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Clinical Psychology and Clinical Psychologists have been and still are at the forefront of developing and disseminating psychological understanding of and interventions for psychological distress in a range of settings across the lifespan. The factors underpinning this remarkable achievement are considered, illustrated with some specific examples. These factors, which are recognised in exemplars of the delivery of psychologically oriented services, include a particular emphasis on understanding those processes involved in the maintenance of difficulties experienced by those we work with. That is, helping people to understand and find ways of changing the processes involved in making their difficulties particularly severe and particularly persistent. Cognitive-behavioural approaches particularly but not exclusively exemplify this philosophy and the way it can be implemented to the advantage of those we seek to help.

 It is clear that day-to-day delivery of effective psychological services requires the integration of coherent empirically-grounded theoretical underpinnings with a person-centred strategy. These together are applied to the understanding of how best to empower service users to find and evaluate ways of increasing their psychological flexibility and personally defined goals and dreams. The same principles can be extended to the development and application of prevention strategies as we develop a clearer understanding of factors involved in the cause of intense and persistent psychological distress.