Mental health is a growing profession in Canada and around the world. Thanks to initiatives like Bell Let’s Talk and other national advocacy campaigns, our population is increasingly aware of mental health symptoms and how to access treatment. Let’s imagine you’ve been feeling depressed lately, unable to participate in activities you previously enjoyed, and have experienced a lot of trouble sleeping. You decide you want to talk to a mental health professional about your experiences. But who do you contact? Your family doctor? A nurse? A psychiatrist? A social worker? A counsellor? Or maybe a clinical psychologist? This chapter will provide a general overview of clinical psychology as a profession to help you answer this question.

What is clinical psychology?

Clinical psychology is defined by the Canadian Psychological Association as “a field of practice that deals with human functioning; either human problems and their solution, as well as with the promotion of physical, mental, and social well-being” (Canadian Psychological Association, 2018). At its core, the goal of clinical psychology is to reduce the distress associated with mental health conditions.

Clinical psychology is a relatively new field of study and practice, emerging as a profession after World War II (Gee et al., 2022). During this time, the United States (and Canada) anticipated a looming demand for clinical services for veterans. A conference in Boulder, Colorado (Hilgard et al., 1947) approved a scientist-practitioner model to train more PhD-level clinical psychologists, meaning that both research and applied clinical skills are foundational to the profession. The Ph.D. training model is sometimes referred to as the “Boulder model” and continues to represent the most common training model in Canada today.

While this training model might seem like overkill (yes, it is like doing PhD-level research at the same time as balancing clinical training and seeing clients), it served to establish the legitimacy as clinical psychology as an evidence-based science. Proponents of this training model argued that “…the future of clinical psychology hinges on our ability to integrate science and practice”, and that ultimately, there is no choice between science or practice (McFall, 1991). In 1991, Richard McFall published this argument in an article known as “McFall’s Manifesto” that argued that scientific clinical psychology is the only acceptable form of clinical psychology. In other words, the scientific training model is necessary for producing clinicians that employ evidence-based interventions. Relatedly, he argued that psychological services should not be administered to the public unless the benefits are first scientifically validated. Consistent with this model, current Canadian clinical psychology graduate students tend to report that their graduate training is slightly more weighted toward research than clinical practice (Peluso et al., 2010).

Critics of the Boulder model argue that it places too much emphasis on research rigour, skills that many practicing clinical psychologists never use in their daily practice (Gee et al., 2022). These criticisms, paired with an ever-increasing demand for a mental health care workforce, have led to the creation of a practitioner-scholar training model, in which clinical psychologists earn a Doctor of Psychology (Psy.D.) degree. The first Psy.D. program was established in 1973 in the United States (Peterson, 1992), with Canadian programs only recently taking off in the mid-2000s.  

There are approximately 30 Canadian universities that are accredited by the Canadian Psychological Association with doctoral training programs (Ph.D. or Psy.D.) in clinical psychology, essentially creating a national standard of training with clinical psychology (Dobson, 2016). While there are some Master’s-level programs in Canada (and some provinces that licence Master’s-level psychologists), the CPA does not accredit Master’s-level training programs. As noted by Dobson (2016), the accreditation of clinical psychology programs in Canada, beginning in 1994, has served to enhance the quality of these programs and the calibre of students who are trained. Indeed, within these programs, becoming a clinical psychologist usually takes 6-7 years. Gaining admittance to a Ph.D. or Psy.D. program in Canada is remarkably competitive, as most programs receive >100 applications for 5-8 spots in a given program (for more information be sure to review a given program’s public disclosure table, such as this one from Dalhousie University).

After earning a PhD or a PsyD, potential clinical psychologists cannot call themselves psychologists until they are licensed as health professionals. In Canada, healthcare falls under provincial jurisdiction, meaning that each province/territory has its own licensing body and their own rules for regulating the profession. To be a registered psychologist, psychologists must meet the standards of the profession as described by the provincial licencing body. In most cases, these standards include an advanced degree (e.g., Ph.D. or Psy.D.), at least one year of supervised practice, and having passed standardized oral and written exams on psychology and ethics of the profession. Ultimately, the purpose of such standards and the licensing body is to protect the public, as clients who believe they have received unethical or incompetent care from a psychologist can lodge a complaint with the regulatory organization.

