Psychologist

Not to be confused with Psychiatrist.
Psychologist David Lewis measures a subject’s responses to a TV commercial in the early 1980s using a specially modified EEG device.

A psychologist is a professional who evaluates and studies behavior and mental processes[1] (see also psychology). Typically, psychologists must have completed a university degree in psychology, which is a master's degree in some countries and a doctorate in others. This definition of psychologist is non-exclusive; in most jurisdictions, members of other professions (such as counselors and psychiatrists) can also evaluate, diagnose, treat, and study mental processes.[2] Some psychologists, such as clinical and counseling psychologists, provide mental health care, and some psychologists, such as social or organizational psychologists conduct research and provide consultation services.

There are many different types of psychologists, as is reflected by the 56 different divisions of the American Psychological Association (APA).[6] Psychologists are generally described as being either "applied" or "research-orientated". The common terms used to describe this central division in psychology are "scientists" or "scholars" (those who conduct research) and "practitioners" or "professionals" (those who apply psychological knowledge). The training models endorsed by the APA require that applied psychologists be trained as both researchers and practitioners,[7] and that they possess advanced degrees.

Most typically, people encounter psychologists and think of the discipline as involving the work of clinical psychologists or counseling psychologists. While counseling and psychotherapy are common activities for psychologists, these applied fields are just one branch in the larger domain of psychology.[8]

Licensing and regulation

The training and licensing of clinical psychologists ranges from 4 year undergraduate degree plus a 4 to 6 year doctorate program. Most programs in the U.S. are PhD programs that have a strong focus on research and are typically housed in universities. There are fewer programs resulting in a PsyD (doctor of psychology), many of which are in private schools and have a greater focus on treatment. There are more students enrolled in PsyD programs overall so that both degrees are about 50/50 in terms of number of students. In the UK, those training to be clinical psychologists have to complete a Doctorate in Clinical Psychology (D.Clin.Psych.), which is a practitioner doctorate with both clinical and research components. This is a three-year full-time salaried program sponsored by the National Health Service (NHS) and based in universities and the NHS.

In the U.S., Canada and the UK the practice of clinical psychology requires a license. Although every state is somewhat different in terms of requirements and licenses, there are three common elements—a degree from an approved educational program, a minimum amount of supervised clinical experience, and passing an examination. Most states also require a certain number of continuing education credits per year in order to renew a license, which can be obtained though various means, such as taking audited classes and attending workshops.

Doctoral level training

The University of Pennsylvania was the first to offer formal education in clinical psychology.

There is stiff competition to gain acceptance into clinical psychology doctoral programs (acceptance rates of 2-5% are not uncommon). Clinical psychologists in the U.S. undergo many years of graduate training—usually 5 to 7 years post-Bachelors—in order to gain demonstrable competence and experience. Licensure as a psychologist takes an additional 1 to 2 years post PhD/PsyD (licensure requires 3,000 hours of supervised training), depending on the state (see below under licensure). Today, in America, about half of all clinical psychology graduate students are being trained in PhD programs—a model that emphasizes research and is usually housed in universities—with the other half in PsyD programs, which has more focus on practice (similar to professional degrees for medicine and law).[9] Both models envision practising Clinical Psychology in a research-based, scientifically valid manner, and are accredited by the American Psychological Association[10] and many other English-speaking psychological societies. APA accreditation is very important for U.S. clinical psychology programs and may affect employment prospects and licensure after one graduates.[11]

Mean debt related to doctoral education in clinical psychology currently exceeds $80,000, according to the 2011 Association of Psychology Postdoctoral and Internship Centers (APPIC) match survey, and 44% of graduates accrue over $100,000 in debt.[12] There is currently a significant internship crisis affecting U.S. clinical psychology programs for the past 10 years.

