Why is Clinical Psychology Considered a Science?, A Brief Investigation

Klinik Psikoloji neden bir bilim kabul edilmektedir sorusu ve bu alanın teorik, pratik özelliklerinin tarihsel süreçte nasıl geliştiği, günümüzde İngiltere, Amerika gibi ülkelerde ne gibi düzenlemelere tâbi olduğu üzerine kaleme aldığım bir makale

Resim: Francisco Goya, The Sleep of Reason Produces Monsters, 1799

key words: clinical psychology, reflective-scientist practitioner model, theory and practice

11.08.2022

What is Clinical Psychology?

Clinical Psychology, according to American Psychological Association (APA), is the specialty of psychology which provides persistent and comprehensive mental and behavioural healthcare both for the individuals and families. Therapeutic intervention, consultation, training, education, and supervision are within its research-based practice. The research-based practice of this branch of psychology is more interested with the psychopathological circumstances of an individual. Thus, clinical psychology uses advanced scientific knowledge and theoretical knowledge while assessing and formulating the psychological problems of individuals.

Practising as a Clinical Psychologist

Given its research-based scope, the education process of clinical psychology was structured according to this scientific point of view. Thus, there are several educational and legal requirements for practising as a clinical psychologist (Llewelyn, S., & Murphy, D., 2014). Today, in the UK, all the clinical psychology training programmes are doctoral courses. These doctoral programmes include undertaking clinical research. Also, the title ‘Clinical Psychologist’ is protected by UK law as the other six practitioner psychologist titles. Practicing as a clinical psychologist was protected by law. After the successful completion of doctoral course, candidates can register to the Health and Social Care Professionals Council (HCPC) as a clinical psychologist.

Why is the Practice of Clinical Psychology Research-Based?

In history, the practice of psychology was affected by the common usage of psychometrics and the protective principles of mental hygiene movement in USA (Llewelyn, S., & Murphy, D., 2014). The influence of psychometrics was resulted with the emergence of the discipline ‘experimental psychology’. Then, the emergence of experimental psychology developed the new practical ways of psychological intervention (Llewelyn, S., & Murphy, D., 2014). Additionally, in 1908, a man named Clifford Beers founded the mental hygiene movement in USA, because of he has witnessed and experienced maltreatment while hospitalised. Starting from 1920s, as an awareness of this movement, the mental hygienists supported the therapeutic treatment of children with the goal of protection and intervention (Llewelyn, S., & Murphy, D., 2014).

Also, in the UK, a clinic only for children’s mental health was founded at the Tavistock Hospital in 1926. Doctors, social workers and psychologists were recruited for this clinic. The psychologists were conducting psychological tests and evaluating the intelligence characteristics of the children (Llewelyn, S., & Murphy, D., 2014).

At the beginning, the psychology practice was mainly focused on children rather than adults. In 1904, the French Ministry of Education was asked psychologist Alfred Binet to develop a standardized test to identify the children who needs education support. And the Binet-Simon Scale was structured being the world’s first intelligence test. Thereafter, American psychologists Lewis Terman and Robert Yerkes adopted Binet’s scale to applying it on a large scale to adults. This version of the test was used on the recruitment process of the US army (Llewelyn, S., & Murphy, D., 2014), which was precisely showing the applied use of psychometrics. During this period, the academic psychology was mainly supported the military issues. However, after the war, the National Health Service (NHS) was founded in UK, and it was the first time the psychologists can formally found a new profession, which was clinical psychology.

