Clinical psychology. Definition, subject, tasks.

Clinical psychology

(
medical psychology
[1][2]) is a branch of psychology (at the intersection with psychiatry) that studies mental phenomena from the point of view of their relationship with diseases. The scope of clinical psychology includes the diagnosis of mental health, the organization and conduct of scientific research to understand psychophysiological problems, and the development, implementation and evaluation of psychological correction (psychotherapy). Psychotherapeutic methods of clinical psychology: counseling, individual psychotherapy, family psychotherapy, family counseling and various forms of support for people experiencing psychological problems associated with physical health disorders.

Subject of clinical psychology

Clinical psychology is a broad-based specialty, intersectoral in nature and involved in solving a set of problems in the healthcare system, public education and social assistance to the population. The work of a clinical psychologist is aimed at increasing a person’s psychological resources and adaptive capabilities, harmonizing mental development, protecting health, preventing and overcoming illnesses, and psychological rehabilitation[3].

medical psychology” has long been accepted

", defining the same field of activity. In the 1990s, as part of bringing the Russian educational program to international standards, the specialty “clinical psychology” was introduced in Russia. Unlike Russia, in which medical psychology and clinical psychology often actually represent the same field of psychology, in international practice medical psychology usually refers to the narrow sphere of psychology of the relationship between a doctor or therapist and a patient and a number of other highly specific issues, including time, as clinical psychology is a holistic scientific and practical psychological discipline[4].

Subject of clinical psychology as a scientific and practical discipline:

• Mental manifestations of various disorders.
• The role of the psyche in the occurrence, course and prevention of disorders.
• The influence of various disorders on the psyche.
• Mental development disorders.
• Development of principles and methods of clinical research.
• Psychotherapy, conducting and developing methods.
• Creation of psychological methods of influencing the human psyche for therapeutic and preventive purposes.

Clinical psychologists study general psychological problems, as well as the problem of determining normality and pathology, determining the relationship between the social and biological in a person and the role of the conscious and unconscious, as well as solving problems of development and disintegration of the psyche.

General characteristics of the direction

There are a lot of stereotypes that form a false opinion about the profession. Often, patients cannot distinguish a psychologist from a psychiatrist or psychotherapist, and the main task of doctors is considered to be serious disorders of mental activity. What is the confusion?

A psychiatrist diagnoses and treats only mentally ill patients. Their blood vessels, brain and nervous system itself do not work properly, which provokes a change in character, the development of hallucinations, and memory deterioration. Psychiatric therapy is often based on injections and pills. Psychotherapists and psychologists work only with healthy people. Doctors help identify, work through, and eradicate the problem that prevents the patient from functioning well.

Anyone who has received a higher psychological education can call himself a psychologist. A psychotherapist is a psychologist who has long experience in practical work. In general, a person will have to spend 12 years of his life to master a profession.

Ideally, a psychologist works as an assistant to a psychotherapist. This is a kind of internship before independent work and seeing patients. He can listen, nod his head politely, and ask exactly how the client plans to solve his problem. This is the entire list of tasks that are within the competence of a specialist. Usually a psychologist works with emotions, since it can be difficult for a person to recognize them.

Is it possible to work through internal problems with a psychologist?

The idea of ​​the profession of psychologist and psychotherapist is formed largely by foreign films and unfounded speculation. It seems to us that a mature man with a beard will sit us down on the couch, listen to our life story and offer clear ways to solve all our problems. But this is not so, and the fictitious picture is as far from reality as possible.

In fact, a psychologist cannot independently accept a patient and give his own recommendations, since he does not have sufficient experience and practice. A doctor can work in conjunction with a psychotherapist, conduct a preliminary diagnosis of patients, identify their fears/experiences/vulnerabilities and transfer the information received to a senior specialist.

Why is it not recommended to visit a psychologist to work through internal experiences? Since the doctor cannot offer the patient options for solving the problem, he becomes a free listener. In some cases, a person just needs to speak out and return to normal rhythm, but this scheme does not suit everyone. There are cases where the patient received temporary support, but not relief, and later became emotionally dependent on the listener.

