CLINICAL PSYCHOLOGY

NOTES

MODULE-1
Introduction to Clinical Psychology: Meaning and nature of discipline

Historical Development of Clinical Psychology

Introduction to Clinical Psychology: Meaning and nature of discipline

Meaning
Father- Lightner Witmer

12th Division of APA.

The Division of Clinical Psychology of American Psychological Association, as by J. H.

Resnick (1991): The field of clinical psychology involves research, teaching, and
services relevant to the applications of principles, methods, and procedures for
understanding, predicting, and alleviating intellectual, emotional, biological,
psychological, social and behavioral maladjustment, disability and discomfort, applied
to a wide range of client populations.

Society of Clinical Psychology (2002) - The field of Clinical Psychology integrates

science, theory, and practice to understand, predict, and alleviate maladjustment,
disability, and discomfort as well as to promote human adaptation, adjustment, and
personal development. Clinical Psychology focuses on the intellectual, emotional,
biological, psychological, social, and behavioral aspects of human functioning across
the life span, in varying cultures, and at all socioeconomic levels.
According to Saccuzzo & Kaplan (1994), “Clinical Psychology is an applied branch of
psychology devoted to helping adjust, solve problems, change, improve and achieve
their highest potential.”

According to Korchin (1986), “Clinical Psychology is most distinctly defined by the

clinical attitude, that is, a concern with understanding and helping individuals in
psychological distress. Clinical Psychology is concern with generating and utilizing
knowledge about the structure and functioning of human personality.”

According to APA (American Psychological Association): “Clinical psychology is the

psychological specialty that provides continuing and comprehensive mental and
behavioral health care for individuals and families; consultation to agencies and
communities; training, education and supervision; and research-based practice.”

Clinical psychologist -A member of a profession devoted to understanding and treating

individuals affected by a variety of emotional, behavioral, and/ or cognitive difficulties.
Clinical psychologists may be involved in numerous activities, including psychotherapy,
assessment and diagnosis, teaching, supervision, research, consultation, and
administration.

Thus, Clinical psychology is the branch of psychology concerned with the assessment
and treatment of mental illness, abnormal behaviour, and psychiatric problems.

Nature of Clinical Psychology

 Clinical psychology is an applied branch of Psychology.
 It is more popular than other branches of Psychology, such as Industrial
Psychology, Educational Psychology, etc.
 It concerned with the assessment and treatment of mental illness, emotional
disorders and behavioral problems.
 Emphasis on science
 Emphasis on maladjustment
 Emphasis on the individual
 Emphasis on helping and solving problems.
 To understand why people have psychological distress
 To prevent emotional disturbance/distress
 To relieve emotional disturbance/distress
 Promote psychological well-being.
 Promote personal development and growth.
 There is an emphasis on diagnosis and treatment of behavioral and emotional
problems, such as mental illness, juvenile delinquency, mental retardation, marital
and family conflicts, drug addiction, criminal behaviour, etc.
 Clinicians have different approach and point of view towards such problems
which is called as ‘Clinical Attitude’ by Korchin (1986).
 To understand the emotional and behavioral problems of the client or patient,
there is an emphasis on the study of personality dynamics in this field. Sigmund
Freud has most concerned with this view.
 Korchin 1986 & Phares (1984) have also emphasized on the study of personality
dynamics in Clinical psychology.
 Clinical psychologists carry out research to find out better ways of diagnosing,
treating, and preventing psychological disorders. They also rely heavily on
standardized tests for identifying the causes of these disorders. They use
psychotherapy, for which they are trained, for the treatment of mental disorders.
But clinical psychologists are not authorized to prescribe drugs to treat behaviour
disorders, as they do not have medical training

Scope and Functions

 Psychotherapy- According to Rotter (1971), “Psychotherapy…is a planned
activity of the psychologists, the purpose of which is to accomplish changes in the
individual that make his life adjustment potentially happier, more constructive or
both.” Clinical psychologists who work as psychotherapists often utilize different
treatment approaches when working with clients.

 Diagnosis and Assessment- collect information about people to in essence

diagnose problematic behavior, describe a person’s personality characteristics,
enhance personal well-being, determine possible career options, select
employment candidates, provide legal decisions (criminal responsibility,
commitment to an institution, family reunification, fitness to return to society,
 etc.), determine readiness and effectiveness of treatment. The effort to better
understand the individual so that a more informed decision can be made or the
most. Assessment, whether through observation, testing, or interviewing, is a way
of gathering information so that an important question can be answered or so that
a problem can be solved. Assessment has long been a critical part of the clinical
psychologist’s role. Indeed, for many years, assessment, especially testing, was
the chief element in the clinician’s professional identity.