Doctorate (PhD and PsyD) programs usually involve some variation on the following 5 to 7 year, 90-120 unit curriculum:

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

Australia

In Australia the psychology profession and the use of the title 'psychologist' is regulated by an Act of Parliament, Health Practitioner Regulation (Administrative Arrangements) National Law Act 2008 following an agreement between the state and territory governments. Under the national law, registration of psychologists is administered by the Psychology Board of Australia (PsyBA).[13] Before July 2010, professional registration of psychologists was governed by various State and Territory Psychology Registration Board.[14] The Australian Psychology Accreditation Council (APAC) oversees education standards for the profession of psychology.

The minimum requirements for general registration in psychology and to use the title 'psychologist' is an APAC approved four year degree sequence in psychology followed by either: (1) a two-year masters program or (2) two years supervised by a registered psychologist.[15][16] Endorsement within a specific area of practice (e.g. clinical, counselling, educational, forensic, health, organizational or neuropsychological) requires additional qualification.[17] These notations are not 'specialist' titles (Western Australian psychologists could use 'specialist' in their titles during a three-year transitional period from 17 October 2010 to 17 October 2013).[18][19][20]

Membership with Australian Psychological Society (APS) differs from registration as a psychologist. The standard route to full membership (MAPS) of the APS technically requires a masters or doctoral degree in psychology in an accredited course. An alternate route is available for academics and practitioners who have gained appropriate experience and made substantial contribution to the field of psychology. Association membership requires four years of APAC accredited undergraduate study.

Restrictions apply to all who want to use the title 'psychologist' in any form in all states and territories of Australia. However, the terms 'psychotherapist', 'social worker', and 'counsellor' are currently self-regulated with several organizations campaigning for government regulation.[21]

Belgium

In Belgium, the title "psychologist" is protected by law since 1993. It can only be used by people who are included as such on the list of a national government commission. The minimum requirement is a completed five years university training in psychology (Master's degree or equivalent). The title of "psychotherapist" is not legally protected (yet).

Finland

In Finland, the title "psychologist" is protected by law. Restriction is governed by National Supervisory Authority for Welfare and Health (Finland). It takes 330 ECTS-credits (about six years) to accomplish the studies.

Germany

In Germany, the use of the title 'Diplom-Psychologe' ('Dipl.-Psych.') is restricted by law, and a practitioner is legally required to hold the corresponding academic title, which is comparable to a higher MSc degree and requires at least five years of training at university.[22] A Diplom degree in psychology awarded in Germany which includes the subject of clinical psychology.[23] With the Bologna-reform, this degree was replaced by a master's degree.[24] The academic degree of Diplom-Psychologe or MSc (Psychologie) does not include a psychotherapeutical qualification, which requires three to five years of additional training. The psychotherapeutical training combines in-depth theoretical knowledge with supervised patient care and self-reflection units. After having completed the training requirements, psychologists take a state-run exam, which, upon successful completion (Approbation), confers the official title of 'psychological psychotherapist' (Psychologischer Psychotherapeut).[25] After many years of inter-professional political controversy, non-physician psychotherapy was at last given an adequate legal foundation through the creation of two new academic healthcare professions.[26]

Greece

In Greece, the title "psychologist" has been protected by law since 1979. It can only be used by people who hold a relevant licence to practice as a psychologist. The minimum requirement is the completion of university training in psychology at a Greek university, or at a university recognized by the Greek authorities.[27]

The Netherlands

In the Netherlands, the title of "psychologist" is not restricted by law. The Dutch professional association of psychologists (NIP), using trademark law, therefore posited its own title "Psychologist NIP" (Psycholoog NIP), which is granted exclusively to holders of a master's degree in psychology, after a year of postgraduate experience. The titles "psychotherapist" (psychotherapeut) and "healthcare psychologist" (gz-psycholoog / gezondheidszorgpsycholoog) are restricted through the Individual Healthcare Professions Act (wet BIG) to those who have followed further postgraduate (PsyD/DPsych or Licentiate level) training. The use of the titles "clinical psychologist" (klinisch psycholoog) and clinical neuropsychologist (klinisch neuropsycholoog) is reserved for those who have followed specialist post-licentiate training.

