Clinical Psychology: Definition and History

Chapter I.

What is Clinical Psychology

It is a subfield of the larger discipline of psychology. Clinical psychologists interest in behavioural and mental process, especially human behaviour and mental process

They conduct research on behaviour and mental process. Their main focus is human subjects, however sometimes they use animal subjects too (ethical concerns-i.e. learned hopelessness)

Clinical psychology involves in the assessment or measurement of the abilities and characteristics of human beings

Another characteristic of clinical psychology is the effort to help people who are psychologically distressed

What distinguishes clinical psychologists from other mental health professionals is a “clinical attitude/approach”

Clinical attitude is the tendency to combine knowledge from research on human behaviour and mental process with efforts on individual assessment in order to understand and help a particular person

Clinical psychologist wants to learn general principles that apply to human behaviour problem in general, but also they also want to know how general principles shape lives, problems, and treatments on an individual level

Legal, Educational, and Ethical Requirements to Be a Clinical Psychologist

EducationExperienceTesting of competenceGood character

Clinical psychology and the related mental health professions

Counseling psychologists and school psychologists

Social workersPsychiatristsPsychiatric nursesMarriage and family therapistsParaprofessionalsOther specialists and caregivers

Clinical Psychologists at Work

Assessment: collecting information about people (behaviour, characteristics, abilities, intellectual functioning). This information is used in to diagnose the problems, to guide the client toward optimal vocational choice, to facilitate the selection of job candidates, to describe the personality characteristics, to select treatment techniques, to help legal decision and so on

Treatment: offering treatments designed to help people better understand and solve distressing psychological problems. These interventions may be called psychotherapy, behaviour modification, psychological counselling. Treatment may be outpatient basis or inpatient, may be as brief as one session or may extend over several years. Treatment goal may be finding a specific solution to a particular problem or reconstruction of one’s personality. It can be offered free of charge, for a fixed fee. The results of the treatment may be positive, neutral or even negative

Research: by training and tradition clinical psychologist are research oriented and the research activity makes clinicians to stand out among other professionals. Clinical psychologist devote time to develop their research skills because:

a. They can be critically evaluate the published research and decide which assessments and treatment strategy is more appropriate for their clients

b. Research training help them to objectively evaluate the results of their own practice

c. Research help to evaluate the effectiveness of mental health centres’ or service agencies’ effectiveness

d. Academics should evaluate and supervise research projects by their students

Teaching: They generally teach classes like abnormal psychology, clinical psychology, personality, psychotherapy, research design, assessment and etc. as well as supervising hours

Consultation: They advice organisations about variety of problems (such as education, advice, direct service, or reducing the conflict)

Administration: Such as a head of a college or university psychology department, director of a graduate programme, dean of a faculty, etc.

What clinicians do in their working time varies with their position at the work place or work setting

Clinical Psychology TrainingThe Boulder Model:

First training conference in 1949Scientist-practitioner modelProficiency in research and professional

practice

Vail Model:Less emphasis on scientific training, more on

preparation for the delivery of clinical services

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Brief history…The Roots of Clinical PsychologyClinical psychology did not emerged as a

discipline until the beginning of the 20th century and did not really developed until the end of the 2nd WW

Three sets of social and historical factors shaped and continue to influence the field are

1. The use of scientific methods in psychology

2. The study of human individual differences3. Changes in how behaviour disorders have

been viewed and treated over the years

The Research Tradition:

The first psychology lab is opened by Wilhelm Wundt at Leipzig in 1879

Attention to Individual Differences: Plato’s Republic, Pythagoras’s Brotherhood, in China for government employees at 4000 years ago, etc.