According to statistics, every third person on the planet lives with an anxiety-depressive disorder. Humanity is in a state of stress and most often tries to suppress a bad mood, rather than find out its cause and overcome its consequences. Willpower alone is not always enough, which is why psychotherapists exist. It is to them that you need to turn to for a list of sequential actions that will help you look at the situation from a different angle, let it go, or, conversely, complete the gestalt.

If you want to speak out, but cannot count on friends or relatives, visit a psychologist. He will not be able to analyze your condition, identify the disease and suggest methods for its correction. A psychotherapist deals with all of the above.

History of appearance and definition

At the beginning of its development as a science, psychology set itself the task of studying “normal” consciousness, leaving deviations from the norm to develop in parallel with neurology and psychiatry, within which the study of patients in mental hospitals was carried out. In these institutions, however, numerous patients with chronic problems, as a rule, were kept in very difficult conditions that were not conducive to scientific work[5].

Lightner Whitmer

The preconditions for the emergence of clinical psychology were laid by the psychological research of French and Russian psychiatrists at the end of the 19th century. The father of French psychology, Théodule Ribot, at the beginning of his career, paid great attention to psychopathology, although his students had to obtain diplomas of psychiatrists or neurologists to study it[6]. In France, empirical research on psychological topics was carried out by I. Taine, J.-M. Charcot, P. Janet. In Russia, pathopsychological studies were conducted by S. S. Korsakov, I. A. Sikorsky, V. M. Bekhterev, V. Kh. Kandinsky and other psychiatrists. The first psychological laboratory in the Russian Empire was founded by V. M. Bekhterev in 1885 at the psychiatric clinic of Kazan University. In the USA, in the 19th century, a research laboratory at the New York Pathological Institute was founded by Boris Sidis, a student of psychologist William James, and a similar laboratory was created by William Krohn at the Eastern Mental Hospital in Illinois[5].

The term “clinical psychology” was coined in 1907 by American psychologist Lightner Whitmer (1867–1956), who narrowly defined it as the study of individuals through observation or experiment with the intention of producing change.[7] According to the modern definition of the American Psychological Association:

The field of clinical psychology integrates science, theory, and practice to understand, predict, and alleviate maladjustment, disability, and discomfort, as well as to promote adaptation, adjustment, and personal development. Clinical psychology concentrates on the intellectual, emotional, biological, psychological, social and behavioral aspects of human functioning across the lifespan, across cultures and at all socioeconomic levels[8].

Whitmer opened his own psychological clinic in 1896 at the University of Pennsylvania. In 1907, thanks to his efforts, the first ever specialized journal on clinical psychology, The Psychological Clinic,

[9]. Using Whitmer's approach, American psychologists began to create new psychological clinics, and in 1917 the first organization of clinical psychologists, the American Association of Clinical Psychology, appeared. The German school of clinical psychology was formed in the middle of the 20th century; it was based on the achievements of experimental psychology, which began in the 1890s[10].

In the 20th century, numerous studies were carried out at the Psychoneurological Institute named after. Bekhterev. The development of clinical psychology in Russia was seriously promoted by such scientists as V.P. Osipov, G.N. Vyrubov, V.N. Myasishchev. A significant scientific and organizational contribution to the development of clinical psychology in Russia in recent years has been made by Myasishchev’s student B. D. Karvasarsky.

Medical psychologist

Today, turning to psychologists for help is gradually becoming the norm - conflicts at work and in the family, various difficulties in communicating with people and building interpersonal relationships make you think and seek help from a specialist.

In the West and in the USA, turning to a psychologist has already become so commonplace that going to a specialist for advice has become as common as going to the store. In Russia, the situation is a little different; historically, the role of psychologists is played by friends or relatives, and more often the person himself tries to cope with the problem.

Why people go to general practice psychologists for help is relatively clear, but who is a medical (or clinical) psychologist , how and who can he help?

Sections of clinical psychology

In clinical psychology the following sections are distinguished:

1. Pathopsychology;
2. Neuropsychology;
3. Psychosomatics;
4. Psychology of abnormal development;
5. Psychotherapy

Pathopsychology and clinical psychopathology

Main article: Pathopsychology

Pathopsychology deals with issues of human mental disorders, disorders of adequate perception of the world due to lesions of the central nervous system. Pathopsychology studies the patterns of disintegration of mental processes in various disorders (diseases), as well as factors that contribute to the creation of effective corrective treatment methods.

