The Clinical Psychologist

Background, Roles, and Functions

Eugene E. Levitt

• Publisher: Routledge
• Year: 2017
• Print ISBN:
  9781138534742
• eBook ISBN:
  9781351484923
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

Clinical psychology is the largest of psychological specialization in the United States. It deals most often and most directly with public health and welfare in government agencies, universities, hospitals, clinics, and private industries and organizations. This volume describes the nature and function of the clinician, traces the evolution of the field, and devines workable training procedures. This collection presents an overview of the major aspects of the field, defi ning the history and professional role of the clinical psychologist.The volume includes the historic Shakow Report, as well as major essays illuminating signifi cant developments in the field. The editors have systematically organized the contributions into the categories of history, training, roles and functions, inter-professional relations and communications, the practice of clinical psychology outside the United States, and general information of particular use to those training in clinical psychology.In this practical and useful volume, the professional in clinical psychology will find a complete, one-volume sourcebook on his field. The student who has elected to specialize in clinical psychology or is considering this move will find it useful to gain a perspective on the development of the field. Those outside clinical psychology-- psychiatrists, psychiatric nurses, social workers, and all mental health specialists--will find practical information that can assist them in their professional roles.

I
HISTORICAL PERSPECTIVES

Historians are fond of saying that the study of history sharpens the perspective of the current scene. To understand what has gone before improves the comprehension of what is now. We trust that the historians are correct in their conjecture and have hence included in this compendium a section on the history of clinical psychology.

It has been said that psychology in general has a long history but a brief existence as yet. This is true of clinical psychology in 1967. Its history dates back identifiably to the nineteenth century, but the actual establishment of the specialty was a consequence of World War II, as Watson and Rotter clearly show. The former presents broad trends up to the immediate postwar decade. Rotter’s account adds the developments of the succeeding ten years and treats the subject matter more specifically in terms of the major functions of the clinical psychologist as they are presented in Part III.

The 1947 report of the Shakow Committee on clinical training is included here because of its great influence on contemporary clinical psychology. The so-called Shakow Plan, which is the substance of the 1947 report, has been the basis of formal training of the clinical psychologist for the past two decades. It deserves an eminent place of its own in any historical account of clinical psychology.

1. A Brief History of Clinical Psychology

ROBERT I. WATSON

CLINICAL psychologists have been surprisingly ahistorical. Very little thought has been given to, and less written about, the origin and development of clinical psychology. In the literature there are articles and books which interpret historically various special aspects or evaluate related fields, some of which have been of considerable help in preparing this paper. Nevertheless, whatever the reasons, there is no available general account of the history of clinical psychology from the perspective of today.

In part, this neglect is due to the upsurge of interest in clinical psychological activity during and following the second World War. Since then, clinical psychologists have had little time to spend inquiring into their origins. Then, too, their day-to-day activities impress them as so new and vital that they are hardly to blame for tacitly accepting that they are pioneers and that somewhere in the chaos of war and its aftermath was born a new profession having little or no relation to what went before. The state of affairs today is curiously reminiscent of the situation found by Kimball Young in 1923 in tracing the history of mental testing. He remarked, “Making history on every hand as we are, we have a notion that we somehow have escaped history” (121, p. 1).

To capture in full measure the sweep and continuity of the history of clinical psychology is beyond the competence of the reviewer, to say nothing of space limitations. In order to do justice to all aspects of the subject one would have to deal with the complex history of the psychology of motivation and dynamic psychology. Similarly, all the ramifications of the relation of clinical psychology to the rest of the field of psychology, of which it is an integral part, as well as an account of the history of test development would have to be considered.

The present account, perforce, presents an examination of men and ideas influential in shaping clinical psychology. But, since psychology is now a profession, attention must also be devoted to those internal and external controls which characterize a profession and to the settings in which the professional practice is conducted.

In presenting a historical account the question arises concerning the most appropriate date at which to begin. With some justification it was decided that since clinical psychology, as we know it, arose at about the turn of the present century it would be appropriate to begin with the immediate forerunners of this first generation of clinical psychologists. The origins of clinical psychology, the first major section of this account, are to be found in the psychometric and dynamic traditions in psychology; the psychologist in the settings of the psychological clinic, child guidance, mental hospitals, institutions for the mentally defective; and the beginnings of psychology as a profession. Somewhat arbitrarily this early pioneer work is considered to come to a close with the end of the second decade of this century. This is followed by a section concerned with clinical psychology in the twenties and thirties. The same topics just mentioned, e.g., the dynamic tradition and psychology as a profession, are again considered. The work of psychologists in the armed services during the second World War and its effect upon psychology in the postwar period are next evaluated. A brief overview of clinical psychology today closes the account.