New Zealand

In New Zealand, the use of the title "psychologist" is restricted by law. Prior to 2004, only the title "Registered Psychologist" was restricted (to people qualified and registered as such). However, with the proclamation of the Health Practitioners Competence Assurance Act 2003, the use of the title "Psychologist" was limited to practitioners registered with the New Zealand Psychologists Board. (The titles "Clinical Psychologist", "Counselling Psychologist", "Educational Psychologist", "Intern Psychologist", and "Trainee Psychologist" are similarly protected.) This is to protect the public by providing assurance that the title user is registered and therefore qualified, competent, and can be held accountable for their practice. The legislation does not currently include an exemption clause for any class of practitioner (e.g., academics, or government employees).

South Africa

In South Africa,[28] psychologists are qualified in one of Clinical-, Counselling-, Educational-, Organisational- or Research Psychology. To attain the qualification, one must complete a recognised Master's degree in Psychology and an appropriate practicum at a recognised training institution,[29] and also sit an examination set by the Professional Board for Psychology.[30] Registration with the Health Professions Council of South Africa (HPCSA)[31] is required, and includes a Continuing Professional Development component. The practicum usually involves a full year internship, and in some specializations the HPCSA requires completion of an additional year of community service. The Master's comprises seminar- and coursework-based theoretical and practical training, and a dissertation of limited scope, and is (in most cases) two years in duration. Prior to enrolling for the Master’s, the student will have studied psychology for three years as an undergraduate (B.A. or B.Sc., and, for Organisational Psychology, also B.Com.), followed by an additional postgraduate honours degree in psychology; see List of universities in South Africa. Qualification thus requires at least five years of study, and at least one of internship. The undergraduate BPsyc is a four-year program integrating theory and practical training, and — with the required examination set by the Professional Board for Psychology — is sufficient for practice as a psychometrist or counselor.[32]

Sweden

In Sweden the title "psychologist" is restricted in law. It can only be used after receiving a license from the government. The basic requirements are a completed five years specialised course in psychology (equivalent of a master's degree) and 12 months of practice under supervision. All other uses are banned, though often challenged. "Psychotherapist" follows similar rules but the basic educational demands are another 1.5 years (spread out over three years) at a specialised course in psychotherapy (that do vary a lot concerning theoretical footing), in addition to an academical level degree within a field concerning the treatment of people (psychologist, social worker, psychiatrist a.s.o.). Others than psychologist usually have to complete their education with basic courses in psychotherapy to meet the demands for the applied psychotherapy classes.

United Kingdom

In the UK the following titles are restricted by law: "registered psychologist" and "practitioner psychologist"; in addition the following specialist titles are restricted by law: "clinical psychologist", "counselling psychologist", "educational psychologist", "forensic psychologist", "health psychologist", "occupational psychologist" and "sport and exercise psychologist".[33] The Health Professions Council (HPC-UK) is the statutory regulator for practitioner psychologists in the UK. In the UK the use of the title "chartered psychologist" is also protected by statutory regulation. The title "chartered psychologist" simply means that the psychologist is a chartered member of the British Psychological Society but it does not necessarily signify the psychologist is registered with the HPC-UK. It is an offense for someone who is not in the appropriate section of the HPC-UK Register to provide clinical psychology services, counselling psychology services, educational psychology services, forensic psychology services, health psychology services, occupational psychology services or sport and exercise psychology services.[34] The threshold level of qualification for entry to the Register for clinical, counselling and educational psychologists is a professional doctorate (and in the case of the latter two the British Psychological Society's Professional Qualification which meets the standards of a professional doctorate).[35] The title ‘psychologist’ is not protected on its own.[36] Also the title of "neuropsychologist" is not protected at present.[36] The British Psychological Society is working with the HPC-UK to ensure that the title of "neuropsychologist" is regulated as a specialist title for practitioner psychologists; one of the options could be the use of post-doctoral level registers.

