Why I love clinical psychology or how I ended up reading the DSM over coffee
Clinical psychology isn’t sexy. It’s not in the movies, it doesn’t have a good soundtrack, and no one mentions it at parties. And yet, 20 years later, I still wake up in the morning curious.
I’ll be honest from the start: I’m not the right supervisor for everyone. I’m meticulous, I have high standards, and yes, I’ve been described as strict at times. If you’re looking for a supervisor who can reassure you that everything is fine and that your gut is enough at the cost of clinical rigor, our paths probably won’t cross much. If, on the other hand, you’re the type who asks “but why?” after every assessment, then we might get along very well.
My enthusiasm for clinical psychology has not diminished in over 20 years of practice. Quite the opposite. And that’s precisely why I wrote this article: because I understand how easily clinical thinking can be ignored in favor of therapeutic thinking, and because I have seen, all too often, what happens when a psychotherapist intervenes without having a good understanding of who they are actually working with.
Clinical psychology has its own logic
Clinical psychology has its own logic, closer to mathematics than to art.
Don’t get me wrong: psychotherapy has structure, and rigor matters there. The difference is that in psychotherapy the intervention is adjusted more to the therapist’s style, to the relationship, to the moment. In clinical psychology, adjustment comes after psychometric rigor and psychopathology. Only then does methodical creativity and curiosity to delve deeper enter the scene. Order matters.
This logic has transcended the boundaries of assessment and permeated the rest of my work. It organizes my therapeutic intervention, structures my courses and trainings, and, if I’m being completely honest, it probably started as a coping mechanism for a former reformed nerd. Along the way, it has morphed into something simpler: genuine satisfaction with a field that is extremely beautiful, interesting, and, most importantly, useful to therapists.
Clinical psychology and psychotherapy are two distinct specializations. It’s no coincidence that they are on the same committee within the College of Psychologists, because they are interconnected, and no matter which one you start with, from time to time you return to the other to recalibrate.
Therapeutic intervention is not done blindly.
It’s good to start with a thorough rather than a casual assessment, because the assessment creates the framework: what is causing this person to have problems at this point in their life, how they’ve coped in the past, what predisposes them, and most importantly, what’s keeping them from having problems. That’s conceptualizing the case. And I assure you, it’s also true for mechanics and hairstylists, so that we don’t end up in a situation where someone asks, with a tight smile, “Ma’am, who worked here?” and we don’t have a good answer.
One of the things I’ve learned over time, and that I try to convey in my supervision, is that sending a client for assessment when you’re not sure of your abilities is not a sign of weakness. It’s actually one of the healthiest things a psychotherapist can do. That’s what clinical psychology is for: to reduce the uncertainty that comes with entering the therapy room.
I like reading clinical guidelines.
I love reading clinical guides. I love stalking, in the most professional and affectionate sense of the word, those who have something relevant to say in clinical psychology. When I first heard about HiTOP (a dimensional model of psychopathology that completely reorganizes the way we think about diagnosis), I subscribed before I could finish the sentence. It’s probably a pretty monotropic mind, not to use the word obsessional, although the difference is more in connotation than in content.
What I want to leave behind from everything I’ve written here is something simpler: clinical psychology is beautiful. I would even say poetic. People are complex and represent an infinite source of understanding and knowledge, and clinical psychology is the tool that helps you navigate this complexity with rigor and, at the same time, humility. It is as important as psychotherapy, even if it remains, stubbornly, the Cinderella of psychology.
I like clinical psychology because it doesn’t allow you to get lost in unsupported interpretations. It keeps you grounded. And after 20 years, I still find that comforting. If you feel something similar reading these lines, we’ll probably get along well.