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Nature, Scope, Role, History and Current status of Clinical Psychology and Assessments

Abisha Angeline E

Department of Science, Christ Academy Institute for Advanced Studies

302 A: CLINICAL PSYCHOLOGY AND ASSESSMENTS

Ms. Trishala M

January 2024
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Nature, Scope, Role, History and Current status of Clinical Psychology and Assessments

The American Psychological Association’s division of clinical psychology defines

clinical psychology as: “The field of clinical psychology integrates science theory and practice

to understand predict and alleviate maladjustment disability and discomfort as well to promote

human adaptation adjustment and personal development. Clinical psychology focuses on the

intellectual emotional biological social and behavioral aspects of human functioning across the

lifespan, in varying cultures, and at all socioeconomic levels”. Clinical psychologists in movies

and series are portrayed in such way that the general public is confused about what exactly the

psychologists do and what are their educational backgrounds. As part of the Indian population,

people still believe in the stigma that, mental illness is something that cannot be cured and

people who are mentally weak and disturbed are titled as MENTAL. Clinical psychologists are

a diverse group with respect to gender, age, culture, ethnicity, theoretical allegiance and roles.

(Norcross, Karpiak, & Santoro, 2005). Based on the specializations, psychologists are given

different titles such as a person who has a practiced therapy is called a psychotherapist,

psychoanalyst; a person who is specialized in conducting research in psychology is considered

to be a clinical scientist, a person who is specialized in counselling and called counselling

psychologists, people who are specialized in the field of organizational counselling are titled

as industrial psychologists. There are different titles that are given to people who are specialized

in different fields of psychology based on their educational qualifications. According to the

American Psychological Association, the title clinical psychologist is given to those people

who are well specialized in the clinical background and profession that includes specific

training and qualifications.

Even after several years of development in the field of psychology, people still

misunderstand that clinical psychologists are doctors or psychiatrists. There are very few

people who are aware about the differences. A clinical psychologist is a person who diagnoses,
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researches and is a member of prestigious professional societies and providers of important

human services where as the main difference between a psychiatrist and a psychologist is that,

the psychiatrists prescribe medicines and the psychologists do not prescribe medicines but use

standardized tools and assessments to diagnose a person. Their educational qualifications also

differ based on the field of specialization. The field of clinical psychology involves research,

teaching and services relevant to the applications of principles, methods, and procedures for

understanding, prediction and alleviating intellectual, emotional, biological, psychological,

social and behavioral maladjustment, disability and discomfort, applied to a wide range of

client population (J.H. Resnick, 1991).

Clinical psychologists work with different individuals who differ from each, for

instance they work with clients who are of different age, gender, culture, countries and so on.

This profession involves students, corporate workers, teachers, families, politicians, children,

and so on. Most of the clinical psychologists pursue Doctoral degree in Clinical Psychology.

This can help them to ace in different areas and also lead to broad range of job opportunities.

When we talk about the qualifications of a psychologist and a psychiatrist, a psychiatrist first

pursues a bachelor’s degree in pre-medical or any science related field. After the bachelor’s

degree the student attends the medical school to acquire a Doctor of Medicine which is often

known as M.D. or Doctor of Osteopathic Medicine which is often known a D.O. This goes on

for four years. After four years of medical school, the psychiatrists attend the residency training

for another four years. This focuses on mainly getting trained in different aspects of psychiatry.

After the completion of the residency training, most of the psychiatrists opt for board-certified

by the American Board of Psychiatry and Neurology (ABPN) which is not compulsory. While

on the other hand, when we talk about the qualifications of a psychologist, individuals start

with pursuing the bachelor’s degree in the field of psychology or anything related to

psychology. Then they pursue a master’s degree, where they mainly focus on specializations
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in the field of psychology, for instance- clinical psychology, counselling psychology, child

psychology, forensic psychology, industrial psychology and so on. After the completion of

master’s degree, most of them opt for MPhil’s which helps the psychologists to get trained

about a specific field and learn the basics about research. MPhil’s mainly focuses on internship

and practice under the guidance of the supervisors. This may last for a yar or two depending

on the master’s degree and the place they have acquired for training. After training, most of the

psychologists earn Doctor of Psychology often known as Psy.D or Doctor of Philosophy also

known as PhD which can last for four to six years.

