1. Chapter 1
The Evolution of
Clinical Psychology
I N T R O D U C T I O N TO C L I N I C AL P S Y C H O L O G Y
L E C T U R E B Y : AY E S H A YA Q O O B
2. Introduction – Topics
2
Importance of Clinical Psychology
Related Mental Health Professions
History of Clinical Psychology
History of Assessment in Clinical Psychology
History of Intervention in Clinical Psychology
3. 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.
Clinical psychology
4. 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
4
5. 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
5
6. 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.)
6
7. 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
7
8. 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
8
9. 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
9
10. 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”
10
11. 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
11
12. 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”
12
13. 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
13
14. 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
14
15. 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
15
16. 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.
16
17. 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
17
18. 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
18
19. 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
19
20. 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.)
20
21. 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
21
22. 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
22
23. 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
History of Intervention in
Clinical Psychology
23
24. 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
History of Intervention in
Clinical Psychology
24
25. 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
History of Intervention in
Clinical Psychology
25
