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HISTORY OF CLINICAL PSYCHOLOGY:Research, Assessment, CONCLUSION

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LESSON 05
HISTORY OF CLINICAL PSYCHOLOGY
ROOTS OF RESEARCH & ASSESSMENT IN CLINICAL PSYCHOLOGY
The evolution of the field of clinical psychology after Lightner Witmer can be best understood through
an examination of how clinical psychologists came to be involved in each of four different activities:
1.
Research,
2.
Assessment,
3.
Treatment, and
4.
Prevention.
Clinical psychologists became involved in these endeavors at different points during the twentieth
century and for very different reasons. It is important to comprehend the role of clinical psychologists in
these four activities both to understand forces in this field's past and to anticipate changes in its future.
Likewise, it is important to possess an understanding not only of the events that shaped clinical
psychology, but also of the broader social context in which the field has developed.
During the early years, clinical psychology was a science and profession dominated by males (Snyder,
McDermott, Leibowitz, & Cheavens, 2000). For example, in 1917, only 13 percent of APA members
were women. Although women made progress in the fields of developmental and school psychology,
from 1920 through 1974 women comprised only 24 percent of graduates with doctoral degrees in
clinical psychology (Snyder et al.).
By 1994, however, 58.7 percent of students admitted to doctoral programs in clinical psychology were
women. Thus, the composition of clinical psychology has changed from being overwhelmingly male to
being overwhelmingly female.
1. RESEARCH
HOW CLINICAL PSYCHOLOGISTS BECAME INVOLVED IN RESEARCH
Witmer and the other founders of clinical psychology were researchers who were interested in the
application of their research to the benefit of others.
Clinical researchers try to add to these bodies of knowledge both to increase their understanding of
psychopathology, illness, and health and to improve their methods for its treatment and prevention.
Because of their broad training in basic behavioral science, clinical psychologists are able to draw
conclusions and contribute to research in a variety of different areas and to collaborate with
professionals from other disciplines.
THE SCOPE OF CLINICAL PSYCHOLOGICAL RESEARCH
Clinical psychological research has steadily grown in its scope since the early 1900s. This subfield now
includes:
Research on the basic characteristics and prevalence of psychopathology. (epidemiology),
the causes of psychopathology (etiology),
the measurement of behavior and psychological characteristics of individuals (assessment),
the role of the brain and central nervous system (clinical Neuropsychology),
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the treatment of psychopathology (psychotherapy),
The prevention of psychopathology and the promotion of psychological health, and the links
between psychological factors and physical health and illness (health psychology/behavioral
medicine).
There has been landmark research in each of these areas during the past 70 years, the results of which
led to substantial changes in knowledge about a particular problem or issue.
RESEARCHES THAT SHAPED THE FIELD
Clinical psychology has been shaped not only by findings from research studies but also by important
reviews of research evidence and by the development of new methods for clinical practice.
Two examples are particularly prominent in this regard:
1) Effectiveness of Psychotherapy
2) Statistical vs. Clinical Prediction
1) EFFECTIVENESS OF PSYCHOTHERAPY
In the early 1950s, the field of psychotherapy was in its early stages of development, and much of the
practice of psychotherapy was based on the psychoanalytic model developed by Freud.
Research on the effectiveness of this approach to psychotherapy was very limited, however-most
practitioners simply assumed that the methods they were using were effective in treating their patients.
Given this widespread acceptance of the belief that psychotherapy was effective, a paper published in
1952 by British psychologist Hans Eysenck created enormous controversy.
Eysenck argued that there was little or no evidence that psychotherapy was any more effective than no
treatment at all.
He reached this conclusion by comparing (two sources of data: the results of 24 studies that had been
conducted on the outcomes of psychotherapy, and information on rates of recovery from emotional
distress in the absence of treatment, or what is referred to as spontaneous remission.
Eysenck reported that treated individuals actually did worse than did people who received no
psychotherapy: Whereas 72 percent of the individuals who did not receive treatment recovered from
their problems, only 44 percent of those receiving psychoanalysis and 64 percent of those receiving
"eclectic" psychotherapy recovered.
Although the rates of improvement presented by Eysenck are much lower than those found in many
studies that have been published since the appearance of his paper, his report had a significant impact on
the field.
Eysenck challenged clinical psychologists and other mental health professionals to provide better
evidence for the effectiveness of their treatment methods.
Initiated by Eysenck's paper, more and better research on the effects of psychotherapy has been
conducted, leading to more effective methods of treatment and a better understanding of how and why
psychotherapy works. The current evidence on the effects of psychotherapy is much more positive than
the perspective offered by Eysenck 50 years ago.
