What is a clinical psychologist?
The clinical psychologist is the psychological intervention expert in health and social care, by virtue of the length, breadth and nature of their training. This is not to deny or belittle the competent use of psychological interventions by other healthcare professionals (which is widespread and essential), but simply to recognise that the clinical psychology profession is unique in having a single focus on psychological processes and the systematic study of mind and behaviour throughout a lengthy and high-level training path. Whilst clinical psychologists are well-versed in the medical model and its application to abnormal behaviour, they are often critical of this approach and offer psychological perspectives to broaden and improve understanding and treatment efficacy.
Clinical psychologists have a critical understanding of, and competence in, a broad range of psychological interventions and are not confined to any single school. The common ethos is that of the reflective scientist-practitioner, in which intervention choice is informed by the evidence-base and systematically evaluated during the course of therapy in order that the best outcome for the client can be obtained. Such competence is developed partly as a result of an extensive training in applied clinical research intrinsic to pre-registration training in clinical psychology. Assessment, formulation, intervention and evaluation are conducted in collaboration with the client, and the client’s perspective is seen as a central component in all of these processes. The profession has a longstanding tradition of skills-transfer to non-psychologists, and is keen to offer consultation, training and supervision in psychological intervention to other healthcare professionals.
Another area in which clinical psychologists have become involved is the provision of supervision to teams. Such supervision may focus on how best to work with individual clients or may assist the team in examining its own processes and issues to enable more effective working. It is of particular value to teams working in an in-patient or residential setting or who adopt a whole team approach to working with service users, such as assertive outreach teams. There are twelve and a half thousand qualified clinical psychologists in the UK, with sixteen hundred in training at thirty three University centres. The profession is predominantly female numerically. Statutory registration is under the Health and Care Professions Council.
How to become a Clinical Psychologist?
Clinical psychology involves a minimum of seven years’ pre-qualification/pre-registration training (as indicated in the schematic below) in psychological models, assessment and treatment. The first three (undergraduate) years have an emphasis on normal psychological processes, whilst the latter three (postgraduate) years emphasise abnormal psychological processes and intervention.
The Clinical Psychology Training Pathway
Admission and Curriculum
Three A levels (average offer of three B grades or higher) are required for entry onto a three- or four-year (Scotland) undergraduate university course in psychology;
Entry into undergraduate psychology is increasingly competitive: psychology is now the second most popular subject choice (after Law) of university applicants.
Postgraduate clinical psychology admission requires at least an upper second class degree plus relevant healthcare experience: on successful completion the doctor of clinical psychology degree is awarded with automatic eligibility for HCPC registration.
Competition for entry into postgraduate clinical psychology training is notoriously severe, with only one in five of well-qualified psychology graduate applicants being successful. Many of the successful applicants already have PhDs and the majority have at least one publication in a peer-reviewed journal. It is unique amongst mental health professions in having many more high calibre applicants/potential recruits than training places, and this has been the case for many years.
Commonly there is substantial training in CBT including the treatment of depression, obsessional compulsive disorder, post-traumatic stress disorders and other anxiety states. There is also foundation training in a broad range of other psychological interventions including psychodynamic psychotherapy and systemic interventions as part of pre-qualification/pre-registration training. Throughout the six years there is training in research methodology and, in the latter half, experience of conducting applied clinical research at doctoral level. Trainees also learn to design and implement small scale research and audit projects relevant to local health service needs (including service evaluation) and critically evaluate literature pertaining to the evidence base for clinical practice. During the postgraduate three-year phase, typically trainees spend two days a week on academic study and research, and three days working in a wide range of clinical placements with a wide variety of client groups. Although closely supervised, they are expected to carry their own caseload and gain direct experience of assessment, formulation and intervention, making a substantive contribution to NHS services.
Post qualification career pathway
Once qualified, a clinical psychologist may choose to specialise in one or two of a wide variety of areas. The profession is much broader than adult mental health: many clinical psychologists work in medical and surgical settings, neuropsychological rehabilitation, forensic and prison settings in addition to working with children, families, older adults, people with a learning disability, etc.
The first post-qualification year is considered an extension of training, and there is heavy emphasis on CPD and on-going supervision (AfC band 7). Many newly qualified clinical psychologists will seek generic or split first posts and delay specialisation to later in their career.
Newly qualified psychologists are encouraged to obtain further specialist postgraduate training, such as in psychotherapy or neuropsychology, and may register for a further part-time degree, whilst continuing to increase their clinical experience with client work.
Normally after two years, the clinical psychologist may attend supervisor training and begin to supervise her own trainees (AfC band 8). However she would normally continue to work within a speciality led by a consultant grade psychologist. After a further four years of experience and CPD, she would be eligible to apply for a consultant grade post (AfC band 8c to 9) herself (i.e. a total of six years post-qualification experience minimum).