section_path: Applications/Mental health care
section_name: Mental health care
paragraph_text: Mental health care
  
  The provision of psychological health services is generally called clinical psychology in the U.S. Sometimes, however, members of the school psychology and counseling psychology professions engage in practices that resemble that of clinical psychologists. Clinical psychologists typically include people who have graduated from doctoral programs in clinical psychology. In Canada, some of the members of the abovementioned groups usually fall within the larger category of professional psychology. In Canada and the U.S., practitioners get bachelor's degrees and doctorates; doctoral students in clinical psychology usually spend one year in a predoctoral internship and one year in postdoctoral internship. In Mexico and most other Latin American and European countries, psychologists do not get bachelor's and doctoral degrees; instead, they take a three-year professional course following high school. Clinical psychology is at present the largest specialization within psychology. It includes the study and application of psychology for the purpose of understanding, preventing, and relieving psychological distress, dysfunction, and/or mental illness. Clinical psychologists also try to promote subjective well-being and personal growth. Central to the practice of clinical psychology are psychological assessment and psychotherapy although clinical psychologists may also engage in research, teaching, consultation, forensic testimony, and program development and administration.
  
  Credit for the first psychology clinic in the United States typically goes to Lightner Witmer, who established his practice in Philadelphia in 1896. Another modern psychotherapist was Morton Prince, an early advocate for the establishment of psychology as a clinical and academic discipline. In the first part of the twentieth century, most mental health care in the United States was performed by psychiatrists, who are medical doctors. Psychology entered the field with its refinements of mental testing, which promised to improve the diagnosis of mental problems. For their part, some psychiatrists became interested in using psychoanalysis and other forms of psychodynamic psychotherapy to understand and treat the mentally ill.
  
  Psychotherapy as conducted by psychiatrists blurred the distinction between psychiatry and psychology, and this trend continued with the rise of community mental health facilities. Some in the clinical psychology community adopted behavioral therapy, a thoroughly non-psychodynamic model that used behaviorist learning theory to change the actions of patients. A key aspect of behavior therapy is empirical evaluation of the treatment's effectiveness. In the 1970s, cognitive-behavior therapy emerged with the work of Albert Ellis and Aaron Beck. Although there are similarities between behavior therapy and cognitive-behavior therapy, cognitive-behavior therapy required the application of cognitive constructs. Since the 1970s, the popularity of cognitive-behavior therapy among clinical psychologists increased. A key practice in behavioral and cognitive-behavioral therapy is exposing patients to things they fear, based on the premise that their responses (fear, panic, anxiety) can be deconditioned.
  
  Mental health care today involves psychologists and social workers in increasing numbers. In 1977, National Institute of Mental Health director Bertram Brown described this shift as a source of "intense competition and role confusion." Graduate programs issuing doctorates in clinical psychology emerged in the 1950s and underwent rapid increase through the 1980s. The PhD degree is intended to train practitioners who could also conduct scientific research. The PsyD degree is more exclusively designed to train practitioners.
  
  Some clinical psychologists focus on the clinical management of patients with brain injury. This subspecialty is known as clinical neuropsychology. In many countries, clinical psychology is a regulated mental health profession. The emerging field of disaster psychology (see crisis intervention) involves professionals who respond to large-scale traumatic events.
  
  The work performed by clinical psychologists tends to be influenced by various therapeutic approaches, all of which involve a formal relationship between professional and client (usually an individual, couple, family, or small group). Typically, these approaches encourage new ways of thinking, feeling, or behaving. Four major theoretical perspectives are psychodynamic, cognitive behavioral, existential–humanistic, and systems or family therapy. There has been a growing movement to integrate the various therapeutic approaches, especially with an increased understanding of issues regarding culture, gender, spirituality, and sexual orientation. With the advent of more robust research findings regarding psychotherapy, there is evidence that most of the major therapies have equal effectiveness, with the key common element being a strong therapeutic alliance. Because of this, more training programs and psychologists are now adopting an eclectic therapeutic orientation.
  
  Diagnosis in clinical psychology usually follows the Diagnostic and Statistical Manual of Mental Disorders (DSM). The study of mental illnesses is called abnormal psychology.