INTRODUCTION HISTORICAL BACKGROUND OF CLINICAL PSYCHOLOGY DR YAZAN

INTRODUCTION & HISTORICAL BACKGROUND OF CLINICAL PSYCHOLOGY DR. YAZAN AL-MRAYAT SUMMER OF 2021

OUTLINES • Definition of clinical psychology • Contribution of medicine to clinical psychology • Historical overview of clinical psychology • Closely Related Mental Health Professions

DEFINITION OF CLINICAL PSYCHOLOGY • The American Psychological Association and the licensing boards of each North American state and province reserve the title “clinical psychologist” for a very select group of professionals with specific training and qualifications.

DEFINITION OF CLINICAL PSYCHOLOGY Resnick (1991) proposed the following definition and description of clinical psychology: 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. According to Resnick, the skill areas central to the field of clinical psychology include assessment and diagnosis, intervention or treatment, consultation, research, and the application of ethical and professional principles. Clinical psychologists are distinguished by their expertise in the areas of psychopathology, personality, and their integration of science, theory, and practice.

DEFINITION OF CLINICAL PSYCHOLOGY The American Psychological Association’s Division 12 defines clinical psychology as: 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. Clinical psychologists work with a range of individuals, from infants to the elderly. Their work can involve individuals themselves, families/ partners, school personnel, other health care workers, and communities. Clinical psychologists often work in a large range of settings, including universities, hospitals, private practice offices, or group medical practices.

MEDICINE’S CONTRIBUTION TO PSYCHOLOGY Medicine is not only a profession but also a scientific field and, as such, served as a model for psychology in general. Many of the founders and influential researchers in the modern academic discipline of psychology, including Wilhelm Wundt, William James, Hermann Helmholtz, and Ivan Pavlov, were physicians by education, but they were scientists and scholars rather than practitioners of medicine. • Wilhem Wundt. Generally credited with founding the first psychology laboratory in 1879, was medically trained, but not a practicing physician. Wundt carried out research in psychology, edited a journal, wrote books summarizing research in the field, and trained many of the first generation of experimental (or “physiological”) psychologists.

MEDICINE’S CONTRIBUTION TO PSYCHOLOGY • Emil Kraeplin. Studied manic-depressive disorder and conceptualized “dementia praecox” (the mental disorder now termed schizophrenia). He established psychology laboratories in mental hospitals, under his direction, and studied experimentally the effects of alcohol and morphine on human reaction time. • William James. Considered to be the founder of modern psychology in the United States, was also trained as a physician, but chose not to practice medicine. James spent his career teaching physiology, psychology, and philosophy at Harvard University, and wrote the classic two-volume textbook on The Principles of Psychology (James, 1890).

MEDICINE’S CONTRIBUTION TO PSYCHOLOGY • Hermann Helmholtz. Was the first to actually measure the speed of the nerve impulse in several different species. • Ivan Pavlov. Spent his career as a researcher. He developed a special chronic physiological procedure, isolating a separate pouch within a dog’s stomach so that digestive juices could be collected from it. He was thus able to carry out a systematic program of research on the neural control of digestive processes in the dog. He began what the world came to recognize as pioneering research in experimental psychology. • Sigmoid Freud. In 1900, Freud published his famous book on the analysis of dreams as the “royal road to the unconscious” in psychoanalysis, marking the formal announcement of this new discipline.

HISTORICAL OVERVIEW OF CLINICAL PSYCHOLOGY (1850 -1899) • Francis Galton was interested in sensory acuity, motor skills, and reaction time, so he established an anthropometric laboratory in 1882. • James Mc. Keen Cattell believed that reaction time differences was a way of approaching the study of intelligence. In fact, Cattell coined the term mental tests to describe his measures. • Lightner Witmer began the current model of treatment in clinical psychology by opening the first psychological clinic in 1896 and starting the first psychological journal, called The Psychological Clinic. • Emil Kraepelin divided mental illness into types determined by exogenous factors (curable) and those caused by endogenous factors (incurable).

