5 Clinical Psychological Science

Meredith L. Chivers, PhD, CPsych, Department of Psychology, Queen’s University, Kingston, Ontario, Canada

Christopher Bowie, PhD, CPsych, Department of Psychology, Queen’s University, Kingston, Ontario, Canada

Su Buchanan, PhD, CPsych, Department of Psychology, Queen’s University, Kingston, Ontario, Canada

Tess Clifford, PhD, CPsych, Department of Psychology, Queen’s University, Kingston, Ontario, Canada

Julie Goodman, PhD, CPsych, Department of Psychology, Queen’s University, Kingston, Ontario, Canada

Lindy Kilik, PhD, CPsych, Department of Psychology, Queen’s University, Kingston, Ontario, Canada

Martin Logan, PhD, CPsych, Providence Care Hospital, Kingston, Ontario

Caroline Pukall, PhD, CPsych, Department of Psychology, Queen’s University, Kingston, Ontario, Canada

Michael C. Seto, PhD, CPsych, Royal Ottawa Health Care Group, Ottawa, Ontario Canada

 

Clinical psychological science is both the most sought-after and, at the same time, probably the most misunderstood post-graduate training program in psychology. Every year at Queen’s University, we receive approximately 150 applications for somewhere between 5-7 positions in our Clinical Psychology Graduate Training Program. It is therefore highly competitive, owing to the large number of applicants and relatively few positions available in our program, and this pattern is common among clinical psychology graduate programs. The purpose of this chapter is to educate undergraduate students about the many facets of clinical psychology. In this chapter, we will define clinical psychology, the scope of practice and research, discuss training paths, and provide examples of careers in clinical psychology. The goal of this chapter is to educate students about clinical psychology, the training needed to become a clinical psychologist, and provide models of how the different facets of clinical psychology are practiced in various settings.

The Science of Clinical Psychology

Clinical psychology is the science of human behaviour applied to real-world concerns with mental health and well-being. Clinical psychologists are foremost scientists, bringing the principles of the scientific method — hypothesis generation, testing, and evaluation — to bear on concerns related to mental health. In this way, we engage in this scientific process with the goals of improving lives and preventing human suffering. Clinical psychologists engage in clinical practice with populations that vary by developmental stage (children, adolescents, early, mid, and later life adults) and social contexts (individuals, couples, families, and organizations) to address a broad array of behavioural and mental disorders including neurodevelopmental, psychotic, mood, sexual, and personality disorders. Clinical psychological science encompasses a wide range of activities with the common goal of improving mental health and well-being. These activities can be divided in to at least seven broad areas of clinical practice: research, assessment, diagnosis, prevention, treatment, program evaluation, and consultation. Below, we provide a brief overview of each area of clinical psychological science.

Research

Scientific research is the foundation of clinical psychology because clinical psychology is a science. Research in clinical psychology takes as many forms as there are research questions, from asking questions about the genetics of individuals who are prone to specific mental difficulties, to the experiences of therapy clients seeking treatment. In the sections that follow, we provide numerous examples of how research is integral to the development of clinical assessment tools, diagnosis, intervention, prevention, program evaluation, and consultation. Later in this chapter, we provide specific examples of clinical psychologists careers, many of which prominently feature research.

Assessment and Diagnosis

The goal of psychological assessment is to evaluate the nature and scope of the psychological difficulties that an individual, couple, or family is experiencing. The information gathered is used to formulate a diagnosis and, in some cases, inform the best approach to intervention. A number of methods are used to gather information, including structured clinical interviews (e.g., the Structured Clinical Interview for the DSM or SCID; First, Williams, Karg, & Spitzer, 2015; First, Williams, Karg, & Spitzer, 2016), symptom checklists, and cognitive (e.g., intelligence) and neurocognitive tests. Each of these instruments is developed through the application of the scientific method to develop the pool of questions or tasks that the individual completes, how the results of the test or assessment are scored, and how ranges of response are interpreted in relation to the referral question. The most widely-used clinical assessment tools are intelligence tests, and most commonly used are  the WAIS (Weschler Adult Intelligence Scale; Weschler, 1955) and the WISC (Weschler Intelligence Scale for Children; Weschler, 1949). The WAIS has been validated and adapted for use in many clinical populations, from seniors experiencing cognitive decline, to those coping with head injury. See https://www.sciencedirect.com/topics/neuroscience/wechsler-adult-intelligence-scale (ScienceDirect, 2018).

With the information gathered in the assessment process, clinicians then formulate a diagnosis.  If they are practising in North America, diagnosis is in accordance with the DSM 5, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013). If they are practising outside North America, diagnosis is typically in accordance with the International Classification of Diseases, 11th revision, (ICD-11) created by the World Health Organization (see https://icd.who.int/en/; World Health Organization, 2019). The purpose of formulating a diagnosis is to organize symptoms into a construct that best represents the domain of psychological difficulties that the person is experiencing. The diagnosis is helpful for communicating with other mental healthcare providers, for guiding decisions about intervention and prevention, and for helping the affected person make meaning of the difficulties they are experiencing. Scientific processes inform the multiple stages of decision-making that clinicians engage in when formulating a diagnosis, including which symptoms are considered unique features of a specific mental disorder (e.g., that discriminate between groups), what severity of symptoms would indicate a disorder, and the length of time that a symptom has to be present for a particular diagnosis to be considered, among a host of other factors that come in to play when considering how to define and develop criteria for diagnosing a mental disorder.

Treatment

Psychological treatments encompass a wide variety of interventions aimed at improving symptoms, building skills, and restoring mental health and well-being. The modern practice of psychological treatments has been driven by empirically supported interventions originating from Behavior Therapy, with Cognitive Behavioural Therapy (CBT) receiving the most empirical support. CBT has been well established as an effective treatment for a number of conditions with research often led by clinical psychologists. In the last 20 years, there has been more interest in the development of “third wave” therapies, which have roots in CBT, including Dialectical Behavior Therapy, Acceptance and Commitment Therapy, and Mindfulness-Based Cognitive Therapy. In clinical practice, clinical psychologists typically use empirically supported interventions.  To learn more about the scientific foundations psychotherapy, including a review of the evidence supporting its capacity to effect change, we recommend reading Hundley, Elliot, and Therrien’s (2013) publication on the efficacy and effectiveness of psychological treatments, (see https://www.cpa.ca/docs/File/Practice/TheEfficacyAndEffectivenessOfPsychologicalTreatments_web.pdf). Martin’s (2016) book on counseling and therapy skills gives a comprehensive overview of psychotherapy skills and the science informing their use in clinical psychology practice.

