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Clinical Psychology:
Past and Present
Presented by Nathaniel Chapman, Psy.D.
What comes to mind?
The field of clinical psychology?
Mental Illness?
Clinical psychology
A broad discipline concerned with the scientific study of psychopathology and with the assessment and treatment of persons with emotional, cognitive, and behavioral problems.
Psychiatry vs Clinical Psychology
Education
Training
Scope of professional practice
Psychologist-more exposure to the behavioral sciences and greater expertise in psychometrics
Psychiatrist- medically trained with more emphasis on biological aspects of psychopathology and psychopharmacology.
History of Clinical Psychology
The field has roots as an area of professional practice as opposed to academia
Inspired to use psychology to help people
History of Clinical Psychology
Lightner Witmer’s Psychology Clinic (1896)
Early interventions for school-aged children with academic and behavioral problems, including difficulties with reading and spelling, Intellectual Disabilities
History of Clinical Psychology
During World War I (1914-1918), assessment developed to screen and classify the thousands of new recruits to the U.S. Army
A concern of clinical psychology throughout its existence has been with the credentialing of practitioners. These efforts began in 1919.
Contributions to classification and diagnosis after World War I, 1919-1939
History of Clinical Psychology
Carl R. Rogers helped move the field of clinical psychology toward psychotherapeutic interventions
After World War II, from 1945 to 1977, every U.S. state passed legislation certifying or licensing psychologists to practice independently.
History of Clinical Psychology
After World War II, there was a move to standardize training in clinical psychology
the Veterans’ Administration (VA) and the newly established National Institute of Mental Health (NIMH) supported these training efforts via grants in clinical psychology.
PsyD model arouse in 1973 at the Vail conference
Training for all clinical psychologist is uniform in the United States but not necessarily in other countries.
General Professional Knowledge (Graduate Courses)
Ethics and Professional Issues
History & Systems of Psychology
Supervision
Industrial and Organizational Psychology
Human Development
Social Psychology
Psychophysiology
Psychotherapy Graduate Courses
Child and Adolescent Psychopathology
Adult Psychopathology
Assessment Graduate Courses
Assessment: Intelligence Testing
Objective Assessment
Projective Assessment
Diagnostic Interviewing
Treatment and Intervention Graduate Courses
Psychological Intervention
Case Conceptualization
Cognitive/Affective Bases of Behavior
Examination for Professional Practice in Psychology (EPPP)
Assessment and Diagnosis (16%
Biological Bases of Behavior (10%)
Cognitive-Affective Bases of Behavior (13%)
Ethical/Legal/Professional Issues (16%)
Growth and Lifespan Development (12%)
Research Methods and Statistics (7%)
Social and Cultural Bases of Behavior (11%)
Treatment, Intervention, and Prevention and Supervision (15%)
I/O is not a single area, but its concepts are sprinkled throughout the exam.
Abnormal psychology
Scientific study of abnormal behavior in an effort to describe, predict, explain, and change abnormal patterns of functioning
What Is Psychological Abnormality?
Common feature across definitions
The Four Ds (Focus on three)
Deviance
Distress
Dysfunction
Danger
Influences
Norms
Culture
Context
The Elusive Nature of Abnormality
Abnormality is defined by general criteria in society.
Criteria are used to judge cases.
Any definition of abnormality may be unable to be applied consistently.
Szaz:
Deviations called “abnormal” are only “problems of living.”
Societies invent the concept of mental illness to better control or change people who threaten the social order.
In short, although abnormality generally is defined as behavior that is deviant, distressful, dysfunctional, and sometimes dangerous, these criteria often are vague and subjective.
Few categories of abnormality are as clear-cut as they seem; most continue to be debated by clinicians.
What Is Treatment?
Treatment or therapy
What Is Treatment?
Essential features of all therapy forms
Sufferer or patient
Trained, socially accepted healer or therapist
Series of therapeutic contacts between the healer and the sufferer
A sufferer who seeks relief from the healer
A trained, socially accepted healer, whose expertise is accepted by the sufferer and his or her social group
A series of contacts between the healer and the sufferer, through which the healer tries to produce certain changes in the sufferer’s emotional state, attitudes, and behavior
Treatment
A systematic process for helping people overcome their psychological difficulties. It typically requires a patient, a therapist, and a series of therapeutic contacts
How Was Abnormality Viewed and Treated in the Past?
Ancient Views and Treatments
Mind as a battleground
Regarded abnormal behavior as the work of evil spirits
Ancient Views and Treatments
Treatment
Trephination and exorcism
Treatment for severe abnormality was to force demons from the body through trephination and exorcism.
Greek and Roman Views and Treatments
500 b.c. to 500 a.d.
Hippocrates believed and taught that illnesses had natural causes; four humors (blood, phlegm, black bile, and yellow bile).
