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HOW CLINICAL PSYCHOLOGISTS BECAME INVOLVED IN TREATMENT

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Clinical Psychology­ (PSY401)
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LESSON 06
HOW CLINICAL PSYCHOLOGISTS BECAME INVOLVED IN TREATMENT
During the period of 1850-1890s, psychologists such as Kraeplin focused on the classification of
psychoses. But by the late 1800s, this focus shifted from psychoses to investigating new treatments for
neurotic patients, such as suggestion and hypnosis. Specifically, Jean Charcot gained a widespread
reputation for his investigations of hysterical patients. Although trained as a neurologist, Charcot
employed a psychosocial approach in explaining hysteria. At about the same time, the momentous
collaboration of Josef Breuer and Sigmund Freud began. In the early 1880s, Breuer was treating a young
patient named "Anna O", who was diagnosed with hysteria.
Anna O's treatment presented many challenges but also led to the theoretical breakthroughs that greatly
influenced the psychotherapy practice later. Based on Freud's work with Charcot and Breuer's
experiences with hysterics, Breuer and Freud published Studies on Hysteria in 1895. This collaboration
served as the launching pad for Psychoanalysis, the single most influential theoretical and treatment
development in the history of psychiatry and clinical psychology.
In 1900, Freud published The Interpretation of Dreams that resulted in mainstream acceptance of the
psychoanalytic perspective. The psychological conference at Clark University in 1906, where Freud
delivered his famous lectures to American professionals and general public, stimulated the acceptance
of Freud's psychoanalytic theories in United States.
For many coming years, the treatment of psychopathology was dominated by the field of psychiatry,
largely because of the influence of Freud and the development of psychoanalysis as the primary method
for treating psychopathology. With his training as a neurologist, it would have been natural for Freud to
assume that the treatment of psychopathology was an extension of the treatment of other disorders of the
nervous system and, therefore, a task best left to trained physicians. Surprisingly, it was not Freud but
his followers who argued that the practice of psychotherapy should be limited to those with medical
training. Consequently, the entry of psychologists into the therapy enterprise became quite difficult.
One of the earliest ways in which psychologists became involved in the treatment of psychological
problems was through the child guidance movement in the early 1900s. In 1909 William Healy
established a child guidance clinic in Chicago to provide services for children with psychological
problems. The clinic was staffed by psychiatrists, social workers, and psychologists who treated
children and adolescents, primarily for problems that are now labeled Conduct Disorder and
Oppositional Defiant Disorder in the DSM-IV.
A second trend that influenced early work in interventions with children was Play therapy. Based mostly
on Freud's psychoanalytic theory, psychologists conducted therapy in which children were encouraged
to engage in play and the therapist would offer psychoanalytic interpretations of their play.
Group therapy also began to attract attention. By the early 1930s, the works of both J. L. Moreno and S.
R. Slavson were having an impact. Another precursor of things to come was the technique of "passive
therapy" described by Frederick Allen (1934). With the exception of the early work of clinical
psychologists in child guidance clinics, the involvement of clinical psychologists in the treatment of
psychopathology has been primarily fueled by forces from outside psychology. In much the same way
that the First World War was critical in increasing the role of psychologists in assessment, the Second
World War played an integral role in the emergence of clinical psychologists as providers of treatment
for psychopathology.
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WORLD  WAR  II:  CLINICAL  PSYCHOLOGY  AND  THE  TREATMENT  OF
PSYCHOPATHOLOGY
The Second World War renewed the need for psychologists to evaluate the competencies of thousands
of men and women who were being enlisted in the armed services. Psychologists were once again asked
to administer psychological tests to draftees. World War II and the period that followed it are most
noteworthy, however, for the emergence of a new set of skills for psychologists. Clinical observations of
soldiers who had experienced the stress of combat led to the identification of a syndrome of symptoms
of psychological trauma that were displayed by many soldiers. This syndrome was labeled "shell shock"
or "battle fatigue" at the time, but is now known as Post Traumatic Stress Disorder (PTSD).