Years ago, clinical psychologists also wished to have and experience the privilege of

the psychiatrists by understanding the use of medication for each disorder (McGrath, 2009).

The psychiatrists focus on prescribing medicines that disturbs the mental activity, behavior and

the mood of the individual. Many scholars believed that there are certain things that makes

clinical psychology different from psychiatry. This involves the different skills used by the

psychologists in assessing psychological components of an individual. This profession is built

on a solid scientific basis. The scholars emphasize that in order to follow-up the field of

psychiatry by immature or untrained attempt of prescribing medicines to the clients may lead

to the destruction the psychologist as well as the uniqueness of the field of clinical psychology.

This can be because, during the complete journey of education, psychologists receive very little

training in prescribing medicines, whereas the psychiatrists are well trained and consider the

aspect of prescribing medicines very important.

There are different activities that are followed by the clinical psychologist. The first and most

important one is the therapy or interventions. Like mentioned in the starting of the introduction,

movies have played a huge role in depicting an image about psychologists in the public’s mind,

where most of the time the patients or the clients lie on the couch and the therapists with a

furrowed brow sits behind the couch. But in real life, there are therapies that uses couch, but it
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also involves many different ways of conducting therapies. It involves face to face or one to

one, where the client is seated comfortably in front of the client and express their problems.

There are also therapies for group that involves couple’s therapy, family therapy, parent training

and group therapy. Teaching is also another activity that is involved by the clinical

psychologists. Most of the clinical psychologists also involve in the area of graduate education

teaching courses in psychopathology, psychological testing, interviewing, intervention,

personality theory, developmental psychopathology and so many other courses. Some may also

involve in teaching the undergraduate students on personality psychology, abnormal

psychology, industrial psychology and so on. Clinical psychologists also involve themselves in

conducting research, where they study about the causes of mental disorders, developmental

issues, cognitive impairments that affects the behavior, and the relationship between the

psychological constructs and its influence on personal and professional life. Consultation is

also another type of activity that is carried out by a psychologist. Consultation takes place in

innumerable forms and in different types of settings. They discuss about general problems

associated with drug addiction, to advertising agencies or corporations to help them out in

developing different products which can have a good mental impact on the customers, helping

out or assisting the attorneys in selecting the jurors for a particular case, consulting with the

police department and most commonly working as consultants to physicians who provide

primary care services. Another activity that the clinical psychologist do is administration. This

activity might seem simple, and most often people think clinical psychologists do not involve

themselves in administration. Whereas administration is also considered to be a crucial part of

the profession. For instance, the administration involves maintaining the client’s records,

updating the records each month based on the reports of the sessions, ensuring the

confidentiality and the clients informed consent forms during research for the rights of the
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human subjects. Most of the clinical psychologists also work for different organizations, where

they have to do administration that includes personnel, research, patient rights and so one.

Assessments

Psychologists consider assessments as a unique element of their expertise

(Krishnamurthy et al., 2004). Assessment is said to be the most important aspect of

psychological practice. Most of the time assessments are not questioned rather they are

assumed. Assessment is supposed to be standardised that goes through different process such

as formation of questions, pilot study, expert review, reliability and validity and check if the

tool has scientific evidence. But there are also few tools or instruments that does not follow

this process and does not have scientific evidence (Hunsley, Lee, & Wood, 2003; Hunsley &

Mash, 2007; Neisworth & Bognato, 2000; Narcross, Koocher & Garofalo, 2006). Assessment

works as a tool that is the key to collect, identify the problems, weakness, strength, background

of the client accurately. There are different types of assessments that are used in different fields

of medicine. Whereas the assessments used in the psychological field mainly focuses on

finding the differences between the clinical inpatient and outpatient.

