Chapter 1
The Evolution of
Clinical Psychology
I N T R O D U C T I O N TO C L I N I C A L P S Y C H O L O G Y 2 E
HUNSLEY & LEE
P R E P A R E D B Y D R . C AT H Y C H O V A Z , K I N G ’ S C O L L E G E , U W O
Introduction – Topics






Importance of Clinical Psychology
Related Mental Health Professions
History of Clinical Psychology
History of Assessment in Clinical Psychology
History of Intervention in Clinical Psychology
Prevention in Clinical Psychology
2
The Importance of Clinical
Psychology as a Discipline



About half of mental disorders begin before age 14
Worldwide 800,000 people commit suicide every year
Worldwide hundreds of millions suffer from mental
disorders


3
Most undiagnosed or misdiagnosed
It is estimated that the Canadian economy loses $14.4
billion annually due to mental disorders in the workplace
Mental Health Commission of
Canada

A national non-profit organization designed to enhance
the health and well-being of those living with a mental
disorder by focussing national attention on mental health
1.
2.
4
Canadians have a right to receive the services and supports
they need
Canadians have the right to be treated with the same dignity
and respect as those with any other kind of illness.
Defining the Importance of
Clinical Psychology



Early definitions stressed assessment, evaluation, and
diagnosis
More recent inclusion of intervention in various forms as
well as prevention
Evidence-Based Practice


5
Active debate on the ‘science of clinical psychology’
McFall’s Manifesto for a Science of Clinical Psychology
Importance of Clinical
Psychology as a Discipline

Evidence-Based Practice



Critics argue (among other points):



6
Importance of using only practices empirically found to be effective
Intuition should not be a part of assessment or treatment
Group-based data is not always sufficient in working with individuals
Research is not always available for all problems
Each person is unique in many different ways (culture, class, family,
etc.)
Other Related Mental Health
Professions (and Differences)

Counselling Psychology



School Psychology



Training in both psychology and education
Work in diverse education-related settings
Psychiatry


7
Historically worked with less severe problems
Different settings than clinical psychologists
Medical school training
Prescribe medication
Other Related Mental Health
Professions (and Differences)

Social Work



Other Mental Health Professionals



8
Emphasis on social/community conditions
Different settings than clinical psychologists (especially
community agencies)
Psychiatric nursing
Child and youth care workers
Applied behavioural analysis counsellors
History of Clinical Psychology


Most early views concluded that demonic possession or
evil spirits were the cause of mental illness
Hippocrates – “father of medicine” may be first to
consider a “biopsychosocial approach”


9
Biological, psychological and social factors all need to be
considered.
“bodily fluid” theory – blood, black bile, yellow bile, phlegm
History of Clinical Psychology



10
St.Vincent de Paul (late 1500’s) emphasized natural
forces and that witchcraft or satanic possession were not
the causes of mental disturbances
Sadly, by this time, in Europe and North America, the
treatment of individuals with mental illness was inhumane
“Bedlam”
History of Clinical Psychology

Enlightenment period (later 1700’s)




1800’s – clinical neurology

11
Philippe Pinel – French reformer: humane treatment of the
mentally ill
William Tuke – English reformer: hospitals based on
appropriate care
Benjamin Rush – U.S.: moral therapy
Hysteria could not be recognized as biological: Charcot, Janet
and Freud
History of Assessment in
Clinical Psychology


1.
2.
3.
Early Clinical Psychology was almost entirely an
assessment-based discipline
Late 1800’s saw scientific principles applied to
understanding normal and abnormal behaviour
Francis Galton (England): differences in reaction time
as intelligence differences
Wilhelm Wundt (Germany): first psychology
laboratory, studied sensation and perception
James McKeen Cattell (USA): studied connection
between reaction time and intelligence

12
Coined term “mental tests”
History of Assessment in
Clinical Psychology

Emil Kraepelin (Germany)




13
Believed that mental disorders were due to biological causes
Worked on classifications of symptoms into syndromes
Huge influence on modern psychiatry and clinical psychology
Much of his work formed basis for DSM and ICD (Ch. 3) and is
still evident today
History of Assessment in
Clinical Psychology

Alfred Binet (France)



Lewis Terman (US)


14
French government asked Binet and collaborator Theodore
Simon to design a measure to assess children with cognitive
deficits
1908 Binet-Simon scale measured 50 tests of mental skills
modified the work of Binet and Simon
first widely available test of cognitive ability
History of Assessment in
Clinical Psychology

World War 1 - committee was struck called the American
Psychological Association (APA) and asked to develop a
scale to measure mental functioning of recruits