 Treatment - offer various interventions to resolve emotional distress and

psychological problems (psychotherapy); most commonly used therapeutic
approaches are cognitive-behavioral, psychodynamic, and humanistic. Goals of
treatment vary from person to person and are determined by clients and their
therapists. Treatment can be performed on an in-patient basis (psychiatric
hospital) or out-patient basis (community mental health center, offices, etc.)

 Teaching - Clinical psychologists who have fullor part-time academic

appointments obviously devote a considerable amount of time to teaching. Those
whose responsibilities are primarily in the area of graduate education teach
courses in advanced psychopathology, psychological testing, interviewing,
intervention, personality theory, developmental psychopathology, and so on.
Some of them may also teach undergraduate courses such as introductory
psychology, personality, abnormal psychology, and introduction to clinical
psychology, psychological testing, and others.

 Clinical Supervision- Clinical supervision is really another form of teaching.

However, it typically involves more one-to-one teaching, small group approaches,
and other less formal, non-classroom varieties of instruction. Whether in
university, internship, or general clinical settings, clinical psychologists often
spend significant portions of their time supervising students, interns, and others.

 Research - conduct research to determine effectiveness of assessment and

treatment procedures; understand etiology of psychological disorders in children
and adults. Studies include searching for the causes of mental disorders,
development and validation of assessment devices, evaluation of therapy
techniques, and so on.
  Consultation - In consultation and in teaching, the goal is to increase the
effectiveness of those to whom one’s efforts are directed by imparting to them
some degree of expertise. Clinical Psychologist provides consultations to
organizations, health care providers, school systems, and governmental agencies.

 Administration- - One of the scope and function of clinical psychology is also to

administer and manage to treat and prevent social problems. Nearly every clinical
psychologist spends time on administrative tasks. For example, client records
must be maintained, those infernal effort reports must be filled out each month,
and research projects must be cleared by committees set up to safeguard the rights
of human subjects.

History of Clinical Psychology

Early Conceptions of Mental Illness: Mind and Body Paradigms
Clinical psychology has borrowed from philosophical, medical, and scientific advances
throughout the centuries.

Mind and Body Paradigms

 Several Greek thinkers were essential in the early development of integrative

approaches to illness, and were pioneer to a biopsychosocial perspective.
 According to them, the gods controlled both health and illness. Greeks didn’t
believe supernatural influences.
 The mind and body were closely interrelated.
 Its roots are based on the ancient era.

Hippocrates (460–377 B.C.)

 Disease was primarily the result of an imbalance in four bodily fluids including
black bile, yellow bile, phlegm, and blood. The relationship between them
determined personality.
 Too much yellow bile resulted in a choleric (angry, irritable) temperament,
 Too much black bile resulted in a melancholic (sadness, hopelessness)
personality.
  He was sensitive to interpersonal, psychological, and stress factors that contribute
to problem behavior.
 He helped to move from a spiritualistic toward a more naturalistic view or model
of health and illness.
 Biological, psychological, and social factors all contribute to both physical and
emotional illness → early biopsychosocial perspective.

Plato (427–347 B.C.)

 Saw the spirit or soul as being in charge of the body and those problems in the
soul could result in physical illness.

Aristotle (384–322 B.C.)

 Maintained a scientific emphasis.
 Treatment for mental problems should include talking and the use of logic.
 The use of logic is one of the major principles of CBT.
 FATHER OF CBT. ARISTOTLE’S IDEA PIONEERED TO CBT.

Galen of Pergamum (A.D. 130–200)

 Galen also used the balance between the four bodily fluids.
 Brain was the center of sensation and reason.
 Vomiting to treat depression and bloodletting to treat diseases were common
treatments.
 During the ancient times, physicians tried to treat people with mental ilnesses by
cutting their vessels and bloodletting.

The Middle Ages (500–1450)

 temporarily derailed from this scientific way, the focus on supernatural influences
 “insanity” were caused by spiritual matters such as the influence of demons,
witches, and sin.

Healing and treatment in Middle Age

  Became a spiritual rather than a medical way.
 People who were “insane” were treated by exorcism.
 Some were chained to church walls; some were tortured and killed.
 In 1484, Pope approved the persecution of “witches.”
 150,000 people were executed in the name of religion.
 Exorcism: get rid of evil by praying.
Saint Thomas Aquinas (1225–1274)
 There was both theological truth and scientific truth. He claimed that mental
illness must have a physical cause.