Prevention

Prevention of mental difficulties is among the newest skills in a clinical psychologist’s toolbox.  Mental health researchers and practitioners now recognize the benefits of intervening before someone develops mental, cognitive, or emotional difficulty, and the benefits of working to lessen the burdens associated with mental disorders. Prevention efforts can be distinguished by the stage of development they target, and generally aim to either reduce the risk of developing the disorder, or enhance factors that would protect someone from having future difficulties. Primary prevention refers to preventing a disorder before it occurs. For example, efforts to reduce aggression in interpersonal relationships, as in bullying or intimate partner violence, helps reduce the likelihood of depression and trauma that can follow being the target of these aggressive behaviours. Secondary prevention is aimed at preventing the recurrence of a disorder after it has been diagnosed and treated. For example, a clinical psychologist might be interested in how mindfulness meditation helps those people who have recovered from depression maintain their gains in treatment, and prevent recurrence of another depressive episode. Last, tertiary prevention refers to efforts to improve the quality of life and reduce disability among those living with a disease or disorder. Cognitive remediation programs are one example of methods of reducing the impact of a disorder, such as schizophrenia, on the cognitive functioning of people living with psychosis.

Program Evaluation

Clinical psychologists are also trained in the evaluation of programs designed to assess, treat, and prevent behavioural and mental disorders. Indeed, many clinical psychologists who are situated primarily in academic settings engage in this form of research. In this context, a clinical psychologist conducting program evaluation research is able to combine applied clinical practice, that is the assessment and treatment of a clinical population, with an intensive research process, the development of a research protocol that adequately assesses outcomes relevant to the research question. For example, a team of clinical psychologists may develop an intervention, for example an internet-based implementation of a virtual therapy group, and wish to know how well that therapy group performs relative to more conventional, in-person therapies. In this case, the research question would be: Do the people who participate in the online version of group therapy show as much or more improvement in their symptoms as those who participate in conventional face-to-face therapy? Clinical psychologists would do research to develop a proposal, write a grant application to obtain funding to do the research, develop the protocol to assess mental difficulty symptoms before, during, and after treatment, train other mental healthcare providers in the implementation of the treatments, supervise the group therapy treatment, then work with a team to compile and analyze the data, and disseminate these findings to other professionals, and work to translate this knowledge so that other clinicians and practitioners learn about these scientifically-supported methods of helping others.

Consultation

Clinical psychologists are also trained in consultation with other healthcare providers. Consultation with other healthcare providers (e.g., physicians) is common among practitioners of health psychology, where psychological factors, like stress, are evaluated in relation to its impact on physical health, such as cardiovascular disease. Clinical psychologists may also consult with other mental health (e.g., psychiatrists, social workers),  typically in the context of practice on multidisciplinary mental health or health teams, either in hospital or clinic settings. Forensic psychologists often consult with legal and correctional services, using data gathered in clinical assessment to inform recommendations for sentencing, probation, or treatment of an offender.  Forensic psychologists may also engage in consultation with the courts to assess risk of violence or to determine if an offender was “of sound mind”, that is, was not experiencing symptoms of a mental disorder, such as a psychotic state, that would prevent them from participating in a criminal trial or would make them not legally responsible for their offense.

I Think I Want To Train as a Clinical Psychologist!

Many students attracted to the idea of being a clinical psychologist arrive at this decision from the core value of wanting to help others. Clinical psychologists do this in a number of ways. Some clinical psychologists help people through direct contact with those coping with mental difficulties, as in assessment or treatment of mood disorders. Some help others more indirectly, as in the development, evaluation, and implementation of empirically-validated methods for assessment, treatment, and prevention. Still others contribute to individual well-being through the execution and dissemination of foundational scientific research that informs our understanding of the factors that underlie the development of behavioural and mental disorders. Each of these forms of clinical practice informs the other: foundational research conducted by clinical psychologists leads to empirically-validated assessment and treatment efforts, which then are implemented by clinical psychologists working directly with clients. Observations made in direct contact with clients are key to hypothesis development regarding the assessment and treatment of mental disorders, and often inspire further insights into better approaches to interventions that ultimately will improve the lives of so many. In these ways, the potential scope of clinical psychology practice is very broad.

The broadness of clinical psychology is, perhaps, among the reasons why students find it challenging to understand what it means to become a clinical psychologist. Many who express interest in pursuing post-graduate training in clinical psychology wish to be psychotherapists. Although becoming a licensed clinical psychologist and exclusively providing psychological therapy services in a private practice setting is often the desired career destination of individuals enrolling in clinical psychology graduate programs, the breadth of clinical psychology means that individuals have many degrees of freedom in sculpting a career in clinical psychology that can be quite varied and unique.

Psychologists usually focus their practice in specific areas such as clinical psychology, counselling psychology, clinical neuropsychology, school psychology, correctional/forensic psychology, health psychology, rehabilitation psychology, or industrial/organizational psychology. Within these areas, a clinical psychologist may work with a variety of individual client populations such as children, adolescents, adults, or seniors, or may focus their attention on families, couples, or organizations. They work in a range of settings including schools, hospitals, medical clinics, industry, social service agencies, rehabilitation facilities, correctional facilities, and universities. Many psychologists and psychological associates (see later in this chapter for a definition of this designation) have their own private practices.

Yes! Exactly! I want to be a therapist with a private practice!

