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Clinical Counseling
STUDY NOTES
OVERVIEW
Clinical Counseling is concerned with the assessment and treatment of mental illness, abnormal
behavior and psychiatric problems. This field integrates the science of psychology with
the treatment of complex human problems, the purpose of clinical counseling is to
Diagnose and treat mental disorders; learning disabilities; and cognitive, behavioral, and
emotional problems, using individual, child, family, and group therapies. Clinical counselors
also design and implement behavior modification programs, they understand, prevent,
relieve psychologically-based distress or dysfunction, promote subjective well-being and
personal development for clients.
Central to the clinical counseling practice are two major elements, the psychological
assessment and psychotherapy.
Dysfunction or Mental health Disorder:
is a psychological or behavioral pattern generally
associated with subjective distress or disability that occurs in an individual, and which is not a
part of normal development or culture. Such a disorder may consist of a combination of
affective, behavioral, cognitive and perceptual components. The recognition and understanding
of mental health conditions have changed over time and across cultures, and there are still
variations in the definition, assessment, and classification of mental disorders, although standard
guideline criteria are widely accepted. A few mental disorders are diagnosed based on the harm
to others, regardless of the subject's perception of distress. Over a third of people in most
countries report meeting criteria for the major categories at some point in their lives. The causes
are often explained in terms of a diathesis-stress model or biopsychosocial model. In biological
psychiatry, mental disorders are conceptualized as disorders of brain circuits likely caused by
developmental processes shaped by a complex interplay of genetics and experience. Services are
based in psychiatric hospitals or in the community. Diagnoses are made by psychiatrists, clinical
psychologists, or psychiatric social workers using various methods, often relying on observation
and questioning in interviews. Treatments are provided by various mental health professionals.
Psychotherapy and psychiatric medication are two major treatment options, as are social
interventions, peer support and self-help. In some cases there may be involuntary detention and
involuntary treatment where legislation allows.
Stigma and discrimination add to the suffering associated with the disorders, and have led to
various social movements attempting to increase acceptance.
Well – Being( in Mental health) is described as either a level of cognitive or emotional free
of a mental disorder. From perspectives of the discipline of positive psychology or holism mental
health may include an individual's ability to enjoy life and procure a balance between life
activities and efforts to achieve psychological resilience. Mental health is an expression of
emotions and signifies a successful adaptation to a range of demands.
The World Health Organization defines mental health as "a state of well-being in which the
individual realizes his or her own abilities, can cope with the normal stresses of life, can work
productively and fruitfully, and is able to make a contribution to his or her community”. It was
previously stated that there was no one "official" definition of mental health. Cultural
differences, subjective assessments, and competing professional theories all affect how "mental
health" is defined. There are different types of mental health problems, some of which are
common, such as depression and anxiety disorders, and some not so common, such as
schizophrenia and Bipolar disorder. Most recently, the field of Global Mental Health has
emerged, which has been defined as 'the area of study, research and practice that places a priority
on improving mental health and achieving equity in mental health for all people worldwide'.
Psychological assessment or mental examination.
Is an examination into a person's mental health by a mental health professional such as a
psychologist. A psychological evaluation may result in a diagnosis of a mental illness. It is the
mental equivalent of physical examination
Psychological assessment may come in two forms: formal and informal. Formal assessment
involves the use of tools such as questionnaires, checklists and rating scales, while in informal
assessment the interview/evaluation usually lacks such structure or organization.[1] The
psychologist or related licensed professional will sometimes start by asking questions of the
person being evaluated, but not always. In psychological evaluations the administration of
standardized psychological tests either by a psychologist, or by someone the psychologist
supervises, are often a component of the evaluation.
Situations requiring psychological evaluations. Applicants to sensitive jobs, such as jobs in
intelligence or other jobs handling state secrets, may be required to submit to a psychological
evaluation before they can be employed, although usually a background check is much more
important.
Courts may order a competency evaluation of a defendant to determine competency to stand
trial. An insanity defense will also usually require the defendant to undergo a psychological
evaluation.
Psychotherapy:
or personal counseling with a psychotherapist is an intentional
interpersonal relationship used by trained psychotherapists to aid a client or patient in problems
of living.
It aims to increase the individual's sense of their own well-being. Psychotherapists employ a
range of techniques based on experiential relationship building, dialogue, communication and
behavior change that are designed to improve the mental health of a client or patient, or to
improve group relationships (such as in a family).
Psychotherapy may also be performed by practitioners with a number of different qualifications,
including psychiatry, clinical psychology, counseling psychology, clinical or psychiatric social
work, mental health counseling, marriage and family therapy, rehabilitation counseling, school
counseling, play therapy, music therapy, art therapy, drama therapy, dance/movement therapy,
occupational therapy, psychiatric nursing, psychoanalysis and those from other psychotherapies.
It may be legally regulated, voluntarily regulated or unregulated, depending on the jurisdiction.
Requirements of these professions vary, but often require graduate school and supervised clinical
experience. Psychotherapy in Europe is increasingly being seen as an independent profession,
rather than being restricted to being practiced only by psychologists and psychiatrists as is
stipulated in some countries.
CLINICAL PRACTICE:
Clinical counselors often work in medical settings, private practice or in academic positions at
universities and colleges, private therapeutic settings offering short-term and long-term
outpatient services to clients who need help coping with psychological distress or
working directly with clients, often those who suffer from severe psychiatric disorders.
Clinical Counselors need to have excellent communication skills. It is also important to be
creative when developing treatment plans and approaches.
Some of the job roles performed by those working in clinical counseling include:

Assessment and diagnosis of psychological disorders

Treatment of psychological disorders

Teaching

Conducting research

Drug and alcohol treatment

Creating and administering program to treat and prevent social problems
HISTORICAL BACKGROUND OF CLINICAL COUNSELING (Clinical
Psychology)
The field is often considered to have begun in 1896 with the opening of the first psychological
clinic at the University of Pennsylvania by Lightner Witmer. In the first half of the 20th century,
clinical psychology was focused on psychological assessment, with little attention given to
treatment. This changed after the 1940s when World War II resulted in the need for a large
increase in the number of trained clinicians. Clinical Counselors are considered to be experts in
providing psychotherapy, psychological testing, and in diagnosing mental illness. They generally
train within four primary theoretical orientations—psychodynamic, humanistic, behavior
therapy/cognitive behavioral, and systems or family therapy.
Many 18th c. treatments for psychological distress were based on pseudo-scientific ideas, such as
phrenology.
Phrenology (from Greek: φρήν, phrēn, "mind"; and λόγος, logos, "knowledge") is a
pseudoscience primarily focused on measurements of the human skull, based on the concept that
the brain is the organ of the mind, and that certain brain areas have localized, specific functions
or modules. Following the materialist notions of mental functions originating in the brain,
phrenologists believed that human conduct could best be understood in neurological rather than
philosophical or religious terms. Developed by German physician Franz Joseph Gall in 1796, the
discipline was very popular in the 19th century, especially from about 1810 until 1840. The
principal British centre for phrenology was Edinburgh, where the Edinburgh Phrenological
Society was established in 1820. In 1843, François Magendie referred to phrenology as "a
pseudo-science of the present day." Phrenological thinking was, however, influential in 19thcentury psychiatry and modern neuroscience. Gall's assumption that character, thoughts, and
emotions are located in the brain is considered an important historical advance toward
neuropsychology. Phrenologists believed that the mind has a set of different mental faculties,
with each particular faculty represented in a different area of the brain. These areas were said to
be proportional to a person's propensities, and the importance of the given mental faculty. It was
believed that the cranial bone conformed in order to accommodate the different sizes of these
particular areas of the brain in different individuals, so that a person's capacity for a given
personality trait could be determined simply by measuring the area of the skull that overlies the
corresponding area of the brain.
As a type of theory of personality, phrenology can be considered to be an advance over the old
medical theory of the four humors. Phrenology, which focuses on personality and character,
should be distinguished from craniometry, which is the study of skull size, weight and shape, and
physiognomy, the study of facial features.
Although modern, scientific psychology is often dated at the 1879 opening of the first
psychological laboratory by Wilhelm Wundt, attempts to create methods for assessing and
treating mental distress existed long before. The earliest recorded approaches were a
combination of religious, magical and/or medical perspectives. Early examples of such
physicians included Patañjali, Padmasambhava, Rhazes, Avicenna, and Rumi
In the early 19th century, one could have his or her head examined, literally, using phrenology,
the study of personality by the shape of the skull. Other popular treatments included
physiognomy—the study of the shape of the face—and mesmerism, Mesmer's treatment by the
use of magnets. Spiritualism and Phineas Quimby's "mental healing" were also popular. While
the scientific community eventually came to reject all of these methods, academic psychologists
also were not concerned with serious forms of mental illness. That area was already being
addressed by the developing fields of psychiatry and neurology within the asylum movement. It
was not until the end of the 19th century, around the time when Sigmund Freud was first
developing his "talking cure" in Vienna, that the first scientifically clinical application of
psychology began.
Early clinical counseling and psychology
Lightner Witmer, the father of modern clinical psychology.
By the second half of the 1800s, the scientific study of psychology was becoming wellestablished in university laboratories. Although there were a few scattered voices calling for an
applied psychology, the general field looked down upon this idea and insisted on "pure" science
as the only respectable practice. This changed when Lightner Witmer (1867–1956), a past
student of Wundt and head of the psychology department at the University of Pennsylvania,
agreed to treat a young boy who had trouble with spelling. His successful treatment was soon to
lead to Witmer's opening of the first psychological clinic at Penn in 1896, dedicated to helping
children with learning disabilities. Ten years later in 1907, Witmer was to found the first journal