The practical tasks of pathopsychology include analyzing the structure of mental disorders, establishing the degree of decline in mental functions, differential diagnosis, studying personality characteristics and studying the effectiveness of therapeutic interventions.

There is a difference between pathopsychology, that is, consideration of the human mental sphere from the point of view of psychological methods, and psychopathology, which considers the human psyche from the point of view of nosology and psychiatry. Clinical psychopathology examines, identifies, describes and systematizes the manifestations of disturbed mental functions, while pathopsychology uses psychological methods to reveal the nature of the course and structural features of mental processes leading to disorders observed in the clinic [11].

The founders of Moscow pathopsychology of the Soviet period are considered to be B.V. Zeigarnik and S.Ya. Rubinstein.

Neuropsychology

Main article: Neuropsychology

Neuropsychology is a broad scientific discipline that studies the role of the brain and central nervous system in mental processes, touching on issues such as psychiatry and neuroscience, as well as philosophy of mind, cognitive science and artificial neural networks.

The Soviet school of neuropsychology was mainly engaged in the study of cause-and-effect relationships between brain lesions, their localization and changes in mental processes. Her tasks included the study of impaired mental functions as a result of brain damage, the study of the localization of the lesion and issues of restoration of impaired mental functions, as well as the development of theoretical and methodological problems of general and clinical psychology.

A significant contribution to the development of neuropsychology as an independent discipline was made by the Soviet scientist A. R. Luria, whose research in the field of aphasia and neurolinguistics received worldwide recognition.

Psychosomatics

Main article: Psychosomatics

Psychosomatics studies the problems of patients with somatic disorders, in the origin and course of which the psychological factor plays a large role. The scope of psychosomatics includes issues related to oncological and other serious diseases (notification of diagnosis, psychological assistance, preparation for surgery, rehabilitation, etc.) and psychosomatic disorders (when experiencing acute and chronic mental trauma; problems include symptoms of coronary heart disease, ulcerative diseases, hypertensive disorder, neurodermatitis, psoriasis and bronchial asthma). Within the framework of clinical psychology, psychosomatics distinguishes between psychosomatic symptoms and psychosomatic phenomena[12].

Psychological correction and psychotherapy

Main article: Psychological correction

Psychological correction, or psychocorrection, is associated with the characteristics of helping a sick person. Within the framework of this section, the development of the psychological foundations of psychotherapy, psychological rehabilitation as a systemic medical and psychological activity aimed at restoring personal social status through various medical, psychological, social and pedagogical measures, psychohygiene as the science of preserving and maintaining mental health [13], psychoprophylaxis , or a set of measures to prevent mental disorders, as well as medical and psychological examination (examination of working capacity, forensic psychological examination, military psychological examination).

What is the difference between psychotherapy and psychological help?

Psychotherapy is one of the types of psychological assistance. It is carried out only by experienced doctors who have become psychologists, completed an internship and started practical work. What do you need to know about referrals and how therapy works?

Features of psychological assistance

Psychological assistance is the field of practical application of psychology. This is specific work with people, which involves many rules and restrictions. Psychological assistance includes:

• psychoprophylaxis (aimed at preventing possible problems);
• education (attending lectures or seminars about the structure of the human psyche, informing about the needs of the body and maintaining emotional health);
• counseling (psychological assistance to patients who are within the normal range of development, psychological adaptation and personal potential);
• psychodiagnostics (identifying problems and other psychological indicators through tests or conversation);
• psychotherapy (solving deep-seated personal problems, personality transformation, getting rid of phobias or attitudes that interfere with quality life);
• psychiatry (complex therapy using medications and various approaches to the patient);
• psychocorrection (restoration of a person’s normal emotional state and personality traits).

All types of psychological assistance are interconnected in one way or another. They can be carried out by different specialists depending on education, experience and specialization.