For example, in Nova Scotia, Psychology is regulated under the Nova Scotia Psychologists Act (2000) and psychologists are registered with the Nova Scotia Board of Examiner’s in Psychology (NSBEP). The Psychology Act (2000) is a law protecting the term “psychologist” and “psychological services”, meaning that only those who have earned the proper credentials and are licensed with NSBEP can call themselves “psychologists” and provide such care. Professors in psychology are not required to be licensed by NSBEP but must clearly identify themselves as “professors of psychology” and not psychologists. Similar laws exist in other provinces, such as The College of Psychologists Act (2017) in New Brunswick and the Psychologists Act (2009) in PEI. 

Related terms, like “therapist” or “counsellor” are not licensed terms, meaning that anyone (with any training or no training at all) can use those terms. If you receive services from an unregulated provider, there is no regulatory organization with whom to lodge a complaint, and there are no standards for providing care. To make it especially confusing, however, “Registered Counselling Therapist” IS a licenced profession (see more below). This is why it is always important to ask questions about the training and background of your mental health care provider!

Clinical psychologists must also follow the Code of Ethics established by their provincial regulatory body. The Code of Ethics consists of guidelines for protecting the well-being of individuals, the public, and society. For example, the Canadian Code of Ethics for Psychologists (4th edition) articulates the ethical principals, values, and standards to guide all members of the Canadian Psychological Association. The ethical guidelines outlined in the Canadian Code of Ethics are structured into four pillars:

The Canadian Code of Ethics also provides guidance for psychologists on ethical decision-making. While all four pillars should be taken into account when engaging in ethical decision making, the four pillars are ordered according to the weight each generally should be given when conflict arises.  

What do clinical psychologists do?

Canada has approximately 21,000 psychologists, with approximately 1424 psychologists in Atlantic Canada (Canadian Institute for Health Information, 2024). However, not all of these are clinical psychologists, and some may be registered with other specialties such as school psychologists. For example, in Nova Scotia there are 696 psychologists, with 464 (67%) primarily registered as clinical psychologists. Across the country, there tends to be an over-representation of clinical psychologists in urban centres, with very few clinical psychologists practicing in rural areas. For example, 60% of all psychologists registered in Nova Scotia work in Halifax county, which accounts for 48% of the population. This discrepancy highlights a growing need for clinical psychologists across Canada, particularly in rural and underserved communities. You can learn more about the need for evidence-based mental health care in rural communities in this article.

In 2013, Hunsley et al. surveyed over 500 psychologists from across Canada to better understand their practice characteristics. Approximately three-quarters of their respondents identified as women, representing a dramatic shift from the early 1990s when 70-80% of psychologists were men (Hunsley & Lefebvre, 1990; Warner, 1991).

As shown in the graphs below, Canadian psychologists commonly work in both public and private sectors, and work with a variety of mental health concerns, the most common being anxiety and mood disorders. Unsurprisingly, clinical psychologists tend to spend most of their time in working directly with clients in intervention and assessment roles, with a smaller proportion of time spent in other activities. The vast majority (80%) of Canadian psychologists approach their work using a cognitive-behavioural theoretical orientation (Hunsley et al., 2013).

The (Modern) Origins of Clinical Psychology

Throughout much of history, little was known about assessing, diagnosing, or effectively treating psychological disorders. People held in asylums were often treated poorly, subjected to the whims of the people who ran them, and received little in the way of sympathetic care (particularly if the asylum was underfunded and overcrowded – unfortunately, quite common). Many individuals paved the way for modern assessment and intervention, and/or fought for more humane treatment of people with psychological disorders.

Phillipe Pinel (1745-1826), a French physician sometimes considered “the father of modern psychiatry”, is credited with helping to improve conditions for mental patients, particularly after he became head physician of the Hospice de la Salpêtrière in 1794. While in this role, he fought to have patients unshackled and led to the cessation of “treatments” such as bleeding, purging, and blistering. He also made contributions to early attempts at classification that helped pave the way for our modern diagnostic systems. He argued that treatments should be tailored to the individual, advocating for speaking to the patient regularly and developing a deep understanding of the person and their illness, foreshadowing modern views.

William Tuke (1732-1822) – Tuke, a tradesperson and philanthropist, is credited with pioneering “moral treatment”. After having learned of a community member’s tragic death in an asylum, likely due to maltreatment, and witnessing the horrific conditions at another hospital, Tuke was inspired to raise funds to build a different kind of asylum. The York Retreat, established in 1792, was built on spacious and beautiful grounds. Tuke believed that good food and exercise were important for mental health, and that patients should receive individualized attention and be treated with kindness. Patients were encouraged to enjoy nature on the grounds, socialize, do light manual labour, and take on hobbies. Some components of the treatment approaches at the York Retreat are now viewed by some to be an early form of occupational therapy. Tuke also contributed to legal reforms aimed at changing how asylums were run, such as reducing the use of restraints.

