vary
hugely.

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Monday:

He typically spends the day from 9 am until 5 pm at Prince Court Medical Centre
which is a private hospital near the centre of Kuala Lumpur. Once a month, he goes to
a meeting where he reviews the children in all the local children’s homes. He
sometimes attends school meetings, sees individual children who are in foster or
adoptive families or do one-off assessments, and score questionnaires that we use to
screen mental health needs.

Tuesday:

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He spends working on projects for the UN’s refugee agency here in Malaysia. He
often attends professionals meetings or case conferences. Dr Daniel sometimes does
psychometric assessments of young people with complex needs and collecting some
of these for research purposes.

Wednesday:

Dr Dan Seal offers consultation appointments in the morning to professionals working

with adoption in a social service base. He meets the social workers, link worker or
other professional but sometimes he does one-off sessions with adoptive or foster
carers, or assessment of children to advise on their placement needs. There are usually
two or three appointments, plus a short meeting with the permanence team manager.
In the afternoon, he does a joint clinic with a consultant psychiatrist where we
consider cases is likely to be a neuro-developmental component, such as ASD. This
leads to a lot of follow-up psychometry. He sees two or three cases in the joint clinic,
using a room in the hospital outpatients department.

Thursday:

He works in clinical work and consultancy at the University of Malay’s Medical

Centre. He often attends professionals meetings or case conferences. Dr Daniel
sometimes does psychometric assessments of young people with complex needs and
collecting some of these for research purposes.

Friday:

Dr Dan Seal sees clients for psychometric assessment and or therapy follow-up
appointments in the morning. Once a month, he meets colleagues for a journal
club/peer supervision lunch. He then spends some time keeping on top of her research
and working on disseminating the results. He also tries to do some admin and respond
to emails and telephone messages.

Generally, the work from 9.30am until 5.30pm. He has some flexibility in exactly
how he configures his hours. His appointments with clients typically last about an
hour. He thinks almost all clinical psychologists do some supervision, consultation

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and or teaching, assessment and administration, so it is good not to forget about these
skills when you detail your experience on clinical course applications. However, the
core work is often seen as the clinical role, both in terms of direct client work and
indirect work. He thinks people naively assume that clinical work is only the face to
face stuff, but he does assessment, formulation and intervention with clients. The
great thing about working as a clinical psychologist according to him is that you are in
a very privileged position and often told information that no- one else in the family
may know. The difficulties are that it is emotionally very demanding and that you get
to see what he called “the dark side’ of life. Some people go through their lives
without ever really believing some of that stuff happens in our world. Personally, he
loves what he does, and particularly love the variety of working with children. It is a
job he recommends, but realise that it is not the job for everyone.

4. Challenges faced by the clinical psychologist in his/her workplace.

As seen from history, many clinical psychologists are based in universities all over
Malaysia while others are in private practice and hospital settings. Given this rising
number of clinical psychologists, issues of professional regulation and clinical
training need to be addressed for future development of the profession. Other issues
include the application of Western ideas in the practice of clinical psychology such as
cognitive-behaviour therapy and psychodynamic psychology within the Malaysia
setting, as well as the overlap in job definitions between psychiatrists, counsellors and
counselling psychologists, which sometimes lead to confusion among other
professionals and the public. This next section then presents the issues facing clinical
psychology as a growing profession in Malaysia.

(a) Cultural validity in clinical practice.

Much of clinical psychology training in Malaysia is based on Western

psychology. Jusmawati et al. (2005) discuss this issue with regard to the use of
English in psychological tests and assessments. Many of these tests are not
applicable to individuals who do not understand English, especially verbal-based

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cognitive tests or reading tests. Furthermore, some of the approaches for

intervention that originated from Western psychology may not necessarily apply
within ethnic cultures of Malaysia. Applied indigenous psychology is still in its
infancy in Malaysia since research on it has not really developed.

(b) Professional Regulation.

A professional body needed to regulate the profession while working closely with
the government in providing consultations with regard to human resource and
clinical training. This type of relationship is still in its infancy in Malaysia given
that MSCP was only registered in July 2010. However, the establishment of
MSCP is considered a major step to regulate and develop the profession. Once
clinical psychologists are regulated under an act, services rendered such as
assessments, diagnosis and therapy would be better recognised as valid within the
health-care system.

(c) Prescribing rights for the Clinical Psychologist.

Under the current practice, only medical doctors are allowed to endorse or
validate application forms for the Welfare Card because clinical psychologists do
not have legally regulated professional and licensing. So, while clinical
psychologists carry out the assessments to support diagnoses, medical doctors
endorse applications based on the psychological assessment reports, among other
relevant reports. When licensed clinical psychologists can be recognised as
clinical professionals to recommend diagnoses, then the process of acquiring the
Welfare Card can be made more efficient and valid. With regard to public safety
and professional regulation, the risk of litigation would increase with the
acknowledgement of clinical psychology as a clinical profession. Therefore,
professional indemnity insurance would be warranted to protect the practitioner.