15
Army Alpha Test (verbal abilities)
Army Beta Test (non-verbal abilities–for those who could not
read or spoke limited English)
These tests and the value they gave recognized clinical
psychology as a sub-discipline of psychology
APA created a subsection of clinical psychology
History of Assessment in
Clinical Psychology

16
Testing began to flourish and the measurement of abilities
continued to be a central focus of clinical psychologists

Wechsler-Bellevue intelligence test 1939 (still considered the
gold standard in IQ tests)

Projective tests – Rorschach Inkblot 1921, Thematic
Apperception Test (TAT) etc.
History of Assessment in
Clinical Psychology

World War II – Psychologists again active in tests for
armed forces

Canadian Psychology Association (CPA) – Test Construction
Committee developed the Revised Examination M
(verbal/nonverbal items used for the selection of military
personnel)

Starke Hathaway (1943) developed the Minnesota
Multiphasic Personality Inventory – MMPI


17
Heavy use of statistics and test development
Ch. 8
History of Assessment in
Clinical Psychology

Criticisms of Early Assessment



18
Paul Meehl’s work (1954) found that a purely clinical approach
to assessment was typically inferior to a more statistically
oriented approach
Walter Mischel’s work (1968) argued that the measurement of
personality traits had only moderate predictive ability i.e. what
a person may feel, think or actually do
Behavioural assessment as a field grew in part from these
criticisms
History of Assessment in
Clinical Psychology

1980’s – Diagnostic and Statistical Manual for Mental
Disorders (DSM-III) published by APA



Several changes in psychological assessment have recently
occurred


19
DSM-III more focused on observable symptoms
Focus on reliability
Clinical utility – does the assessment help with treatment
Service evaluation – do treatments work
History of Intervention in
Clinical Psychology

Sigmund Freud (German psychiatrist)





20
First elaborated treatment of mental health issues
Early connection to neurology and work of Charcot
Focus on role of unconscious
1900 publication of The Interpretation of Dreams
Many subsequent followers elaborating related psychodynamic
theories (e.g., Jung, Adler, Anna Freud.)
History of Intervention in
Clinical Psychology

In addition to psychodynamic models, two other
approaches were influential:
1. Lightner Witmer (USA, 1900)– coined the term
‘clinical psychology’ – opened a clinic (1904) to assess
and remediate learning difficulties
2. John Watson (USA, 1920)- Conditioning principles →
little Albert and furry white animals
21
History of Intervention in
Clinical Psychology

WWII - 1940’s & 1950’s



22
Needs for therapy increased with soldiers returning from war
Members of public affected by loss
VA hired many clinical psychologists which lead to an
enormous increase in both Canada and USA
History of Intervention in
Clinical Psychology

Many therapy approaches developed in 1940’s – 60’s






23
Carl Rogers (1940’s): Client-centered approach
Alexander & French (1946) – Several adaptations to Freud’s
model
Harry Stack Sullivan (1950’s) – interpersonally focused
strategies
Fritz Perls – Gestalt therapy
Viktor Frankl - Logotherapy
Joseph Wolpe – Systematic desensitization
History of Intervention in
Clinical Psychology

Criticisms of Psychotherapy



Hans Eysenck 1952 - critiqued the effectiveness of
psychotherapy
Levitt, 1957 – critiqued child psychotherapy research
Resulted in enormous amount of research on whether
psychotherapy works



24
Efficacy studies – focus on studies that emphasize internal validity
of the study
Effectiveness studies – focus on studies that look at real world
conditions
Meta-analysis – statistical technique combining several
studies, showed psychotherapy effective
History of Intervention in
Clinical Psychology

Contemporary approaches




Albert Ellis (USA, 1960’s)-– Rational Emotive Therapy
Eric Berne (1960’s) – Transactional Analysis
Don Meichenbaum (Canada,1977) – Cognitive-Behaviour
Therapy
Aaron Beck (USA, 1979) - Cognitive Therapy


25
Cognitive Behavioural Therapy
Short-term Dynamic Therapy
Prevention in Clinical
Psychology


A growing area of Clinical Psychology
The profession is evolving
1.
2.
3.

26
Ph.D. science-practitioner model (focussing on research)
Psy.D. practitioner-scholar model (focussing on clinical
practice).
Psychological associates
Prescription privileges in Canada???
Copyright
Copyright © 2010 John Wiley & Sons Canada, Ltd. All rights reserved.
Reproduction or translation of this work beyond that permitted by Access
Copyright (The Canadian Copyright Licensing Agency) is unlawful. Requests
for further information should be addressed to the Permissions Department,
John Wiley & Sons Canada, Ltd. The purchaser may make back-up copies for
his or her own use only and not for distribution or resale. The author and
the publisher assume no responsibility for errors, omissions, or damages
caused by the use of these programs or from the use of the information
contained herein.