Recent History of Clinical Psychology

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 ProfessionalSchools 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. Veteran’s 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 departmentsin universities across the country had a great deal of freedom to determinehow 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 mentalhealth movement rose. Psychotropic medicationin 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 morescientifically 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 (1849–1936)

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 tothe social and political influences of the time. It was an optimistic notion that wecould 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 alteredthrough 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 Ellis’s Rational-Emotive Therapy; Aaron Beck’s 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 alterthe patient’s irrational beliefs about themselvesand others. Beck’s cognitive approach focuseson to alter maladaptive thought patternsand developing more adaptive ways ofthinking. Depressed peopletend to view themselves, others, and theworld as more negative. Meichenbaum’s self-instructional approach uses self-talk to alter problematic thinking and behavior..

25. Their commonalities are that learning and behavior are cognitively mediated by attitudesand attributions. that the role of thetherapist 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 patient’s 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 forcefollowing the psychodynamic and behavioral approaches.

28. The Humanistic Approach It was strongly influenced by philosophy and the existential approach. The existential approach became popularafter World War I andin 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 person’s 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 willand regarded human behavior as not just aby-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.

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 prescribedare related to depr andanx. 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, obtainemployment, and cope with thestresses of life and social demands. Interest inthe prevention of mental illness as well as thesocial factors that contribute to mental illness—such as poverty, homelessness, racism, unemployment, and divorce—developed 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 dissatisfiedwith 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.