Paracelsus (1490–1541)
 A Swiss physician
 Suggested that various movements of the stars, moon, and planets influenced
mood and behavior.
 Paracelsus focused on the biological foundations of mental illness and developed
humane treatments.

The Renaissance (14th–17th centuries)

 New discoveries in chemistry, physics, biology, and mathematics revealed.
 The emphasis on scientific observation and experimentation rather than
mythology, religious beliefs, and dogma provided a model for future research.
 New medical discoveries resulted in biomedical approach that disease, including
mental illness, could be understood by scientific observation and experimentation
rather than beliefs about mind and soul.

Descartes (1596–1650)
 A French philosopher
 Argued that the mind and body were separate. >> dualism of mind and body
 Mental illness was often considered a disease of the brain, and the insane was
treated using the medical orientation.
 insane: mad, psychosis

Bedlam
  Despite the medical developments, treatment was bad.
 St. Mary of Bethlehem Hospital in London— Bedlam (1547) was opened. Cures
included ice water (hydrotherapy) and bloodletting.

The Nineteenth Century

 Many advances allowed for a more sophisticated understanding of the
relationship between body and mind in both health and illness.
 Disease and illness could be attributed to dysfunction at the cellular level.
 The nineteenth-century discoveries that germs or microorganisms can cause
disease have continued to support the “Cartesian dualism” perspective of
Descartes.
 Dualism was softened due to the influence of a belief that the mind and body
were connected, not separate.

Franz Mesmer (1734 – 1815)

 An Austrian physician, noticed that many people experiencing paralysis,
deafness, and blindness had no biomedical pathology, leaving psychological
causes suspect.

Claude Bernard (1813–1878)

 Argued for the role of psychological factors in physical illness.

Jean Martin Charcot (1825-1893)

 a French physician,
 Used hypnosis to treat a wide variety of conversion disorders such as paralysis,
blindness, deafness without apparent physical cause.

Philippe Pinel
 Pinel found moral therapy to treat patients as humanely as possible and
encouraged the nurturance of interpersonal relationships.
 He improved the living conditions and treatment approaches used by mental
hospitals
 Dr. Pinel saved the patients from their chains.
Dorothea Dix (1802–1887)
 a Massachusetts school teacher,
 During the Civil War, she acted as the head nurse for the Union Military.
 Worked to improve treatment conditions for the mentally ill in the USA in the
asylums.
 Mentally ill patients had to live in these bad positions in the asylums.

Emil Kraepelin (1856–1926)

 German physician,
 Defined the term dementia praecox to describe SCH.
 Claimed that mental disorders were brain disorders.
 Assisted in developing a classification system for understanding and categorizing
many mental disorders.
 Early dementia

Franz Alexander (1891–1964)

 Studied the association between psychological factors and both physical and
mental illnesses.
 As a specific stressor occurred, a genetically predetermined organ system
responds. By repressing conflict, psychic energy could be channeled into the
sympathetic nervous system, thus producing disease. While one person might
repress conflict and develop an ulcer, another person might develop colitis,
headache, or asthma.

The Birth of Psychology

 Wilhelm Wundt developed the first lab of psychology at the University of
Leipzig, Germany in 1879, psychology was born.
 He was interested in individual and group differences in sensation and perception
in various lab experiments.

William James
  Established a psychology lab at Harvard University at about the same time with
Wundt.
 Published Principles of Psychology, the first classic psychology text.
 Stanley Hall established the second American psychology lab at John Hopkins
University in 1883, while James McKeen Cattell established the third American
lab in 1888.
 Hall established the first independent psychology department at Clark University
in 1887.
 In 1892, the American Psychological Association (APA) was founded. Stanley
Hall was elected its first president.
 Until that time, psychology departments were dependent to philosophy.

Sir Francis Galton

 Although not a psychologist, a relative of Charles Darwin, Galton was interested
in statistical analysis of differences among people in reaction time, sensory
experiences, and motor behavior. First testing attempts
 In the USA, James McKeen Cattell (1860–1944) also studied reaction time and
other differences in human behavior.
 Psychology was founded, but psychologists were interested in empirically
measuring various aspects of human behavior to better understand the mind. They
had very little interest in applying their findings to help people with problems or
disorders. The desire to apply these methods and principles to people was soon to
result in the birth of clinical psychology.