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2) Statistical vs. Clinical Prediction
A second example of research that changed the field is a short but important book; "Statistical Versus
Clinical Prediction" published by psychologist Paul Meehl in 1954 that had a significant impact on
psychological testing and assessment. Before Meehl published his book, psychologists relied heavily on
their subjective judgments and intuitions in interpreting the results of psychological tests.
This approach, referred to as clinical judgment or clinical prediction, was based on the assumption that
clinical psychologists learn a unique set of skills that allows them to make accurate judgments about
people and to predict such things as patients' ability to benefit from psychotherapy, people's potential for
success in a job, or the likely course of individuals' psychological problems.
Meehl challenged these assumptions by demonstrating that judgments based on statistical data
representing patterns of behavior in large samples of people provide a more accurate basis for making
judgments and predictions about specific individuals than do the subjective judgments of single
clinicians.
The findings reported by Meehl in 1954 still hold true today (Dawes, Faust, & Meehl, 1989; Meehl,
1997), statistically based predictions are still more accurate than clinical judgment.
CONTRIBUTION OF RESEARCH IN CLINICAL PSYCHOLOGY
Although single groundbreaking studies and commentaries have clearly important effects on the field of
clinical psychology, they are relatively rare and do not represent how most of the growth and
development in the field occurs. Rather, the greatest contribution of research in clinical psychology is
the slow and gradual accumulation of knowledge that comes from the results of dozens of studies on a
particular topic.
For example, procedures for the treatment of anxiety disorders have been developed through the efforts
of a large number of different researchers who have conducted many series of carefully designed studies
using a wide variety of research methods (Barlow, 1998).
These procedures include the treatment of generalized anxiety disorder, panic disorder, post-traumatic
stress disorder, and specific phobias. One of the most striking features of research in clinical psychology
today is the breadth of topics that are included within the field.
Throughout much of the first century of clinical psychology, three topic areas have been focal points of
research:
·
The nature and etiology of psychopathology;
·
The reliability and validity of methods of psychological assessment, especially psychological
tests; and
·
Psychotherapy efficacy (whether or not psychotherapy can work) and effectiveness (whether
psychotherapy actually does work in practice).
RESEARCH IN CLINICAL PSYCHOLOGY TODAY
Today, however, research in clinical psychology extends well beyond these core topics of research.
Areas that clinical psychologists now investigate include:
·
The role of psychological factors in the development of physical disease (e.g., cancer, heart
disease),
·
The relative effectiveness of psychotherapy as compared with medication in the treatment of
psychopathology,
·
The prevention of violent behavior,
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·
The long-term consequences of sexual assault, harassment and rape, and many, many other
topics.
2. ASSESSMENT
CLINICAL PSYCHOLOGISTS INVOLVEMENT IN ASSESSMENT
Since its inception, psychology has been uniquely concerned with the measurement of differences
between individuals on important cognitive and personality characteristics. The study of differences
between individuals on psychological tests and measurements began with the work of Sir Francis Galton
in England in the late 1800s.
Galton was fascinated by the work of his cousin Charles Darwin on differences in characteristics both
between and within species, and in the process of natural selection that is influenced by these
differences. Galton focused on the concept of individual differences between people, especially in
various aspects of perception and menial abilities.
STUDY OF INDIVIDUAL DIFFERENCES
Early interest in individual difference testing in the United States is marked by the work of James
McKeen Catell at the University of Pennsylvania. Trained in Wundt's laboratory in Germany and
influenced by a meeting with Galton in England, Catell constructed tests to measure various facets of
sensori-motor functioning.
As a result of these early influences, one strong thread through the history of clinical psychology is the
development of tests and other procedures to assess and measure characteristics of individuals.
THE INFLUENCE OF BINET'S INTELLIGENCE TEST
BACK GROUND TO BINET'S INTELLIGENCE TEST
Around the time that Witmer was developing an application of psychology to help children who were
experiencing difficulties learning in school, events in Europe were also leading to the development of
methods to measure children's potential for learning.
In 1904, the Minister of Public Instruction in Paris wanted to ensure that children with limited
intellectual skills were still provided with an education. Alfred Binet and Theodore Simon were
commissioned by the French government to develop a tool to aid in decisions about the appropriate
educational programs for French schoolchildren.
Binet was a French researcher trained in both law and medicine. In order to study individual differences,
he felt it was necessary to sample a wide range of complex intellectual processes so that the spread of
scores obtained by different individuals would be broad (Reisman, 1976).
Binet's work resulted in the first formal test of intelligence, the 1905 Binet-Simon scale, consisting of
30 items of increasing difficulty.
By 1908 this original simple test had been expanded into an instrument composed of 59 tests grouped at
age levels from three to thirteen years according to the percentage of children of a particular age who
passed a given item (Reisman).