Dorothea Dix  (1802-1887) was a retired American schoolteacher who advocated for asylum reform, petitioning the government and raising awareness. As part of an investigation into the treatment of the mentally ill in Massachusetts, she was dismayed to witness the terrible conditions, her report indicating that patients were, “in cages, stalls, pens! Chained, naked, beaten with rods, and lashed into obedience” (Dix, 2006).  She began lobbying for better treatment throughout America and the greater commonwealth. She even travelled to Nova Scotia in 1844 and 1849 and spoke to the legislature to argue for better care for the mentally ill. These efforts helped lay the groundwork for the province’s first psychiatric hospital, the Mount Hope Asylum for the Insane (now the Nova Scotia Hospital; Goldman, 1990).  Fun fact: while she was in the Maritimes, she even aided a shipwreck on Sable Island!

Although Pinel and Tuke emphasized talking with and developing a deep understanding of, individual patients, the modern origins of psychotherapy (AKA. “Talk Therapy”) owe a great deal to Sigmund Freud (1856-1939). When Freud was studying in Paris under French neurologist Jean-Martin Charcot (1825-1893), he observed patients hypnotized by Charcot apparently experiencing great emotional release. He interpreted this as catharsis, a process of emotional release and healing that comes from bringing unconscious material into conscious awareness and processing it, which he believed essential for reducing neuroses. Upon returning to Vienna, Freud experimented with patients talking about their symptoms and difficult memories while under hypnosis and observed improvements, such as in his famous case, referred to as Anna O. (who is credited with coining the term “talking cure”). Freud gradually moved away from hypnosis, observing similar successes by encouraging patients to talk freely, believing that free and uncensored discussion (“free association”) helped clients gain awareness of unconscious material and experience catharsis, which was essential to overcoming psychological problems.

An individual important to modern understanding of the classification of psychological disorders is Emil Kraepelin (1856-1926), a German psychiatrist. Kraepelin emphasized the collection of clinical data and, through careful observation of patients, helped to classify symptoms into manic-depression (now called bipolar I disorder) and dementia praecox (schizophrenia), setting the stage for contemporary classification systems, like the DSM (Decker, 2004). However, we should also note that Kraepelin espoused harmful theories about sexual orientation, and he supported eugenics, so his legacy is problematic.

Alfred Binet (1857 – 1911). The origins of modern cognitive testing are traced to France around the turn of the 20th century. The French government wanted a means of assessing young children entering the school system to identify children who were likely to struggle in regular classroom placements due to learning difficulties. Psychologist Alfred Binet was commissionsed to develop just such a test. Along with colleague Theodore Simon, they developed what came to be known as the Binet-Simon test. Across the pond in America, Lewis Terman (1877 – 1956) standardized the Binet-Simon test for American samples. The Stanford-Binet, as it became known, is still a widely used test of intelligence and now in its 5th edition.

Lightner Witmer (1867 –1956) was an American psychologist who is often credited with founding the field of clinical psychology (and coining the term “clinical psychology”). Witmer was educated in a variety of fields before making waves in psychology, such as studying Art and Finance, and teaching History and English. Witnessing the social problems of the civil war and students struggling with learning issues, inspired him to fight for improved social and educational conditions and made strides in specialized educational supports for students with learning difficulties. He made significant contributions to experimental psychology, educational psychology, and trained other important figures in the field. In 1896, he presented a roadmap to a new discipline to the American Psychological Association, which he called “clinical psychology”. He emphasized a scientific basis, which can be seen in his explanation of the choice of term:

Who were “The Termites”?

When Lewis Terman adapted the Binet-Simon into the Stanford-Binet, it was used for more than the French government’s original purpose of identifying children who would struggle in school. Terman and colleagues expanded the use, such as using test results to predict the best placements for new military recruits. Terman was also interested in understanding giftedness.

In 1921, he began a now-famous longitudinal study of children identified as gifted. The children, referred to colloquially as “Termites” after Terman, were identified as highly intelligent and were followed through to their mid-lives. Many of the gifted children went on to achieve heights of education and accomplishment, winning awards and excelling in their careers. However, there were also examples of talent not being realized, which Terman attributed to factors such as personal obstacles and lack of opportunities. The outcomes for the “Termites” mirror research findings over 100 years since on correlates of intelligence today – although IQ is correlated with factors like school and career success, it is far from a perfect predictor, and many other factors contribute to those outcomes.

After Terman’s death, the study was continued by one of the “Termites” themselves!