Darwin’s master piece Origin of Species offers two ideas: a. Variation of individual characteristics occurs within and between species, b. natural selection takes place in part on the basis of those characteristics

Galton applied Darwin’s notions to individual differences, especially in mental abilities

Cattell applied psychological method to the study of individual differences. He opened up a psychology lab in US after William James and Stanley Hall

In 1895 Alfred Binet began to develop measures of complex mental ability in normal and defective children

Changing Conception of Behaviour Disorder:

1. Magical forces and supernatural events (possessed by demons or spirits, treatment methods like exorcism)

2. In 4th century B.C. Hippocrates suggested these aberrations stem from natural causes (distribution of bodily fluids: blood, black bile, yellow bile, and phlegm)

3. In the Middle Ages, demonological explanation regained prominence by the influence of the Church and religious personnel again took over responsibility for dealing with all cases of deviance

4. In 16th century hospitals and asylums started to treat deviant individuals (St Mary of Bethlehem Hospital in London, i.e. Bedlam)

5. In 18th and early 19th centuries more humane living conditions and treatment begun to appear

6. Organic causes of mental disorders7. Ironically, at the same time, psychological

causes of mental disorders. Anton Mesmer animal magnetism

Between the Wars: 1918-1941Large numbers of military recruits had to be

classified in terms of intellectual prowess and psychological stability

To measure mental abilities Army Alpha and Army Beta intelligence tests and to measure behaviour problems Robert Woodworth’s Psychoneurotic Inventory were produced

In these period Jung’s Word Association Test, the Rorschach Inkblot Test, Goodenough Draw-A-Man Test, TAT, Bender-Gestalt Test and etc. were also introduced

Slowly, clinicians added treatment function to their assessment, training and research roles

The Post War Explosion Mass testing of the intelligence, ability, and

personality of the military personnel became important again in WW2

Arm General Classification Test, Personal Inventory, short forms of Rorschach and TAT as well as several ability tests

Psychologies involved far deeper than WW I this time

So many psychologists hooked in the area of treatment after the war

David Shakow’s Committee on Training in Clinical Psychology recommended that:1.Clinical psychologist should be trained first as

a psychologists (i.e. as a scientist first and second as a practising professional)

2.Clinical training should be as rigorous as that given to non-clinicians and thus should consist of a four year doctorate, including a year supervised clinical internship experience

3.Clinical training should focus on Holly Trinity (assessment, research, and treatment)

Clinical Psychology in the 21st Century The Challenges of Health Care Reform: for

many years clinical psychology operated on a fee-for-service basis.

The last 15 years there is a dramatic change to managed care service for insurance companies

Fundamental changes because of the economic reasons occurred and we expect further changes, such as:

1. More clinicians join group practices to cut the costs2. An increase in the use of brief therapies that

focuses on problem solving skills and rapid symptom reduction

3. An emphasis on prevention, so that fewer clients in extended and expensive psychotherapy

4. A demand to use only empirically effective methods

5. A larger role for clinicians at BA or MA level (cheaper than PhDs)

6. More involvement with people with serious or chronic diseases

7. Pressure to obtain privilege to prescribe cost-effective psychoactive drugs

Integrated Theories and Interdisciplinary WorkClinicians are becoming increasingly aware

that mental disorders can often best be understood and treated by focusing on a combination of biological, sociocultural, and psychological factors

Diathesis-stress theoriesFewer psychologists maintain strict

adherence to traditional theoretical approaches and many of them started to refer themselves as eclectic

Boundaries between psychological and other conceptions of human behaviour are fading. Physical and psychological disturbances co-occur in a great many illnesses, and changes in psychological functioning can often have dramatic effects in physical functioning (and vice versa)

Increasing levels of employment in medical setting

The Challenge of Cultural DiversityDiversity refers to variations in ethnic and racial

background, sexual and religious orientations, or other dimensions that create psychological experiences that are significantly different from experiences of persons in other cultures or groups

Clinical psychologists need to be more aware of how diversity affects clinical practice

Psychological disorders sometimes manifest themselves very differently across cultural groups

Culturally bounded syndromesClinicians who are not aware of the specific

symptoms and cultural context can make inaccurate diagnosis and assessments