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Prevalence of Mental Disorders
This chart illustrates the percentage of people in the United States who experience a particular class of mental illness at some point during their lives. The figures are derived from the National Comorbidity Survey, in which researchers interviewed more than 9,000 people over 18 years of age.
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Clinical Psychology, branch of psychology devoted to the study, diagnosis, and treatment of people with mental illnesses and other psychological disorders.
Clinical psychologists assess and treat a wide range of psychological problems. These problems range from short-term emotional crises, such as those due to family conflicts, to severe and chronic mental illnesses, such as schizophrenia. Some clinical psychologists specialize in treating specific problems, such as phobias or depression. Others specialize in treating specific populations, such as children, the elderly, or members of ethnic minority groups. Clinical psychologists usually seek to treat emotional and behavioral problems with psychotherapy, a form of intervention that relies primarily on verbal communication between therapist and client.
In addition, many clinical psychologists study the normal human personality and the ways in which individuals differ from one another in their patterns of thinking, feeling, behaving, and relating to others. Still other clinical psychologists administer and interpret various kinds of psychological tests. These include personality tests, intelligence tests, and aptitude tests. These tests are routinely given in schools and businesses to assess an individual’s skills, interests, and emotional functioning. Clinical psychologists also use psychological tests to diagnose possible mental disorders. By identifying early signs of distress or mental disturbance, clinical psychologists work to promote mental health and to prevent mental disorders.
Clinical psychologists work in a wide variety of settings. These include hospitals, mental health clinics, schools, universities, governmental agencies, prisons, and military bases. Many clinical psychologists also work in private practice.
Clinical psychology overlaps with other fields that deal with mental health and mental illness. Counseling psychology focuses primarily on treating people with less severe adjustment problems and everyday difficulties related to work, family, school, or marriage. Psychiatry is the branch of medicine concerned with mental disorders. The work of psychiatrists and clinical psychologists is very similar, except that psychiatrists are physicians who can prescribe medication.
The work of clinical psychologists falls into three main categories: (1) testing and diagnosis, (2) treatment of psychological disorders, and (3) research. Many clinical psychologists combine several of these activities. For example, those who work in academic settings often combine teaching, research, and counseling.
Some clinical psychologists administer achievement tests to children to assess their performance in school. Others administer aptitude tests to workers to help private businesses and government agencies assign employees to appropriate positions. Clinical psychologists most commonly administer psychological tests for the purposes of assessing a person’s mental health. For example, a clinical psychologist may give a child an intelligence test to determine whether that child has mental retardation. Personality tests, such as the Minnesota Multiphasic Personality Inventory, may help determine whether someone has a personality disorder or another psychological problem. Clinical psychologists also conduct detailed interviews with patients, asking questions intended to reveal signs of a psychological problem.
At times, it is difficult to determine whether someone should be identified as having a psychological disorder. According to the American Psychiatric Association, a pattern of behavior or thinking is considered a psychological disorder only if (1) the person is experiencing significant distress or impairment, (2) the source of the problem resides within the person and is not a normal response to negative life events, and (3) the problem is not a deliberate reaction to conditions such as poverty, prejudice, or conflicts with society.
To formulate an effective method of treatment, clinical psychologists must not only determine that there is a problem but also must make a specific diagnosis. That is, they must identify the specific disorder or problem affecting the patient. For this purpose, the most widely used diagnostic scheme in the United States is the Diagnostic and Statistical Manual of Mental Disorders, a reference book published by the American Psychiatric Association. This manual contains a complete list of psychological disorders classified into 16 broad categories. For example, panic disorder, post-traumatic stress disorder, obsessive-compulsive disorder, and phobias are grouped under the category of anxiety disorders. The manual describes the main symptoms for each disorder in concrete behavioral terms. It also gives the prevalence rates for men and women in the population; a list of predisposing factors; the normal age of onset; and the prognosis, or expected outcome.
A psychologist listens to her client during a psychotherapy session. Psychotherapy can be an effective treatment for many mental disorders. Some forms of psychotherapy try to help people resolve their internal, unconscious conflicts, and other forms teach people skills to correct their abnormal behavior.
Many clinical psychologists work directly with people who have a mental illness or psychological disorder. By choosing an appropriate treatment, clinical psychologists can help such people overcome their problem or, at minimum, manage their symptoms.