Interest in Binet's work grew over the next few years, and versions of the Binet-Simon scale were
imported to the United States. The version that eventually became the accepted U.S. translation and
standardization of the Binet-Simon scale (the Stanford-Bind Intelligence Test) was developed by
psychologist Louis Terman of Stanford University in 1916.
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WORLD WAR I; A TEST FOR CLINICAL PSYCHOLOGY
As the United States prepared to enter the war that was raging in Europe in 1917, the American military
was faced with an unprecedented task: the conscription and creation of a massive army and navy. There
was an enormous need to evaluate quickly and accurately the qualifications of over 1 million young men
as potential members of the armed forces (Driskell & Olmstead, 1989).
Physicians were enlisted in the task of conducting physical evaluations of these draftees to determine
whether they were physically fit to serve during the war. But the military recognized the need to also
evaluate the mental and intellectual qualifications of these potential soldiers. Physicians could not fill
this role, because the evaluation of mental functioning was not within their realm of expertise.
Based on their knowledge of human learning and memory and the measurement of individual
differences in human intelligence, psychologists were called on to fill this role. In 1917, a group of
psychologists, headed by APA president Robert Yerkes, undertook the task of developing tools to
measure the mental abilities of future soldiers (Driskell & Olmstcad, 1989).
The psychological tests that were available and in use at the time (e.g., the test developed by Binet and
Simon) required individual administration. Consequently, these tests were impractical for use with the
large number of recruits involved in the military. Therefore, Yerkes and his colleagues set about the task
of developing a quick and efficient test of intelligence that could be administered to large groups of
individuals simultaneously.
There effort yielded two tests,
1. The Army Alpha (a test of verbal skills) and
2. The Army Beta (a test of nonverbal skills).
The enduring consequence of this work is that it established psychologists as experts in the
measurement of individual characteristics in ways that were practical and useful. This opportunity for
psychology to contribute to the war through the application of psychological tests increased the status
and visibility of psychologists and of psychological testing.
It is unlikely that this first large-scale application of scientific psychological knowledge and methods
would have occurred without strong pressure from external sources, in this case the U.S. military.
ASSESSMENT AFTER WORLD WAR I
Following World War I, clinical psychologists became well known for their testing skills. A testing
development occurred, such that by 1940 over 500 psychological tests had been produced.
These tests included both verbal and non verbal intelligence tests, career interest, personality and
vocational skills tests. Tests were available for children of all ages and abilities as well as for adults.
ADVANCES IN PSYCHOLOGICAL TESTING AND ASSESSMENT
In addition to the powerful social forces that led clinical psychology to become involved in
psychological assessment and testing, significant advances in research have also played an important
role. For example, the publication of the Minnesota Multiphasic Personality Inventory (MMPI) by
psychologist Starke Hathaway in 1943 represented a major change in the way that psychologists
measured personality and psychopathology.
The MMPI relies on statistical comparisons of the test responses of an individual to those of a large
sample of other people who have already been tested. These comparisons are used to determine the
degree to which the individual is similar to a group of people with known personality characteristics, or
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people with a specific type of psychopathology. Thus, the MMPI represented an important shift away
from the more clinical, subjective approach to assessment and toward a more statistical, empirically
based method of assessment.
Another important advance in assessment occurred during the 1960s with the recognition that direct
observations of people's behavior might represent an important source of information, perhaps more
valid than relying on their responses to psychological tests.
The first applications of behavioral observation as a means of assessment were conducted in schools and
psychiatric hospitals, settings in which it was rather easy for a psychologist to observe an individual's
behavior and in which the environment was relatively contained and controlled.
For example, Bijou, Peterson, Harris, Alien, and Johnston (1969) described a method for the
experimental study of young children in natural settings, including their home, school, and other
institutions, as well as the behavior of parents, peers, and professional workers.
In general, research has shown that behavioral observations can be conducted in a manner that is
reliable (different raters independently generate similar ratings of the same individual) and that these
observations can be useful in formulating and evaluating the effects of treatment.
CONCLUSION
If the development of clinical psychology had followed the path set by Witmer, Terman, and others in
the early 1900s, it would have slowly emerged as a field that was based on the careful application of the
young science of psychology. This is not what happened, however. Indeed, much of the rest of the
history of the field is marked by decisions made by psychologists to move into new areas and new
applications even though the scientific knowledge in these areas may not have been sufficient to warrant
such an application.
There were often powerful social forces pressing psychologists to step forward to address an important
issue or assume an important role. The results of these decisions have been far-reaching, because the
field of clinical psychology has expanded at a rate that has at times challenged its scientific knowledge
base and expertise.