As can be seen from this discussion of history and important early influences, many diverse circumstances, from religion and military to early views of the physical body, helped shape the early origins of assessment, diagnosis, and treatment. So, what do all these factors lead us to today?

Setting the Context: Recognizing Missing Voices

As you may or may not have noted as you read through the above information on important people influencing the history of clinical psychology, they are mostly men from Western cultures. As a result, many voices are under-represented throughout the history of psychology, such as 2SLGBTQIA+, women, people of colour, and people from less individualistic cultures. This is an important limitation to keep in mind throughout this course!

Canada’s indigenous peoples are one of these underrepresented groups. Although there are many, distinct indigenous groups in Canada, with their own rich histories and traditions, indigenous peoples tend to approach health in a more holistic way and use cultural rituals as part of healing. Thus, mental health practices that are strongly influenced by Europeans and settlers may be less effective and potentially even harmful. This, combined with the intergenerational harms caused by longstanding racism and the residential school system, points to a strong need to welcome indigenous voices in all aspects of the health care system in Canada. Within the Truth and Reconciliation Commission Calls for Action, there are calls to “acknowledge that the current state of Aboriginal health in Canada is a direct result of previous Canadian government policies, including residential schools…”,  “in consultation with Aboriginal peoples, to establish measurable goals to identify and close the gaps in health outcomes Calls to Action| 3 between Aboriginal and non-Aboriginal communities” (which includes mental health, suicide, and addictions), “…provide sustainable funding for existing and new Aboriginal healing centres to address the physical, mental, emotional, and spiritual harms caused by residential schools…”, and:

After covering the past and current practice of clinical psychology, we can think about the future of this profession. The future of clinical psychology depends on greater diversity among trainees and faculty to better reflect the populations they serve. As noted by Goghari (2022), White females remain overrepresented in clinical psychology programs, despite Canada’s rapidly shifting demographics—by 2036, immigrants are expected to make up 25% to 30% of the national population (Statistics Canada, 2017). To remain relevant and equitable, training programs must proactively recruit faculty and students from underrepresented groups. This focus on diversity would also mean reevaluating traditional admission metrics that may unintentionally disadvantage diverse applicants. Fostering diversity in training is essential not only for social justice, but also for ensuring that psychological care is culturally responsive and accessible to all communities.

An emerging and debated issue in the future of clinical psychology is the potential for prescription authority. Some part of the United States (e.g., New Mexico, Louisiana, Colorado, Illinois, Iowa, Idaho) currently grant prescription privileges to appropriately trained psychologists, with several other states introducing legislation to follow suit (Sepehry et al., 2025). This shift has shown positive impacts on access to care and treatment outcomes. For example, in states that have granted psychologists prescription authority, death by suicide decreased 5%-7% (Choudhury & Plemmons; 2023). Prescription authority, however, remains controversial. Major medical organizations like the American Medical Association and the American Psychiatric Association oppose it, arguing that psychologists do not have sufficient training in psychotropic medications and psychopharmacology to warrant such an expanded scope (American Medical Association, 2009). Although Canada has not yet approved this expanded scope of practice, provincial associations in Ontario and British Columbia have advocated for it. A recent study by Sepehry et al. (2025) found that 88% of Canadian psychologists and psychology students believe prescription authority would improve service delivery for specific populations and enhance access to effective treatments. Notably, 65% said they would pursue the necessary training if prescription privileges became available in Canada.

Finally, to meet the growing demand for mental health services, the field of clinical psychology must also prioritize increasing its workforce. Currently, only about 1% of the global health workforce is dedicated to mental health, and psychologists make up just 7% of that small fraction (Bradley, 2019; Goghari, 2022; Mikail & Nicholson, 2019). Innovative solutions are needed to expand training opportunities and output of trained mental health professionals. The development of PsyD programs has emerged as one response to the mental health care crisis, aiming to train more practice-oriented clinicians. These programs have become particularly popular in Atlantic Canada, with a PsyD program at Memorial University in Newfoundland, UPEI, and a new program in development at Mount Saint Vincent University in Nova Scotia. Additionally, Dalhousie University recently opened the Dalhousie Centre for Psychological Health, which offers training opportunities for PhD students and four residency positions for students at the end of their degree. Programs like this, coupled with targeted incentives (e.g., scholarships for students who commit to practicing in rural or remote areas) could help bolster the number of psychologists where they are needed most. Similar to models used in nursing (e.g., Mbemba et al., 2013), these approaches might help ensure more equitable access to psychological care across Canada.