Treatment
Quiet life
Vegetable diet
Exercise
Celibacy
Bleeding
Humors: yellow bile, black bile, blood, and phlegm
Europe in the Middle Ages: Demonology Returns
500–1350 a.d.
The Church rejected scientific forms of investigation and controlled all education
Mental disorders had demonic causes; mass madness; shared delusions and hallucinations
Treatment-Exorcism
At the close of the Middle Ages, demonology and its methods began to lose favor again (1400 AD)
Treatment
Torture
Gradually hospitalization
The Renaissance and the Rise of Asylums
1400–1700 a.d.
With increased scientific knowledge, demonological views of abnormality continued to decline
Care at religious shrines (e.g., Gheel) was the precursor of community health programs
Asylums emerged by the mid-sixteenth century
The Nineteenth Century: Reform and
Moral Treatment
Nineteenth century
Care of people with mental disorders began to improve
Pinel (France) and Tuke (England)
Advocated moral treatment that emphasized humane and respectful techniques
Moral treatment movement ended in the United States and Europe by the early twentieth century
Benjamin Rush (father of American psychiatry) and Dorothea Dix (Boston schoolteacher)
Promoted moral treatment in the United States
Movement disintegrated in the late nineteenth century; mental hospitals warehoused inmates and provided minimal care
By the end of the nineteenth century, several factors led to a reversal of the moral treatment movement:
Money and staff shortages
Declining recovery rates
Overcrowding
Emergence of prejudice
By the early years of the twentieth century, the moral treatment movement had ground to a halt; long-term hospitalization became the rule once again.
The Early Twentieth Century: Dual Perspectives
Somatogenic perspective
Abnormal functioning has physical causes
Two factors responsible for the rebirth of this perspective
Emil Kraepelin: Physical factors are responsible for mental dysfunction
New biological discoveries linked such things as untreated syphilis and general paresis
Results were generally disappointing until effective medication was developed
The Early Twentieth Century: Dual Perspectives
Psychogenic perspective
Abnormal functioning has psychological causes
Rise in popularity based on work with hypnotism
Mesmer: Hysterical disorders
Freud: Psychoanalysis; outpatient therapy
Psychoanalytic theory and treatment became widely accepted
How Are People with Severe Disturbances Cared For?
New psychotropic medications discovered in 1950s
Antipsychotic drugs
Antidepressant drugs
Antianxiety drugs
Led to deinstitutionalization and rise in outpatient care
The Impact of Deinstitutionalization
Psychotropic medications: Drugs that mainly affect the brain and reduce many symptoms of mental dysfunction.
The number of patients (around 42,000) now hospitalized in public mental hospitals in the United States is a small fraction of the number hospitalized in 1955. (Information from Lang, 1999; Smith & Milazzo-Sayre, 2014; Torrey, 2001.)
How Are People with Severe Disturbances Treated?
Before 1950
Almost all outpatient care took the form of private psychotherapy
Today
Outpatient care is the primary mode of treatment; more insurance coverage
Prevention programs are increasing; positive psychology has grown
Programs dealing with one kind of psychological problem have been created
The Increasing Influence of Insurance Coverage
Today the dominant form of insurance coverage is the managed care program, in which the insurance company determines key care issues
Reimbursements for mental disorders tend to be lower than those for medical disorders
In 2008, a federal parity law went into effect; in 2014, the Affordable Care Act (ACT) went into effect
In 2011, a federal parity law went into effect.
Recent Decades and Current Trends
Negative public attitudes still exist, but there have been major changes in the last 60 years in the ways clinicians understand and treat abnormal functioning:
More theories and treatment types
More research and information
More disagreements about abnormal functioning
Survey: 43% of people believe that people bring mental health disorders upon themselves; 35% consider mental health disorders to be caused by sinful behavior.
Multicultural Psychology
seek to understand how culture, race, ethnicity, gender, and similar factors affect behavior and thought and how people of different cultures, races, and genders may differ psychologically
What Are Today’s Leading Theories and Professions?
A variety of professionals offer help to people with psychological problems
| Degree | Began to Practice | Current Number | Average Annual Salary | ||
| Psychiatrists | MD, DO | 1840s | 49,000 | $194,000 | |
| Psychologists | PhD, PsyD, EdD | Late 1940s | 188,000 | $73,000 | |
| Social workers | MSW, DSW | Early 1950s | 649,000 | $46,000 | |
| Counselors | Various | Early 1950s | 570,000 | $45,000 |
Technology and Mental Health
The digital world provides new triggers and vehicles for the expression of abnormal behavior
Use of tele-mental health services rapidly increasing
Mental health apps in the marketplace are increasing sharply
Enormous volume of Web-based misinformation