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Table of Contents:
  1. MENTAL HEALTH TODAY: A QUICK LOOK OF THE PICTURE:PARA-PROFESSIONALS
  2. THE SKILLS & ACTIVITIES OF A CLINICAL PSYCHOLOGIST:THE INTERNSHIP
  3. HOW A CLINICAL PSYCHOLOGIST THINKS:Brian’s Case; an example, PREDICTION
  4. HISTORICAL OVERVIEW OF CLINICAL PSYCHOLOGY:THE GREEK PERIOD
  5. HISTORY OF CLINICAL PSYCHOLOGY:Research, Assessment, CONCLUSION
  6. HOW CLINICAL PSYCHOLOGISTS BECAME INVOLVED IN TREATMENT
  7. MODELS OF TRAINING IN CLINICAL PSYCHOLOGY:PROFESSIONAL SCHOOLS
  8. CURRENT ISSUES IN CLINICAL PSYCHOLOGY:CERTIFICATION, LICENSING
  9. ETHICAL STANDARDS FOR CLINICAL PSYCHOLOGISTS:PREAMBLE
  10. THE ROLE OF RESEARCH IN CLINICAL PSYCHOLOGY:LIMITATION
  11. THE RESEARCH PROCESS:GENERATING HYPOTHESES, RESEARCH METHODS
  12. THE CONCEPT OF ABNORMAL BEHAVIOR & MENTAL ILLNESS
  13. CAUSES OF MENTAL ILLNESOVERVIEW OF ETIOLOGY:PANDAS
  14. THE PROCESS OF DIAGNOSIS:ADVANTAGES OF DIAGNOSIS, DESCRIPTION
  15. THE CONCEPT OF PSYCHOLOGICAL ASSESSMENT IN CLINICAL PSYCHOLOGY
  16. THE CLINICAL INTERVIEW:The intake / admission interview, Structured interview
  17. THE ASSESSMENT OF INTELLIGENCE:RELIABILTY AND VALIDITY, CATTELL’S THEORY
  18. INTELLIGENCE TESTS:PURPOSE, COMMON PROCEDURES, PURPOSE
  19. THE USE AND ABUSE OF PSYCHOLOGICAL TESTING:PERSONALITY
  20. THE PROJECTIVE PERSONALITY TESTS:THE RORSCHACH
  21. THE OBSERVATIONAL ASSESSMENT AND ITS TYPES:Home Observation
  22. THE BEHAVIORAL ASSESSMENT THROUGH INTERVIEWS, INVENTORIES AND CHECK LISTS
  23. THE PROCESS AND ACCURACY OF CLINICAL JUDGEMENT:Comparison Studies
  24. METHODS OF IMPROVING INTERPRETATION AND JUDGMENT
  25. PSYCHOLOGICAL INTERVENTIONS AND THEIR GOALS:THE EXPERT ROLE
  26. IMPORTANCE OF PSYCHOTHERAPY:ETHICAL CONSIDERATIONS
  27. COURSE OF NEW CLINICAL INTERVENTIONS:IMPLEMENTING TREATMENT
  28. NATURE OF SPECIFIC THERAPEUTIC VARIABLES:CLIENT’S MOTIVATION
  29. THE BEGINNING OF PSYCHOANALYSIS:THE CASE OF ANNA, THE INSTINCTS
  30. PSYCHOANALYTIC ALTERNATIVES:EGO ANALYSIS, CURATIVE FACTORS
  31. CLIENT CENTERED THERAPY:PURPOSE, BACKGROUND, PROCESS
  32. GESTALT THERAPY METHODS AND PROCEDURES:SELF-DIALOGUE
  33. ORIGINS AND TRADITIONAL TECHNIQUES OF BEHAVIOR THERAPY
  34. COGNITIVE BEHAVIORAL THERAPY:MODELING, RATIONAL RESTRUCTURING
  35. GROUP THERAPY: METHODS AND PROCEDURES:CURATIVE FACTORS
  36. FAMILY AND COUPLES THERAPY:POSSIBLE RISKS
  37. INTRODUCTION AND HISTORY OF COMMUNITY PSYCHOLOGY:THE ENVIRONMENT
  38. METHODS OF INTERVENTION AND CHANGE IN COMMUNITY PSYCHOLOGY
  39. INTRODUCTION AND HISTORY OF HEALTH PSYCHOLOGY
  40. APPLICATIONS OF HEALTH PSYCHOLOGY:OBESITY, HEALTH CARE TRENDS
  41. NEUROPSYCHOLOGY PERSPECTIVES AND HISTORY:STRUCTURE AND FUNCTION
  42. METHODS OF NEUROLOGICAL ASSESSMENT:Level Of Performance, Pattern Analysis
  43. FORENSIC PSYCHOLOGY:Qualification, Testifying, Cross Examination, Criminal Cases
  44. PEDIATRIC AND CHILD PSYCHOLOGY: HISTORY AND PERSPECTIVE
  45. INTERVENTIONS & TRAINING IN PEDIATRIC AND CLINICAL CHILD PSYCHOLOGY