Clinical Psychology

The Study of Personality and Behavior

Max Gluckman, Sol L. Garfield

• Publisher: Routledge
• Year: 2017
• eBook ISBN: 9781351527880
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

Interest in clinical psychology has been growing as indicated by large numbers of undergraduates applying for admission to graduate programs and the professional degrees granted. This book is written for anyone with a strong interest in clinical psychology, but also provides a comprehensive and realistic view of the field.

The book, therefore, can serve as a reference for courses in clinical psychology, but it will be relevant to courses in personality and personal counseling. Professional clinical psychologists and members of related professions may also find the book valuable because Garfield describes important historical developments that have helped to shape the field, the roles and functions of the clinical psychologist, their training programs, and contemporary issues and problems. The text also describes the theoretical models that guide the work of the clinical psychologist and upon which the divergent approaches to clinical work are based. Changes in the functions of the clinical psychologist are reflected in the greater emphasis on psychotherapeutic and behavior change methods and in the correspondingly reduced emphasis on diagnostic testing procedures--a development discernible in the decline in studies of high quality bearing on diagnostic issues.

This book provides a reliable source of information for the individual who contemplates a professional career as a clinical psychologist and seeks to learn what the profession encompasses.

1

Introduction and Historical Development

Although clinical psychology can claim to have existed for more than seventy years, its most rapid and significant growth has taken place in the last quarter century. Paralleling somewhat the general growth of the field of psychology itself, clinical psychology emerged slowly to play an increasingly important role in the area of human adjustment. While part of this emergence is undoubtedly due to society’s increased interest in mental health and adjustment in recent years, a substantial part rests also on the contributions made by psychologists and on the potential services they are seen as capable of providing.

This development, however, has not always proceeded smoothly. There have been conflicts between the professional and practical interests of clinical psychologists and the more research-oriented and scientific interests of other areas of psychology, and there have been some real struggles within clinical psychology itself concerning issues of training, professional roles, and the relative significance of the scientific and professional components of the clinical psychologist. There have also been some significant professional rivalries with older established professional groups such as the medical profession. While these problems have by no means been conclusively settled, clinical psychology continues to thrive and develop despite them.

Clinical psychologists today are employed in a variety of settings and are engaged in a great diversity of activities. These activities include the interviewing and testing of varied kinds of clients for assessment and diagnostic purposes; counseling and psychotherapeutic services for children, adults, college students, and families; consultation with schools, industry, government, and community groups; teaching in colleges and universities; administering clinics, hospitals, and various governmental programs; and engaging in basic and applied research pertaining to personality, abnormal behavior, and the evaluation of clinical techniques. As is evident from even this partial listing of activities, the clinical psychologist tends to interact with a variety of other professional groups. Moreover, it appears that, with such a diversity of activities and settings, the field of clinical psychology is of real interest to large numbers of people who have some motivation to work with others or have some curiosity concerning human behavior and adjustment. The latter assertion seems to be supported by the large number of individuals who every year inquire about and apply for graduate training in clinical psychology. Although many prospective students apply to more than one graduate school, the number of applicants to most graduate clinical programs is between fifteen to twenty for each available opening.

In any event, it is apparent that the field of clinical psychology has grown rapidly in recent years and that it has been recognized increasingly for its contribution to the study and treatment of problems in human adjustment. As indicated previously, however, this growth and development has at times been accompanied by various problems and conflicts concerning the primary roles for clinical psychology, the shortage of trained manpower in the mental-health field, and similar matters. Some of these issues have resulted both from the rapid expansion of the field since World War II and from the various historical influences that have helped to shape its development. It may be appropriate at this point, therefore, to examine the historical roots from which clinical psychology developed.

Historical Background

Clinical psychology, as a specialty area within the broader field of psychology, is of course closely related to its parent field. We can, therefore, start this historical account with the beginning of psychology as a science, which is usually associated with the founding of the first laboratory by Wilhelm Wundt in Leipzig, Germany, in 1879 (Boring, 1929). The areas of research were chiefly those of sensation and perception. Thereafter, for many years such problems and related ones were of primary interest to psychologists. Nevertheless, certain other interests of a more practical nature became evident. Although still measuring mainly sensory functions, James McKeen Cattell attempted to appraise the mental abilities of incoming students to Columbia University, in New York City, with a battery of psychological tests as early as 1894. Others, too, experimented with such approaches to mental measurement at this time.

