This opening chapter provides a broad survey of the field. It describes what features define clinical psychology and what clinical psychologists do in their roles as researchers, therapists, teachers, consultants, and administrators. It describes the increasingly diverse demographic characteristics of clinicians and their clients, and the wide range of settings in which they work. The chapter also outlines the personal, educational, and experiential requirements needed to enter the field. It discusses the continued appeal of clinical psychology as a profession, popular conceptions and misconceptions about clinical psychologists held by the general public, and how clinical psychology overlaps with, and differs from, other mental health professions, including counseling, school, and educational psychology, as well as social work and psychiatry.

The applied psychology of religion takes information from the knowledge base developed by psychologists of religion and uses this information for some social, psychological, or spiritual/religious purpose. When we seek to apply research and theory in this field we must first answer questions about our objectives, and it is unlikely that we will arrive at much agreement on ultimate goals. Still, it is possible that some consensual objectives and applications can emerge among researchers and those who seek to apply what researchers have learned. This chapter lists and discusses a broad range of potential applications. One major domain of application concerns clinical psychology, counseling psychology, psychiatry, social work, and related fields. We see that in recent decades, there have been many proposals – partly driven by the findings of empirical research – to integrate religious and spiritual approaches into mainstream psychotherapy. As with nearly everything else in the psychology of religion, these proposals can be controversial. In addition, the chapter discusses proposed spiritual and religious competencies for psychologists.

Our thoughts affect our feelings and our feelings affect our thoughts. But the way to break into this cycle is through changing our thoughts. Experimental evidence shows the effectiveness of many ways of doing this. Cognitive behaviour therapy (CBT) teaches us to observe our automatic negative thoughts and make space for more positive thinking. Positive psychology builds on this, applying the lessons to all of us, and not just those in distress. It helps us all to build our emotional intelligence. The Action for Happiness movement applies these lessons through their 10 Keys to Happier Living. Mindfulness meditation, through non-judgemental and friendly engagement with the present moment, can transform our mental state and improve our immune system.

In this chapter, the author examines clinical psychological, traumatic developmental, and sociocultural perspectives of a serial murder. This includes media dynamics and feminist perspectives. The author discusses malingering, or the faking of mental illness. The case of female serial killer (FSK) Aileen Wuornos is revisited to illustrate clinical psychological issues. The cases of male serial killers (MSKs) Ronald Dominique and Dennis Rader (BTK Strangler) highlight phenomena from the chapter.

Summarizes how psychologists define psychopathology. Discusses ways in which abnormality was viewed historically, and modern mental health care. Identifies the research methods that psychologists utilize.

How to talk about variations in sex development is a major theme for impacted individuals and families. This is the topic of Chapter 12. The author summarizes the research literature with caretakers and with adults about the difficulties of disclosure. Considerable criticism has been levied at health professionals for failing to role model affirming communication. For sure there are gaps in health professionals’ talk, but the biggest contributor to the difficulties is to do with the widespread misunderstanding about the biological variations. Psychological care providers are not there to put a cheerful gloss over clients’ negative expressions. However, they can be part of the favorable social condition in which a wider range of meanings about bodily differences are negotiated. In the practice vignette, the author highlights how tentative and uncertain the enabling process is, where a negative view of sex variations is still widely endorsed in the social context.

In a gendered world, doctors and caretakers took for granted that making atypical bodies more typical was a humane way out of a difficult situation for child and family. Had the professionals carried out proper research, they would have learned from their young patients that the approach was physically and psychologically risky. But research on the long-term effects was not carried out, certainly not from the patients’ perspective. There was also no comparison group made up of people growing up with unaltered genital variations. Research with adults is the topic of Chapter 4 of this book. Since the 1990s, a number of outcome studies with adults have identified many problems of childhood surgery, such as multiple operations, scarring, shrinkage, sensitivity loss, unusual genital appearance and sexual difficulties.

Chapter 8 begins by pointing out the current lack of collective clarity about the role of psychological care providers (PCPs) and suggests that researchers and practitioners make collective effort to develop the role of PCPs in sex development in future. Meanwhile it outlines the psychological consultation process that is generic and familiar to most PCPs. The author provides an initial assessment template and summarizes the popular psychotherapeutic interventions. The template is visible in several of the practice vignettes in the ensuing chapters of the book. The author ends the chapter by arguing that the tertiary environment is set up for diagnostic workup and treatment and unsuitable for the kind of ongoing psychosocial input that is needed by individuals and families living in their communities. The author makes a case for PCPs in DSD centers to collaborate with peer support workers to enable nonspecialist providers in the community to contribute to ongoing support for individuals and families.

Chapter 11 of the book reviews potential psychological contributions in the highly charged process of assigning legal gender to a newborn with genital variations. Although a number of psychological theories exist for understanding gender development, it is the brain gender framework that has been singularly privileged in intersex and DSD medicine. However, the decades of research cannot contribute to the certainty professionals and caretakers seek. Psychological care providers (PCPs) have other frameworks to draw from in order to work ethically and pragmatically with families. In the practice vignette, the author envisions how a highly skilled PCP in a high-functioning DSD team could work substantially to help caretakers to cope with uncertainty and minimize the need for psychosocially motivated medical interventions. In the vignette, the psychological care path is in position before medical investigations begin. It remains highly active long after the medical and legal processes are completed. Although the vignette is built around a child diagnosed with 17β-hydroxysteroid dehydrogenase-3 deficiency, the care principles are relevant to legal binary gender assignment for children born with a range of sex development variations.