There are several criteria for psychological assistance. One of them is the friendliness of the doctor. The patient should feel comfort and calm, not stress and shame about his own life. The psychologist must listen carefully, refuse to judge, and focus on the patient’s norms/values, and not socially accepted attitudes. A psychologist is prohibited from giving advice; this is the prerogative of a psychotherapist. Also, the doctor must guarantee complete anonymity and suppress any attempts to make friends with the patient or start a romantic relationship outside the office. This will negate an objective assessment of actions on both sides and neutralize therapy.

Features of psychotherapy

The human psyche can be compared to a computer program. Failures that occur at different levels require specific correction and subsequent preventive measures. First, the psychotherapist determines the level at which the person is failing and begins to formulate a sequence of exercises/tasks to get rid of the problem. The duration of therapy is determined in each specific case. The same psychotherapist can change a patient’s life in one two-hour session, and in another case, study a person and his pathologies for months or years.

Each visit to a psychotherapist is strictly scheduled. A psychologist may be present as a trainee for some (or all) sessions. This is how he develops skills and learns from a professional. If the patient is not ready to discuss his life with two people, he warns the doctor about this and stays for a one-on-one conversation. At the first consultations, a person is asked to undergo a mountain of tests that will indicate his internal state, social phobia, and some fears, but the final verdict is made only after an individual conversation. Then the psychotherapist draws up the topic of the visit, prescribes activities and exercises that the person should do in his presence and independently at home.

The first real results can occur after several weeks, months or even years, depending on individual characteristics and the influence of external factors. The psychotherapist focuses on the changes happening to the person and gradually takes him to a new level, returning him to normal life.

Methods of clinical psychology

Clinical psychology uses many methods to objectify, differentiate and qualify various variants of normality and pathology. The choice of technique depends on the task facing the psychologist, the mental state of the patient, the patient’s education, and the degree of complexity of the mental disorder. The following methods are distinguished:

• Observation
• Conversation
• Psychophysiological methods (for example, EEG)
• Biographical method
• Study of creative products
• Anamnestic method (collection of information about treatment, course and causes of the disorder)
• Experimental psychological method (standardized and non-standardized methods)

Wage

As for wages, it depends on work experience, place of work, region, etc. However, the generalized average salary of such specialists in Russia is 26 thousand rubles. As for the capital, this figure is almost twice as high (45 thousand rubles).

A graduate of the Department of Clinical Psychology begins his career with a salary of 15.4 thousand rubles. By moving up the career ladder or opening his own business, his income can increase to 235 thousand rubles.

Psychotherapy

Main article: Psychotherapy

Psychotherapy is the main method of psychological correction carried out by a clinical psychologist, in general terms it is a set of techniques and methods used by a psychotherapist to change a person’s psycho-emotional state, his behavior and communication patterns, improve his well-being and improve his ability to adapt to society. Psychotherapy is carried out both individually and in groups.

There are many different areas of psychotherapy: psychodynamic psychotherapy, cognitive psychotherapy, humanistic psychotherapy, family psychotherapy, gestalt therapy, emotional-imaginative therapy, body-oriented psychotherapy; In recent decades, there has also been an emergence of transpersonal types of psychotherapy.

Who is a clinical neuropsychologist and where can he work?

Neuropsychologists work in large medical hospitals, in psychiatry, and in specialized institutions for neurological disorders. Both neuropsychology and PC services have access to validated tests and other assessment tools.

Clinical psychological treatment includes a wide range of work: from classical psychoanalysis to other forms of therapy:

Treatment also includes habilitation of people with disabilities and rehabilitation after illnesses and injuries that lead to disability.

Some clinical psychologists are psychotherapists in private practice, but the vast majority work in public health settings, where they are part of a team of doctors, nurses, sociognomists and other professional groups.

The problem of mental norm and pathology

Clinical psychology deals with the problem of determining what mental norm and pathology are. Within the nosological approach, it is customary to distinguish two human states - health and disease.

Typical signs of health

The structural and physical safety of the nervous system and human organs, individual adaptability to the physical and social environment, and the preservation of stable, habitual well-being are considered.

