Examination of Clinical Psychology Paper

Examination of Clinical Psychology Paper

Due 01-21-2018

Write a 1,050- to 1,400-word paper in which you examine clinical psychology.

Address the following items:

· Discuss the history and evolving nature of clinical psychology.

· Explain the role of research and statistics in clinical psychology.

· Discuss the differences between clinical psychology and other mental health professions, including social work, psychiatry, and school psychology.

Include a minimum of two sources from peer-reviewed publications.

Format your paper consistent with APA guidelines.

Plagiarism free

Rubric

1[OA] Signature Assignment: Examination of Clinical Psychology Paper1001Discuss the history and evolving nature of clinical psychology(25%)

Does Not Meet Expectations Did not explain or discuss the history and evolving nature of clinical psychology

Approaches Expectations Identified some historical events in clinical psychology, but did not discuss or explain the significance of those events in the context of the evolving nature of clinical psychology

Meets Expectations Explained or discussed the history and evolving nature of clinical psychology

Exceeds Expectations Explained or discussed the history and evolving nature of clinical psychology in a clear, concise fashion using examples of innovators and theories that demonstrates the historical evolution of origins and techniques within the field

2Explain the role of research and statistics in clinical psychology.(20%)

Does Not Meet Expectations Did not identify or explain the role of research and statistics in clinical psychology

Approaches Expectations Identified some aspects of research in clinical psychology, but did not explain the role of research and statistics in clinical psychology

Meets Expectations Explained the role of research and statistics in clinical psychology

Exceeds Expectations Explained the role of research and statistics in clinical psychology in a clear, concise fashion using examples that demonstrate the relationship between data and application

3Discuss the differences between clinical psychology and other mental health professions including social work, psychiatry, and school psychology(35%)

Does Not Meet Expectations Did not explain or discuss the differences between clinical psychology and other mental health professions including social work, psychiatry, and school psychology

Approaches Expectations Identified key aspects of some mental health professions and clinical psychology, but did not discuss the significant differences between them.

Meets Expectations Discussed the differences between clinical psychology and other mental health professions including social work, psychiatry, and school psychology

Exceeds Expectations Discussed the differences between clinical psychology and other mental health professions including social work, psychiatry, and school psychology in a manner that draws notable comparisons and contrasts among them with clear, concise examples that specify limits and boundaries of theory and practice

4Quality of written communication Write a 1050-1400 word paper with two peer-reviewed resources/references(10%)

Does Not Meet Expectations The paper did not meet the minimum word count and did not include the required elements of the assignment. Inconsistent grammar, spelling and paragraphing throughout paper and inability to explain findings clearly. Surface errors are pervasive enough that they impede communication of meaning.

Approaches Expectations The paper may have met the minimum word count but lacked some of the required elements of the assignment. Adequate explanation of findings. Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language, sentence structure, and/or word choice are present.

Meets Expectations The paper met the minimum word count and included all of the required elements of the assignment. Clear and logical written explanation of findings. Some mechanical errors or typos are present, but are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.

Exceeds Expectations The paper met the minimum word count, included all of the required elements of the assignment, and provided some analysis and/or evaluation beyond the required elements of the assignment. Exceptionally concise written explanation of findings. Prose is free of mechanical errors. A variety of sentence structures and effective figures of speech are used. Writer is clearly in command of standard, written, academic English.

5Use of APA Format/Style(10%)

Does Not Meet Expectations APA format and style are not evident

Approaches Expectations Missing APA elements; in-text citations, where necessary, are used but formatted inaccurately and not referenced

Meets Expectations All key elements of an APA title page are present; In-text citations and a reference page are present with few format errors. Mechanics of writing are reflective of APA style

Exceeds Expectations A broad understanding of APA format and style is evident. Accurate citations and references are presented. No APA errors are evident

PSY/480 Text

Chapter 1

As you can tell from this example, clinical

psychology is a complex field that

parallels the complexity of human behavior

and emotion. Just as we are defined by more

than blood and tissue, emotions and ideas, or

our relationships to others, the field of clinical

psychology is, by necessity, an integrative

effort to understand the interaction of the biological,

psychological, and social factors that

make each of us ‘‘tick.’’ Furthermore, modern

clinical psychology must respond to contemporary

issues that impact all of our lives. For

example, the importance of ethnicity, culture,

and gender in today’s society informs and

enriches the field of contemporary clinical

psychology as do current issues related to

economics, technology, ethics, and popular

culture.