of this new field, The Psychological Clinic, where he coined the term "clinical psychology,"
defined as "the study of individuals, by observation or experimentation, with the intention of
promoting change." The field was slow to follow Witmer's example, but by 1914, there were 26
similar clinics in the US. Even as clinical psychology was growing, working with issues of
serious mental distress remained the domain of psychiatrists and neurologists. However, clinical
psychologists continued to make inroads into this area due to their increasing skill at
psychological assessment. Psychologists' reputation as assessment experts became solidified
during World War I with the development of two intelligence tests, Army Alpha and Army Beta
(testing verbal and nonverbal skills, respectively), which could be used with large groups of
recruits. Due in large part to the success of these tests, assessment was to become the core
discipline of clinical counseling for the next quarter century, when another war would propel the
field into treatment.
Early professional organizations
The field began to organize under the name "clinical psychology" in 1917 with the founding of
the American Association of Clinical Psychology. This only lasted until 1919, after which the
American Psychological Association (founded by G. Stanley Hall in 1892) developed a section
on Clinical Psychology, which offered certification until 1927 Growth in the field was slow for
the next few years when various unconnected psychological organizations came together as the
American Association of Applied Psychology in 1930, which would act as the primary forum for
psychologists until after World War II when the APA reorganized. In 1945, the APA created
what is now called Division 12, its division of clinical psychology, which remains a leading
organization in the field. Psychological societies and associations in other English-speaking
countries developed similar divisions, including in Britain, Canada, Australia and New Zealand.
World War II and the integration of treatment
The US army conducts a psychological test developed by clinical psychologists for
selection purposes.
When World War II broke out, the military once again called upon clinical psychologists. As
soldiers began to return from combat, psychologists started to notice symptoms of psychological
trauma labeled "shell shock" (eventually to be termed posttraumatic stress disorder) that were
best treated as soon as possible. Because physicians (including psychiatrists) were over-extended
in treating bodily injuries, psychologists were called to help treat this condition. At the same
time, female psychologists (who were excluded from the war effort) formed the National Council
of Women Psychologists with the purpose of helping communities deal with the stresses of war
and giving young mothers advice on child rearing. After the war, the Veterans Administration in
the US made an enormous investment to set up programs to train doctoral-level clinical
psychologists to help treat the thousands of veterans needing care. As a consequence, the US
went from having no formal university programs in clinical psychology in 1946 to over half of
all Ph.D.s in psychology in 1950 being awarded in clinical psychology. WWII helped bring
dramatic changes to clinical counseling, not just in America but internationally as well. Graduate
education in psychology began adding psychotherapy to the science and research focus based on
the 1947 scientist–practitioner model, known today as the Boulder Model, for Ph.D. programs in
clinical psychology. Clinical psychology in Britain developed much like in the U.S. after WWII,
specifically within the context of the National Health Service with qualifications, standards, and
salaries managed by the British Psychological Society.
A changing profession
Since the 1970s, clinical counseling has continued growing into a robust profession and
academic field of study. Although the exact number of practicing clinical counselors is unknown,
it is estimated that between 1974 and 1990, the number in the US grew from 20,000 to 63,000.
Clinical counselors continue to be experts in assessment and psychotherapy while expanding
their focus to address issues of gerontology, sports, and the criminal justice system to name a
few. One important field is health psychology, the fastest-growing employment setting for
clinical psychologists in the past decade. Other major changes include the impact of managed
care on mental health care; an increasing realization of the importance of knowledge relating to
multicultural and diverse populations; and emerging privileges to prescribe psychotropic
medication.
In the UK psychology is now one of the most popular degree subjects, and over 15,000 people
graduate in psychology each year, many with the hope of developing this into a career, although
only around 600 places for doctoral training in clinical psychology means there is intense
competition for these places.
Professional Clinical Counseling Practice
Clinical Counselors can offer a range of professional services, including: Administer and
interpret psychological assessment and testing

