Historical Overview of Clinical Psychology

1. Historical Overview of Clinical Psychology Clinical Psychology has it’s roots in 3 sets of historical factors: Use of scientific research methods by psychologists Study of human individual differences The ways in which behavioral disorders have been viewed and treated over the years

2. The Research Tradition in Psychology • 19th Century beginnings in psychophysics – Fechner, Weber • Experimental physiology of Helmholtz and Wundt • The early history of psychology is the history of experimental psychology – clinical psychology did not emerge until 17 years later – early clinicians came out of this experimental tradition

3. Individual Differences • Scientific measurement of individual differences came from astronomy and anatomy • Differences in observations in astronomy led to the study of reaction times • Anatomy – phrenology • “Mental tests” by 1890 • Role of Darwin, and his cousin, Sir Frances Galton

4. Individual Differences (cont.) • James McKeen Cattell – established a standard battery of mental tests for measuring individual differences • Alfred Binet – developed measures of complex mental abilities

5. Conceptions of Behavior Disorders • Earliest views – disordered behavior attributed to magical forces and supernatural agents • Hippocrates – invoked natural causes • Return of supernatural causes in the Middle Ages • Age of the Asylums • Reformation – Pinel, Rush • Psychological causes first noted due to work of Mesmer, Charcot, Janet – led to Freud

6. Birth of Clinical Psychology By the end of the 19th Century: • 1. Psychology had emerged as a distinct scientific discipline • 2. Psychologists had begun to apply scientific methods to the study of individual differences • 3. Freud’s dynamic approach to mental disorders was about to open up vast new areas of subject matter for psychologists interested in understanding deviance.

7. Lightner Witmer The first recognized clinical psychologist Graduated from U of Penn in 1888 • Ph.D. under Wundt at U. of Leipzig • Completed doctorate in 1892 • Appointed director of U. of Penn Psychological Laboratory • March, 1896 – asked to help with a child who was a “chronic bad speller.” • Presented clinical psychology to APA Convention in 1896 • Offered Clinical Psychology courses at Penn in 1904 • First Clinical Journal – The Psychological Clinic (1907)

8. Henry H. Goddard • Brought the Binet-Simon Scale to the U.S. – revised in 1916 as the Stanford-Binet

9. Child Guidance Movement • Stimulated by the National Committee for Mental Hygiene, founded by Clifford Beers and supported by William James and Adolf Meyer • Founded in 1909 • Emphasized Freudian ideas – became hugely popular with the visit of Freud to Clark University – strongly influenced American views of mental disorders

10. The main role of Clinical Psychology, however, was the testing of problematic children in clinics and guidance centers • Primarily intelligence testing, but also some personality assessment • At this point, there was no formalized training or licensing of psychologists.

11. After WWI Increased emphasis on adult populations, with numerous tests developed for a variety of purposes. Word Association Test (1919) Rorschach (1921) MAT (1926) TAT (1935) Bender-Gestalt (1938) Wechsler-Bellevue Test of Intelligence (1939) Mental Measurements Yearbook – 1938 Psychological Corporation (J.M. Cattell – 1921)

12. Between the Wars (1918-1941) • WWI led to a need to classify large number of men in terms of their intellectual abilities and emotional stability – the Army asked Robert Yerkes (APA president) to develop appropriate measures • Army Alpha and Army Beta Intelligence Tests • Personal Data Sheet About 2 million men were eventually assessed.

13. 1930’s A few private practitioners were providing psychotherapy by the late 1930’s, with most focusing on children. However, clinical psychology was not a recognized profession in the ’30’s. no official training programs few Ph.Ds, or even M.A’s. little support from universities (questioned the appropriateness of “applied psychology”…plus the cost associated with clinical training.

14. The Postwar Explosion Psychology played a much more important role in WWII than in WWI. By 1944, over 60 million tests had been given to 20 million individuals. The overwhelming caseloads of psychiatrists resulted in psychologists assuming more of a role in providing therapy. At the war’s end, over 40,000 soldiers were in V.A. psychiatric hospitals, causing an immediate need for clinicians.

15. 1946 VA Circular Defined clinical psychology as a profession that engaged in diagnosis, treatment and research relating to adult disorders. Described clinicians as holding a Ph.D. 4700 individuals needed to fill lucrative, high-prestige jobs…and the VA would pay for clinical training. “This document, more than any other single thing, has served to guide the development of clinical psychology.”

16. The Boulder Model Two years after Shakow made his recommendations, a national conference on clinical training was held in Boulder, CO, at which these recommendations were formally adopted. The “Boulder Model” was reaffirmed in 1955, 1958, 1962, 1965 and 1973.

17. In 1946, the medical director of the VA asked a number of major universities to start formal clinical training programs In 1947, David Shakow’s Committee on Training in Clinical Psychology was appointed by the APA to: 1. recommend the content of clinical programs 2. set up training standards 3. report on current programs. His report became the “bible” of all departments hoping for a favorable review by the APA, although Shakow, himself, felt this was premature.

18. Shakow’s Recommendations • Clinical psychologists should be trained first as psychologists (i.e., as scientists). • Clinical training should be as rigorous as non-clinicians (4 years for doctorate, plus 1 year of clinical internship experience) • Clinical training should focus on the “holy trinity” (assessment, research and therapy) by offering courses in general psychology, psychodynamics, assessment techniques, research methods and therapy.

19. The Vail Model • Dissension with the recommendations of the Boulder conference culminated in a 1973 national training conference held in Vail, Colorado (hence, the Vail model). • The Vail conferees endorsed different principles, leading to an alternative training model. • Psychological knowledge, it was argued, had matured enough to warrant creation of explicitly professional programs along the lines of professional programs in medicine, dentistry, and law.

20. The Vail Model (cont.) • These professional programs were to be added to, not replace, Boulder-model programs. Further, it was proposed that different degrees should be used to designate the scientist role (PhD) from the practitioner role (PsyD--Doctor of Psychology). • Boulder-model programs are almost universally located in graduate departments of universities. However, Vail-model programs can be housed in three organizational settings: within a psychology department, within a university-affiliated psychology school, and within an independent, freestanding psychology school. The latter programs are not affiliated with universities; rather, they are independently developed and staffed.

21. Comparison of Boulder vs. Vail Model Training • http://www.psichi.org/pubs/articles/article_171.asp