Although provision of psychotherapy is among the skills that clinical psychologists develop, providing therapy is not unique to clinical psychology. Other mental health and health practitioners, including counsellors, occupational therapists, social workers, and registered psychotherapists, provide psychotherapy to their clients. Students who are primarily interested in becoming psychotherapists are encouraged to consider these other disciplines.  There is more than one training path to becoming a psychotherapist, and many of these paths are less selective and take less time to complete than clinical psychology.  What makes clinical psychology unique from these other professions is our training in the application of the scientific method to the assessment, treatment, and prevention of mental disorders, and promotion of mental wellness, across a range of settings such as the direct provision of clinical services, like assessments and treatments, to conducting research in hospital and university settings.

How Do I Become a Clinical Psychologist?

When undergrad students come to me saying they want to get into clinical psychology, I (Meredith Chivers) give them “The Talk”. This speech consists of informing students that clinical psychology is not just about becoming a psychotherapist, but about becoming a scientist who uses the scientific method to have both direct and indirect impacts on mental health and well-being. I also tell them that clinical psychology graduate school is very demanding — I call it Grad School Plus. Like other graduate students in psychology, they are required to complete coursework, master’s and doctoral theses, serve as teaching or research assistants (to make money to pay for grad school!) and then (unique to clinical psychology), they complete about 1-2 days per week of practical clinical training under the supervision of a broad range of licensed clinical psychologists in multiple settings. If you like having a variety of roles in your work, are great with time management, and have energy to spare, you will be fine! If just reading that list of demands seems daunting, think carefully about choosing clinical psychology as your graduate program.

Graduate Training Explained

Training in clinical psychology begins at the graduate level. Students who have successfully completed honours undergraduate degrees majoring in psychology are eligible to apply for graduate training in clinical psychology, and some students with more varied undergraduate education are able to apply, though often with additional coursework to meet base level of training.  The typical training program lasts about 8 years, from start of the Master’s to registration with the College of Psychologists: 2 years to complete a master’s level degree (at Queen’s, it’s a Master’s of Science); 3-5 years to complete doctoral-level training (PhD), of which one year is a clinical residency or internship in a direct practice setting such as a hospital; and one year of clinical practice supervised by a licensed clinical psychologist for licensure.

To complete the Master’s degree, students take foundational courses in ethics, psychopathology, statistics, research design, assessment, and treatment, and complete a Master’s thesis. Once these requirements are successfully completed, the student is admitted to the PhD component of training that includes more in-depth clinical practica in assessment and treatment, advanced courses in statistics and research design, advanced clinical skills training, and courses tailored to specific disorders and/or populations. Students complete a doctoral dissertation, a multi-year research program with multiple studies that converge on a particular topic in clinical psychology. As part of their doctoral requirements, students usually must also complete a comprehensive exam, typically a two-part process of an oral examination of a clinical case to evaluate knowledge of assessment and treatment, and a written portion, the scope of which varies by training program.

In the last year of PhD training, students complete a full-year clinical residency, working full time in a clinical setting, usually a hospital or outpatient clinic. Residency is among the quintessential experiences that reveals to people if they will be happy working in a mostly applied clinical setting. Although practica during graduate training are great for getting a taste of what different forms of clinical assessment and treatment are like, there’s nothing that compares to doing the job 40 hrs (often more) a week for a year.

Post-Graduate Training Explained

Once these training steps are completed, students receive their PhD and can finally call themselves Doctor! But this does not mean that the Doctor is ready to nail up their shingle and start practising. Students wishing to independently practice as a licensed psychologist are required to complete several board exams to register with the a provincial College of Psychologists. Some clinical psychology graduates never go on to become licensed, particularly if they choose an academic career, although most faculty in Clinical Psychology are required to be registered. In essence, “practice” in this sense means to provide psychological services that are regulated by the Regulated Health Professionals Act (1991), specifically the Psychology Act (1991). These services include communicating a diagnosis identifying the cause of a person’s mental disorder symptoms, and the delivery of psychotherapy in a therapeutic relationship addressing a serious disorder of thought, cognition, mood, emotion regulation, perception or memory that may seriously impair the individual’s judgement, insight, behaviour, communication, social functioning, or potential for harm to others.

Registration includes two written exams. The first is the Examination for Professional Practice in Psychology (EPPP), a general psychological knowledge exam. The second is the Ethics and Jurisprudence exam, evaluating knowledge of the acts and professional standards that regulate the practice of psychology in a jurisdiction. Last, students complete an oral examination with a panel of licensed clinical psychologists. These examinations are to ensure that registered Psychologists, that is, members of the College of Psychologists, practise in accordance with applicable legislation, regulations, standards of conduct, professional guidelines, and professional codes of ethics. After licensure, Psychologists are required to complete regular self-assessments of their competency to practice. For more information about the professional practice of psychology, including registration with the College of Psychologists of Ontario, see http://www.cpo.on.ca (College of Psychologists of Ontario, 2018).

Another Path to Clinical Practice – Psychological Associate.

Some individuals opt not to complete a PhD in clinical psychology, and instead finish their academic education with a Master’s degree in clinical psychology. With a Master’s degree, completion of four years of supervised applied psychology work, a year of supervised clinical practice, and required registration exams, it is possible to register with the College of Psychologists as a Psychological Associate. From the viewpoint of legislation and regulation of the profession of psychology in Ontario, the scope of applied clinical practice for Psychological Associates is identical to that of Psychologists because Psychological Associates are able to conduct psychological assessments and treatment, and to formulate and communicate a diagnosis. Because Psychological Associates do not complete a doctoral dissertation and therefore do not receive advanced training in research methods, statistics, and scientific knowledge translation, the practice of Psychological Associates tends to focus primarily on more applied clinical practice than research. Note that in Ontario, only people who complete a PhD in Clinical Psychology and register with the College of Psychologists can use the protected title, “Psychologist”, or refer to themselves as “Dr.”. For more information about becoming a Psychological Associate, we recommend visiting the Ontario Association of Psychological Associates (2018) webpage, https://oapa.on.ca/. Also note that registration requirements vary greatly by province and territory. Please see the relevant provincial governing bodies below:

Province/Territory Provincial Governing Body URL
Alberta College of Alberta Psychologists www.cap.ab.ca
British Columbia College of Psychologists of British Columbia www.collegeofpsychologists.bc.ca
Manitoba The Psychological Association of Manitoba www.cpmb.cs
New Brunswick College of Psychologists of New Brunswick www.cpnb.ca
Newfoundland & Labrador Newfoundland and Labrador Psychology Board www.nlpsycboard.ca
Northwest Territories Registrar of Psychologists https://www.hss.gov.nt.ca/en/services/professional-licensing/psychologists
Nova Scotia Nova Scotia Board of Examiners in Psychology www.nsbep.org
Nunavut Registrar, Professional Licensing https://www.gov.nu.ca/health
Ontario College of Psychologists of Ontario www.cpo.on.ca
Prince Edward Island Prince Edward Island Psychologists Registration Board www.peipsychology.org
Quebec Ordre des psychologues du Québec www.ordrepsy.qc.ca
Saskatchewan Saskatchewan College of Psychologists www.skcp.ca
Yukon Territory No association

 But What Do Clinical Psychologists Actually Do?

There are many ways to create a vibrant career in clinical psychology. Depending on who you want to work with and how, your career could be any combination of doing research, conducting assessments and treatment, supervising other healthcare providers providing clinical services, program development and evaluation, teaching undergraduate and graduate students, consulting with community and health authorities, working with an interprofessional team (with primary care physicians, psychiatrists, social workers, counsellors, etc.), giving expert testimony in court proceedings, or providing academic services to the mental health community, such as reviewing research grants and journal articles for publication. Depending on where the clinical psychologist works, they can choose the combination that fits best with their strengths and interests, and meets their career goals. In the section that follows, I asked several psychologists, the majority working as clinical psychologists, practising in the Queen’s and Kingston communities to talk about how they became interested in clinical psychology, what their training consisted of, and how they currently practice.

Christopher Bowie – Adult Psychopathology in a University/Hospital Setting.

I am a Professor and the Director of Clinical Training in the Department of Psychology, and a member of the Psychiatry Department and Centre for Neuroscience Studies, at Queen’s University in Kingston, Ontario. I also practice and do research as the Head Psychologist at the Early Psychosis Intervention Program in Kingston. Much of my work that originates at Queen’s is disseminated elsewhere, perhaps most often due to my additional appointment as a Clinician Scientist at the Centre for Addiction and Mental Health in Toronto. Most of my research interests focus on determining the causes and correlates, and developing treatments for, cognitive deficits in mental disorders such as schizophrenia, depression, and bipolar disorder.

I became interested in psychology during an Abnormal Psychology class with Dr. Karen Wolford at SUNY Oswego. I was fortunate to have an opportunity to immerse myself in psychology by joining Dr. Wolford’s lab, as well as doing research on perception with Dr. Stephen Wurst. These early experiences provided me with an insight into the science of psychology and how studying the science of human behaviour could have profound implications on developing treatments and improving lives. This led to a switch from a Business degree to Psychology, just in time to meet criteria for graduate school admissions. I was definitely one of those students who discovered a passion for psychology late in my undergraduate career and was lucky to have great mentors who not only trained and inspired me, but also showed me what the life of a psychologist is like on a daily basis. Five years later, I completed my Ph.D. at Hofstra University in New York, training with Drs. Mark Serper and Philip Harvey. My doctoral internship at the Clinical Neuroscience Center of Pilgrim Psychiatric Center introduced me to the integration of science and practice – in fact the cognitive remediation treatments that we are now sharing across the globe had their origins in my ability to test new ideas during my work on this inpatient unit with people who had experienced very severe mental illness with few periods of high functioning following their diagnosis.  I did post-doctoral training with Dr. Barbara Cornblatt, earning a Young Investigator Award from the National Alliance for Research in Schizophrenia and Depression (NARSAD) to study how to treat cognitive impairments in adolescents who showed early risk signs for schizophrenia. My first academic appointment at Mount Sinai School of Medicine came a year later and continued to study the functional consequences of cognitive impairment in schizophrenia before moving to Queen’s in 2008. Currently our lab is leading multiple trials of cognitive remediation for severe mental disorders and studying early intervention for mental illness. More recently, I have put more emphasis on advocacy for clinical psychology and dissemination or our research. Our flagship treatment, Action-Based Cognitive Remediation, is being used in over 50 sites worldwide, from treating those with Bipolar Disorder in Copenhagen, Depression in New Zealand, to First-Episode Psychosis in Georgia (Best & Bowie, 2017; Bowie, Gupta, & Holshausen, 2013; Horan & Green, 2017). Our research group has created an online portal to share our treatment methods, including those to treat cognitive deficits and to combat internalized stigma in early psychosis. These methods of delivering treatment materials and staying in touch with a community allows us to examine all of the challenges and excitement of taking clinical treatment research from lab to clinic to community. I have also joined the board of the Ontario Psychological Association, with an active role in addressing academic issues and advocating for the training of the science of psychology.  To read more about the science informing cognitive treatments for psychosis, I recommend Best and Bowie (2017), Bowie, Gupta, and Holshausen (2013), and Horan and Green (2017).

Su Buchanan – Clinical Psychology in a Family Health Team Setting

When I was in my undergraduate program at the University of Manitoba, I greatly enjoyed the Introduction to Psychology course, taught by Dr. Jim Forrest, which led me down the path to Major in Psychology.  During my undergraduate degree, I had opportunities to volunteer with research labs.  I found working directly with people to be most interesting, rather than the data entry or the animal behavior training research.  I would say that the combination of this direct experience with children with disabilities, both physical and mental, and the Abnormal Psychology course experience solidified my goal to become a Clinical Psychologist. I completed a Bachelor of Arts in Psychology and Sociology, a Master of Arts in Social Psychology, and a Ph.D. in Clinical Psychology all through the University of Manitoba.  I completed a Pre-doctoral Residency in Clinical Health Psychology at the University of Manitoba.

