PS380: Clinical Psychology

1. PS380: Clinical Psychology Instructor: Sara Barnett, M.S., Ed.M., M.A. Unit 2: Evolution of Clinical Psychology

2. Warm-Up Questions • What stigma exists regarding those who attend therapy? • Why is said stigma existent in some communities and not in others?

3. Warm-Up Questions • What are some differences in the treatment of the mentally ill today versus 100 years ago?

4. Agenda • Announcements • Discussion of Chapter 1: Evolution of Clinical Psychology • Mini-Discussion of Chapter 2: Current Controversies • Questions, Comments, Reflections

5. Announcements • Nice job on the discussion boards! • Stay committed to the practicum assignments

6. Evolution of Clinical Psychology • Psychology dates back to scientific revolutions in Europe (16th – 19th centuries), and arguably back to the Greek philosophers (5th century BC) and Confucius (6th century BC) • Clinical psychology did not exist until the late 1800s/early 1900s (when study of psychology was complemented by applied practice)

7. Evolution of Clinical Psychology • For much of history, the mentally ill were: • Considered to be possessed by evil spirits/devil, stricken with illness due to bad behavior and/oras dangerous as criminals • Shunned by society, discarded by family, locked away and/or dehumanized • Early pioneers of the modern mental health movement helped to change the above…

8. Early Pioneers • Who were some of the early pioneers of clinical psychology?

9. Early Pioneers • England: William Tuke (1732-1822) • Visited asylums and argued that patients should be treated with greater dignity, kindness and decency • Raised funds to establish “retreats”, which then spread throughout Europe and the United States

10. Early Pioneers • France: Philippe Pinel (1745-1826) • Challenged the imprisonment of the mentally ill • Argued that the mentally ill deserved compassion (empathy rather than cruelty) • Created new institutions wherein the mentally ill were given healthy food and allowed activities v. kept in a dungeon, beaten and chained to walls and beds • Required staff to conduct case histories, complete progress notes, and maintain case files

11. Early Pioneers • America: Eli Todd (1768-1832) • Physician who saw greater need for humane facilities for the mentally ill (only 3 existed in America) • Recognized burden/shame felt by families • Opened “retreats” and encouraged staff to focus on/promote patients strengths versus weaknesses

12. Early Pioneers • America: Dorothy Dix (1802-1887) • Worked as Sunday school teacher in Boston jail – argued many inmates were mentally ill, not criminal • Traveled through cities, collected data on mentally ill and their treatment, presented findings to community leaders • Ultimately contributed to the opening of 30 mental institution in U.S. wherein patients were deserving of understanding and help

13. Early Pioneers • Germany: Lightner Witmer (1867-1956) • Opened first clinical psychology clinic (1896) at the University of Pennsylvania and encouraged others to do the same (1914 – 20 clinics; 1935 – 150 clinics) • Aimed to “throw light upon the problems that confront humanity” • Largely focused on children (learning and behavioral struggles) • * Did not keep comprehensive records

14. Early Diagnosis • Stage was set by the pioneers… now there was work to be done! • Early diagnostic terminology included: Neurosis and Psychosis Exogenous Disorders and Endogenous Disorders Emil Kraeplin (1855-1926) identified more specific disorders (paranoia, depressive psychosis, autistic personality), ultimately leading to the creation of the Diagnostic and Statistical Manual of Mental Disorders (DSM)

15. DSM • What is the DSM? • What are its benefits?

16. DSM DSM • Manual of psychological disorders published by the American Psychiatric Association • Covers all mental health disorders for both children and adults • Lists known causes of disorders, statistics in terms of gender, age at onset, and prognosis as well as some research concerning optimal treatment approaches

17. DSM-IV Major Depressive Episode Criteria • Major Depressive Episode Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure ( Note: Do note include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations) • Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood. • Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others). • Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.

18. DSM-IV- Major Depressive Episode Criteria • (4) insomnia or hypersomnia nearly every day. • psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down). • fatigue or loss of energy nearly every day. • feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick). • diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others). • recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

19. DMS-IV: Major Depressive Episode Criteria • The symptoms do not meet criteria for a Mixed Episode. • The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. • The symptoms are not due to the direct physiological effects of a substance or a general medical condition • The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

20. Influence of Intelligence Study The Intelligence Testing Movement and Clinical Psychology • Emergence of clinical psychology coincided with rise of study of intelligence (late 1800s/early 1900s) • General intelligence was thought to overlap with physical and mental abilities (link between low IQ and mental health struggles – now known not always the case) • Assessments created for intelligence… then created for mental health testing/personality testing

21. Assessment • What do you know about assessment as it pertains to the field of psychology? • What are some different types of assessment? • What are some commonly used assessments?

22. Psychotherapy • Clinical psychologists were largely academicians w/ small practices until the mid 1900s when number of practices grew… Why did this boom occur?

23. Psychotherapy • The Influence of WWII • Mental tests used to position military and better understand human mind; Ultimately additional tests were created for personality, etc. • US veterans returned home “shell shocked” and in need of mental health care • Influential figures such as Freud forced to flee home countries and ideas on psychology in turn spread throughout Europe and the world

24. Evolution of Psychotherapy • Early1900s: Psychodynamic theories proposed • 1950s: Behaviorism gained popularity * 1953: APA Ethical Code established • 1960s: Humanistic approach gained popularity • 1970s: Family therapy and other specialties developed * Cognitive psychology meanwhile grew (arguably most popular today) • 1970s/80s: Insurance coverage, more diversity among professionals • Today – Clinical psychology stands as an accepted profession and practice

25. Current Controversies • Prescriptions • Manualized Therapy • Insurance Coverage • Diagnosis • Cultural Issues

26. Questions, Comments, Reflections • ???