From the first emergence of clinical psychology, several different perspectives have influenced the nature of the profession, both in UK and USA. Although, in UK, at famous British psychiatric hospital Maudsley, the behavioural and later cognitive-behavioural model was appeared. And it was influenced the overall psychiatric perspective in the UK (Llewelyn, S., & Murphy, D., 2014). Initially, clinical responsibility of the psychologists at Maudsley was only to conduct psychometric tests. A psychologist Hans Eysenck, the head of psychology department at Maudsley back then, argued that the therapeutic approach is not consistent with the scientific discipline like psychology, promoting only psychometric testing for psychologists’ responsibility (Llewelyn, S., & Murphy, D., 2014; Lane, D., A., & Corrie S., 2006). However, with the developing person-centred perspective, a clinical practice based on the single case experimental method was emerged. At first, this practice was limited only with the diagnosis process, but the classical conditioning theory shown by Pavlov and other behavioural perspectives suggested an opportunity to apply this approach as intervention (Llewelyn, S., & Murphy, D., 2014; Lane, D., A., & Corrie S., 2006). Thus, in 1958, Hans Eysenck at the Royal College of Psychiatry, explained the new appearing field of behavioural therapy and suggested an intervention style that the psychologists should modify learned unhelpful responses of the patients, while the psychiatrists should focus on the disease processes. Later, two clinical psychologists from the Maudsley Hospital, H. Gwynne Jones and Vic Meyer, developed a behavioural therapy technique consisted of the learning theory to treat anxiety disorders (Llewelyn, S., & Murphy, D., 2014). This historical development and the later integration of science and practice in the field of clinical psychology can briefly demonstrate why and how the clinical psychology is research-based. By the time, the evidenced findings of experimental psychologists’ were integrated into the clinical psychologists' intervention and therapeutic responsibilities.

What is the Current Status Between Science and Practice for Clinical Psychology?

In UK, the National Institute for Health and Clinical Excellence (NICE) was formed in 1999. It has been an important public body which is helping the integration between science and practice particularly for the health and social care sector. NICE regularly publishes evidence-based guidelines in four areas: The use of health technologies within NHS (such as new or existing medicines, treatments, and procedures), the clinical practice (guidance on evidenced treatment and care of people), the guidance on public sector workers, and the guidance for social care services and its users (nice.org.uk). In 2008, NICE was suggested a new stepped-care model. Later, the Department of Health in England funded this new programme of psychological therapies, “Increasing Access to Psychological Services (IAPT)”. The main objective of this programme was to deliver formal evidence-based psychological therapies with additional six-thousand trained psychological therapists (Llewelyn, S., & Murphy, D., 2014). The guidelines and models which are suggested by NICE could be an example of the current status of science and practice.

Furthermore, the observations and experiences of clinical practice can also be used to improve earlier theories which are supporting the interventions of the psychological disorders. Likewise, the early adaptations of classical conditioning and psychometrics have strongly influenced the scientific foundations of clinical psychology. Thus, this dynamic interaction between clinical practice and psychological research resulted with impressive development of the profession. Although, the professional identity of clinical psychologists is hotly debated in the past and even today, providing detailed, theoretically driven assessments or formulations and evidenced-based treatments for variety of patients have been the fundamental abilities of clinical psychologists since then (Llewelyn, S., & Murphy, D., 2014; Lane, D., A., & Corrie S., 2006). Also, together with this scientific approach to clinical problems, clinical psychologists helped clinical literature to develop. For some cases, the tasks carried out earlier by other groups were taken on and developed by the psychologists, for example, testing children or psychotherapy. Moreover, for some instances, they become innovators of services, for example, setting up new behavioural therapies and neuropsychological assessments (Llewelyn, S., & Murphy, D., 2014). Although their earlier work was often related with the mental health problems, today psychologists work in various healthcare environments, for example, diabetes units, burns, spinal injury, palliative care, and paediatrics, this can show the profession’s growing integration with the mainstream services and its multi-disciplinary contribution (Llewelyn, S., & Murphy, D., 2014). With the developing healthcare sector, the psychological issues are more recognised today. This is creating more opportunities and roles for psychologists to support the wellbeing of the people. These numerous new avenues for psychologists give them opportunities to application of research or evidence-based therapeutic models particularly oriented to clinical problems or phenomena (Llewelyn, S., & Murphy, D., 2014).

What is Reflective Scientist-Practitioner?