Conduct psychological research

Consultation (especially with schools and businesses)

Development of prevention and treatment programs

Program administration

Provide expert testimony (forensic psychology)

Provide psychological treatment (psychotherapy)

Teach
In practice, clinical Counselors 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 counselors who engage in research and
teaching do so within a college or university setting. Clinical counselors may also choose to
specialize in a particular field—common areas of specialization, some of which can earn board
certification, include:

Child and adolescent

Family and relationship counseling

Forensic

Health

Neuropsychological disorders

Organization and business

School

Specific disorders (e.g. trauma, addiction, eating, sleep, sex, clinical depression,
anxiety, or phobias)

Sport
Assessments in Clinical Counseling.
An important area of expertise for many clinical Counselors is psychological assessment, and
there are indications that as many as 91% of psychologists engage in this core clinical practice.
Such evaluation is usually done in service to gaining insight into and forming hypotheses about
psychological or behavioral problems. As such, the results of such assessments are usually used
to create generalized impressions (rather than diagnoses) in service to informing treatment
planning. Methods include formal testing measures, interviews, reviewing past records, clinical
observation, and physical examination. There exist literally hundreds of various assessment
tools, although only a few have been shown to have both high validity (i.e., test actually
measures what it claims to measure) and reliability (i.e., consistency). These measures generally
fall within one of several categories, including the following:

Intelligence & achievement tests – These tests are designed to measure certain
specific kinds of cognitive functioning (often referred to as IQ) in comparison to a
norming-group. These tests, such as the WISC-IV, attempt to measure such traits as
general knowledge, verbal skill, memory, attention span, logical reasoning, and
visual/spatial perception. Several tests have been shown to predict accurately certain
kinds of performance, especially scholastic. Personality tests – Tests of personality aim
to describe patterns of behavior, thoughts, and feelings. They generally fall within
two categories: objective and projective. Objective measures, such as the MMPI, are
based on restricted answers—such as yes/no, true/false, or a rating scale—which
allow for computation of scores that can be compared to a normative group.
Projective tests, such as the Rorschach inkblot test, allow for open-ended answers,
often based on ambiguous stimuli, presumably revealing non-conscious psychological
dynamics.
Neuropsychological tests – Neuropsychological tests consist of specifically
designed tasks used to measure psychological functions known to be linked
to a particular brain structure or pathway. They are typically used to assess
impairment
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