The primary symptoms of PTSD are high levels of anxious arousal, recurrent and persistent intrusive
thoughts and emotions pertaining to the trauma, and persistent efforts to avoid all reminders and
thoughts about the traumatic event. Physicians and others involved in providing medical assistance to
combat soldiers noted that the symptoms could be managed most effectively if the victims were treated
as quickly as possible and in the context of battle. Those soldiers for whom treatment was delayed and
administered in a hospital removed from the battlefield were more likely to suffer extended and more
severe reactions than those who received immediate psychological attention.
The dilemma faced by the armed services in addressing the needs of these thousands of "psychological
casualties" was the insufficient number of trained individuals available to provide treatment. Medical
personnel, including those physicians trained in the relatively young field of psychiatry, were needed to
treat physical casualties. Psychologists were called on once again to fill a need because they were
perceived as having the most representative set of skills needed for the task (StrickSand, 1986).
THE NATIONAL COUNCIL OF WOMEN PSYCHOLOGISTS
During this time the majority of people who pursued college and graduate degrees were male, and as a
result, most clinical psychologists were men. However, women in psychology emerged as an important
force during the Second World War (Strickland, 1988). Experimental, social, applied, and clinical
psychologists all developed new respect for each other as they worked together and brought their own
special skills to the military and to national defense. Interestingly, women psychologists were excluded
from APA's war mobilization effort. Women within psychology founded the National Council of
Women Psychologists and worked to help with community problems, such us reducing the stress of war
on civilians and giving advice about child care to women who worked outside their homes during the
war, many for the first time. This organization was just one example of the struggles of women to
achieve equal status with men in clinical psychology.
THE VETERANS' ADMINISTRATION
The end of World War II brought rapid and dramatic changes in the field of clinical psychology. At the
conclusion of the war, the armed services and the Veterans' Administration (VA) were faced with the
task of providing care for more than 40,000 psychologically wounded veterans who had returned home.
Too few psychiatrists were available to manage this task; consequently, the VA chose to draw on
psychology as a new source of professionally trained mental health personnel. At this time, the
membership of APA, including psychologists in all specializations, was barely 4,000. The VA system
estimated that 4,700 clinical psychologists were needed to provide treatment for psychological
casualties from World War II. To meet this need, the VA invested enormous amounts of money to pay
for the training of doctoral-level clinical psychologists.
Consequently, whereas in 1946 there were no formal university programs to train clinical psychologists,
by 1950 half of all PhDs in psychology were being awarded in clinical psychology.
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ALTERNATIVE APPROACHES TO PSYCHOTHERAPY
The role of psychologists in conducting psychotherapy was expanded by more than just the military and
VA hospitals. Carl Rogers, one of the founders of humanistic psychology, was also influential in
involving psychologists in psychotherapy during this period. Rogers provided a strong impetus to move
psychotherapy out of the exclusive realm of medicine, psychiatry, and psychoanalysis. While he was
director of the Rochester Child Guidance Center, Rogers spearheaded an effort to loosen the hold of
psychiatrists on the practice of psychotherapy, arguing that trained and qualified clinical psychologists
could perform as well as medically trained analysts.
With the publication in 1942 of his book Counseling and Psychotherapy, Rogers not only identified
psychotherapy as a legitimate activity for clinical psychologists but also offered the first model of
psychotherapy that was not based on psychoanalytic theory.
THE BEHAVIORAL APPROACH
Finally, the role of psychologists in providing treatment for psychological disorders was also fueled by
advances in theory and research on learning and conditioning processes that led to behaviorally oriented
treatments. As models of classical conditioning and operant conditioning of behavior emerged over the
course of the early i and mid 1900s, psychologists began to see the potential value of these models for
explaining and treating maladaptivc behavior. For example, the early work of Watson, Raynor, and
Jones showed the role that conditioning and learning play in the development of fears (e.g., Jones,
1924a, 1924b).
Among the first to apply behavioral models to treatment was psychiatrist Joseph Wolpe (1958), who
suggested that "neurotic" behaviors (anxiety disorders) were learned through a process of conditioning
and could be unlearned by a similar process, which he called "reciprocal inhibition". The principles of
conditioning and learning theory were applied to treat variety of clinical problems including phobias,
obsessive-compulsive disorder, anxiety and disruptive behavior in children. In 1967,Association for
Advancement of Behavioral Therapy (AABT) was founded and remains one of the major professional
organizations for clinical psychologists.