From the historical standpoint, the earliest person who made a direct contribution to the development of clinical psychology was Lightner Witmer. If anyone merits the claim of being the founder of clinical psychology, it was undoubtedly this man. He studied with Wundt and received his Ph.D. degree from the University of Leipzig in 1892. He was then appointed director of the laboratory of psychology at the University of Pennsylvania. In 1896, a date that is sometimes given as the beginning of clinical psychology, Witmer founded the first psychological clinic in the United States and gave the first formal course in clinical psychology. In fact, Witmer gave the new discipline its name, and although a number of those who followed him were not enamored of it, it has, nevertheless, been retained.

Witmer’s clinical work began with the case of a child who had difficulties in spelling, and his interests continued to center on childhood disturbances. While he was particularly concerned with sensory difficulties, mental retardation, speech disorders, and problems in school learning, he apparently also tried to work therapeutically with psychotic children (Sarason and Gladwin, 1958).

Witmer also taught courses in Child, Clinical, and Abnormal Psychology and set up a training school and hospital to accompany his clinical teaching. In 1907 he founded the journal, The Psychological Clinic, and was active as editor and contributor to the journal until it ceased publication in 1935. Surprisingly, however, in spite of the fact that Witmer was an energetic worker and made significant contributions to the field of clinical psychology, his influence on later developments appears to have been limited.

Several writers have speculated about the surprising lack of influence of Witmer’s work on later developments. Some have pointed out that Witmer was mainly concerned with sensory and intellectual problems and that the child-guidance movement, which developed later, focused more on social and behavioral difficulties (Shakow, 1948; Watson, 1953). It is difficult to tell whether this explanation really accounts for the later expansion of the child-guidance movement and the more limited -impact of Witmer’s work. It is certainly conceivable that since psychology itself was in the early stages of its development, Witmer was considerably ahead of his time. In any event, Witmer was clearly a pioneer in the field of clinical psychology, and his clinic was one of the first to conduct psychological examinations. A somewhat more detailed account of Witmer’s contribution and the early history of clinical psychology in the United States can be found elsewhere (Garfield, 1965).

More important, historically, was the work of Binet in France at the end of the nineteenth century. Faced with the problems of school retardation and mental deficiency, Binet and his colleague, Simon, developed the first workable test of intelligence, one which was the prototype for most present-day intelligence tests, including the well-known revised Stanford-Binet Scale. The advent of standardized individual intelligence tests was an important development in applied psychology. World War I subsequently provided an opportunity for the use of group tests on a wide scale and, after the war, the group testing movement developed rapidly.

Closely related to the development of mental tests was the gradual application of such techniques to the study and care of the mentally retarded. Although psychologists such as Goddard and Witmer were working with defectives before the Binet Scale was introduced into the United States, the Goddard revision of the scale, in 1908, was readily applied to problems of diagnosis and classification. The Vineland School for feebleminded children in New Jersey, under the leadership of Goddard, pioneered in this work. It is interesting to note, too, that the early use of this scale was limited largely to retardates.

Although, as we have noted, Witmer founded the first psychological clinic in 1896 at the University of Pennsylvania, clinical psychology did not progress very rapidly before the introduction of the intelligence test. The influence of this test on clinical psychology is commented upon by Pintner in the following passage:

Although clinical psychology proper dates back at least to the last decade of the nineteenth century, it is undoubtedly true that the Binet Scale was the one most potent factor in its development and expansion. Shortly after the first work with the Scale in the institutions for the feebleminded, we find psychological testing of all kinds spreading rapidly to juvenile courts, reformatories, prisons, children’s homes and schools. The psychological clinic did not and does not depend upon the Binet Scale, but it is unquestionably true that the appearance of the Binet Scale acted as a tremendous stimulus to this type of work (Pintner, 1931).

In addition to tests of intelligence, other types of tests were also developed. At the same time that Cattell was testing Columbia students, Rice was working on comparative tests of spelling. This was the beginning of the testing movement in education, which was given real impetus a few years later by Thorndike and his students. Tests were devised for a variety of school purposes, including the measurement of achievement and diagnosis. Tests of special aptitude, such as the well-known Seashore Test of Musical Talent, also were developed before 1920. These developments were the forerunners of the school adjustment, guidance and remedial services which today are accepted as regular functions of educational institutions.

