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Recent History of Clinical Psychology

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Title: Recent History of Clinical Psychology


1
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2
Recent History of Clinical Psychology
3
Lecture Preview
  • Clinical Psychology Immediately after World War
    II
  • The Rise of Alternatives to the Psychodynamic
    Approach
  • A New Training Model Emerges The Vail Model and
    Professional Schools of Psychology

4
Clinical Psychology Immediately after World War
II
  • Following the war, over 40,000 veterans were
    hospitalized. Psychiatrists were unable to meet
    the treatment demands of these huge numbers of
    veterans. It resulted in increase in the number
    of clinical psychologists.
  • Veterans Administration hospitals became the
    largest single employer of clinical psychologists
    in the USA.

5
  • Many others preferred to focus on the science of
    psychology in academic environments.
  • There was a division between science and practice
    from the beginning.

6
Training
  • The APA Committee on Training in Clinical
    Psychology recommended that training be
    comprehensive in research, treatment, and
    assessment.
  • In 1948, the APA began to carefully evaluate and
    accredit doctoral training programs. Psychology
    departments in universities across the USA had a
    freedom to determine their training programs.

7
The Boulder Conference
  • Prior to 1949, psychology departments in
    universities across the country had a great deal
    of freedom to determine how they should run their
    training programs.
  • The Boulder Conference was called (convened) in
    1949.
  • It was the first national meeting to discuss
    standards for doctoral training.

8
The Boulder Conference
  • This training model stated that a PhD degree in
    psychology from a universitybased training
    program plus a one-year clinical internship were
    necessary for adequate preparation.
  • The Boulder model became known as the
    scientist-practitioner model.
  • Clinical psychologists should be competent in
    both conducting research and providing
    professional services such as psychotherapy and
    assessment.

9
Post-Boulder Conference Events
  • Additional conferences convened to discuss the
    pros and cons of the clinical psychology training
    model.
  • The growth of clinical psychology during the
    1950s was enormous.
  • APA membership more than doubled during the
    1950s.

10
Post-Boulder Conference Events
  • In 1952, American Psychiatric Association
    published diagnostic categories in Diagnostic and
    Statistical Manual (DSM - I).
  • In 1953, the first attempt to outline ethical
    principles for psychologists was published by the
    APA.

11
The Rise of Alternatives to the Psychodynamic
Approach
  • During the first half of the 20th century, the
    psychoanalytic approach founded by Freud and the
    behavioral conditioning approach founded by John
    Watson.

12
The Rise of Alternatives to the Psychodynamic
Approach
  • During the 1950s, 1960s, and 1970s, many new
    approaches were developed as alternatives to the
    traditional psychodynamic approach
  • humanistic,
  • behavioral,
  • cognitive-behavioral, and
  • family systems approaches

13
The Rise of Alternatives to the Psychodynamic
Approach
  • In the 1960s, the community mental health
    movement rose. Psychotropic medication in
    treating mental illness introduced. These two
    events had powerful influences on clinical
    psychology.

14
The Behavioral Approach
  • The behavioral approach applies theories of
    learning and conditioning to the understanding of
    human behavior and the treatment of problems.
  • It had its roots in the conditioning research of
    Ivan Pavlov in Russia. The behaviorism and
    learning theory in the USA conducted by
  • John Watson, Edward Thorndike, Clark Hull, John
    Dollard, Neal Miller, and B. F. Skinner.

15
The Behavioral Approach
  • Behaviorism became an attractive alternative to
    medical and psychodynamic strategies during the
    1950s and 1960s.
  • Some research-oriented clinicians felt that
    behavior therapy proved more effective in
    empirical research trials relative to traditional
    theories and methods such as psychoanalysis.

16
The Behavioral Approach
  • The behavioral approach was viewed by many as
    more scientifically based than the psychodynamic
    approach.
  • Behavioral techniques were more readily
    operationalized to allow for research and
    statistical analysis. It was easier to measure a
    person had a panic attack than measuring
    constructs such as the id, transference, or
    unconscious conflicts.

17
Pavlov (18491936)
18
The Behavioral Approach
  • Behavior therapy approaches to treatment were
    developed in South Africa by Joseph Wolpe (1915 -
    1997). He developed systematic desensitization to
    treat phobias.

19
The Behavioral Approach
  • Behavior therapy was well suited to the Boulder
    model because clinical psychology training was
    designed to emphasize both the science and
    practice.
  • The behavioral approach was well suited to the
    social and political influences of the time. It
    was an optimistic notion that we could create a
    more perfect society using social engineering and
    conditioning techniques.

20
The Behavioral Approach
  • There are various types of behavior therapy such
    as applied behavioral analysis, social learning
    theory-based treatment of Bandura and CBT.
  • Their commonality is that most problematic
    behavior is learned and can be altered through
    the use of learning principles.
  • Treatment methods are scientifically based
    procedures and can be objectively used and
    evaluated.