In the UK, clinical psychologists undertake a Doctorate in Clinical Psychology (D.Clin.Psych., Clin.Psy.D. or similar), which is a doctorate with both clinical and research components. This is a three-year full-time salaried program, provided by 30 centres across the UK, sponsored by the National Health Service (NHS). These clinical psychology doctoral degrees are accredited by the British Psychological Society and the Health Professions Council (HPC). Entry into these programs is highly competitive, and requires at least a three-year undergraduate degree in psychology, plus some form of experience, usually in either the NHS as an Assistant Psychologist or in academia as a Research Assistant.[37][38] More information about the path to training in the UK can be found at the central clearing house for clinical psychology training applications, and at www.ClinPsy.org.uk where questions can also be answered on the forum, which is run by qualified UK clinical psychologists.

In the UK there are currently protected 'psychologist' titles. These are: • Practitioner psychologist • Registered psychologist • Clinical psychologist • Counselling psychologist • Educational psychologist • Forensic psychologist • Health psychologist • Occupational psychologist • Sport and exercise psychologist

The public can check whether a psychologist is registered on the Health Professions Council website (http://www.hpc-uk.org), which would prove they are genuine. It is compulsory for a psychologist to register with the Health Professions Council in order to practice using one of the protected titles in the United Kingdom. The terms 'clinical psychologist' and 'counselling psychologist' cannot be used legally by any member of the public for any purpose, unless that person is registered with the Health Professions Council.

Clinical Psychologists are required to be licensed in the UK in order to practice. It is a requirement to be a member of the Health Professions Council in order to practice.

United States and Canada

A professional in the U.S or Canada must hold a graduate degree in psychology (MA, PsyD, Ed.D., or PhD) or have a state license in order to use the title "psychologist".[39][40] The exception to this is the profession of a school psychologist who can be certified by boards of education to practice and use the title "psychologist" with an Education Specialist (Ed.S) degree. The most commonly recognized psychology professionals are clinical and counseling psychologists, those who provide psychotherapy and/or administer and interpret psychological tests. There are state-by-state differences in requirements for academics in psychology and government employees.

Psychologists in the United States have campaigned for legislation changes to enable specially trained psychologists to prescribe psychiatric medicine. New legislation in Louisiana, New Mexico, and Illinois has granted those who take an additional masters program in psychopharmacology permission to prescribe medications for mental and emotional disorders in co-ordination with the patient's physician. Louisiana was the second state to provide such legislation.[41] This legislation has not come without considerable controversy. As of 2009, Louisiana is the only of the United States where the licensing and regulation of the practice of psychology by medical psychologists who prescribe medications is regulated by a medical board (i.e., the Louisiana State Board of Medical Examiners) rather than a board of psychologists.[42] While other states have pursued prescriptive privileges, they have yet to be successful. Similar legislation in the states of Hawaii and Oregon passed through the legislative House and Senate but it was vetoed by the Governor.[41]

In 1989 the U.S Department of Defense was directed to create the Psychopharmacology Demonstration Project. By 1997, ten psychologists were trained in psychopharmacology and granted the ability to prescribe psychiatric medications.[43]

Full membership with the American Psychological Association in United States and Canada requires doctoral training (except in some provinces like Alberta where a master's degree is sufficient). Associate membership requires at least two years of postgraduate studies in psychology or approved related discipline. The minimal requirement for full membership can be waived in certain circumstances where there is evidence that significant contribution or performance in the field of psychology has been made.[44]

Sample Curriculum for MA in Clinical Psychology in the U.S.
State Required School Required Electives

Chemical Dependency: 3
Human Sexuality: 2
Child Abuse: 2
Domestic Violence: 2
Aging: 2
Ethics & Law: 3
Psychological Testing: 3
Psychopharmacology: 3

