Chapter 1The Evolution of Clinical Psychology

INTRODUCTION TO CLINICAL PSYCHOLOGY 2EHUNSLEY & LEE

PREPARED BY DR. CATHY CHOVAZ, KING’S COLLEGE, UWO

Introduction – Topics

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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

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 Most undiagnosed or misdiagnosed

It is estimated that the Canadian economy loses $14.4 billion annually due to mental disorders in the workplace

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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 health1. Canadians have a right to receive the services

and supports they need2. Canadians have the right to be treated with the

same dignity and respect as those with any other kind of illness.

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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

Active debate on the ‘science of clinical psychology’

McFall’s Manifesto for a Science of Clinical Psychology

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Importance of Clinical Psychology as a Discipline Evidence-Based Practice

Importance of using only practices empirically found to be effective

Intuition should not be a part of assessment or treatment

Critics argue (among other points): 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.)

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Other Related Mental Health Professions (and Differences) Counselling Psychology

Historically worked with less severe problems Different settings than clinical psychologists

School Psychology Training in both psychology and education Work in diverse education-related settings

Psychiatry Medical school training Prescribe medication

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Other Related Mental Health Professions (and Differences) Social Work

Emphasis on social/community conditions Different settings than clinical psychologists

(especially community agencies) Other Mental Health Professionals

Psychiatric nursing Child and youth care workers Applied behavioural analysis counsellors

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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” Biological, psychological and social factors all

need to be considered. “bodily fluid” theory – blood, black bile, yellow

bile, phlegm

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History of Clinical Psychology

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”

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History of Clinical Psychology

Enlightenment period (later 1700’s) 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

1800’s – clinical neurology Hysteria could not be recognized as biological:

Charcot, Janet and Freud

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History of Assessment in Clinical Psychology Early Clinical Psychology was almost entirely an

assessment-based discipline Late 1800’s saw scientific principles applied to

understanding normal and abnormal behaviour

1.Francis Galton (England): differences in reaction time as intelligence differences

2.Wilhelm Wundt (Germany): first psychology laboratory, studied sensation and perception

3.James McKeen Cattell (USA): studied connection between reaction time and intelligence

Coined term “mental tests”12

History of Assessment in Clinical Psychology Emil Kraepelin (Germany)

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

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History of Assessment in Clinical Psychology Alfred Binet (France)

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

Lewis Terman (US) modified the work of Binet and Simon first widely available test of cognitive ability

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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 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

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History of Assessment in Clinical Psychology 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.

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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 Heavy use of statistics and test development Ch. 8

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History of Assessment in Clinical Psychology Criticisms of Early Assessment

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

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History of Assessment in Clinical Psychology 1980’s – Diagnostic and Statistical Manual for

Mental Disorders (DSM-III) published by APA DSM-III more focused on observable symptoms Focus on reliability

Several changes in psychological assessment have recently occurred Clinical utility – does the assessment help with

treatment Service evaluation – do treatments work

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History of Intervention in Clinical Psychology Sigmund Freud (German psychiatrist)

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.)

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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

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History of Intervention in Clinical Psychology WWII - 1940’s & 1950’s

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

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Many therapy approaches developed in 1940’s – 60’s 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

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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 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

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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

Cognitive Behavioural Therapy Short-term Dynamic Therapy

History of Intervention in Clinical Psychology

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A growing area of Clinical Psychology The profession is evolving

1. Ph.D. science-practitioner model (focussing on research)

2. Psy.D. practitioner-scholar model (focussing on clinical practice).

3. Psychological associates

Prescription privileges in Canada???

Prevention in Clinical Psychology

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