21
The Cognitive-Behavioral Approach
  • became popular during the 1970s. Many behavioral
    researchers and clinicians admitted a number of
    significant limitations in their model. The
    approach ignored the contributions of thinking
    and attitudes in human behavior.

22
The Cognitive-Behavioral Approach
  • Albert Elliss Rational-Emotive Therapy
  • Aaron Becks cognitive treatments for depression
  • the cognitive restructuring work of M. Mahoney
  • the stress inoculation work of Meichenbaum
  • the self-efficacy work of Bandura
  • led the integration cognitive approaches with
    behavioral approaches.

23
Aaron Beck (1921- )
24
The Cognitive-Behavioral Approach
  • Ellis REBT focuses on to alter the patients
    irrational beliefs about themselves and others.
  • Becks cognitive approach focuses on to alter
    maladaptive thought patterns and developing more
    adaptive ways of thinking. Depressed people tend
    to view themselves, others, and the world as more
    negative.
  • Meichenbaums self-instructional approach uses
    self-talk to alter problematic thinking and
    behavior..

25
Their commonalities are
  • that learning and behavior are cognitively
    mediated by attitudes and attributions.
  • that the role of the therapist is to serve as a
    coach and educator in assisting the alteration of
    maladaptive cognitive processes and behavior.

26
The Humanistic Approach
  • employed philosophy, existentialism, and theories
    of human growth and potential.
  • It focused on the patients experience or
    phenomenology.
  • It offered warmth, empathy, and unconditional
    positive regard in psychotherapeutic
    interactions.

27
The Humanistic Approach
  • During the 1950s and 1960s, the humanistic
    approach gained common acceptance.
  • Psychodynamic and behavioral views perceived the
    human nature as negative. The humanistic school
    accepted the more optimistic and approval views.
  • The humanistic approach became known as the third
    force following the psychodynamic and behavioral
    approaches.

28
The Humanistic Approach
  • It was strongly influenced by philosophy and the
    existential approach. The existential approach
    became popular after World War I and in response
    to Nazi Germany during World War II.
  • Kierkegaard, Nietzsche, Sartre, Buber, and
    Heidegger were existantialists.
  • This approach focused on the meaning of life.

29
The Humanistic Approach
  • American psychologist Rollo May and psychiatrist
    Irvin Yalom helped to popularize the existential
    approach to humanistic therapy in the USA.
  • Psychoanalytic writers such as Hans Kohut and
    Otto Kernberg have integrated some of the
    humanistic perspective into their writing.
  • Carl Rogers, Abraham Maslow, Frederick Perls,
    Victor Frankl contributed to the development of
    the humanistic approaches to psychotherapy.

30
Their commonalities are
  • that humans are able to be consciously reflective
    and have the ability to experience
    self-determination and freedom. Thus, therapists
    must be able to fully understand a persons
    perception.
  • that humans struggle toward growth and are not
    trying to maintain homeostasis by satisfying
    various primitive needs and conflicts.

31
Existantialists
  • Sartre Kierkegaard
    Nietzsche

32
Their commonalities are
  • that defended a belief in free will and regarded
    human behavior as not just a by-product of early
    childhood experiences or only conditioned
    responses to the external environment.
  • that is person-centered with maximum respect for
    the individual and his or her experiences.

33
Carl Rogers (1902-1987)
  • The client-centered approach of Carl Rogers
    became the most influential humanistic therapy.
  • The approach emphasizes empathy,
  • unconditional positive regard, congruence,
  • intensive active listening, and support to
    reach full human potential.

34
The Family Systems Approaches
  • tend to use the whole family in understanding and
    treating problematic feelings and behavior.
  • Prior to the 1950s, the family members of the
    identified patient were left out of the treatment
    and not viewed as potentially active agents of
    dysfunction and recovery.
  • During the 1950s, 1960s, and 1970s, the family
    systems approach became popular.

35
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36
The Family Systems Approaches
  • Therapists observed that patient functioning
    often worsened when the patient interacted with
    family members. Therefore, all family members
    were treated together.
  • The family systems approach emerged from the
    Bateson Project during the 1950s. Gregory
    Bateson, an anthropologist, was interested in
    communication styles, collaborating with Jay
    Haley to examine communication styles such as
    double-bind communication. Double-bind messages
    include impossible-to-satisfy requests.

37
The Family Systems Approaches
  • Jay Haley later joined with Salvador Minuchin to
    develop the structural family therapy model and
    focused on family boundaries and generational
    hierarchies.
  • Haley, in the 1970s, founded the Washington
    Family Institute where his wife, Cloe Madanes,
    developed the strategic therapy model. Strategic
    therapy uses paradoxical intention.