Process and Psychotherapy: 4
Personality Theory: 6
Cross-Cultural: 3
Comparative Theories: 6
Psychology and Society: 2
Systems Theory & Family: 5
Assessing and Planning: 3
Brief Therapy: 2
Group and Couples Treatment: 6
Applied Therapeutic Techniques: 9
Developmental Psych and pathology: 9

Gay and Lesbian Issues: 2
ADHD: 1
Crisis Intervention: 2
Cognitive/Behavioral: 2
Existential Psychology: 2
Clinical Intervention with Adolescents: 2
Narratives of Women's Lives: 2

Where subject is required by both the state and the school, it is shown under the school's required column. Similar courses have been lumped together, for example "Group Treatment Techniques" and "Couples Counseling" were combined, their units added together and called "Group and Couples Treatment"—just to keep the table of manageable size.

There are a number of U.S. schools offering accredited programs in clinical psychology resulting in a Masters degree. Such programs can range from 48 to 84 units, most often taking 2 to 3 years to complete post-Bachelors. Training usually emphasizes theory and treatment over research, quite often with a focus on school or couples and family counseling. Similar to doctoral programs, Masters-level students usually must fulfill time in a clinical practicum under supervision; some programs also require a minimum amount of personal psychotherapy.[45] While many graduates from Masters-level training go on to doctoral programs, a large number also go directly into practice—often as a Licensed Professional Counselor (LPC), Marriage and Family Therapist (MFT) or other similar license.[46]

Other related licenses open to Masters-level graduates in the U.S. include: Marriage and Family Therapist (MFT), Licensed Professional Counselor (LPC), and Licensed Psychological Associate (LPA).

Professional practice

Clinical psychologists can offer a range of professional services,[47] including:

  • Provide psychological treatment (psychotherapy)
  • Administer and interpret psychological assessment and testing
  • Conduct psychological research
  • Teaching
  • Development of prevention programs
  • Consultation (especially with schools and businesses)
  • Program administration
  • Provide expert testimony (forensics)

In practice, clinical psychologists may work with individuals, couples, families, or groups in a variety of settings, including private practices, hospitals, mental health organizations, schools, businesses, and non-profit agencies. Most clinical psychologists who engage in research and teaching do so within a college or university setting. Clinical psychologists may also choose to specialize in a particular field—common areas of specialization, some of which can earn board certification,[48] include:

Licensure

Comparison of mental health professionals in USA
Occupation Degree Common Licenses Prescription Privilege Ave. 2004
Income (USD)
Clinical Psychologist PhD/PsyD Psychologist Mostly no $75,000
Counseling Psychologist (Doctorate) PhD MFT/LPC No $65,000
Counseling Psychologist (Master's) MA/MS/MC MFT/LPC/LPA No $49,000
School Psychologist PhD, EdD Psychologist No $78,000
Psychiatrist MD/DO Psychiatrist Yes $145,600
Clinical Social Worker PhD/MSW LCSW No $36,170
Psychiatric Nurse PhD/MSN/BSN APRN/PMHN No $53,450
Psychiatric and mental health Nurse Practitioner DNP/MSN MHNP Yes (Varies by state) $75,711
Expressive/Art Therapist MA ATR No $45,000
Sources: [49][50][51][52][53][54]

The practice of clinical psychology requires a license in the United States, Canada, the United Kingdom, and many other countries. Although each of the U.S. states is somewhat different in terms of requirements and licenses (see and for examples), there are three common elements:[55]

  1. Graduation from an accredited school with the appropriate degree
  2. Completion of supervised clinical experience
  3. Passing a written examination and, in some states, an oral examination

All U.S. state and Canada province licensing boards are members of the Association of State and Provincial Psychology Boards (ASPPB) which created and maintains the Examination for Professional Practice in Psychology (EPPP). Many states require other examinations in addition to the EPPP, such as a jurisprudence (i.e. mental health law) examination and/or an oral examination.[55] Most states also require a certain number of continuing education credits per year in order to renew a license, which can be obtained though various means, such as taking audited classes and attending approved workshops.