Difficulties with communication about bodily differences are strongly linked to sexual experiences. In Chapter 13, the author critiques the dominant ways of talking about sexuality in the wider society. These oppressive ideas can give rise to insecurities, self-objectification and body shame for people in general. Adults who have been medically managed are particularly vulnerable to the effects of objectification and shame. The author outlines typical components of sex therapy programs. However, rather than fix sexual problems, which can perpetuate people’s sense of inadequacy, the author suggests that psychological care providers support clients to process any trauma and develop a more relaxed and appreciative relationship with the body. This work, which requires generic therapy knowledge and skills, can be integrated with a range of specific sex therapy techniques and resources to reimagine a sexual future that focuses on bodily pleasure rather than gender performance. Although the practice vignette is built around a female couple, one of whom has partial androgen insensitivity syndrome, the care principles have wide applications for people with variations more generally.

Inconsolable distress is neither a universal nor inevitable response to inability to have biological children. In Chapter 14, the author criticizes research with clinic samples that has produced a problem-saturated account of childlessness that obscures a wide range of alternative responses. The author examines the influence of pronatalist ideology on people who are impacted by infertility including many people with sex variations. Away from the treatment context, psychological input can guide individuals, couples and groups to explore personal meaning of nonparenthood. It can facilitate service users to grieve for what is not possible, challenge feelings of deviance and shame, reengage with a range of life goals and, perhaps most important of all, recast adult identities. Through the practice vignette built around a heterosexual couple, one of whom has a late diagnosis of Klinefelter syndrome, the author teases out the difficulties of working psychologically in a treatment context, where complex existential issues and relational dynamics are compressed into the frame of pressurized treatment decisions.

Chapter 9 tackles the theme of choosing “normalizing” interventions, which applies to children and adults with variations. It explores the limits of choice regarding invasive and irrevocable “normalizing” interventions in the field of sex development. It considers the role of emotion in decision-making and the complexities of obtaining informed consent. In the practice vignette, demand for surgery by a young person (with CAH) is a foregone conclusion – a familiar scenario in DSD services and one that places the psychological care provider (PCP) in an ambiguous position. The service user also has clear psychosocial care needs. She brings a unique suite of intersecting social circumstances that place demand on the PCP to be fluid and responsive to the dynamic and challenging referral context. The PCP in the vignette does not have the answers, but it is hoped that the story opens up conversations on the theme.

Psychological care is endorsed in DSD medicine. Psychosocial research has been on the increase. But these positive moves have not given psychological practice the kind of collective focus that is enjoyed by the biomedical disciplines. However, psychological care providers have a wide variety of thinking tools and practice techniques to draw on, if to work in an ad hoc way at times. These tools and techniques do not change, but some are more useful and relevant than others for this service context. In Chapter 7, the author discusses the strengths and weaknesses of key theoretical frameworks in healthcare psychology. A major weakness of the individualistic models is their lack of capacity to address structural inequalities in psychological wellness and distress. The author introduces aspects of the Power Threat Meaning Framework and describes how to draw from its theoretical richness to think systemically about what sex variations pose to individuals and families in the social context and how they are responded to. The Framework provides the theoretical backbone for some of the practice vignettes in the final section of the book (Chapters 9–14).

In Chapter 10, the author suggests immense possibilities for psychological care providers (PCPs) to contribute to compassionate care following the birth of a child with variations (and in the antenatal period). Psychosocial research and first-person accounts inform us of caretakers’ brokenness, which is often responded to by “normalizing” the child. Here, the author suggests that PCPs work with caretakers in a grief-informed way. Grief is a language that everyone understands and compels services to privilege psychological safety as a first care principle. The practice vignette is built around an expectant mother in difficult circumstances with an unborn child with TS. However, the concept of grief is also relevant for older children and adolescents who are newly diagnosed. Indeed processing loss is integral to adjustment, whereby taken-for-granted ideas of selfhood give way to new identities.

The chapter describes how the clinical psychologist can work in rural and remote settings. The specific rewards and challenges are outlined. The chapter reviews the effectiveness of therapy at a distance and developments in the delivery of clinical psychology services. Consideration is given to the relevant legislation and regulations, and provides a practical guide to providing therapy at a distance. These steps involve a consideration of privacy and security, risk management, telehealth, and adapting therapeutic skills to the digital and distance context. The chapter concludes with the unique elements of mental health services in rural communities and the impact on professional boundaries of life in small communities.

The science-informed approach to clinical practice is founded upon ongoing quality improvement and involves key skills that allow clinical psychologists to confidently provide services in a competitive health care market. Thus, programme evaluation is a core clinical psychology competency but needs to be provided via a co-design framework. The chapter outlines how co-designed programme evaluation addresses patients’ needs in five steps: (i) asking the right questions, (ii) developing an evaluation plan, (iii) collecting and analysing data to produce usable findings, (iv) translating the findings into recommendations for action, and (v) advocating and promoting change. The chapter illustrates how empirically-based programme evaluation supports accountable clinical practice, both at the level of the individual patient and at the aggregate level of the service provider or agency.