38
  • In Europe, Maria Selvini-Palazoli and colleagues
    founded the Milan Associates to treat families
    confronted with anorexia nervosa in a family
    member.
  • Murray Bowen used psychoanalytic theory in their
    application of family therapy.

39
The Family Systems Approaches
  • Carl Whitaker and Virginia Satir focused on
    experiential models.
  • Nathan Ackerman and Salvador Minuchin developed
    structural family therapy and focused on family
    boundaries and generational hierarchies.

40
The Family Systems Approaches
  • While there are various types of family
    therapies, commonalities are
  • a focus on the role of the whole family system in
    producing and maintaining problematic behavior,
  • communication patterns associated with family
    problems,and
  • ongoing maladaptive relationship patterns among
    family members.
  • Intervention at the family level rather than at
    the individual level became the goal of these
    treatment strategies.

41
Psychotropic Medication
  • Biological treatments and medications such as
    opium, insulin, and electric convulsive therapy
    (ECT) were used to treat mental illnesses during
    the early and mid part of the 20th century.

42
ECT
43
  • Clinical Psychology Immediately after World War
    II
  • Boulder Conference in 1949, standards for
    doctoral training, scientist-practitioner model.
  • Alternative psychotherapies rose to the
    Psychodynamic Approach

44
Psychotropic Medication
  • In 1950s, the effective medications were
    developed to treat severe disorders such as SCH
    and bipolar illness. It was by accident.
  • In 1952, Jean Delay gave the chlorpromazine
    Largactil to patients. They found that
    schizophrenic patients experienced fewer
    hallucinations and delusions.

45
Psychotropic Medication
  • Benzodiazepines (such as Diazem) were found in
    the 1960s to be effective in reducing anxiety.
  • The prophylactic use of neuroleptics increased
    the possibility of community residence and
    decreased the demand for hospitalization. There
    was a trend to deinstitutionalize for
    schizophrenic patients.
  • The increasing use of medication to treat
    psychiatric problems gave the leadership role
    physicians.

46
Psychotropic Medication
  • Today, about 20 to 30 of all medications
    prescribed are related to depr and anx.
  • Psychologists obtained prescription privileges in
    Louisiana, New Mexico and Guam.

47
Community Mental Health Movement
  • During the period of deinstitutionalization,
    patients needed outpatient services to adjust to
    the society, obtain employment, and cope with the
    stresses of life and social demands. Interest in
    the prevention of mental illness as well as the
    social factors that contribute to mental illness
    such as poverty, homelessness, racism,
    unemployment, and divorcedeveloped community
    mental health movement.

48
  • The community mental health clinics opened
    throughout the USA. Psychologists provide a wide
    range of professional services in these clinics.

49
The Integrative Approaches
  • After the explosion of new theories and
    approaches during the 1950s, 1960s, and 1970s,
    many researchers and clinicians felt dissatisfied
    with one particular theory. Each school such as
    behavioral, CBT, humanistic, family systems,
    psychodynamic developed their own philosophy or
    worldview.

50
The Integrative Approaches
  • Many psychologists felt dissatisfied with one
    particular theory. During the late 1970s and
    early 1980s, many professionals sought to
    integrate the best.
  • Research was unable to demonstrate that any one
    treatment approach or theoretical orientation was
    superior relative to the others. Majority of
    clinicians identified themselves as being
    eclectic or integrative.

51
The Integrative Approaches
  • Dollard and Miller (1950) tried to understand
    psychodynamic concepts through behavioral or
    learning theory language.
  • Jerome Frank examined the commonalities of
    various methods and found that they all include
    instilling hope in the patient, encouraging
    improved morale and understanding of self and
    others, a healing setting (e.g., psychotherapy
    office), and supporting change outside of the
    treatment environment.

52
The Integrative Approaches
  • Others focused on the nature of the professional
    relationship as being a common curative factor in
    all types of therapies.

53
The Biopsychosocial Approach
  • Since the 17th century and the influence of
    Descartes and Newton, theories of health and
    illness have tended to separate the mind from the
    body. Western medicine view sickness as being
    influenced either by biology, such as genetics
    and neurochemical imbalances, or by the mind,
    such as personality and interpersonal conflicts.

54
The Biopsychosocial Approach
  • During the last half of the 20th century,
    advances in medicine, science, psychology,
    sociology, ethnic and minority studies have
    provided evidence for interactive
    multidimensional influences on health and
    illness.

55
The Biopsychosocial Approach
  • New discoveries in genetics and neurochemistry,
    such as neuroimaging, have hardened the
    contribution of biology to emotion and behavior.
    The effectiveness of psychotropic medications
    provided evidence to the biological influences
    impacting behavior.

56
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57
  • The new theories provided evidence to
    psychological and social factors influencing
    health, illness, and behavior. The community
    mental health movement demonstrated the influence
    of social, cultural, and economic factors.