In the past 35 years ago, the American Psychological Association has been publishing the

Diagnostic and Statistical Manual that is commonly or in short known as the DSM. Based on

the DSM, most of the psychologist diagnose the clinical inpatient. The process of assessment

involves different steps such as Interview- which is the most common type of way of

assessment. In the initial interview, the therapist collects the basic and personal information of

the client, creating a rapport and ensuring that the client is aware about the confidentiality

clause and the objectives of the sessions. This process is also known as the intake or diagnostic

interview (Summerfeldt & Antony, 2002). The interview involves identifying the current

symptoms, history of the problem presented by the client, duration of the existing problem,

intensity and the frequency of the problem, the coping strategies used by the clients, the
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strengths of the clients’, family relationship, educational qualification, relationship history,

medical or mental health history, trauma or abuse history, substance abuse issues and many

other aspects (Morrison, 1997). Standardized questionnaires are another method that used by

psychologists. These standardizes questionnaire consists of questions related to certain

psychological constructs. Based on the symptoms of the clients identified by the psychologists,

they hand over questionnaires to the clients which will help the psychologists to confirm and

diagnose the disorders. There are also other brief standardized questionnaires used in primary

health care services, which at times may fail to detect the mental health issues (Bufka,

Crawford, & Levitt, 2002). Observation is another method or process of assessment, where the

observation may happen in natural or laboratory settings. Therapists may observe clients in

different settings such as classroom, work place, social arena or home. Observation provides

minute evidences which may be failed to identify through interviews or questionnaires.

Observation helps in finding the unconscious meaning behind the gestures, expression that the

clients show that may also not be aware of.

History of clinical psychology

Several texts written by different scholars on the history of psychopathology and the

treatments used in psychopathology describes that the main cause of mental illness or

dysfunction rather than a demonic possession, was a natural cause. Hippocrates who was one

among the Greek scholars and also someone who was titled as the father of medicine, provided

an understanding about something that is called biopsychology. Biopsychology is a type of

study that involves the understanding of both physical and psychological disorders.

Hippocrates emphasized that the emotional disturbances is caused due to the imbalance in the

levels of blood, black bile, yellow bile and phlegm. There were other Greek scholars who also

agreed with Hippocrates, namely Plato and Aristotle. Their ideas also gained a lot of attention

where they contributed to the ideas and principles of Hippocrates but in different ways.
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According to Plato, mental disorders were caused due to the roles of societal forces and

psychological needs. Whereas Aristotle focused on the biological determinants of mental

disorders.

St. Vincent de Paul, in the late 1500s also emphasized that mental and physical illness

are caused by natural forces. Even though the scholars emphasized that they are not caused by

any witchcraft or demonic possession, those people who had severe mental illness were strictly

isolated in areas like Europe and north America. By the latter half of 1700s, there was a period

of enlightenment in Europe and north America where people started viewing mental health

differently. They started understanding the causes, issues and solved them in the methods of

science and believed that those methods can be used to all natural phenomena. Initially as

people believed that mental illness was caused because of demonic possession, they were

always tied in huge chains. In the late 1700s, reformer Phillippe Pinel ordered to remove the

chains from those mental illness patients. On the other hand, in England, a prominent figure

named William Tuke put forth to develop hospitals by keeping the modern ideas in mind and

to retreat the people who suffered from mental illness. Benjamin Rush from the United States

advocated on using moral therapy on mentally ill patients. By this time there was development

in the European medicines which were neurology based. At the same time, attention and

recognition towards the different conditions of mental illness also increased, but they could not

give proper explanations about the causes only on the basis of biology. That is when Jean-

Martin Charcot cam into picture who was appreciated and honored as the primary developed

of clinical neurology. He developed and put forth he role of psychological factors in hysteria.

Professionals started using his suggestions and hypnosis in treating hysteria which eventually

grabbed the attention of many physicians’ medical students. Prominent figures namely,

Sigmund Freud, Pierre Janet and many other used Charlot’s theories and his use of hypnosis as

a basis to create their own theories.

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History of assessment in clinical psychology

Along with the development of clinical psychology, simultaneously there was

development of assessments in clinical psychology as well which was a strong foundation for

the field of clinical psychology. The history of development of clinical assessments states from

1800s. in order to understand the human behavior, the enlightenment principles were

influenced in the application of scientific principles. Francis Galton from England focused on

the individual differences, mainly on motor skills and reaction times with regard to intelligence.