The work and responsibilities of most contemporary clinical psychologists supported by “the reflective scientist-practitioner model” (Llewelyn, S., & Murphy, D., 2014). This model was used to underpin the ability of reflexivity around the activities of clinical psychologists. The New Oxford American Dictionary explains the term reflexivity as considering the effect of personality or presence of the researcher on what is being investigated. Thus, the integration of evidence-based practice with the practitioners’ personal awareness of the context and the ethical circumstances emphasised with the reflective scientist-practitioner model (Llewelyn, S., & Murphy, D., 2014; Lane, D., A., & Corrie S., 2006). Moreover, earlier studies suggested that by being reflective about their clinical work, the clinical psychologists understand their personal impact on their work, and it was specifically effective for the development of the therapeutic relationship, mostly when psychologists felt ‘stuck’ (Fisher, P., Chew, K., & Leow, Y. J., 2015). Similarly, it was said that reflection increases the awareness of subjectivity to better understand decisionmaking process within the clinical work, this understanding helps clinical psychologists to be aware of how their assumptions resonating with the evidence-based structure of the therapy (Hanley, T., 2017). Thus, reflexivity helps clinical psychologists to maintain their science-oriented practice within their clinical work. The reflective scientist-practitioner model helps professionals to understand their role as clinicians and support the ethical standards (Fisher, P., Chew, K., & Leow, Y. J., 2015).

How Reflective Scientist-Practitioner Model Integrates Research, Theory and Practice in Clinical Psychology?

Clinical psychologists often adopt a cycle of competencies in applying reflective scientist-practitioner model. These competencies include the steps of assessment, formulation, intervention, evaluation, communication/consultation, and service development. These steps, structuring the intervention process, are all to a varying degree based on the psychological theory and empirical evidence (Llewelyn, S., & Murphy, D., 2014). In 1949, at Boulder Conference, where the scientist-practitioner model was first coined out, the professionals at the conference was suggested that the psychologist who works according to this model must consistently apply and adjust theories and practices supported by evidence within clinical practise (Llewelyn, S., & Murphy, D., 2014).

Moreover, in the conference it was suggested that the scientist part of the model not only aimed at the psychologist’s approach to ground his/her professional intervention on evidence, but also, and in fact more importantly, his/her aim to approach each client, patient, and family like a scientist might approach a research question (Lane, D., A., & Corrie S., 2006). Therefore, the clinical psychologist must choose an intervention based on a theoretical hypothesis, this intervention hypothesis may be accepted, changed to develop, or rejected depending on the therapeutic outcome (Jones, J., L., & Mehr, S., L., 2007).

Furthermore, the reflective part of the later version of the model suggests that the psychologist must be sensible of the limits of what they are offering and how the personal values and beliefs form the understanding of what needs to be provided (BPS, 2003). Thus, the clinical psychologists’ work is always subject to psychologists’ own critical observation and examination of the particular case. Alongside with the integration of what earlier research suggests, questioning the prior values and purpose of the work is also important in the manner of ethical considerations of the clinical work (Llewelyn, S., & Murphy, D., 2014).

References

BPS Clinical Psychology, (2003). Issue 27. Special Issue: Reflective Practice, 6-15. Fisher, P., Chew, K., & Leow, Y. J. (2015). Clinical psychologists’ use of reflection and reflective practice within clinical work. Reflective Practice, 16(6), 731- 743.

Hanley, T. (2017). The scientist-practitioner and the reflective-practitioner. In Counselling Psychology, Routledge, 167-182.

Jones, J., L., & Mehr, S., L., (2007). Foundations and Assumption of the Scientist-Practitioner Model. American Behavorial Scientist, Sage Publications, Vol 50(6), 766-771.

Lane, D., A., & Corrie S., (2006). The modern scientist-practitioner: A guide to practice in psychology. Routledge, E-book Edition, 1-23, ISBN: 0-203-62461-0.

Llewelyn, S., & Murphy, D., (2014). What is clinical psychology. Oxford University Press, 5th Edition, 1-36. ISBN 978–0–19–968149–5.