HISTORICAL OVERVIEW OF CLINICAL PSYCHOLOGY (1900 -1919) • Alfred Binet and Theodore Simon developed the Binet-Simon scale to assess intelligence in 1908. • Woodworth developed his Psychoneurotic Inventory in 1917. This was perhaps the first questionnaire designed to assess abnormal behavior. • When the United States entered World War I in 1917, the need arose to screen and classify the hordes of military recruits being pressed into service.

HISTORICAL OVERVIEW OF CLINICAL PSYCHOLOGY (1920 -1939) • Between the two world wars, there was substantial progress in diagnostic psychological testing. In 1930, the Arthur Point Scale appeared, and in 1934, it was followed by the Cornell-Coxe test. In 1926, the Goodenough Draw-a-Man technique for measuring intelligence was published. • In 1928, Gesell’s developmental scales were published, and in 1936, Doll’s Vineland Social Maturity Scale appeared. • Hermann Rorschach, a Swiss psychiatrist, published Psychodiagnostik. In this book, Rorschach described his use of inkblots to diagnose psychiatric patients. Rorschach’s work proposed that when people respond to an ambiguous test stimulus, they will reveal something of their responses to real-life experiences.

HISTORICAL OVERVIEW OF CLINICAL PSYCHOLOGY (1940–PRESENT) • Referring physicians and psychiatrists began to ask more complex questions. Questions such as “What is this patient’s ability level? ” began to evolve into more complicated questions that dealt with differential diagnosis. For example, “Is this patient’s level of functioning a product of constitutional intellectual limitations, or is a ‘disease process’ such as schizophrenia eroding intellectual performance? ” Because answering such questions involved more than simply identifying an IQ level, new methods of examining the patient’s performance on intelligence tests were developed. • In 1943, the Minnesota Multiphasic Personality Inventory (MMPI) appeared. • the 1970 s witnessed the rise of behavioral assessment. Behaviors were understood within the context of the stimuli or situations that either preceded or followed them. • The first edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-I) appeared in 1952. Revisions of the manual have appeared periodically. The latest version was published in 2013 (DSM-V).

CLOSELY RELATED MENTAL HEALTH PROFESSIONS - PSYCHIATRISTS • A psychiatrist is a physician. Psychiatry is rooted in the medical tradition and exists within the framework of organized medicine. Thus, psychiatrists are often accorded the power and status of the medical profession, even though their intellectual heritage comes from the non-medical contributions of Freud, Jung, Adler, and others. Although the latter were physicians, they stepped out of the medical tradition to develop a psychoanalytic system of thought that had very little to do with medicine. • Consistent with its roots in the medical tradition, psychiatry regards psychopathology as a mental “illness” with discrete (often biologically based) causes that can best be remedied with a medical treatment, such as psychotropic medication. Psychiatrists, like all medical doctors, complete a general medical school curriculum early in their training.

CLOSELY RELATED MENTAL HEALTH PROFESSIONS - PSYCHIATRISTS • In contrast to psychiatrists, clinical psychologists typically receive little training in medicine. However, clinical psychologists do receive more extensive training in the psychological principles governing human behavior, in formal assessment of psychological functioning, and in scientific research methods. As compared to psychiatrists, clinical psychologists also receive more extensive training in psychotherapy (i. e. , “talk” therapy as opposed to medications) and are more likely to view psychopathology as a consequence of interactions between individuals’ biological/psychological/ social predispositions and their experiences within the environment. • The proportion of medical school graduates who choose psychiatric residencies has generally declined since 1970, but over the last 5 years has stabilized at about 4. 1 to 4. 6%.

CLOSELY RELATED MENTAL HEALTH PROFESSIONS - PSYCHIATRISTS • Reasons offered for the decline in interest, especially among medical students from the United States, include: v Psychiatry’s increased emphasis on biological approaches (thus making the field more conventional and similar to other medical specialties), v The economic impact of managed care on psychiatric practice, v The increased competition from other mental health specialties, such as clinical psychology. Consequently, many psychiatrists do not conduct extensive psychotherapy with their patients, but rather often schedule brief (i. e. , quarter-hour) “medication management” appointments with each patient, v Opportunities to work in depth with individuals experiencing psychological symptoms or to help teach behavioral skills that may reduce and prevent symptoms are more limited in psychiatry than in clinical psychology. v Prescription privileges for non-medical health care professionals, including clinical psychologists v Many physicians do not rely on psychiatrists for advice or guidance concerning the prescription of psychiatric medications, as a signal of the “demise of psychiatry” as a medical specialty.