Disease

characterized by a general or partial decrease in adaptability, while the following possible outcomes of the disease are distinguished: complete recovery, recovery with the presence of residual effects, disability (defect) and death.

Pathological mental state is also distinguished

, due to the etiology of the process and having no outcome.

The issue of determining norm and pathology is extremely complex and affects various spheres of human activity - from medicine and psychology to philosophy and sociology. A number of attempts were made to derive criteria for mental norms, which included the maturity of feelings appropriate to a person’s age, adequate perception of reality, the presence of harmony between the perception of phenomena and the emotional attitude towards them, the ability to get along with oneself and the social environment, flexibility of behavior, a critical approach to life circumstances , having a sense of identity, the ability to plan and evaluate life prospects. In many cases, the mental norm determines how adapted an individual is to life in a social environment, how productive and critical he is in life.

When making a diagnosis, psychiatrists and clinical psychologists use both personal experience and general guidelines, as well as the International Classification of Diseases (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Problems that a clinical psychologist helps solve

After the main course of treatment, every person who comes to the attention of a psychiatrist or psychiatrist-narcologist is usually prescribed a course of post-treatment rehabilitation, which implies a mandatory visit to a psychotherapist. A course of psychotherapy is usually designed for a certain period, but is always built individually, based on the person’s illness and medical indications.

The main goal of psychotherapy is to resocialize the patient, return to normal life, return to work or study. That is, assistance in restoring relationships with society damaged by the disease. Often, people who are in trouble, who have experienced psychosis, or who have gone through a period of addiction, face difficulties in returning to the life that is familiar to an ordinary person.

In addition to social problems, such as employment or study, illness causes conflicts in the family, misunderstanding of loved ones, or categorical rejection of one’s illness. These and many other problems are helped to be solved by a clinical psychologist, who is well aware of the nature of both mental disorders and the stages of addiction formation.

Notes

1. Clinical psychology: textbook for universities / ed. B. D. Karvasarsky. — 4th ed. - St. Petersburg: Peter, 2011. - P. 9, 268, 269. - 864 p. — (Series “Textbook for Universities”). — ISBN 9785459008081.
2. Medical psychology / Tkhostov A. Sh. // Manikovsky - Meotida. - M.: Great Russian Encyclopedia, 2012. - P. 505. - (Big Russian Encyclopedia: [in 35 volumes] / chief editor Yu. S. Osipov; 2004-2017, vol. 19). — ISBN 978-5-85270-353-8.
3. Karvasarsky, 2011, p. 18.
4. Karvasarsky, 2011, p. 9.
5. ↑ 1 2 Benjamin LT
   The Birth of the New Applied Psychology in America // A Brief History of Modern Psychology. — Third Edition. - Wiley, 2020. - P. 86-103. — ISBN 978-1-119-49324-2.
6. Routh DK
   A History of Clinical Psychology: Theodule Ribot // The Oxford Handbook of Clinical Psychology / Edited by David H. Barlow. — Updated Edition. - Oxford University Press, 2014. - P. 25-26. — ISBN 978-0-932871-0.
7. Compass, B. & Gotlib, I. (2002). Introduction to Clinical Psychology. New York, NY: McGraw Hill. ISBN 0-07-012491-4. (English)
8. American Psychological Association, Division 12, “About Clinical Psychology.” (English)
9. Routh DK
   A History of Clinical Psychology: Lightner Witmer // The Oxford Handbook of Clinical Psychology / Edited by David H. Barlow. — Updated Edition. - Oxford University Press, 2014. - P. 26-27. — ISBN 978-0-932871-0.
10. Karvasarsky, 2011, p. 250, 268.
11. Karvasarsky, 2011, p. 378.
12. “Psychosomatic symptom as a cultural phenomenon” by G. A. Arin in the collection “Psychosomatics: corporeality and culture: Textbook for universities” / Ed. V. V. Nikolaeva - M.: Academic project, 2009. - 311 pages
13. The book of the Czech psychologist Doctor of Science (PhDr.) Thomas Novak (written in collaboration with V. Capponi) “Be Your Own Psychologist”, St. Petersburg, 2001, is devoted to issues of mental hygiene (as well as methods of self-knowledge). I am my own psychologist.