THE COGNITIVE ­ BEHAVIORAL APPROACH
The treatment focus in 1970s was on changing thoughts; feelings and expectations became important as
the goal of changing overt behavior. The works of Albert Ellis using Rational Emotive Behavior
Therapy, Aron Beck using Cognitive treatments for depression; and the self-efficacy work of Bandura,
led to the changes in the integrative cognitive approaches with behavioral approaches.
PRESENT APPROACHES
During the late 1970s and early 1980s professionals sought to integrate the best methods of the various
approaches on case-by-case basis. An emphasis was placed on the common factors leading to an
Eclectic Approach.
Emerged in late 1900s, the Bio-psycho-social approach suggested that the biological, psychological
and social aspects of health and illness intimately influence each other. Thus psychologists must
understand the multidimensional bio-psycho-social influences in order to treat and understand others.
Psychotherapy research has been one of the most active areas of empirical investigation for clinical
psychologists. We have already noted several important events in psychotherapy research, including
Rogers's (1942) early research on client-centered therapy, Eysenck's (1952) critical evaluation of the
effectiveness of psychotherapy, and Wolpe's (1958) work on the use of behavioral methods to treat
anxiety. Other landmark studies in psycho- therapy research include the first evidence of the efficacy of
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cognitive therapy in the treatment of depression (Rush, Beck, Kovacs, & Hollon, 1977), the first use of
the statistical technique of meta-analysis to integrate and evaluate large numbers of different studies of
the effects of psychotherapy (Smith & Glass. 1977). The first evidence that behavioral methods could he
used to treat sexual dysfunction (Lobitz & LoPiccolo, 1972), and comparisons of the efficacy of various
forms of psychotherapy and pharmacotherapy in the treatment of depression (e.g., Rush, Beck, Kovacs,
& Hollon, 1977) and anxiety disorders (Power, Simpson, Swanson, & Wallace, 1990).
CLINICAL
PSYCHOLOGISTS
INVOLVEMENT
IN
THE
PREVENTION
OF
PSYCHOPATHOLOGY
The treatment of psychopathology, like the treatment of any problem or disorder, can reduce the
prevalence or number of existing cases of disorder. Treatment cannot, however, reduce the incidence of
new cases of a disorder. That is, no matter how effective psychologists become in treating problems
related to anxiety, depression, eating disorders, or substance abuse, to name but a few, the treatment of
existing problems will not reduce the number of new individuals who develop these problems.
Recognition of this simple fact provided the impetus for the development of prevention efforts in public
health in general and for the prevention of psychopathology in particular. Prevention of psychological
problems was not an integral part of the goals of clinical psychology as the science and profession
developed during the first half of the twentieth century. Beginning in the 1950s, however, a number of
factors increased psychologists' awareness of the importance of prevention in dealing with mental health
concerns in American society.
The report of the United States Joint Commission on Mental Illness and Health in the late 1950s,
President Kennedy's initiative for new programs to combat mental retardation and psychological
disorders in 1963, and the development of comprehensive community mental health centers in the 1960s
were all landmark events in moving prevention into mental health programs and policies in the United
States. All these initiatives highlighted the need to reduce the incidence of new cases of
psychopathology. In addition, they emphasized the unequal access of Americans to mental health
treatment. Individuals of lower socioeconomic status (as reflected in levels of education and occupation)
have less access to mental health professionals and are less able to pay for such services because of lack
of income and lack of health insurance to cover the costs of such services.
Prevention programs that can eliminate some of the social factors that contribute to the development of
psychological problems may be able to eliminate some of these inequities. Clinical psychologists have
played a central role in the development of prevention programs to reduce the incidence of new cases of
a wide range of psychological problems and disorders. Prevention programs focus primarily on children
as psychologists attempt to prevent the onset of disorders early in children's lives.
Prevention includes programs to prevent aggressive behavior and conduct disorder, depression, and
substance use and abuse.