For my Ph.D., I was advised by a research advisor, Dr. Gerry Sande, and a clinical advisor, Dr. David Martin. This allowed me to continue my social-clinical research in the sociocultural factors that influence the development of psychological well-being in children, both boys and girls, including body image, self-esteem, and mental wellness. During my Ph.D., I assisted in the development and subsequent delivery of four distance education classes, team-taught Introduction to Psychology, and taught Abnormal Psychology.  As Ph.D. student I was financially supported by a SSHRC doctoral scholarship. During my Clinical Psychology Ph.D. program, I had three children. As a result, it took me longer to complete the Ph.D. than my original plan of five years.

Currently, I am a Clinical Psychologist working in a Family Health Team in Kingston, Ontario. There are 26 family physicians and 8 Nurse Practitioners who can refer almost 40,000 patients, who are under their care, to my psychological services.  Referrals are for therapy, consultation, and assessment.  I work within a mental health team including social work, psychiatry, psychology, and mental health counsellors. As a team, we have agreed to provide time-limited, solution-focused cognitive behaviour therapy.  I explain to the patients that we will be working together (collaborative therapy) to teach healthy skills for coping with difficult situations that life brings.  As a result of this brief therapy model, I will refer people to other more specialist services in the community for additional therapy (e.g., Mood Disorders Clinic, Personality Disorders Clinic, etc.) and will bridge the time waiting for the other clinic services to start.  As a result, I am able to see 200 new patients per year.  I am registered with the College of Psychologists of Ontario (CPO) to see children, adolescents, and adults, couples, families, and groups.

In addition to conducting individual therapy, I have developed, run, and evaluate group programs in Cognitive Behaviour Therapy.  I supervise a mental health counsellor’s clinical practice as she is working to become a Psychological Associate. I hold a position as an Adjunct Associate Professor and Clinical Supervisor with the Department of Psychology at Queen’s University. Frequently, I give workshops and lectures in the community on a variety of topics including mental health concerns in children, youth, and parenting concerns.  This past year, in collaboration with the Clinical Psychology Outreach Program (CPOP) and Kingston, Frontenac and Lennox & Addington (KFLA) Public Health, I helped to run a series of eight lunch time workshops in a local high school.  We applied for a Bell Let’s Talk Grant, as we are hoping that this initial pilot project will expand into other area high schools.

Meredith Chivers – Adult Sexuality and Gender Psychology in a University Setting

I am a psychological scientist and clinical psychologist whose research focuses on how sex (biological attributes) and gender (social roles and identities) influence our sexuality.

From an early age, I was fascinated by science, nature, and behaviour. All pets underwent (humane!) behavioural experiments, including a grade 7 science project on factors influencing maze-running behaviour in hamsters. In high school, I discovered social sciences and decided to pursue a science degree in psychology, a program that wasn’t widely available yet. I was fascinated by the brain, at one time wanting to be a neurosurgeon, so neuroscience and neuropsychology became my focus. I had considered psychiatry, curious about the application of psychological science to helping others, but discovered clinical psychology and the potential to do both clinical work and scientific research, and science was consistently a strong interest of mine, from biology to physics. For my undergraduate honour’s thesis, I investigated sexual orientation variations on cognitive abilities and thus discovered (and fell in love with) the science of sexuality. After graduating, I worked as a research assistant in a forensic sexuality clinic, firming my decision to pursue clinical psychology with a focus on sexuality. At that time, I envisioned a career in a teaching hospital, applying clinical and research skills to understanding sexual difficulties.

I left Canada in 1997 to study clinical psychology at Northwestern University, and received my PhD in 2003. Trained by scientists at the Kinsey Institute at the University of Indiana Bloomington, I built a sexual psychophysiology lab and began a program of research on gendered sexual response at Northwestern University, discovering that women’s and men’s sexual responses were not two sides of the same coin. I came back to Canada to complete my clinical residency at the Centre for Addiction and Mental Health (CAMH) in 2002/3, completing rotations in dialectical behaviour therapy, sexuality-related aspects of forensic psychology, and gender dysphoria. After residency, I continued my research training as a postdoctoral fellow at the University of Toronto and CAMH, and continued my clinical training, conducting assessments and providing treatment, doing sex therapy with a local physician, and doing some clinical consulting. After a proposal to open a sex addiction assessment and treatment clinic was turned down by CAMH, I came very close to taking a full-time clinical position in forensic psychology. When I consulted my research supervisor on this career move, he reminded me that I was always my happiest when doing the science; it was clear that I needed to pursue an academic career. I needed to stay in Canada, however, if I was to be able to fund my research program on sexual response; long story, but the US government got involved in decisions about funding sexuality research in 2003 and it was clear I couldn’t have a career in the US (see Epstein (2006), if you’re curious to read more about the politics of doing sexuality research!).

In 2007, I received a Queen’s National Scholar Award and was recruited to Queen’s University. After parental leave, I began my academic phase of my career in 2009. I am now an Associate Professor and Canadian Institutes of Health Research New Investigator, leading an exceptional team of junior researchers keen to understand how gender and sex influence our sexual responses, sexual orientations, and sexual health. I spend most of my time doing research, but also teach undergraduate and graduate students. I also collaborate on research with a number of clinical research teams outside Queen’s, consult with community and health authorities, and provide varied academic services.

My graduate training began with the intent of having an applied clinical position in a teaching hospital, but evolved in to a full-time academic career. Although I do miss working directly with clients doing assessment and treatment, I have learned that academia can also have a huge impact on individual lives. My career as a predominantly research-focused clinical psychologist conducting research on basic and applied aspects of sexuality and gender, and working to disseminate these findings outside of academia, has had significant influence on many aspects of people’s sexual well-being, from informing clinical assessment and practice, to helping people understand what is “normal” about their sexuality (a question I often receive via email). In the future, my career may include more direct clinical practice — we’ll see! One of the best parts of being a clinical psychologist is the flexibility my training affords me. For now, however, there’s a lot of work to be done on the basic science of sexuality and gender so I’m content to focus my career on addressing those knowledge gaps. To read more about the basic and clinical science I’ve conducted that informs clinical practice, I recommend Chivers and Brotto (2017) and Chivers (2017).