The Founding of Clinical Psychology

 The clinical psychology as a specialty area was born in 1896 with the opening of
the first psychological clinic at the University of Pennsylvania by Lightner
Witmer.
 Wilhelm Wundt and his students founded a field of psychology that came to be
known as “Structuralism”, they were concerned with studying the basic elements
of consciousness.
 William James (1842-1910) was one of the founders of the school of
Functionalism, they were concerned with how mental processes help organisms
 adapt to their environment. They believed behaviors were adaptive because they
were successful; less adaptive behaviors were dropped or discontinued.
 In 1892, the American Psychological Association (APA) was founded and
Stanley Hall was elected its first president. Until that time, psychology
departments were dependent to Philosophy.
 John B. Watson (1878- 1958) Behaviorists believe behaviour can be studied in a
methodical and recognizable manner with no consideration of internal mental
states. Watson believed that it was unscientific to study consciousness as a private
event; he asserted that if psychology was to be a natural science, it must be
observable and measured.
 Skinner (1904-1990) he added to the behaviorist tradition reinforcement.. Skinner
showed that when an animal is reinforced, or rewarded, for performing an action,
it is more likely to perform the action in the future
 The psychology of Gestalt which means shape or form in German is based on the
idea that perceptions are more than the sums of their parts; rather they are wholes
that give shape or meaning.
 Sigmund Freud and the School of Psychoanalysis Sigmund Freud (1856-1939),
was one of the most famous of the early psychologists. The school of thought that
he founded was called “Psychoanalysis”, it emphasizes the importance of
unconscious motives and internal conflicts and how they can influence behaviour.
 Alfred Binet, a French scientist, founded the first psychology laboratory in
France, in 1885. Binet was interested in developing tests to investigate mental
abilities in children. In 1904, a French commission invited Binet and Theodore
Simon, to develop a method to assist in providing mentally disabled children with
appropriate educational services. Binet and Simon intelligence test was
developed.
 Freud proposed that unconscious conflicts and emotional influences could cause
mental and physical illness. Freud’s publication of The Interpretation of Dreams,
published in 1900 resulted in acceptance of the psychoanalytic perspective.

Lightner Witmer (1867–1956)

 Completed undergraduate studies at the Univ. of Pennsylvania in 1888.
 Earned his PhD at the Univ. of Leipzig under Wundt in 1892.
  The first recognized clinical psychologist Graduated from U of Penn in 1888
 Completed doctorate in 1892
 Appointed director of U. of Penn Psychological Laboratory
 March, 1896 – asked to help with a child who was a “chronic bad speller.”
 Presented clinical psychology to APA Convention in 1896
 Offered Clinical Psychology courses at Penn in 1904
 First Clinical Journal – The Psychological Clinic (1907)
 Returned to the Univ. of Pennsylvania as the director of psychology lab.
 He was asked by a teacher to help her student who was not performing well in
school. After assessing the child’s problem, Witmer developed a specific
treatment program.
 He proposed that a psychological clinic could be assigned to diagnosis and
evaluation, individual treatment, research, and the training of students. His
colleagues disliked his idea, because, during this time, «psychology was
considered a science, it shouldn’t be applied to actual clinical problems.

His contributions to the present day

 Many of his principles are still used today.
 A multidisciplinary team approach.
 He was interested in preventing problems before they emerged.

The Influence of Binet’s Intelligence Test

 Alfred Binet, a French scientist, founded the first psychology laboratory in
France, in 1885.
 Binet was interested in developing tests to investigate mental abilities in children.
In 1904, a French commission invited Binet and Theodore Simon, to develop a
method to assist in providing mentally disabled children with appropriate
educational services.
 Binet and Simon developed an intelligence test.
 Henry Goddard learned the Binet-Simon scale while in Europe during He brought
it back to the USA for translation and use.
 In 1916, Stanford University psychologist Lewis Terman revised the scale and
renamed it the Stanford-Binet.
  Measuring the intellectual abilities of children became a major activity.

The Influence of Freud in America

 Freud proposed that unconscious conflicts and emotional influences could cause
mental and physical illness. Freud’s 1900 publication of The Interpretation of
Dreams resulted in acceptance of the psychoanalytic perspective.

 In 1909, Clark University was celebrating its 20th anniversary and Stanley Hall
invited a large number of psychologists, psychiatrists, and academics for a series
of lectures.
 In addition to Freud, Carl Jung, Otto Rank, Sandor Ferenczi, James McKeen
Cattell, E. B. Titchener, and William James were invited. This conference
increased the acceptance of Freud’s psychoanalytic theories in the USA.