Clinical psychologists use psychotherapy as their main method of treating psychological disorders. In most types of psychotherapy, a therapist talks one-on-one with a patient or client. The therapist and client meet regularly, typically in weekly sessions, until both agree that the client has substantially improved and does not need further treatment. Although clinical psychologists cannot prescribe medication, they often combine psychotherapy with drug treatment by working in collaboration with the client’s physician.
There are many different approaches to the practice of psychotherapy. Each is based on different ideas about the sources of personal problems. Most therapies can be classified as (1) psychodynamic, (2) humanistic, (3) behavioral, (4) cognitive, or (5) eclectic. Psychodynamic therapies try to help clients uncover and resolve their unconscious motivations and conflicts. Psychoanalysis, developed by Sigmund Freud, is the best-known form of psychodynamic therapy. Humanistic therapies seek to provide a safe, supportive setting in which clients can find their own path to self-fulfillment through insights and personal realizations. Behavioral therapies focus on changing distressing behaviors, using the principles of conditioning and learning to replace problem behaviors with more appropriate ones. Cognitive therapies focus on changing distressing beliefs and thoughts, and try to teach people to interpret significant events in their lives in ways that are more rational and adaptive. Most modern therapists describe their approach as eclectic, which means that they borrow therapy techniques, as needed, from the different approaches.
Normal and Schizophrenic Brains
Magnetic resonance imaging (MRI) reveals structural differences between a normal adult brain, left, and the brain of a person with schizophrenia, right. The schizophrenic brain has enlarged ventricles (fluid-filled cavities), shown in light gray. However, not all people with schizophrenia show this abnormality.
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Research is a central activity of clinical psychologists who work in academic or clinical settings. Primarily, these clinical psychologists study the causes of mental disorders and try to determine the most effective methods of diagnosis and treatment. They also try to improve methods of testing and measuring personality, intelligence, and other personal characteristics.
There are two dominant views on what causes psychological disorders and how they should be treated: the biological perspective and the psychological perspective. The biological perspective, also called the medical model, views mental illnesses as having a biological cause, just as physical illnesses do. Over the years, this perspective has gained support from the fact that certain medical interventions—such as antipsychotic drugs, antianxiety drugs, antidepressants, mood stabilizers, and electroconvulsive therapy—have helped enormously in the treatment of certain psychological disorders. Biologically oriented researchers study genetic predispositions to mental illness, damage to the brain and nervous system, biochemical imbalances, and other physiological underpinnings of mental disorders.
In contrast to the medical model is the psychological perspective, which holds that psychological disorders are caused and maintained by past and present life experiences. This perspective asserts that mental disorders result from negative life events such as prolonged illness, stress, physical and sexual abuse, divorce, poverty, war, the death of a loved one, peer rejection, and chronic failure. Today, most psychologists and psychiatrists believe that mental disorders are caused by a combination of biological and psychological factors.
Another important area of research in clinical psychology concerns the effectiveness of psychotherapy. Most studies have found that no one method of psychotherapy is superior to another. Rather, the different types of psychotherapy are about equally effective, in part because they all share certain qualities. For example, all psychotherapies provide people in distress with hope for recovery, personal support and encouragement, and an opportunity to open up and talk freely about their problems.
In the United States, the education of clinical psychologists typically involves four to six years of graduate study to obtain a doctoral degree, either a Ph.D. or Psy.D. degree, usually followed by a one-year internship at a hospital or clinic. All states in the United States require practicing clinical psychologists to have a doctoral degree from an accredited clinical psychology program. In Canada, some provinces and territories require a minimum of a master’s degree, while others require a doctoral degree.
As part of their training, clinical psychologists may choose to specialize in a particular subfield. For example, clinical neuropsychology is a subfield that studies, assesses, and treats disorders such as Alzheimer’s disease and other dementias that are caused by malfunctioning in the brain and central nervous system. Other clinical psychologists specialize in developmental disabilities that arise in infancy, childhood, and adolescence, such as mental retardation, autism, speech disorders, attention-deficit hyperactivity disorder, juvenile delinquency, and learning disorders.
See also Mental Illness; Psychotherapy; Psychological Testing.
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