Tess Clifford – Child/Adolescent Psychology in an Outpatient/University Setting

While I cannot exactly pinpoint when I decided to become a clinical psychologist, I am sure being raised by a parent who advocated for meaningful vocation for people with developmental disabilities was very influential in the decision-making process. My undergraduate education focused on psychology with a specialization in development, especially atypical development and neurodiversity, with a minor in Health Studies, focused on social justice issues related to mental health and disability. I was fortunate to engage in a number of applied research activities during my last 2 years of undergraduate training, including observing structured clinical interviews with an anxiety treatment and research centre, and applied behaviour analysis with children with developmental disabilities. I entered graduate training in Clinical Psychology having spent the previous year as an instructor therapist with two young children with autism. I was passionate about issues related to parenting children with atypical development, and focused my Master’s thesis and Dissertation on these topics, including implementing and evaluating an online support group for parents of children with Autism Spectrum Disorders (ASD) (at a time when online support was transitioning from open forums to closed groups). I became passionate about knowledge translation and finding ways to share research with the wider community, especially participants. I was involved in several other research projects, including one that allowed me to engage in specialized training for the diagnosis of ASD, and assess numerous individuals with this tool, developing expertise. At the same time, I completed a number of practicum placements in a broader range of child and adolescent psychology, including psychological assessments and therapy. I was sparked by the detective work of assessment in complex cases where development and mental health intersect, and pursued more advanced training in this area of dual diagnosis during my internship, including broadening my experience to work with adults as well.

Currently, I am a registered clinical psychologist and the director of a training clinic for graduate students in clinical psychology that serves our community by offering services with fees that are geared to income. I have focused the last several years on learning about theory and best practice in supervision, and recently started teaching senior students on this topic. I supervise almost all of the students in our graduate program at some stage of their training, and am invigorated by their energy and knowledge, and the learning they encourage for me on a daily basis. I am still very involved in the detective work of complex assessment, often with children and adolescents, although I see many adults in my work as well. I provide parenting support, and have recently become more involved in community education related to positive parenting and emotion regulation skill development. I consult on smaller research projects related to early diagnosis and intervention for ASD. I very much enjoy the flexibility of my work to see a variety of presenting problems, and engage in a number of different activities, while also serving clients who may not otherwise access services.  To learn more about evidence-based practices with people with autism spectrum disorder, I’d recommend reading Wong et al.’s (2015) review paper. To learn more about how mindfulness can benefit teachers and students, I recommend Meiklejohn et al. (2012) paper on this topic.

Julie Goodman – Clinical Psychology in an Educational Setting

I have only vague memories of times when my career path was not set on clinical psychology. My father was a clinical psychologist who practiced in Ontario for more than 45 years, and I learned early on that studying psychology would give me the opportunity to help others and to put my interest in science, math, and English to good use. I grew up learning to look at situations with a critical eye, always looking for the evidence that would support or refute a claim. My undergraduate education taught me about the scientific foundations of clinical psychology and sparked an interest in research and statistics. Following my 3rd year, I had the opportunity to spend a summer working as a research assistant in the Pain Research Laboratory at Dalhousie University in Halifax, under the supervision of Dr. Patrick McGrath. Dr. McGrath later became my Ph.D. supervisor, where I spent several years examining the factors that influence how children learn about pain from their parents, and the prevalence of painful conditions and its associated disability among children and adolescents. I completed a pre-doctoral internship in clinical and child health psychology at the children’s hospital in Halifax, where I had the opportunity to learn how to help young people with chronic or severe illnesses using cognitive-behavioural interventions. I also had the opportunity to further my skills in psychological assessment.

Since completing my formal training, I have worked in a variety of settings with children and adolescents, including an inpatient mental health unit, outpatient mental health service, and a children’s treatment centre serving young people with physical, developmental, or complex neurocognitive disabilities. In all these settings, consultation with school personnel helped to ensure that the child’s needs were supported. Currently, I am a registered clinical psychologist working for the Algonquin and Lakeshore Catholic District School Board. My clinical work mostly consists of assessing students with complex learning and/or mental health concerns and identifying the remediation and support that students require. I also conduct educational sessions and workshops for school personnel on a broad range of topics. Through an appointment with Queen’s, I have had the opportunity to supervise graduate students on practicum at varying stages of their training. Through all of these experiences, I have learned that regardless of the clinical setting, psychologists who work with children often support a child’s functioning at school, and can bridge the gaps between education, medicine, and mental health care to ensure that they are able to fulfill one of their primary social roles. To learn more about clinical science’s role in understanding and helping children with typical and atypical cognitive development, I recommend reading Pugh and McCardle’s (2009) book on how children learn to read, and the Ontario Psychological Association’s (2018) guidelines on assessment and diagnosis of children with learning disabilities.

Lindy Kilik – Neuropsychology in Hospital, Community, and Academic Settings

My interest in psychology came from my curiosity about biology and human behaviour. I wasn’t sure how these two areas might combine until taking an intro psychology course taught by a Neuropsychologist… I was hooked! My training included a psychology/neuroscience undergraduate degree, followed by graduate work where my coursework and clinical placements focused on clinical psychology, rehabilitation psychology and neuropsychology. I am registered in all three areas. My student research included the areas of normal aging, dementia and program evaluation. I had the opportunity to be part of different labs for these projects and work with different teams. I was a TA and also gave some guest lectures… it was great preparation for the future.