THE ORIGINS OF CLINICAL PSYCHOLOGY: THE PSYCHOMETRIC TRADITION

This tradition, one of the headwaters from which clinical psychology sprang, was, in turn, a part of the scientific tradition of the nineteenth century. With all the limitations with which it is charged today, it is to this movement that the clinical psychologist owes much of his scientific standing and tradition. Whenever a clinical psychologist insists upon objectivity and the need for further research, he is, wittingly or otherwise, showing the influence of this tradition. Moving with Galton through Binet and Terman, this tradition met the demand that psychology, if it was to become a science, must share with other sciences the respect for quantitative measurement.

Psychometrics as a tool for clinical psychology owes its beginnings to Francis Galton (53) in England. Grappling as he was with the problem of individual differences, he and his followers did much to lay the groundwork for the investigation of ability by using observations of an individual’s performance for information on individual differences. He thus founded mental tests.

In 1890 Cattell (29) introduced the term “mental tests” in an article describing tests which he had used at the University of Pennsylvania. Even at that date he was pleading for standardization of procedure and the establishment of norms. From the time of his days as a student of Wundt’s, Cattell was interested in the problem of individual differences and did much to stimulate further investigation. Along with Thorndike and Wood-worth, he also stressed dealing with individual differences by means of statistical analysis—a really new approach at this time. Some of these investigations, both from Cattell’s laboratory and from others in various parts of the country, made positive contributions to various facets of the problem of psychometric measurement. For example, Norsworthy (82) in 1906 compared normal and defective children by means of tests and found the latter not a “species apart,” pointing out that the more intelligent of the feebleminded were practically indistinguishable from the least intelligent of the normal.

Most of the investigations of the time were concerned with simple sensorimotor and associative functions and were based on the assumption that intelligence could be reduced to sensations and motor speed, an attempt which, as is now known, was doomed to failure. Furthermore, although more suitable verbal material was used, the studies of college students at Cornell, such as Sharp’s (95), and the Wissler study (113) at Columbia, were found to be essentially non-predictive. What the workers failed to take into account was that the college students are a highly selected group having a considerably restricted range. The negative finding of these studies effectively blocked further investigation at the college level for years. When one stops to consider that the dominant systematic position of the day was the structuralism of Titchener, who had banished tests as nonscientific, it is no wonder that “tests” were viewed with at least a touch of condescension.

In the meantime Binet had been working in France developing his tests based on a wider sampling of behavior than had yet been used. His success in dealing with the intellectual classification of Paris school children is well known and needs no amplification at this point. The translation of his tests and their use in this country followed shortly after the turn of the century. It was Goddard (simultaneously with Healy), a student of G. Stanley Hall, who introduced the Binet tests to this country. Through a visit abroad and contact with Decroly, he became acquainted with Binet’s work (121). In 1910 he began publishing findings with the test and in 1911 published his revision of the 1908 Binet Scale. This revision, along with Kuhlmann’s, also published in 1911, gained some popularity among clinicians, but the subsequent development by Terman far overshadowed their work.

Probably the test that had the most influence upon trends in clinical psychology was the Terman Revision of the Binet Scale (83). In fact, for years the major task of the clinical psychologist was to administer the Stanford-Binet. In view of the importance of this test it is desirable to present in some detail the background of its development.

Lewis M. Terman (101) received his graduate training at Clark just after the turn of the century under Hall, Sanford, and Burnham. As Terman put it, “For me, Clark University meant briefly three things: freedom to work as I pleased, un-limited library facilities and Hall’s Monday evening seminar. Any one of these outweighed all the lectures I attended” (101, p. 315). This influence of Hall’s was more from the enthusiasm he inspired and the wide scope of his interests than from his scientific caution and objectivity. Sanford was his doctoral adviser, but Terman chose his own problem in the area of differentiation of “bright” and “dull” groups by means of tests and worked it through more or less independently.