CLOSELY RELATED MENTAL HEALTH PROFESSIONS - COUNSELING PSYCHOLOGISTS • The activities of counseling psychologists overlap with those of clinical psychologists. Traditionally, counseling psychologists work with normal or moderately maladjusted individuals. Their work may involve group counseling or counseling with individuals. Their principal method of assessment is usually the interview, but counseling psychologists also do testing (e. g. , assessment of abilities, personality, interests, and vocational aptitude). • Counseling psychologists (like clinical psychologists) also work in hospitals, rehabilitation centers, mental health clinics, and industry. • In general, counseling psychologists see themselves providing the following services: (a) preventive treatment, (b) consultation, (c) development of outreach programs, (d) vocational counseling, and (e) short-term counseling/therapy of from one to fifteen sessions.

CLOSELY RELATED MENTAL HEALTH PROFESSIONS - CLINICAL SOCIAL WORKERS • The professional activities of clinically trained social workers often seem similar to those of psychiatrists and clinical psychologists. • Social workers tended to deal with the social forces and external agents that were contributing to the patient’s difficulties. The social worker would take the case history, interview employers and relatives, make arrangements for vocational placement, or counsel parents.

CLOSELY RELATED MENTAL HEALTH PROFESSIONS - CLINICAL SOCIAL WORKERS • Clinically trained social workers often perform many of the same psychotherapeutic activities as their psychological and psychiatric counterparts. Typically, however, social workers still place a greater focus on the familial and social determinants of psychopathology. • Characteristic of social workers is their intense involvement with the everyday lives and stresses of their patients. They are more likely to visit the home, the workplace, or the street—the places where their patients spend the bulk of their lives.

CLOSELY RELATED MENTAL HEALTH PROFESSIONS - SCHOOL PSYCHOLOGISTS • School psychologists work with students, educators, parents, and school administrators to promote the intellectual, social, and emotional growth of school-age children and adolescents. Toward this end, school psychologists may conduct psychological and educational assessments, develop learning programs and evaluate their effectiveness, and consult with teachers, parents, and school officials.

CLOSELY RELATED MENTAL HEALTH PROFESSIONS - HEALTH AND REHABILITATION PSYCHOLOGISTS • Health psychologists. They may design, execute, and study programs to help people stop smoking, manage stress, lose weight, or stay fit. • Rehabilitation psychologists. Work with individuals who are physically or cognitively disabled. The disability may result from a birth defect or later illness or injury. Rehabilitation psychologists help individuals adjust to their disabilities and the physical, psychological, social, and environmental barriers that often accompany them.

CLOSELY RELATED MENTAL HEALTH PROFESSIONS - PSYCHIATRIC NURSES • Because they spend many hours in close contact with patients, they are not only in a position to provide information about patients’ hospital adjustment but also can play a crucial and sensitive role in fostering an appropriate therapeutic environment. Working in close collaboration with the psychiatrist or the clinical psychologist, they implement therapeutic recommendations. • Certified nurse practitioners now have prescription privileges in all but a few states in the United States.

CLOSELY RELATED MENTAL HEALTH PROFESSIONS - OTHERS • Most well-staffed hospitals employ a variety of otherapeutic personnel, including occupational therapists, recreational therapists, art therapists, and so on. They can teach skills that will help patients in a variety of non-hospital settings. They can help make hospitalization a more tolerable experience, and they can provide outlets that increase therapeutic value of institutions. Whether their role is to help put patients in touch with their feelings via art, music, gardening, or dancing or to enhance patients’ personal and social skills, the contributions of such therapeutic personnel are significant.

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