My career has always been a combination of clinical work, clinical research and teaching. The variety is my way of stemming boredom and protecting against burnout. My clinical work has included working with countless clinical multidisciplinary teams, each with their own character and focus, including stroke, ABI, dementia, spinal cord and dementia, all in the context of, inpatient, outpatient and outreach models. Collaboration has been key in this work. My clinical functions include neuropsychological assessment, behavioural assessment, cognitive remediation and behavioural intervention with patients, but much is also working with teams in implementing interventions, supporting them in their roles, and some administrative/committee work. There is also a leadership part to play, such as in leading behaviour rounds and developing consensus in behavioural care plans for inpatient teams. I teach at both the Undergraduate and Graduate levels in psychology and supervise students ranging from diploma behaviour technology students, to practicum and internship students. I do this with great joy. My research has always had an applied focus: my clinical practice informs my research questions; my research informs my practice, (and hopefully that of others). My goal in research is to put something useful into the hands of clinicians, for example, developing the “Priming/Timing/Miming” model of behavioural care planning for inpatient dementia unit staff. Often my research has involved collaborating with other organizations: the Ministry of Transportation – developing pamphlet materials for patients with dementia and their families as well as for clinicians making decisions about driving and dementia; working on a driving simulator for seniors, developing a screening tool for police officers to use in the field when working with seniors they suspect may have a cognitive impairment, and crisscrossing the province to train various police groups, participating in a provincial working group on revising a Long-term-care behavioural observation tool.  Development of dementia screening tools has been a considerable part of my research – these are aimed to measure cognitive and behavioural changes, the capacity for safe driving, as well as caregiver stress and patient self-awareness. I also offer clinical workshops based on my research and am often invited to speak at conferences.  Opportunities have appeared all along the way to do innovative and rewarding work. I wouldn’t have imagined all of these ahead of time – it has been a wonderful journey so far.

Martin Logan – Rehabilitation/Neuropsychology in a Hospital Setting

My interest in the area of psychology stems from my family and personal history.  Having had family members who required the support of psychologists and mental health teams allowed me to have a glimpse of the benefits of psychologists from an early age.  My interest in neurological functioning came from personal experiences with concussion and brain injury and a desire to better understand rehabilitation and neuroplasticity.

I started my studies in the area of Clinical Psychology at the University of Ottawa; however, because of my interest in “disability”, rehabilitation, and brain functioning, I decided to complete my Ph.D. at the University of Calgary.  The reason for the move was a new program at the University of Calgary that offered the opportunity to train specifically in the area of rehabilitation.  My research there focused on resiliency following neurological injury (congenital vs. adult onset).  In addition, I was part of a national study examining vocational opportunities for individuals with disability and identifying best practice for vocational rehabilitation.   This was incredibly rewarding and allowed me to focus my training to working with clients with neurologically based injuries and their families.  Following the completion of my Ph.D. at the University of Calgary I enrolled in a post-doctoral Internship at McMaster’s Hamilton Health Sciences in the area of Neuropsychology.

My career path has led me to working with individuals with traumatic and acquired brain injuries, developmental/intellectual disabilities, and back to individuals with acquired brain injuries.  The settings have included: hospitals and clinics, private practice, community supported living, and community outreach.  I became a member of the Ontario College of Psychologists a year after my internship (2001) and I registered in the areas of Rehabilitation and Neuropsychology with adults.  Even though my interning included children and older adults, I decided that my fit was more with adults.  In my current role as a neuropsychologist at Providence Care – Community Brain Injury Services (CBIS), I provide consultation to our outreach rehabilitation team, complete neuropsychological assessments, and have a limited counselling roster (pertaining directly to adjusting to brain injury).  Through CBIS we are conducting ongoing research into the areas of best practice for rehabilitation (Roles as Goals) and resiliency following concussion (Post Concussion Action Group).  We are closely involved with Queen’s University where I am a clinical supervisor and adjunct member of the Departments of Psychology and Psychiatry.

Caroline Pukall – Sexuality Research and Sex Therapy in a University/Outpatient Clinic Setting

Since early adolescence, I knew that I wanted to work in a job that involved “helping people”. Friends in my social circle would often ask for my advice relating to many issues, and I did lots of research, reading, and asking questions in order to stay “on top” of the topics. I wound up developing a reputation for being the “go to” person for advice. I really liked this role—I enjoyed getting to know people on a deeper level. It wasn’t apparent to me at this time that I was developing skills that would help lay the foundation for my eventual career as an academic clinical psychologist. All of this didn’t happen right away, of course; it took a number of years and many experiences to shape my particular career track.

By the time I completed high school, I recognized that there were many careers that involved “helping people”, so I enrolled in an undergraduate psychology program for exposure to the different fields within it. My plan was to stick with psychology later on if it appealed to me, and if not, then I could use this undergraduate experience as a stepping stone into a different field, such as medicine. During this time, I fully explored what psychology had to offer: I volunteered at different clinical facilities (e.g., psychiatric, medical), took a broad range of courses, and was involved in different research labs. What I wasn’t prepared for was the compelling “pull” of research; I loved the process of developing hypotheses, using methods to test those hypotheses, delving into different literatures, learning new skills… and importantly, learning not only from the professor, but also from lab members—especially the graduate students. I spent a lot of time trying to “choose” which path would be best for me (research or clinical), and then realized that I could do both: it all clicked for me in a sex research lab when I was working on a treatment study of women with genital pain—a clinical research study—one that involved research and “helping people”! I ultimately stayed in this lab for my graduate studies in a combined Masters-PhD program in Clinical Psychology. This program was research intensive and involved extensive clinical training and courses, which was challenging at times but also very rewarding. I ran studies, worked with people at different levels of training, published and presented my work, took courses, was a teaching assistant, received clinical training, and was part of a supportive, collaborative, and productive lab environment.