(d) A clinical threat of Pseudoscience in the practice of Clinical Psychology in

Malaysia.

Training in clinical psychology emphasizes the scientist-practitioner method

whereby therapy approaches are based on empirical evidence, as in the medical

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practice. The lack of clinical research in Malaysia leads local clinical

psychologists to rely on Western models of intervention to manage their cases.
This lack of literature on indigenous applications and meta-analysis of efficacy
studies on the local population makes it difficult for local practitioners to base
their therapy approaches on existing Malaysia studies. Given the difficulty of
cross-cultural application due to differences in concepts of causes and prescribed
treatment of mental disorders and similar conditions, local clinical psychologists
may resort to pseudoscience or pre-scientific practice. This is a presupposed issue
since recent reports on studied in the USA have revealed that licensed clinical
psychologist practitioners there are largely pre-scientific, seemingly preferring to
base their treatment methods on clinical experiences over scientific evidence
(Baker, McFall,& Shoham,2009).

5. How does this clinical psychologist maintain the balance of work and life?

Managing both your personal and professional lives requires some effort and
planning, but the rewards are worth it. No matter how sound the system or how
smooth a person’s ability to juggle everything, inevitably challenges arise. For
instance, our own beliefs can be sabotaging. Take the worry of unplugging. Many
people fret that they are somehow missing out on something important. Work-life is a
never-ending topic of discussion among psychologists. They constantly discuss how
to juggle career advancement, marriage, and children. Achieving balance is easier said
than done in many respects. Psychologists feel a deep sense of duty and professional
responsibility to their clients, and even the best-laid plans for leisure time or to reflect
may be interrupted or hard to keep. Still, psychologists have ways to practice the same
habits and activities, they had recommended to clients. It may take time to balance the
scales of professional and personal life, so the important thing is to keep at it and
always be honest with yourself.

(a) Know the signs of burnout.

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Burnout, the dreaded ultimate fatigue, is not uncommon among mental health
professionals who exhaust their mental, emotional, and physical capacities to care
or and treat clients on a day-to-day basis. Fortunately, research has found that
clinical psychologists have lower levels of burnout when compared to other
mental health disciplines. Awareness of the sign of burnout will help
psychologists establish and maintain healthy habits to prevent deep dissatisfaction
that can negatively affect clients, career longevity, and familial relationships.

(b) Set boundaries, but maintain flexibility.

Sometimes, psychologists need to be able to say no, which can be particularly

challenging when working with clients who struggle with excessive dependency
and consequently push boundaries.Conservations with clients that establish clear
expectations and roles from the beginning of any counselling relationship are
reflective of following best practice. One of many important benefits of
monitoring psychologist/client boundaries is the increased likelihood that
psychologists will remain mindful of personal priorities and safe-care.

(c) Exercise or meditate.

Psychologists are often the first to advise their clients to practice healthier habits.
Exercise has the double benefit of helping generate gains in physical as well as
mental shape. Remember, exercise does not begin and end with running a mile or
two a day. It is important to find a type of sustainable exercise that you enjoy
such as efforts like a spin class to less demanding options like swimming, yoga,
taking the stairs and even posture exercise. Meditation fits in here, as well.
Similar to exercise, proper meditation does not require you to be of any advanced
level; closing your eyes in a darkened room for 15 minutes and letting all the
hectic thoughts flush away as you focus on a single question or mantra can help
centre your mine.

(d) Have a support network.

No psychologist is an island, and working professionals need companionship.

Having a support network drawn from all spheres of life (family, friends,

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colleagues, peers) will ensure a psychologist has someone to depend and lean on.
Loved ones can do their own part to help psychologists get through whatever
obstacle, they are facing. A consultation with qualified mental health peer is an
example of tapping into a support network. Spending time with family or friends
will often help distract from the workload.

Again, achieving a “work-life balance” will look different for everyone. The key is
finding what is most important to you and no doubt having a good planner.

6. The clinical psychologist’s perspective of the world in encountering much

negativity in his/her cases or workload.

The practice of clinical psychologist involves assessing, diagnosing, and treating

mental health disorders, stress, relationship problems and other issues in individuals,
couples, families and groups. Although they are specially trained to help clients
through difficult and trying moments, clinical psychologists are only human, and not
immune to the some of the emotional stressors inherent to their jobs.

(a) Personal Issues.

Clinical psychologists have lives outside of their professional practices. They deal
with personal issues, such as loss, relationship problems, and stress, just like
anyone else. The interaction between personal issues and professional practice
can be a significant cause of emotional stress, especially in times of acute crisis.
The American Psychological Association’s Ethical Principles of Psychologists
and Code of Conduct points out that psychologists should not engage in the
practice if they feel that their personal problems will affect their professional role.
In such cases, seeking professional supervision and consultation can help
psychologists decide whether to temporarily limit or suspend their services.