The American Psychological Association and Early Clinical Psychology

 During 1910s and 1920s, the APA was interested in scientific research in
academic settings and was disinterested in clinical applications in the field.
 Clinicians felt the lack of interest and support by the APA and they decided to
leave the organization. American Association of Clinical Psychologists (AACP)
was founded in 1917.
 The AACP rejoined the APA as a clinical section in 1919.
 This difference of opinion between clinicians and academicians in psychology
and between the applied clinical professionals and academic and scientific
members of APA continues.

The Influence of World War I

 When the USA entered the war in 1917, a large number of recruits needed to be
classified based on their intellectual and psychological functioning. The U.S.
Army asked from the APA an appropriate test for the military recruits.
 Army Alpha and Army Beta intelligence tests were developed by Henry Goddard,
Lewis Terman, and Guy Whipple.
 The Army Alpha was a verbal test; Army Beta was a nonverbal test.
  The Army Alpha and Army Beta tests could be administered to very large groups
of people and both literate and non-literate adults.

Clinical Psychology between World Wars I and II

 A testing development explosion occurred; over 500 psychological tests had been
produced. These tests included both verbal and nonverbal intelligence tests,
personality and psychological functioning tests, and career interest and vocational
skill tests.
 Rorschach Inkblot Test (1921),
 the Good enough Draw- A-Man Test (1926),
 the Thematic Apperception Test (1935), and
 the Wechsler-Bellevue Intelligence Scale (1939)
 James McKeen Cattell founded the Psychological Corporation to sell
psychological tests to various organizations and professionals.

Hermann Rorschach
 In 1921, Hermann Rorschach published Psychodiagnostik, the famous inkblot
test.
 Rorschach was a Swiss psychiatrist who died shortly after the publication of his
famous test.
 In 1937, S. J. Beck and Klopfer published scoring procedures for the Rorschach
that facilitated much more research to be conducted using the instrument.

David Wechsler
 In 1939, he developed the first comprehensive and individually administered
intelligence test for adults. The Wechsler-Bellevue → WAIS

Psychotherapy
 The early work of clinical psychologists involved psychological and intellectual
testing. Psychotherapy and other treatment services were conducted by
psychiatrists. Psychiatrists in the USA believed that only physicians could
provide psychotherapy. In the late 1980s, psychologists won the right to be
 admitted as full members of American psychoanalytic institutes, resulting in their
current ability to conduct psychoanalysis with patients.
 Unlike the psychoanalytic treatment provided by psychiatrists at the time,
psychological treatment was more behavioral, reflecting the research
developments in academic laboratories.

John Watson (1878 – 1958)

 In 1920, he detailed the well-known case of little Albert who was conditioned to
be fearful of white furry objects. Mary Cover Jones demonstrated how these types
of fears could be removed using conditioning techniques, in 1924.

Training
 By the early 1940s, there were no official training programs or policies regulating
the field of clinical psychology. The majority of the APA membership consisted
of academics primarily interested in research rather than practice applications.
 In 1935, the APA Committee on Standards of Training in Clinical Psychology
recommended that a PhD and one year of supervised clinical experience be
required to become a clinical psychologist.
 But the recommendation was ignored because the APA did nothing to enforce
their recommendation at that time.
 A large group of clinicians again left the APA in 1937 to form a new
organization, the American Association of Applied Psychology (AAAP). This
new organization rejoined the APA in 1945.

The Influence of World War II

 With the United States involvement in World War II, the need to assess military
recruits again became serious. A committee developed a group administered
intelligence test called the Army General Classification Test. The committee
recommended several other tests, such as the Personal Inventory, and brief
versions of the Rorschach Inkblot Test and the TAT.
  New tests were developed such as the MMPI as an objective personality
inventory by Hathaway in 1943.
 In 1949, David Wechsler published the Wechsler Intelligence Scale for Children
(WISC).
 The American Board of Examiners in Professional Psychology (ABEPP) was
created to certify psychologists. This examination is now used in every state.

Clinical psychology has changed, and it will certainly change even more. Witmer would
scarcely recognize it. G. Stanley Hall, the APA’s first president, would doubtless be
amazed at the things the APA and APS are doing. However, although training and
practice are in a state of flux, certain constants remain. Clinical psychologists are still
involved in assessment and treatment. They still have research contributions to make,
and they are still concerned with their professional development. The goal that binds
clinical psychologists together remains the same: to apply their knowledge and skill to
the mental health needs have people everywhere.