To say that the testing movement was the sole important factor in the historical development of clinical work in psychology, however, would be to distort the actual significance of this factor. Several other movements were of decided, although sometimes indirect, importance. Some of these can be mentioned rather briefly as indications of the diverse influences on what we recognize today as clinical psychology.

Other Early Related Developments

The growth of the mental-hygiene movement following the publication in 1908 of Beers’s famous account of his own hospitalization in A Mind That Found Itself (Beers, 1948) is noted here. Beers’s book and his untiring activity in behalf of the movement helped greatly to bring public awareness to the problems of mentally disturbed patients. This work tended to emphasize two main aspects of the problem: (1) Improvement in the care and treatment of patients hospitalized for serious personality disturbance, and (2) Prevention of such disorders. The concern with prevention of adult disorders led to planning for child-guidance clinics as active agencies for the early detection and treatment of deviant behavior patterns. These clinics were staffed by professional personnel competent to cope with such problems.

The first child-guidance clinic was founded in Chicago, in 1909, to work with delinquent children. Originally named the Juvenile Psychopathic Institute, it continues today as the Institute for Juvenile Research. The professional staff, at first, consisted of the psychiatrist, William Healy, as director, and the psychologist, Grace Fernald. Later, a social worker was added. It is of interest to note also that Healy introduced the Binet-Simon scale into the clinic in 1910 (Healy and Bronner, 1948).

In 1912, in connection with the recently established Boston (Mass.) Psychopathic Hospital, another children’s clinic was founded. In the following year, the Henry Phipps Clinic opened in Baltimore, Maryland, with a separate unit for children. A few years later, in 1917, Healy moved to Boston to set up and direct what is now known as the Judge Baker Guidance Center. Thus, in the United States, the child-guidance movement developed slowly at first, but continued to grow. Originally, the clinics appeared to have a primary concern with problems of delinquency, but later on they gradually enlarged the scope of their activities to include most types of adjustment problems. The psychologist’s contribution was that of psychological testing, but included other activities, depending on the training of the psychologist and the specific setting in which he worked. As an historical footnote, it can be mentioned that Healy visited Witmer’s clinic and Goddard’s laboratory at Vineland in 1908, and thus the latter conceivably had some influence on the child-guidance movement.

Paralleling some of these historical trends was a growing interest in the problems of the mentally disturbed as a proper field of study and treatment. Not too long ago, psychotics, epileptics, and others were looked upon as anomalies and as persons afflicted with evil spirits. Many were herded into prisons and “asylums,” and others were chained. Pinel was one of the first to regard them as individuals in need of sympathetic treatment. Along with a more humane attitude toward patients, there developed a greater knowledge and scientific interest concerning those unfortunates. Although a complete account of this story makes interesting reading (Deutsch, 1949; White, 1948), only a few aspects of it can be mentioned here—namely, those relating to the development of psychiatry and abnormal psychology.

In the latter half of the nineteenth century there was an increased interest in describing and classifying some of these behavioral disturbances in the field of medicine. Kraepelin’s well-known classification of some of the frequently observed psychopathological patterns was one of the important contributions to psychiatry and helped to emphasize it as a special field of study. Although psychiatry is considered a specialty within the field of medicine, it is an area whose subject matter overlaps with that of abnormal psychology and clinical psychology. There will be more said about this relationship later.

Although, as indicated, the care and treatment of hospitalized patients were confined to physicians, by the beginning of the present century psychologists began to conduct their own studies on psychotic patients. This work can be called “abnormal psychology,” in that an attempt was made to apply psychological methods to the study of various mental functions in patients. There was little intensive study of individuals as specific cases for understanding and treatment. Rather than “clinical’ contacts with patients, what was sought were studies of characteristic psychological reactions in various groups of patients. Such cross-sectional studies involved the appraisal of a given sample of subjects and emphasized the common or distinctive patterns found in the group rather than the study of individuals as individuals. Nevertheless, the application of psychological techniques to the study of personality disorders was a natural forerunner to the later development of clinical psychology.