(b) Professional Isolation.

Professional isolation can be a source of stress for some psychologists, according

to the Board of Professional Affairs’ Advisory Committee on Colleague

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Assistance of the APA. Clinical psychologists in private may not have the
opportunity to talk to other professionals during the normal course of their
workdays. Professional isolation can cause frustration and result in feeling out of
touch with development in the field, especially if psychologists do not seek out
chances to discuss in peer supervision or attend professional conferences or refer
to a professional body like APA.

(c) Demands of Practice.

In addition to treating patients, clinical psychologists may also face emotional

stress from the business aspects of running their practices. Some of the
business-related demands clinical psychologists often need to attend to include
patient scheduling, billing, insurance and managed care demands, decreased
revenue and paying rent on office space. Depending on their area of practice and
location, some psychologists may experience stress from having too many clients
and needing to turn away referrals, while others may struggle with obtaining
referrals and dealing with low caseloads.

(d) Compassion Fatigue.

Compassion fatigue is the term used to refer to a type of secondary stress disorder
that results from experiencing empathy and identifying with clients going through
emotional upheaval and trauma. Even though they are trained to handle these
issues, they can still become stressed by feelings of intense compassion and
empathy. Compassion fatigue can result in symptoms of burnout and stress, such
as insomnia, depression, and dizziness.

7. Summary.

Clinical psychology is the largest single subfield within the larger discipline of
psychology. It involves research, teaching, and other services designed to understand,
predict, and alleviate maladjustment and disability. To become a licensed clinical
psychologist, one must meet certain educational, legal, and personal qualification. In

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Malaysia, clinical psychology has had a history of almost 30 years, and yet it is still a
struggling mental health profession with regard to recognition, professional practice,
research, and training. Given the gradually increasing acknowledgement of the need
for clinical psychologists and the increasing diversity of the population in need of
mental care is very much needed to improve the validity of approach with regard to
clinical assessment, diagnoses and treatment within a multicultural and multilingual
society found in Malaysia. Clinical psychologists face numerous challenges, not the
least of which is that most people with psychological problems still do not receive
treatment. Other factors shaping the discipline involve, among other issues, decisions
about how science and practice should be conducted, how the various theoretical
approaches can be integrated and how the current and future systems of health care
delivery affect the practice of clinical psychology. At the same time, clinical
psychology also needs to work together with counselling in spearheading the
development of the psychology discipline to facilitate growth in other applied
psychology professionals in the country. Internationalisation is seen as a way to be
updated on global trends in the evolution of the profession. But, first, the profession
needs to build itself up by focusing on fundamental growth issues such as human
resources, training, regulation and professional practice competency issues.

(3852 Words)

8.0 References.

American Psychological Association (1993). Guidelines for Providers of

Psychological Services to Ethnic, Linguistic, and Cultural Diverse Populations.
American Psychologist, 48, 45-48.

Ansari, Z. A., Noor, N. M., & Haque, A. (2005). Psychology in Malaysia: Looking
ahead. In Z. A., Noor, N. M., & A. Haque (eds.). Contemporary issues in Malaysia
psychology (pp. 285-296). Singapore: Thomson Learning.

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Baker, T. B., McFall, R. M., & Shoham, V. (2009). Current status and future prospects
of clinical psychology: Toward a scientifically principled approach to mental and
behavioural health care. Psychological Science in the Public Interest, 9,67-103.

Haque, A. (2005). Mental health concepts and program development in Malaysia.

Journal of Mental Health, 14, 183-195.

Jusmawati, F., Ansari, Z. A., Rahmatullah Khan, A. W. K (20015). Patterns of

psychological test usage in Malaysia. In Z. A. Ansari, N. M. Noor, & A. Haque (Eds.)
Contemporary issues in Malaysia psychology (pp. 265-283). Singapore: Thomson
Learning.

Ng, L. O. (2007). Kajian rintis tentang kesedaran bidang psikologi klinikal di

kalangan Ahli Perubatan dan Sains Kesihatan di Malaysia. Malaysia Journal of Health
Sciences, 5, 23-30.

Parameshvara Deva, M. (2004). Malaysia mental health country profile. International

Review of Psychiatry, 16, 167-176.

Rahmatullah Khan, A. W. K. (2008). Why do we need more clinical psychologists?

Malaysia Journal of Medical Sciences, 15, 1-2.

Stamm, B. H.(1999). Secondary traumatic stress. Self-care issues for clinicians,

researchers. And educators. (2nd ed.). Baltimore: Sidran.

Tartakovsky, M. (2016). How Clinicians Balance Work and Life. Psych Central.
Retrieved on January 23, 2018, from https://psychcentral.com/lib/how-clinicians-
balance-work-and-life/

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