1. Chapter 1 The Evolution of Clinical Psychology
Introduction to Clinical Psychology 2e hunsley & lee
PREPARED BY DR. cathy chovaz, king’s college, Uwo

2. Introduction – Topics Importance of Clinical Psychology
Related Mental Health Professions
History of Clinical Psychology
History of Assessment in Clinical Psychology
History of Intervention in Clinical Psychology
Prevention in Clinical Psychology

3. The Importance of Clinical Psychology as a Discipline
About half of mental disorders begin before age 14
Worldwide 800,000 people commit suicide every year
Worldwide hundreds of millions suffer from mental disorders
Most undiagnosed or misdiagnosed
It is estimated that the Canadian economy loses $14.4 billion annually due to mental disorders in the workplace

4. Mental Health Commission of Canada
A national non-profit organization designed to enhance the health and well-being of those living with a mental disorder by focussing national attention on mental health
Canadians have a right to receive the services and supports they need
Canadians have the right to be treated with the same dignity and respect as those with any other kind of illness.

5. Defining the Importance of Clinical Psychology
Early definitions stressed assessment, evaluation, and diagnosis
More recent inclusion of intervention in various forms as well as prevention
Evidence-Based Practice
Active debate on the ‘science of clinical psychology’
McFall’s Manifesto for a Science of Clinical Psychology

6. Importance of Clinical Psychology as a Discipline
Evidence-Based Practice
Importance of using only practices empirically found to be effective
Intuition should not be a part of assessment or treatment
Critics argue (among other points):
Group-based data is not always sufficient in working with individuals
Research is not always available for all problems
Each person is unique in many different ways (culture, class, family, etc.)

7. Other Related Mental Health Professions (and Differences)
Other Related Mental Health Professions (and Differences)
Counselling Psychology
Historically worked with less severe problems
Different settings than clinical psychologists
School Psychology
Training in both psychology and education
Work in diverse education-related settings
Psychiatry
Medical school training
Prescribe medication

8. Other Related Mental Health Professions (and Differences)
Other Related Mental Health Professions (and Differences)
Social Work
Emphasis on social/community conditions
Different settings than clinical psychologists (especially community agencies)
Other Mental Health Professionals
Psychiatric nursing
Child and youth care workers
Applied behavioural analysis counsellors

9. History of Clinical Psychology
Most early views concluded that demonic possession or evil spirits were the cause of mental illness
Hippocrates – “father of medicine” may be first to consider a “biopsychosocial approach”
Biological, psychological and social factors all need to be considered.
“bodily fluid” theory – blood, black bile, yellow bile, phlegm

10. History of Clinical Psychology
St. Vincent de Paul (late 1500’s) emphasized natural forces and that witchcraft or satanic possession were not the causes of mental disturbances
Sadly, by this time, in Europe and North America, the treatment of individuals with mental illness was inhumane
“Bedlam”

11. History of Clinical Psychology
Enlightenment period (later 1700’s)
Philippe Pinel – French reformer: humane treatment of the mentally ill
William Tuke – English reformer: hospitals based on appropriate care
Benjamin Rush – U.S.: moral therapy
1800’s – clinical neurology
Hysteria could not be recognized as biological: Charcot, Janet and Freud

12. History of Assessment in Clinical Psychology
Early Clinical Psychology was almost entirely an assessment-based discipline
Late 1800’s saw scientific principles applied to understanding normal and abnormal behaviour
Francis Galton (England): differences in reaction time as intelligence differences
Wilhelm Wundt (Germany): first psychology laboratory, studied sensation and perception
James McKeen Cattell (USA): studied connection between reaction time and intelligence
Coined term “mental tests”

13. History of Assessment in Clinical Psychology
Emil Kraepelin (Germany)
Believed that mental disorders were due to biological causes
Worked on classifications of symptoms into syndromes
Huge influence on modern psychiatry and clinical psychology
Much of his work formed basis for DSM and ICD (Ch. 3) and is still evident today

14. History of Assessment in Clinical Psychology
Alfred Binet (France)
French government asked Binet and collaborator Theodore Simon to design a measure to assess children with cognitive deficits
1908 Binet-Simon scale measured 50 tests of mental skills
Lewis Terman (US)
modified the work of Binet and Simon
first widely available test of cognitive ability