58
The Biopsychosocial Approach
  • emerged during the late 1970s. In 1977, George
    Engel published a paper that proposed the
    biopsychosocial approach as the model of
    understanding and treating illness. The approach
    suggests that physical and psychological problems
    are likely to have a biological, psychological,
    and social element that should be understood in
    order to provide effective intervention
    strategies.

59
The Biopsychosocial Approach
  • The biological, psychological, and social aspects
    of health and illness influence each other.
  • When designing treatment and prevention
    interventions, an understanding of these
    interactions should be taken into consideration.

60
The Vail Conference
  • A turning point in the training of clinical
    psychology occurred during the 1973 Vail
    Conference.
  • The Conference aimed to discuss how training
    could be altered to accommodate the changing
    needs of both clinical psychology students and
    society.

61
The Vail Conference
  • In addition to the Boulder or scientist-practition
    er model, the Vail or scholar-practitioner model
    was an alternative.
  • This model suggested that clinical training could
    emphasize the delivery of professional
    psychological services while minimizing research
    training. Graduate training need not occur only
    in university psychology departments but could
    also occur in professional schools of psychology.

62
The Vail Conference
  • The Conference approved the PsyD (or doctor of
    psychology) degree as an alternative to the PhD
    degree.

63
Salt Lake City Conference
  • During 1987, the National Conference held another
    meeting to examine how training models best fit
    the needs of students, society, and the
    profession.

64
Salt Lake City Conference
  • This Conference approved the notion that all
    graduate training in clinical psychology,
    regardless of the degree (PhD or PsyD) or setting
    (university or professional school), should
    include a core curriculum containing courses such
    as research methods, statistics, professional
    ethics, history and systems, psychological
    assessment, and on the biological, social,
    cognitive, and individual difference bases of
    behavior.

65
Salt Lake City Conference
  • The Conference stated that all APA accredited
    programs should at least be affiliated with a
    regionally accredited university. This measure
    was passed in order to maintain better control
    over the professional schools. But, this
    recommendation has been ignored. The majority of
    professional schools of psychology are still not
    associated with any university.

66
New training model
  • Clinical scientist model is a more
    research-oriented and scientific approach to
    training relative to Boulder and Vail models. It
    developed in the 1990s.

67
Michigan Conference on Postdoctoral Training
  • The APA accredits and provides detailed
    guidelines for graduate and internship training,
    no APA guidelines have been provided for
    postdoctoral training.
  • The Michigan Conference developed guidelines and
    plans for control and regulation of postdoctoral
    training.

68
Michigan Conference on Postdoctoral Training
  • Recommendations included
  • the completion of APA accredited doctoral and
    internship training programs prior to admission
    to accredited postdoctoral training programs
  • at least two hours per week of face-to-face
    supervision by a licensed psychologist and
  • a systematic evaluation mechanism for examining
    the trainees.

69
The rise of Empirically Supported Treatments
  • Empirically supported treatments are
    well-established treatment approaches.
  • Standards for empirically supported treatments
  • They have received significant research support
    demonstrating their efficacy using between- group
    design or single-case design methods.

70
Empirically Supported Treatments
  • Results must have demonstrated superiority to
    placebo or other treatments.
  • Experiments must have used enough subjects.
  • They must have used treatment manuals.
  • The effects must be found by two independent
    researchers.

71
Empirically Supported Treatments
  • Examples
  • Exposure treatment phobia, PTSD.
  • CBT headache, panic, bulimia, irritable bowel
    syndrome
  • Insight-oriented dynamic therapy depression,
    marital discord.

72
Evidence-based practice
  • Evidence-based practice attempts to integrate the
    best available clinical research with quality
    clinical expertise to help the unique individual
    seeking professional services get his/her needs
    met.

73
Significant recent events
  • 1970 DSM II published
  • 1973 Vail conference,
  • 1980 DSM III published
  • 1981 APA ethical standards revised
  • 1982 Health psychology defined
  • 1985 ???????
  • 1987 DSM III-R published
  • 1987 Salt Lake City conference

74
Significant Recent Events
  • 1988 American Psychological Society founded
  • 1992 Michigan Conference
  • 1994 DMS IV published
  • 2002 APA ethics code revised
  • 2002 New Mexico allows psychologists
    medication prescription authority

75
Present Status
  • Diversity in gender, culture, ethnicity,
    language, religion, sexual orientation, physical
    ability and disability, and the entire spectrum
    of individual differences has been important for
    the practice.
  • Training itself is undergoing significant
    changes.
  • The gender distribution of clinical psychologists
    has changed from being mostly men to being mostly
    women.

76
Present Status
  • Economic factors in health care are altering the
    field. Significant reductions in funding
  • Solo independent practice may become less
    attractive as a career option in the future.
    Clinical psychology has expanded beyond the
    mental health field into the general health care
    and preventative health care fields.

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