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

Licensed behavior 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 behavior analysis and the philosophy of behaviorism. Behavior analysts have at least a master's degree in behavior analysis or in a mental health related discipline as well as at least five core courses in applied behavior analysis. Many behavior analysts have a doctorate. Most programs have a formalized internship program and several programs are offered online. Most practitioners have passed the examination offered by the behavior analysis certification board. The model licensing act for behavior analysts can be found at the Association for Behavior Analysis International's website.

In the UK registration as a clinical psychologist with the Health Professions Council (HPC) is necessary. The HPC is the statutory regulator for practitioner psychologists in the UK.

In the UK the following titles are restricted by law: "registered psychologist" and "practitioner psychologist"; in addition the specialist title "clinical psychologist" is also restricted by law. The title of "Assistant Psychologist" is used by a psychology graduate under the supervision of a qualified clinical psychologist, and the title "Trainee Clinical Psychologist" is used during the three-year doctoral program.

Employment

In the United States the vast majority of 170,200 psychologist jobs, 152,000 are employed in clinical, counseling, and school positions, 2,300 are employed in industrial-organizational, and 15,900 in "all-other" positions. Opportunities are very limited for bachelor's degree and master's degrees holders, and they will face intense competition in the job market.[1]

In the United Kingdom as of the end of December 2012 there were 19,000 practitioner psychologists registered,[60] across 7 categories: clinical psychologist, counselling psychologist, educational psychologist, forensic psychologist, health psychologist, occupational psychologist, sport and exercise psychologist. At least 9,500 of these are clinical psychologists,[61] which is the largest psychology group within clinical settings such as the NHS. Around 2,000 are educational psychologists.[62]

The median salary in the U.S. in 2012 for clinical, counseling, and school psychologists was US$69,280 and the median salary for organizational psychologists was US$83,580.[1][63]

Contrast with psychiatrist

Main article: Psychiatrist

Although clinical psychologists and psychiatrists can be said to share a same fundamental aim—the alleviation of mental distress—their training, outlook, and methodologies are often quite different. Perhaps the most significant difference is that psychiatrists are licensed physicians. As such, psychiatrists often use the medical model to assess mental health problems and rely on psychotropic medications as the chief method of addressing mental health problems.[64] Clinical psychologists receive extensive training in psychological test administration, scoring, interpretation and reporting (psychiatrists are not trained in psychological testing and cannot administer Qualification Level C Tests). These tests help to inform diagnostic decisions and treatment planning. For example, in a medical center, a patient with a complicated clinical presentation who is being seen by a psychiatrist might be referred to a clinical psychologist for psychological testing to aid in diagnosis and treatment. In addition, psychologists (particularly those from PhD programs) spend several years in graduate school being trained to conduct behavioral research, including research design and advanced statistical analysis. While this training is available for physicians via dual MD/PhD programs, it is not typically included in medical education. Conversely, psychiatrists, as licensed physicians, have received training more broadly in other areas such as medicine and neurology and may bring this knowledge to bear in identifying and treating medical or neurological conditions that can present similarly to psychiatric diseases.

Psychologists generally do not prescribe medication, although in some jurisdictions psychologists have limited prescribing privileges. Clinical and other psychologists are experts at psychotherapy (typically clinical psychologists are trained in a number of psychological therapies, including, behavioural, cognitive, humanistic, existential, psychodynamic, and systemic approaches), and psychological testing (e.g. including neuropsychological testing). In three US states (Illinois, Louisiana, and New Mexico), some psychologists with post-doctoral pharmacology training have been granted prescriptive authority for certain mental health disorders upon agreement with the patient's physician.[65][66]

See also

References

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  2. "What's the Difference Between a Counselor and a Psychologist?" Oregon Unlicensed Practitioners, January 27, 2015
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