Clinical Psychology

What is Clinical Psychology?

For my post this week, I thought I would talk a bit about something that I get asked at least once a
day. Clients, especially in my NHS job, always want to know exactly what it is that I do, and what
it means to be a clinical psychologist. If I'm honest, I often struggle to answer them - it's hard to
distill down exactly what I do into a snappy sound-bite, because psychology is quite complicated.
But just for you, I'm going to try to explain what it is that clinical psychologists do, to give you
more of an idea of what you might get from seeing a psychologist. This is by no means an
exhaustive post, but it's a start.
Sometimes the best way to explain something is with a good old definition! Wikipedia defines
clinical psychology as:
"...an integration of science, theory and clinical knowledge for the purpose of understanding,
preventing, and relieving psychologically-based distress or dysfunction and to promote subjective
well-being and personal development."

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

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

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

Clinical psychologists are not psychiatrists

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

Clinical psychologists are not counsellors

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

Clinical psychologists are not life coaches

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

A note on protected titles

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

Yeah, okay but, what do you actually do?

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

Clinical psychology: mental health

If you are struggling with your mental health, I'd be happy to talk to you to find out if we can work
together to help you feel better. The kinds of difficulties I tend to work with are things like low mood,
anxiety (either about specific things or more generally), problems with relationships, difficulties that can
arise when people are thinking about their gender and sexuality, and more general things like stress
management. I'm happy to meet with you for a one-off discussion, and will never pressure you in to
signing up to more therapy sessions, or doing anything that makes you feel uncomfortable without
explaining fully why it might be necessary.

Clinical psychology: physical health

As previously mentioned I am a physical health specialist. If you are struggling with chronic pain
(including conditions such as fibromyalgia, chronic back pain, nerve pain, and migraines/headaches)
CFS/ME, diabetes, HIV, cancer or other physical health conditions, we can talk about how to manage
them differently to help you to do the things you want to do. Please note that with conditions such as
chronic pain and CFS/ME talking about your difficulties, and changing the way you do things so that your
health condition has less of an impact on your functioning, won't take away your pain or fatigue. I can
also help you to manage the knock-on effects of your health condition such as sleep difficulties,
communication problems, or difficulties managing stress.

Financial therapies
Do you spend a lot of your time wondering why you can't meet your financial goals? Why you try to save
money but end up using your credit card more often? If so, we can look at the reasons that this keeps
happening to you. This will involve using cognitive behavioural skills to think about your beliefs and
attitudes towards money, the cycles of spending you tend to get into, and how to break bad habits
when it comes to money. Please note that I can't advise you on financial products or debt management,
and if you are in serious debt you should go here or here to try to manage this. Psychological therapy
can help to break cycles of spending related to difficult emotions, which can aid in getting out of and
staying out of debt.

Goal-setting

Whether it's fitness-related goals or activities such as stopping smoking, losing weight, or working
towards something specific in your professional life or personal life, one or two sessions with a clinical
psychologist can help you to get a better handle on the barriers to you meeting your goals. Why not get
in touch to have a think about whether we can work together to help you to become more successful in
meeting your targets and getting what you want out of life?

By: __
Dr Sarah Blackshaw: Clinical Psychologist, blogger.