By a severely limited survey such as this it would be easy to give the impression that little or nothing else was being done along the lines under discussion except that reported. Terman was not alone in his interest in the development and standardization of tests by any manner of means. In his autobiography Terman (101) mentions as known to him in 1904 the work of Binet, Galton, Bourdon, Oehrn, Ebbinghaus, Kraepelin, Aschaffenburg, Stern, Cattell, Wissler, Thorndike, Gilbert, Jastrow, Bolton, Thompson, Spearman, Sharp, and Kuhlmann.

At the suggestion of Huey, who had been working in Adolf Meyer’s clinic at Johns Hopkins, Terman, undeterred by the prevailing hostile attitude of most psychologists, began work with the 1908 Binet Scale and in 1916 published the Stanford Revision of the Binet-Simon tests. Terman’s interest in both the test and results from it continued unabated, resulting in still another revision in 1937.

Performance tests, so necessary for work with the linguistically handicapped, actually antedated the Stanford-Binet. The Seguin, Witmer, and Healy form boards and other performance tests were already in clinical use. Norms, although not lacking, were undeveloped, and the directions placed a high premium on language. What seemed to be needed was a battery of performance tests sampling a variety of functions and not as dependent upon language. Among the earliest to appear and to come into fairly common use was the Pintner-Paterson Scale of Performance Tests (55), published in 1917. Included in this scale were several form boards, a manikin and a feature-profile construction test, a picture completion test, a substitution test, and a cube-tapping test.

Another major step was the development of group tests under the impetus of the need for large scale testing of recruits in World War I. This testing program is described with a wealth of detail by Yerkes (120). Although group tests were not unknown before the war, as witness those described in Whipple’s Manual of Mental and Physical Tests (110), the need for quick appraisal of the basic intelligence of a large number of men provided the impetus for extensive development. The Alpha scale for literate English-speaking recruits and the Beta scale for illiterates and non-English-speaking recruits were developed rapidly under this demand. The Woodworth Personal Data Sheet (118), the first of a long line of psychoneurotic inventories, also was a product of military needs. So successful were these tests in overcoming the prejudices against testing both within the field of psychology and in the general public that after the war a veritable flood of group tests appeared. Many extensive surveys in the public schools were made for classificatory purposes. Further developments in this tradition during the twenties and thirties will be appraised after examination of other aspects of the origin of clinical psychology.

A major source of influence contributing to the growth of clinical psychology was the thinking and writing of the “Boston group’’ who promulgated “the new psychology’’—William James, G. Stanley Hall, and their associates. Although in no way could they be labeled clinical psychologists, their thinking was much closer to the heart of the clinical psychology movement and to progressive psychiatry than was the structural point of view of Titchener. Heresy though it may be, it cannot be denied that at that time academic psychology had relatively little to contribute to clinical psychology. Psychology, to be sure, had been placed by Fechner, Helmholtz, Wundt, Kraepelin, and others upon a scientific, quantitative foundation instead of being permitted to remain an indistinguishable cohort of philosophy. This was an essential step without which there could have been no clinical psychology; nevertheless, a sensationalistic approach to conscious intellectual experience offered relatively little for the clinical method and the profession with which it was to be associated.

The psychiatry of the day was in the main concerned with pathology and the search for an explanation of mental disturbances in disease processes. Kraepelin (68) had introduced clarity through his classification of mental disease, but at the expense of deeper understanding. Based upon symptoms and primarily descriptive in character, his classification served to diminish—even to discourage—in its users any urge toward understanding the psychological dynamics.

French psychiatric thinking and research profoundly influenced James (80). The work of Janet and Charcot was particularly important in this connection. With Morton Prince, he did much to stimulate interest in the phenomena of dissociation, feeling as he did that it was a fruitful method of investigation of personality functioning. Early in his career he recognized the value of a clinical approach which led him “whenever possible to approach the mind by way of its pathology’’ (77, p. 20).

The influence of James was expressed primarily through his Principles of Psychology (55), published in 1890, and to a lesser degree by his Varieties of Religious Experience (66), published in 1902. Both of these works were sufficiently removed from the otherwise prevailing psychological thinking of his day to be considered major pre-Freudian, dynamic influences. The choice of the term dynamic in this context is neither idle nor wishful thinking. James himself used the term to distinguish his point of view from the struc...

Table of contents

• Cover Page
• Half title
• Title
• Copyright
• Contents
• Foreword
• Introduction
• Part I: Historical Perspectives
• Part II: Training and Background
• Part III: Roles and Functions
• Part IV: Interprofessional Relations and Communication
• Part V: International Aspects of Clinical Psychology
• Part VI: General Information
• Index