Wilhelm Wundt established the first psychology laboratory in the year 1879 in Leipzig,

Germany to study the human experiences. James McKeen Cattell coined the term “mental

tests” and explored the connection between reaction time and intelligence

Emil Kraepelin, a German psychiatrist, and Alfred Binet, a French psychologist, were

pivotal in the early work on assessment in clinical psychology. Kraepelin focused on biological

factors, developing a classification system for mental disorders. Binet developed the Binet-

Simon scale to identify children with limited intelligence. This period spans the late 1800s to

the early 1900s. Lewis Terman adapted Binet's scale, and during World War I, Robert Yerkes

led the development of Army Alpha and Beta tests. The American Psychological Association

recognized clinical psychology with the creation of the Section on Clinical Psychology in 1919.

This development occurred in the early 1900s to World War I.

David Wechsler's Wechsler-Bellevue test marked a milestone in intelligence testing.

Interest tests and personality measures like Woodworth’s Personal Data Sheet and Rorschach

Inkblot Test emerged in the 1920s-1930s. Projective tests, including the Rorschach Inkblot

Test, House-Tree-Person Test, and Thematic Apperception Test, gained prominence in the

1920s-1930s. These tests assessed personality and psychological functioning without sufficient

attention to standardization and reliability. Projective tests developed without adequate

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attention to standardization, reliability, validity, and norms, leading to enduring concerns about

their quality and utility. Critiques became prominent in the mid-20th century.

Psychologists played a crucial role in developing selection tests for the armed forces.

The Minnesota Multiphasic Personality Inventory (MMPI) became a milestone in assessment

during this period (1939-1945). Starke Hathaway published the MMPI in 1943, aiming to

screen for psychological disturbances among adults. The MMPI's criterion-oriented approach

relied on statistical analysis, setting it apart from projective tests. This occurred in 1943. Paul

Meehl's 1954 review emphasized the superiority of statistically oriented approaches over

purely clinical ones. Walter Mischel's critique in 1968 questioned the predictive validity of

personality traits. This shift occurred in the 1950s-1960s. Walter Mischel's analysis highlighted

the shortcomings of personality traits for understanding human behavior, emphasizing the

importance of considering past experiences and environmental influences for accurate

predictions in 1968.

Mischel's critique contributed to the rise of behavioral assessment approaches.

Behavioral assessment focused on observable behaviors influenced by operant, classical, and

observational learning paradigms, providing immediate value in treatment planning. This rise

occurred in the 1960s-1970s. Assessment of children's emotional and behavioral problems

began with the publication of rating scales pioneered by Achenbach, Quay, and Conners in the

1970s. The publication of DSM-III in the 1980s emphasized the value of structured interview

approaches for diagnostic information in the 1980s. Recognition that assessment data should

come from multiple methods and informants, reflecting a rapprochement among different

perspectives on psychological assessments. This shift occurred in the 1990s to the present.

Increased attention to the relevance of assessment data for treatment planning and evaluation.

Growing pressure for clinical psychologists to demonstrate the effectiveness of their services

in recent decades. Attention to service evaluation, emphasizing the effectiveness of clinical

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services. A shift towards brief, specific, and repeated-use assessment measures characterize

current trends. This shift is ongoing.

Nature of clinical psychology

Clinical psychology is a branch or field of psychology that mainly focuses on

conducting assessments, diagnosing the clients and providing treatment for the mental illness

and behavioural dysfunctions. Clinical psychology not only addresses the problems of

individual clients, but also focuses on the problems of groups that includes diagnosis, treatment

and therapies for groups such as families, students, children, relationship, and so on. Clinical

psychology along with psychological assessments, formulation and psychotherapy, it also

involves in research, testing, consultation, forensic testimony and program development and

administration.

Nature of clinical assessment

The most common or the important nature of clinical assessment is to understand the

problem, to diagnose the problem, identify the factors that causes the problem and treat the

mental illness that is affecting the behavior of the individuals. It is a multifaceted approach that

includes different types of methods such as interviews, observation, psychological tests and

collecting information from different resources. Assessments take into consideration the

biological, psychological, and social factors that are affecting and influencing the well being

the individual or group. Clinical assessments are a way of building rapport between the

therapist and the clients, ensuring comfortable, healthy and trusting relationship. It adheres to

confidentiality of the client through informed consents. Based on the assessment, the therapist

finds it easy to diagnose and treat the individuals with mental illness. Psychologists while

conducting assessments, also collaborate with other professionals namely, psychiatrists,

medical doctors or social workers or primary health care takers. Compared to any other

assessment tools, standardizes assessment tools are the ones that provide, measure and quantify
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the information. This helps in comparison. Clinical assessments assess cognitive abilities,

emotional regulation, coping mechanism to gain insights.

