Chapter 1

The Evolution of
Clinical Psychology

INTRODUCTION TO CLINICAL PSYCHOLOGY

LECTURE BY : AYESHA YAQOOB

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

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Clinical psychology

 Clinical psychology is a broad discipline concerned with

the scientific study of psychopathology and with the
assessment and treatment of persons with emotional,
cognitive, and behavioral problems.
 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

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 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

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 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.)

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 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

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 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

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 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

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 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”

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 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

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 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

1. Francis Galton (England): differences in reaction time as

intelligence differences
2. Wilhelm Wundt (Germany): first psychology laboratory,
studied sensation and perception
3. James McKeen Cattell (USA): studied connection
between reaction time and intelligence
 Coined term “mental tests”
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 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

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 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

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 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

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 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.

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 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

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 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

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 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

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 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.)

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 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

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 History of Intervention in
Clinical Psychology
 WWII - 1940’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

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 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

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 History of Intervention in
Clinical Psychology
 Criticisms of Psychotherapy
 Hans Eysenck 1952 - 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

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 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

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