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Clinical and Counseling Psych: Time to End the Distinction

It is time to retire the distinction between clinical and counseling psychology.

What is the difference between a clinical and a counseling psychologist? Going forward, the correct answer should be nothing.

Those familiar with the discipline know that clinical and counseling psychology represent different historical identities associated with the practice of psychology. Clinical psychology is the older discipline. It evolved just after the turn of the 20th Century, and is often dated to the opening of Lightner Witmer’s clinics. Initially, clinical psychologists tended to be focused on diagnosis, psychopathology, and psychological assessment and regularly worked under psychiatrists. They were also heavily influenced by both behavioral and psychoanalytic perspectives. In the mid1940s, clinical psychology took off because there were so many war veterans returning home who needed assistance in adjusting to post-war life.

In the 1950s, the humanistic tradition of Carl Rogers and Abraham Maslow was catching fire as a “third force” that challenged the determinism and pessimism and focus on psychopathology that characterized both psychoanalysis and behaviorism. In addition, there were many applied and professional psychologists who argued for the need to focus on wellness, optimal functioning, and “normal” development across the lifespan. There was also a recognized need to focus on human vocation, positive human relationships, diversity, and adjustment. Ultimately, it was this push gave rise to counseling psychology, as a distinct identity from clinical psychology. In 1951, The Division of Personnel and Guidance Psychology changed its name to The Division of Counseling Psychology and in the late 1950s formal training in counseling psychology emerged.

All of this made good sense at the time. But as the world of professional psychology has evolved, the logic of the distinction has faded, such that it no longer makes sense for the profession to be divided into these two separate practice areas, because it unnecessarily weakens and fractures the field. Here are some of the major reasons:

1. There is essentially no difference between clinical and counseling psychology in the eyes of the public and the distinction does not help in defining or signaling any particular skill set or approach.

2. In terms of meaningful terminology and word usage, the distinction between "clinical" and "counseling" is captures virtually nothing. Clinical psychologists counsel people and counseling psychologists do clinical work. The general nature of the words adds to confusion and offer little in terms of meaning both inside and outside the discipline.

3. There are essentially no substantive differences between clinical and counseling psychologists in the way that they function in the real world. In all states, both kinds function as licensed professional psychologists, and no state makes a distinction between them. And both have essentially the same legal and ethical obligations.

4. Even inside the discipline, the general training structure is essentially identical. The competencies for training clinical and counseling psychologists as laid out by the APA Standards of Accreditation in doctoral training are the same for both clinical and counseling psychologists (that is, the Standards of Accreditation offer no substantive distinction between the two and essentially insist on the same competencies to be covered).

5. Psychological theory has evolved beyond the forces of behaviorism, psychoanalysis and humanistic theory. Both clinical and counseling psychology should teach modern psychological science and it should cut across the behavioral/cognitive behavioral, modern psychodynamic, and humanistic traditions.

6. Clinical psychologists are very interested in concepts like well-being and optimal functioning. Indeed, the famed clinical psychologist Martin Seligman launched the positive psychology movement.

7. Counseling psychologists have become increasingly likely to be working with mentally ill populations and often find themselves in hospitals, mental health clinics, etc. Counseling centers at universities, one of the most common places for a counseling psychologist to work, are now largely committed to doing clinical work because the demand for mental health services are so high.

8. The emergence of the Counseling Profession adds to the confusion because there now is a clear professional line between counseling and psychology, whereas that was not the case in the 1950s. Counselors, although they do therapy, are not psychologists are not trained like psychologists and have a totally different accreditation, licensing and professional identity. As such, it is important that counseling psychologists first and foremost identify as psychologists.

9. Psychology and the other mental health professions are a mass of confusing, overlapping identities with fuzzy boundaries and roles. We should work to reduce that confusion, if possible.

10. The separate nature of the fields fosters tribalism and unnecessary divisions that only had historical relevance. In contrast a merger of the two fields opens up pathways to draw from both traditions in a manner that is complementary and synergistic.

My friend Craig Shealy has often described himself as a “clinical psychologist in recovery". What he meant by that is early in his career he thought of himself as a clinical psychologist and took pride in the fact that these programs are the hardest to get into and supposedly offered a unique identity. However, he realized that all those were basically ego and tribal issues, that the division was more harmful than helpful and it clearly behooves the field to move past these old practice areas.

So, what is the future? I think the concept of Health Service Psychology as delineated in the new APA Standards of Accreditation works well. HSP denotes a psychologist who is trained to be a licensed health care provider, one who specializes in psychological knowledge and offers the ethical delivery of psychological services. I believe Health Service Psychology can set the stage for a more unified professional psychology, a concept Bob Sternberg and I argued for over a decade ago. Hopefully, in the upcoming next decades, we will see clinical and counseling psychology merged and replaced with this more general and apt term for our discipline.

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