15. History of Assessment in Clinical Psychology
World War 1 - committee was struck called the American Psychological Association (APA) and asked to develop a scale to measure mental functioning of recruits
Army Alpha Test (verbal abilities)
Army Beta Test (non-verbal abilities–for those who could not read or spoke limited English)
These tests and the value they gave recognized clinical psychology as a sub-discipline of psychology
APA created a subsection of clinical psychology

16. History of Assessment in Clinical Psychology
Testing began to flourish and the measurement of abilities continued to be a central focus of clinical psychologists
Wechsler-Bellevue intelligence test 1939 (still considered the gold standard in IQ tests)
Projective tests – Rorschach Inkblot 1921, Thematic Apperception Test (TAT) etc.

17. History of Assessment in Clinical Psychology
World War II – Psychologists again active in tests for armed forces
Canadian Psychology Association (CPA) – Test Construction Committee developed the Revised Examination M (verbal/nonverbal items used for the selection of military personnel)
Starke Hathaway (1943) developed the Minnesota Multiphasic Personality Inventory – MMPI
Heavy use of statistics and test development
Ch. 8

18. History of Assessment in Clinical Psychology
Criticisms of Early Assessment
Paul Meehl’s work (1954) found that a purely clinical approach to assessment was typically inferior to a more statistically oriented approach
Walter Mischel’s work (1968) argued that the measurement of personality traits had only moderate predictive ability i.e. what a person may feel, think or actually do
Behavioural assessment as a field grew in part from these criticisms

19. History of Assessment in Clinical Psychology
1980’s – Diagnostic and Statistical Manual for Mental Disorders (DSM-III) published by APA
DSM-III more focused on observable symptoms
Focus on reliability
Several changes in psychological assessment have recently occurred
Clinical utility – does the assessment help with treatment
Service evaluation – do treatments work

20. History of Intervention in Clinical Psychology
Sigmund Freud (German psychiatrist)
First elaborated treatment of mental health issues
Early connection to neurology and work of Charcot
Focus on role of unconscious
1900 publication of The Interpretation of Dreams
Many subsequent followers elaborating related psychodynamic theories (e.g., Jung, Adler, Anna Freud.)

21. History of Intervention in Clinical Psychology
In addition to psychodynamic models, two other approaches were influential:
1. Lightner Witmer (USA, 1900)– coined the term ‘clinical psychology’ – opened a clinic (1904) to assess and remediate learning difficulties
2. John Watson (USA, 1920)- Conditioning principles → little Albert and furry white animals

22. History of Intervention in Clinical Psychology
WWII ’s & 1950’s
Needs for therapy increased with soldiers returning from war
Members of public affected by loss
VA hired many clinical psychologists which lead to an enormous increase in both Canada and USA

23. History of Intervention in Clinical Psychology
Many therapy approaches developed in 1940’s – 60’s
Carl Rogers (1940’s): Client-centered approach
Alexander & French (1946) – Several adaptations to Freud’s model
Harry Stack Sullivan (1950’s) – interpersonally focused strategies
Fritz Perls – Gestalt therapy
Viktor Frankl - Logotherapy
Joseph Wolpe – Systematic desensitization

24. History of Intervention in Clinical Psychology
Criticisms of Psychotherapy
Hans Eysenck critiqued the effectiveness of psychotherapy
Levitt, 1957 – critiqued child psychotherapy research
Resulted in enormous amount of research on whether psychotherapy works
Efficacy studies – focus on studies that emphasize internal validity of the study
Effectiveness studies – focus on studies that look at real world conditions
Meta-analysis – statistical technique combining several studies, showed psychotherapy effective

25. History of Intervention in Clinical Psychology
Contemporary approaches
Albert Ellis (USA, 1960’s)-– Rational Emotive Therapy
Eric Berne (1960’s) – Transactional Analysis
Don Meichenbaum (Canada,1977) – Cognitive-Behaviour Therapy
Aaron Beck (USA, 1979) - Cognitive Therapy
Cognitive Behavioural Therapy
Short-term Dynamic Therapy

26. Prevention in Clinical Psychology
A growing area of Clinical Psychology
The profession is evolving
Ph.D. science-practitioner model (focussing on research)
Psy.D. practitioner-scholar model (focussing on clinical practice).
Psychological associates
Prescription privileges in Canada???
Prescribing privileges
Uniqueness of psychology

27. Copyright
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