What are examples of clinical psychology

Clinical psychology and psychotherapy

Area overview | Prof. Dr. Franz Petermann (†)

Clinical psychology comprises the research, diagnosis and therapy of all mental disorders in humans. As a basic discipline, it represents the framework for the prevention, treatment and rehabilitation of people with a mental disorder. In the context of coping with a physical illness, clinical psychology offers concepts whose principles and methods are used to support patients in dealing with the psychosocial consequences of a to cope better with (chronic) physical illness. Thus, prevention, psychotherapy and rehabilitation are areas of application of clinical psychology, with the focus being on "psychotherapy" as an area of ​​application. In the last ten years, clinical child psychology has separated itself from clinical psychology in adulthood and has established itself as a specialist discipline in its own right. The basics of clinical child psychology deals with the causes, development and course of mental disorders in childhood and adolescence, with risk and protective factors that take effect at an early stage of particular importance (Petermann, 2013).

Mental disorders

An essential feature of the definition of the subject clinical psychology and psychotherapy is the concept of "mental disorders". Mental disorders are not clearly defined, fixed entities, but represent, according to the current state of research, meaningful constructs on which researchers and practitioners have agreed. This consensus includes the possibility that the definition of mental disorders or whole parts of a classification system may change with new scientific knowledge. 1980 took place z. B. the abandonment of the diagnostic term anxiety neurosis in favor of the diagnoses panic disorders and generalized anxiety disorder. Corresponding fundamental revisions of the ICD (ICD-10) and DSM (DSM-5) take place at intervals of approximately 20 years. Mental illness is not only understood to mean the diagnostic terms that are often discussed in public, such as B. depression, schizophrenia and alcohol addiction, but also psychological disturbance phenomena in physical illnesses, various behavioral disorders of childhood and personality disorders. In-depth knowledge of the manifestations of mental disorders, their classification and the associated diagnostic procedures are indispensable for all fields of psychological application. In view of the breadth of topics in clinical psychology, it is obvious that there is no comprehensive, comprehensive theory of mental disorders. There are many theories and models as well as findings, but their scope is mostly limited to partial aspects, selected groups of disorders or procedures. With the resulting obligation to further develop scientific theories, models and their testing and implementation, a further characteristic of clinical psychology is its research orientation.

Central keywords for mental disorders, based on the structure of the ICD-10:

F0 Organic disturbances

F1 disorders from psychotropic substances

F2 Schizophrenia, schizotypal and delusional disorders

F3 Affective disorders

F4 Neurotic Stress and Somatoform Disorders:

F5 behavioral problems with physical disorders

F6 personality and behavior disorders

F7 mental retardation

F8 developmental disorders

F9 onset in childhood and adolescence


Organizational principle

The organizational principle of clinical psychology can be described according to the matrix created by Perrez and Baumann (2011), which includes disorder-related and general aspects. At the level of the disruption-related aspects, disrupted functions or disrupted functional models are considered. A distinction is also made between an intra- and an interpersonal level. At the intrapersonal level, the disturbed functions relate to those functions that are also defined in general psychology as well as bio- and neuropsychology (e.g. perception, memory, learning). The disturbed functional patterns relate to psychological disorders in the narrower sense, such as depressive disorders, anxiety disorders, specific or social phobias, somatoform disorders or psychological impairments in physical illnesses such as pain or neurodermatitis. In clinical psychology, as in neighboring medical disciplines, these disorders are defined using diagnostic classification systems. The diagnostic conventions codified in Chapter V (F) of the 10th revision of the International Classification of Diseases (ICD-10) are internationally binding for all health systems and professions. Clinical psychology and psychotherapy, like psychiatry, also refers to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV, 1994; since 2013: DSM-5) as the standard in research and teaching. The spectrum of clinical-psychological research, intervention and application areas goes beyond the mental disorders defined in ICD-10 and DSM-5. The subject area of ​​the subject also includes disorders of systems that are located on the interpersonal level. These include disorders that can occur in the context of couple relationships, family, school or work, such as relationship disorders, sexual disorders, and social behavior disorders.

Models of mental disorders and psychotherapy

An integrative definition that can claim to be valid for all psychotherapeutic approaches comes from Strotzka (1975, 4): «Psychotherapy is a conscious and planned interactive process for influencing behavioral disorders and states of suffering, which are based on a consensus (if possible between patient, therapist and reference group ) are considered to be in need of treatment, with psychological means (through communication), mostly verbally but also averbally, in the direction of a defined goal, if possible jointly developed (symptom minimization and / or structural change of the personality) using teachable techniques based on a theory of the normal and pathological behavior. As a rule, a stable emotional bond is necessary for this ». In the method paper of the Scientific Advisory Board Psychotherapy, 2010, 4-5) according to § 11 PsychThG, a distinction is made between the terms psychotherapy process, psychotherapy method and psychotherapeutic technique: “A psychotherapy process suitable for treating sick people is characterized by a comprehensive theory of the development and maintenance of diseases and their treatment or treatment . various theories of the development and maintenance of diseases and their treatment on the basis of common theoretical assumptions, and a related psychotherapeutic treatment strategy for a wide range of areas of application or several related psychotherapeutic treatment methods for a wide spectrum of areas of application, and related concepts for Indication, for individual treatment planning and for shaping the therapeutic relationship. ... A psychotherapy method suitable for the treatment of one or more disorders with disease value is characterized by a theory of the origin and maintenance of this disorder or disorders and a theory of their treatment, indication criteria including their diagnostic assessment, the description of the procedure and the description of the desired Treatment effects. A psychotherapeutic technique is a concrete procedure with the help of which the desired goals are to be achieved within the framework of the application of psychotherapeutic methods and procedures, e.g. B. in the field of the psychodynamic procedure: the transference interpretation for the awareness of updated unconscious relationship patterns, or in behavior therapy: stimulus confrontation in vivo ».

