Haruhiko Shimoyama, Ph.D., The University of Tokyo, Japan

Clinical psychology has developed rapidly as a profession in this decade in many countries. However, the way in which the developments have occurred varies by countries and the changing processes are still ongoing. So it is very difficult for any clinical psychologist to make a definite prognosis for the future and prescribe the right way to grow.

Nevertheless, in response to the rapid developments and social demands, clinical psychologists have to improve the training system for the future. The training programmes should be drawn up according to the future model and I think psychologists should extract some common rules of the development by comparative study. So I try to do comparison between developments of clinical psychology in Britain and in Japan here.

British Clinical psychology (BCP) has already established its distinction and consistency as a discipline. Clinical psychologists define their profession in terms of (a) the basic science of psychology and (b) its application to the understanding and resolution of human problem. The clinical psychologist is first and foremost “scientist practitioner”. Marzillier & Hall (1999) describe the distinction between clinical psychologists, psychotherapists and counsellors as follows. The main differences occur in training and in the formal structure of the work. Clinical psychology training involves a specialized knowledge of psychological functioning and psychological methods, which provides particular expertise in carrying out psychological assessments such as psychometric tests, formulating problems psychologically, psychological treatment, and psychological methods of research and evaluation. In basic training clinical psychologists specialize in behavioural and cognitive therapy.

As a result they have achieved a social role and independence. The profession has undergone a relatively recent evolution from an ancillary service to the medical profession, operating in very confined contexts, to the clinical psychologists of today, many of whom act as independent practitioners, contributing to virtually every aspect of health care, not only in patient-related activities, but also in environmental, organisational, planning and managerial aspects.

On the contrary, Japanese clinical psychology (JCP) still remains to be in state of confusion and splits, where there are ambiguous overlaps between clinical psychology, psychotherapy and counselling. Psychodynamic (especially Jungian) theory has maintained its influence so much that purely intra-psychic psychotherapy has continued to be an ideal model. However, the intra-psychic model is actually so specialized that it is difficult for most members to master it. In addition, many problems that clinical psychologists are now expected to deal with are concerned with social behaviours in daily life. So such kinds of psychotherapy are of no practical use. As a result, the reality is that only a few leaders are psychodynamic (analytical) psychotherapists and the larger body are en effect counsellors. And very few are clinical psychologists as described by the British definition.

Such a state has brought JCP a variety of troubles as follows.

1) Theory based sectionalism

Since psychotherapy adheres to its own theory it is inevitable that clinical psychology led by a group of psychotherapists is unable to go beyond sectionalism towards integration. As each school sees clinical psychology just from its own theoretical point of view, it is very difficult to decide what should be taught as basic knowledge and skills and what training should be given. As a result, such theory-based sectionalism has caused a sort of paralysis as JCP struggles to establish a consistent discipline and develop the training system.

2) Split between practice and research (alienation of research)

Psychodynamic psychotherapy particularly tends to direct such exclusive attention on its own intra-psychic theory and etiology that it cannot help being against evidence-based scientific thinking. In fact, JCP has not paid attention to psychological assessment and psychological research.

3) Spilt between training courses in universities and clinical fields in the community

Psychodynamic psychotherapy tends to focus on the training of special skills such as dream analysis, transference analysis, sand play techniques for the individual and intra-psychic psychotherapy in the closed and fixed setting apart from clinical fields in the community. So JCP has not made efforts to develop training in placements. In turn the practitioners in the field do not trust training courses in the university because such individual and intra-psychic psychotherapy is of no practical use.

As a result, JCP has been confronting and suffering from social conflicts and limitation of social recognition as follows.

1) Conflict with academic psychology

JCP has kept itself apart from academic psychology, which has maintained a scientific paradigm, so that the two psychologies have no connection with each other. Moreover, since clinical psychology began to invade the territories that academic psychology used to occupy in the universities, serious conflicts between the two psychologies have occurred. A society of academic psychologies often expresses its formal objections to JCP.

2) Conflict with psychiatry

The association of psychiatrists declares that it strongly objects to legitimatising the qualifications of clinical psychologists as long as clinical psychology does not accept the condition of working only under the control of psychiatrists. As a result, the activities of clinical psychologists are greatly limited not only in the medical setting but also in mental health fields. Now the professional role of clinical psychologists is becoming confined to that of counsellors in the educational context.

I think I can make a conclusion from the comparison above that attitude toward science has played an important role in development of clinical psychology as a profession. Since BPC established its distinction and consistency as a discipline in terms of the scientist-practitioner model and got its social role and independence officially recognised as a mental health profession, it has already achieved an identity and grown into a profession. By contrast, JCP which has refused to introduce scientific attitude in to its area, is not only suffering from confusion and internal splits, which makes it impossible for it to define itself as a definite discipline, but it is also involved in social conflicts, which limit social recognition. JCP has had great difficulty in achieving an identity despite social demands.

BCP has matured into adulthood without any serious identity crisis, while JCP is kept in adolescence. BCP even seems to have developed the shortest route to professional recognition for clinical psychology in the world, compared with the longer and more controversial route taken by clinical psychology in the United States over the 50 years .