One other historical antecedent is also worthy of mention in this brief review. The development of psychoanalysis by Sigmund Freud (1938) and his followers introduced many new and significant concepts in psychopathology. Freud was among the first to emphasize the importance of psychological factors in the etiology and treatment of neuroses. Although some of his former followers such as Alfred Adler, Carl Gustav Jung, Karen Horney, and Otto Rank have deviated from many of Freud’s basic postulates, they have also emphasized psychological factors in the understanding and treatment of personality disturbances.

Many of the clinical deductions and theoretical concepts offered by the psychoanalysts have had tremendous influence on both the theory and practice of clinical psychological work with a wide variety of persons. One of the most important and influential concepts of Freud was that which concerned the unconscious determinants of behavior. He was impressed with the fact that many of his patients appeared to have motivations of which they were unaware. In understanding a patient and his personal difficulties, one was forced to go beyond what the patient initially volunteered about himself. The analyst must probe below the surface to uncover the dynamic and complicated motivational forces accounting for the patient’s symptomatic behavior. Furthermore, in exploring these hitherto hidden aspects of personality, the psychoanalysts brought forth new views concerning the complex nature of human motivations and the factors associated with the “repression” of wishes and impulses dating from an earlier stage of the individual’s development. The psychological treatment of such problems also was found to be a complicated matter, and much work was directed toward improving the psychotherapeutic process. Psychoanalysis became both an investigative theory of personality and a method of psychotherapy. We will have more to say about these matters in later chapters pertaining to personality theories and psychotherapy.

The result of these “dynamic” theories of personality was an increased emphasis on psychological or psychogenic factors in behavioral pathology. Stress was put on understanding the symptoms of the individual patient instead of being unduly concerned with the description and classification of behavioral symptoms. Thus, these earlier workers were important as contributors to personality theories which clinicians utilize in the understanding and modification of behavior and as assumptions underlying some of our clinical techniques, for example, word association and projective tests.

These diverse developments, some within the field of psychology and some in related areas, have all contributed in some way to the historical development of clinical psychology. It is from this unique background that clinical psychology has emerged as a specialized professional discipline within psychology. Although declaring allegiance to psychology, clinical psychology is differentiated from the more traditional areas of general experimental psychology. At the same time, because of its historical derivation from within psychology, clinical psychology, although an applied clinical area, is differentiated from other related clinical professions which deal with similar subjects, for example, psychiatry, psychoanalysis, social work. Because of its unique development, clinical psychology offers a distinctive contribution to applied psychological work which no other related discipline can completely duplicate. Before this point is more fully explained, however, let us complete our historical sketch of the development of clinical psychology.

Although, as we have noted, clinical psychology was given its start by Witmer at the University of Pennsylvania over seventy years ago, there was no rapid acceptance or expansion of such activities in the years which immediately followed. Psychology was still a very young scientific discipline in the early years of the present century and not too much effort was devoted to this embryonic clinical development. While some psychologists turned their attention toward clinical problems, and a few became enthusiastic followers of the psychoanalytic movement, the majority of psychologists were primarily interested in academic laboratory work. The increased use of standardized psychological tests in the 1920s, however, was instrumental in setting up some demand and interest in psychological examinations. Some psychologists functioned as examiners in schools, and others began to apply these new techniques in clinics and hospitals. While the expansion of activities in this area was modest, there developed a gradual acceptance of psychological testing, particularly the testing of intelligence; within limits, clinical psychologists were lar...

Table of contents

• Cover Page
• Copyright Page
• Title Page
• Contents
• Preface
• 1. Introduction and Historical Development
• 2. Personality and Behavior Theories
• 3. Diagnosis and Personality Assessment
• 4. The Clinical Interview and the Gase Study
• 5. Psychological Tests and the Appraisal of Intellectual Functioning
• 6. Personality Appraisal
• 7. Other Diagnostic and Assessment Techniques
• 8. The Psychotherapeutic Function
• 9. Variations in Psychotherapy
• 10. Variations in Psychotherapy
• 11. Behavioral Therapies
• 12. Group Psychotherapy, Play Therapy, and Other Therapies
• 13. Research in Clinical Psychology
• 14. Community Psychology and Mental Health
• 15. Professional Problems and Development
• Index