Within the (neuro-) biological perspective The causes of mental disorders lie in the functioning of the genes, the constitution and the metabolism of the brain, the nervous and endocrine systems. Disturbances are explained by structural and biochemical processes (see area overview psychopharmacotherapy).

The psychodynamic perspective sees the causes of behavior and mental disorders in intrapsychic, mostly unconscious, conflicts, impulses and processes (instincts, biological drives, thoughts, emotions) that can often be traced back to early childhood conflicts. Methodological approaches include conversation and indirect subjective measures (dreams, resistance).

Humanistic therapy procedures

focus on supporting the client in his quest for self-realization and psychological growth. A symmetrical therapy relationship as well as understanding-oriented, empathic and appreciative communication behavior of the therapist particularly supports problem insight, understanding of meaning and self-actualization tendencies of the client.

Cognitive-behavioral approaches

describe mental disorders on the basis of the mismatched and learned (e.g. operant, classical conditioning, model learning) behavior and attitude patterns that arise from vulnerabilities and stress. In this context, cognitive processes (attention, remembering, thought and attribution patterns, problem solving) play a special role. Variants are (cognitive) behavioral therapy and other cognitive therapy methods. The evaluation methods include the experiment, controlled study designs, direct objective (laboratory) and indirect measures.

As part of a integrative perspective Mental disorders are the result of complex vulnerability-stress interactions in which biological, cognitive-affective, social, environmental and behavioral aspects interact. All available scientific knowledge components are used, including the aforementioned perspectives.

Research and quality standards in psychotherapy

Psychotherapists are legally obliged to practice quality assurance. This obligation includes ensuring that your psychotherapeutic services financed by the health insurance companies must be necessary and appropriate (have an appropriate cost-benefit or cost-effectiveness ratio). The quality assurance of outpatient psychotherapeutic services mostly includes the areas of structure, process and outcome quality. Measures to ensure consistent structural quality in psychotherapy include: (1) the license to practice medicine and the certificate of specialist knowledge of the practitioner, (2) the obligation to carry out guidelines (psychoanalysis / psychotherapy based on depth psychology, behavioral therapy), (3) obtaining a medical consultant's report for clarification somatic aspects as well as (4) the requirement for approval by the expert procedure. Quality assurance in the use of psychotherapeutic procedures (process quality) is legally covered by the documentation requirement. In addition, the expert procedure can also have a process-controlling effect, especially for long-term therapies. Further quality assurance measures that relate to the therapy process are the responsibility of the therapist; Above all, this includes supervision and intervision, regular training and the use of modern, empirically based techniques. It is also up to the therapist to determine the quality of the results of the therapy (e.g. through standardized multimodal preliminary and follow-up examinations).

Reference disciplines and interdisciplinary aspects

Clinical psychology is particularly closely related to psychiatry, sociology, the neurobiological subjects (including genetics and psychopharmacology), neurology and behavioral medicine (cf. Petermann & Reinecker, 2005). Overlaps with other sub-areas of psychology arise, for example, in the family context, with school problems and partial performance disorders, with disorders in working life and the professional world, in the area of ​​prevention and health care (see area overview of health psychology; company health promotion) and the rehabilitation of physical illnesses. Overlapping areas with medical disciplines result e.g. B. in the therapy of overweight patients, in the prevention of recurrence in patients with schizophrenia, the rehabilitation of failed perceptual and motor functions after a stroke (neurology), the reduction of harmful behavior (e.g. nicotine dependence, obesity in coronary heart diseases; internal Medicine), pain therapy for chronic diseases (orthopedics) or in palliative situations (oncology). The contribution of clinical psychology ranges from basic research in the field of diagnostic conceptions of disorders to scientific models and paradigms for explaining the development and maintenance of disorders to the basics of intervention and evaluation. An important characteristic of clinical psychology is its basic interdisciplinary orientation due to the breadth and complexity of the subject. The close interdisciplinary cooperation forms the basis for specializations in the fields of work and areas of activity with the aim of process or target group-related optimization. Behavioral medicine, as an interdisciplinary field of research and practice, is based on a comprehensive biopsychosocial model for health and disease problems; this integrates the knowledge of behavioral and biomedical sciences for application to health and disease problems as well as intervention and rehabilitation. Clinical neuropsychology deals with the effects of diseases and injuries of the brain on experience and behavior in research and practice. Against the background of the growing neuroscientific orientation of psychology, however, there are also considerable expansions of the fields of application, which show great overlap with clinical psychology in the narrower sense. Neurology, on the other hand, is a branch and subject of medicine and the teaching of organic diseases of the central, peripheral and vegetative nervous system. Psychopathology is the psychiatric study of the description of abnormal experiences, well-being and behavior in connection with mental disorders. Psychopharmacology is the study of the influence of psychotropic drugs on mental processes. Social psychiatry and forensic psychiatry are teaching subjects in psychiatry, in that epidemiological and sociological aspects of mental illnesses are dealt with, and legal questions that affect the mentally ill are dealt with. Child and adolescent psychiatry is the name given to the branch of psychiatry that deals with the research and treatment of mental disorders from infancy to adolescence. Finally, psychosomatics is a subject in medicine in which the focus is primarily on diseases that appear physically and that are mentally entertained.

References and in-depth literature

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