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

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

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

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

Announcements  Nice job on the discussion boards!  Stay committed to the practicum assignments

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

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/or as 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…

Early Pioneers  Who were some of the early pioneers of clinical psychology?

Early Pioneers  England: William Tuke ( ) - 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

Early Pioneers  France: Philippe Pinel ( ) - 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

Early Pioneers  America: Eli Todd ( ) - 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

Early Pioneers  America: Dorothy Dix ( ) - 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

Early Pioneers  Germany: Lightner Witmer ( ) - 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

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 ( ) identified more specific disorders (paranoia, depressive psychosis, autistic personality), ultimately leading to the creation of the Diagnostic and Statistical Manual of Mental Disorders (DSM)

DSM  What is the DSM?  What are its benefits?

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

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.

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.

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.

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

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?

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

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

Evolution of Psychotherapy  Early 1900s: 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

Current Controversies  Prescriptions  Manualized Therapy  Insurance Coverage  Diagnosis  Cultural Issues

Questions, Comments, Reflections  ???