Role and Scope of clinical psychology

• Clinical psychology mainly focuses on conducting assessments, understanding the

problem and diagnosing various psychological disorders and dysfunctions.

• It provides evidence-based interventions and therapies to not only individuals but also

to groups, families addressing different issues such as emotional, behavioral and mental

health issues

• Clinical psychology not only focuses on conducting assessments and diagnosis, rather

it also engages in research to understand different psychological phenomena, the causes

for different psychological dysfunctions, treatments and its effectiveness and how

different factors that results and influences the psychological dysfunctions.

• Clinical psychologists also collaborate with different professionals

• This field also involves in implementing awareness programs that help in educating

public about how to prevent mental illness and promote overall well-being.

• They also provide support at very serious crisis, or emergency or life-threatening issues.

• Apply principles to legal and criminal justice systems.

• Focuses on the understanding and relationship between the psychological problems and

its affect on physical health.

• Focuses on how to handle mental health issues among the adults.

• This field also focuses on specializing in the psychological needs of children and

adolescents throughout the developmental stages.

• Applies principles to improve workplace dynamics and the employee relationship and

well being
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Role and Scope of clinical assessment

• Clinical assessments are used in identifying and classifying he mental health disorders

using the assessment, evaluations and other methods

• They use standardized tools to measure the different psychological constructs such as

cognitive abilities, personality traits, emotional functioning and other biological issues

that is related to psychological issues.

• It also involves conducting semi-structured, un-structured interviews to gather

information about the client’s history and other things that are relevant to the case.

• It also includes observation methods that helps the therapist to notice and understand

minute expressions that might be unknown to the clients themselves.

• There are assessments that assesses the cognitive abilities such as memory, attention,

problem solving, reasoning and so on.

• Also assessing observable behaviors including maladaptive behaviors.

• Assessments also includes assessing personality traits, structure to understand the

individuals’ differences and any problems with the personality of the clients.

• It also assesses the relationship between the brain functions and other brain issues

resulting in changes in behaviour

• It incorporates cultural considerations while assessing individuals of diverse

backgrounds.

Current status of Clinical psychology

• Due to the Covid-19 affect, many clinical psychologists have adapted to the

telehealth services where digital platforms are used for conduction of assessments

and conducting therapy sessions and intervention.

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• This field is slowly increasing to focus on the cultural influences and its competence

within the field to address disparities in mental health among diverse population.

• There are several other developments in the field itself including the clinical

assessments including neuropsychological assessments, where enhancing the

precision is very important for the diagnostic process.

• These days technology plays a very huge role in the field of clinical psychology

where it provides services in the areas like virtual reality therapy, online

assessments and so on.

• Recently most of the researches are based on the effectiveness of different

therapeutic modalities such as mindfulness-based interventions, cognitive

behavioural therapy and may other evidence-based approaches.

• In recent days, there are a lot of awareness among people on mental health which

is also reducing the stigma about mental health and illness along with promoting

policies, principles which are used to support mental health services.

• Clinical assessments also focus on combining different methods of assessments

such as self-report measures, observations, interviews, and so on.

• Person-centered therapy is also being increasingly emphasized where the therapist

considers the opinions, perspectives and the experiences of the clients.

• As there are technological advancements, the privacy of the clients and the sessions

are highly secured and therapists make sure that they are kept confidential.

• There are a lot of online training programs for clinicians, where they are also trained

about how to use technology pertaining to the field of psychology and therapies.
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Reference

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Hurt, S. W., Reznikoff, M., & Clarkin, J. F. (2012). Psychological assessment, psychiatric

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Geisinger, K. F. (Ed.). (2013). APA Handbook of Testing and Assessment in Psychology,

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