Currently, I am Professor of Psychology at Queen’s University. I am the supervisor of a dynamic lab called the Sexual Health Research Lab (SexLab) in which we study various aspects of human sexuality, from arousal to relationships in healthy participants as well as those with clinical conditions (e.g., genital pain, sexual dysfunction, cancer). In this lab, I supervise trainees of all levels as well as a part-time employee (who keeps us all on track), and I collaborate with researchers from Queen’s and beyond. I am also the Director of the Sex Therapy Service (Queen’s Psychology Clinic) in which I train and supervise selected graduate students in Clinical Psychology in sex and couples therapy; we see clients with sexual, gender identity, and relationship concerns. We conduct assessments and therapy, as well as engage in consultations with other healthcare providers in order to best serve our clients; recently, we have started to offer therapy groups for certain sexual issues (e.g., genital pain). In addition, I teach in-demand sexuality and clinical psychology courses, write grants to fund our research studies, publish and present, and am involved in various committees, journals, and organizations. Although it may seem like a lot to juggle, I absolutely would choose to do nothing else in terms of my career. To learn more about how sex therapy helps people with sexual difficulties, I recommend reading The Knowledge Centre for the Health Service’s 2012 report on this topic, available here (https://www.mentalhealthcommission.ca/sites/default/files/KEC%252520%25255BInterim%252520Report%25255D%252520Low%252520Res_0.pdf).

Michael Seto – Forensic Psychology in a Hospital Setting

I had what I think is a very common experience, of taking intro psych as a first-year elective in a general science course load, out of curiosity, and discovering I was fascinated by the topics that were covered and deciding then and there to pursue a degree in psychology. Combining my new interest in psychology and a longer standing interest in science (biology, zoology, chemistry), I completed a B.Sc. in biological psychology at the University of British Columbia, in my hometown of Vancouver. By third year, I was confident I wanted to pursue graduate studies in psychology. I was originally interested in addictions and applied to a number of programs in Ontario in 1989, though I knew my chances weren’t great because I had had a terrible work ethic as an undergraduate (I’d describe myself as smart but lazy) and therefore didn’t have the best grades, but I did have killer GRE scores. I was only accepted by two Canadian programs, Queen’s and the University of Waterloo, and chose Queen’s because it had the best reputation out West, even though I had to do an extra qualifying year because I didn’t complete an honour’s thesis.  Demonstrating the role of luck in career paths, I had no idea that Queen’s (at the time) had a very strong clinical forensic program and was ideally situated for that kind of program, with six federal penitentiaries within an hour and a forensic unit at the local psychiatric hospital. My first choice advisor was on sabbatical the year I arrived and wasn’t taking new students, so I looked at the other faculty and decided sexual behavior was also really interesting. Howard Barbaree agreed to supervise my honour’s thesis and then master’s thesis, both on sexual offending. When Howard left to take over as clinical director of the forensic program at the then Clarke Institute of Psychiatry in Toronto, my PhD supervision was taken over by Vern Quinsey (PhD topic was on risky sexual behavior, because my interests were veering towards general sex research rather than specifically forensic research at the time.)

Luck struck again when Howard offered me a research scientist position at the Clarke in 1994 while I was still completing my PhD. I hustled to finish collecting my data and then took longer than I should have to finish writing my dissertation on topic of a full-time job (not recommended). I did complete the thesis and other requirements and was registered as a clinical and forensic psychologist in 1998. I initially spent about half my time in research and half involved in clinical work, conducting assessments of forensic clients, offering individual and group therapy, and supervising MA-level psychology staff. Over time, that has shifted to almost entirely research, though I continue to be involved in some clinical supervision and training of practicum students and interns.

A lot of people don’t know that I had tried to switch over from the clinical to experimental stream as a PhD student because I knew I wanted to focus on research and didn’t want to have to complete the one year internship requirement; I might have been the first student who had ever tried to switch OUT of clinical rather than INTO clinical. I wasn’t allowed to do so, and I am glad now because I have had a rich, varied, and I believe productive career as a clinical and research psychologist. I stayed at the job in Toronto (as the Clarke Institute merged with other institutions and became the Centre for Addiction and Mental Health) from 1994 to 2008, when I moved to the Royal Ottawa Health Care Group as a psychologist and now the forensic research director. I am cross-appointed to four different universities – University of Toronto, Ryerson University, Carleton University, University of Ottawa – and currently supervise three graduate students, two at Carleton and one at the University of Ottawa. I flirted with seeking an academic position at times, with two job offers that didn’t work out for different reasons, but I’m glad that I’ve stayed in a university-affiliated academic hospital environment. To learn more about clinical forensic science, I’d recommend Bonta and Andrews (2016) book, Farrington and Welsh’s (2005) review on experimental criminology research, and Fazel, Singh, Doll, and Grand’s (2012) review on how risk assessment predicts violent behaviour.

Conclusion

Clinical psychology can lead to many different career paths– not just becoming a professor, practising as a clinical psychologist in a hospital or clinic setting, or some combination of those two, but other paths like teaching, working in a pharmaceutical company designing clinical trials, and supervising other healthcare professionals, just to name a few possibilities. If you think that you might be interested in pursuing a career in clinical psychology, get involved! Volunteer in a lab, volunteer in a clinical setting, ask healthcare professionals what their day is filled with and what they find rewarding and challenging. Although searching the web can be an informative start to making decisions about a possible career in psychology, you need to be ready to work with people, and talking to people who actually work with people is a valuable start to learning more. And remember that learning what career you want to devote yourself to is a process, indeed, for some, a lifelong process. We encourage you to allow yourself the time and experience to learn what is the right balance for you, knowing that, even if you train in one aspect of a profession, your interest can, and may change at any point in your career. With a degree in clinical psychology, practitioners have many degrees of freedom to pursue the range of activities that they find rewarding, that fit their talents, and help them meet their career goals.  Although training in clinical psychology is a long process, it is also one of self-discovery that allows for numerous learning opportunities. In the end, a career in clinical psychology is one that offers considerable flexibility to follow one’s intellectual curiosities and passions, to engage in a variety of activities that are meaningful in the lives of many people, and to participate in these pursuits from a grounding in science.

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Please reference this chapter as:

Chivers, M. L., Bowie, C., Buchanan, S., Clifford, T., Goodman, J., Kilik, L., Logan, M., Pukall, C., & Seto, M., C. (2019). Clinical psychological science. In M. E. Norris (Ed.), The Canadian Handbook for Careers in Psychological Science. Kingston, ON: eCampus Ontario. Licensed under CC BY NC 4.0. Retrieved from https://ecampusontario.pressbooks.pub/psychologycareers/chapter/clinical-psychological-science/

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