THE DEVELOPMENT OF CLINICAL PSYCHOLOGY AS A PROFESSION
As clinical psychologists have acquired new skills and roles, particularly in the areas of assessment, and
treatment, psychology has needed to organize itself as a profession to monitor and regulate the activities
of those who present themselves to the public as clinical psychologists. What does it mean to say that
you are a clinical psychologist? What skills, competencies, and credentials must you have in order to
use this label for yourself? What are the ethical and professional standards that govern psychologists'
interactions with their clients? What assurances are provided to the public that the methods used by
clinical psychologists have been proven to be effective?
These issues have all had to be addressed as clinical psychology has worked to define and regulate itself
as a profession. The APA has played a leading role in the development and regulation of the profession
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of psychology, including establishing ethical principles for the practice of psychology, accrediting
training programs in clinical psychology, and working with state legislatures and the U.S. Congress to
support legislation to monitor and regulate the practice of psychology. Academic research-oriented
psychologists and applied psychologists have often found it difficult to integrate scientific psychology
and professional psychology.
CLINICAL PSYCHOLOGY'S INTERACTIONS WITH APA
During the early part of the twentieth century, clinical and other applied psychologists complained that
their interests were not being met within the APA. As a result, in 1917 fifteen of the 375 members of
APA broke off to form the American Association of Clinical Psychology (AACP). With the threat of
losing more members, APA reluctantly agreed to consider certifying some members as "consulting
psychologists" and two years later established a special Clinical Section to handle professional issues. In
the early 1930s, the New York State Psychological Association, in an attempt to deal with issues of
ethics, licensing, and standardization of training, became the Association of Counseling Psychologists
(ACP). In 1937, the clinical section of the APA disbanded, left the APA again, and joined ACP, which
was renamed the American Association for Applied Psychology (AAAP).
This move represented a significant split between the scientific and applied aspects of psychology. In a
reflection of this split, in 1939 Carl Rogers discussed the possibility of awarding professional
psychologists a doctor of psychology degree (similar to the current PsyD degree) rather than a PhD. In
1939 AAAP published a model certification act for state affiliates who could use such a document in
their state legislative efforts within states to gain certification or registration for psychologists.
This model certification was a major factor leading to the establishment of state boards for the licensing
of psychologists. The split between scientific and applied psychology was addressed in the 1940s when
APA changed its membership standards. The APA previously had required that its members must have
at least two research publications beyond the dissertation. In 1945 APA was restructured in ways that
were particularly supportive of practitioners, including an elimination of the requirement of publications
for membership.
The impetus for this change came from the need to unify psychologists for the purpose of responding to
the country's wartime needs. The APA by laws were expanded to include the advancement of
psychology not only as a science but also as a profession and as a means of promoting human welfare.
An arm of the APA, the Practice Directorate, is devoted specifically to issues that pertain to psychology
as a profession. The Practice Directorate supports legislation that is important to psychology, conducts
public education campaigns, and engages in efforts to support practicing psychologists.
FORMATION OF A NEW ORGANIZATION: THE AMERICAN PSYCHOLOGICAL
SOCIETY (APS)
The tension between research and applied interests of psychology arose again in the 1980s when
academic psychologists raised concerns that APA had become too involved with the practice of
psychology and was ignoring psychological research. These concerns led to the formation of a new
organization, the American Psychological Society (APS), in 1988. The APS is strongly committed to
the promotion of scientific research in basic and applied psychology and provides an alternative for
psychologists who worry that APA has become more of a guild to protect the practice of psychology in
ways that are not tied to the scientific basis of the field.
The two groups function independently of one another with separate governing bodies, separate annual
conventions, and separate scientific journals. However, many psychologists, and many scientifically
oriented clinical psychologists in particular, are members of both organizations.
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CONCLUSION
The history of clinical psychology can be traced through advances and landmark events in research,
assessment, treatment, and prevention and through the development of the profession of clinical
psychology. Contemporary clinical psychology is ever evolving, currently adapting to numerous
changes and challenges.
Clinical psychology has now found its way into general health care with applications to numerous
medical problems and issues. Although the changes in clinical psychology have been radical, the goal
that binds clinical psychologists together remains the same: to apply their knowledge and skill to the
mental health needs of people everywhere.
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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