As with medicine and other fields, the

roots of clinical psychology are viewed as

simplistic and narrowly conceived. However,

with scientific advancements and collaboration

between various fields and schools of

thought, contemporary clinical psychology

champions a sophisticated integration that

pulls together the best of these models for

optimal treatment, assessment, consultation,

and research.

Before describing the historical evolution

of clinical psychology into its contemporary

form, this chapter defines clinical psychology

and the varied roles and activities of

today’s clinical psychologist. In addition, the

integrative and evidence-based nature of contemporary

clinical psychology will be highlighted.

The purpose of this chapter is to

examine exactly what clinical psychology is all

about. I will define clinical psychology as well

as outline the educational process for clinical

psychologists, detail their typical roles and professional

activities, list the usual employment

settings, the various subspecialties within clinical

psychology, the professional organizations

of clinical psychology, and the similarities and

differences between clinical psychology and

What Is Contemporary Clinical Psychology? 5

related fields. Subsequent chapters will highlight

these issues (and others) in much more

detail. In doing so, a comprehensive and realistic

view of the field of clinical psychology

will be presented.

Throughout the course of this book, I discuss

the field of clinical psychology as understood

and practiced in the United States.

However, clinical psychology is recognized

and practiced in many other countries. The

American Psychological Association (APA),

the Canadian Psychological Association, and

the British Psychological Society, for example,

have more similarities than differences and

often host joint meetings and other professional

activities. The doctorate is the expected

level of training for psychologists in the United

States, Canada, and the United Kingdom.

Much of Europe and elsewhere do not require

doctoral training for clinical

psychologists.

Unfortunately, it is beyond the scope

of this book to detail the training, history,

and activities of clinical psychologists in other

countries. However, much of the information

presented is universally relevant to clinical

psychologists.

Definition and Inherent Intrigue

What could be more intriguing than human

behavior and interpersonal relationships in

all their complexity? A visit to any major

bookstore or a Google search of ‘‘psychology’’

reveals that topics such as clinical psychology,

self-help, and the general use of psychological

principles in understanding our lives are

enormously popular and pervasive. Hundreds

if not thousands of books are published each

year that focus on ways to better understand

human behavior, replete with methods

to improve psychological functioning as it

interacts with physical wellbeing, emotions,

and interpersonal relationships. Furthermore,

a popular television program during recent

years has been The Dr. Phil Show, a clinical

psychologist offering advice on numerous

wide-ranging topics for willing participants

and a national audience.

Although the independent discipline of

psychology is only about 100 years old,

psychology is one of the most popular current

undergraduate majors in most colleges and

universities. Furthermore, clinical psychology

is the most popular specialty area within

psychology (APA, 2009a, b; Norcross, Sayette,

& Mayne, 2008). Doctorates in psychology

are more common than any other doctoral

degree awarded in the United States with

the majority of psychology doctorates being

awarded in clinical psychology (APA, 2009a,

b; Norcross et al., 2008). The majority of

members of the APA list clinical psychology

as their area of specialization (APA, 2010a).

Additionally, being a clinical psychologist has

also made recent lists of ‘‘hottest jobs’’ by

Money magazine and other popular national

publications.

How is clinical psychology defined? Clinical

psychology focuses on the assessment, treatment,

and understanding of psychological and behavioral

problems and disorders. In fact, clinical

psychology focuses its efforts on the ways in

which the human psyche interacts with physical,

emotional, and social aspects of health and

dysfunction. According to the APA, clinical

psychology attempts to use the principles of

psychology to better understand, predict, and

alleviate ‘‘intellectual, emotional, biological,

psychological, social, and behavioral aspects

of human functioning’’ (APA, 2009a). Clinical

psychology is ‘‘the aspect of psychological science

and practice concerned with the analysis,

treatment, and prevention of human psychological

disabilities and with the enhancing of

personal adjustment and effectiveness’’ (Rodnick,

1985

, p. 1929). Thus, clinical psychology

uses what is known about the principles of

human behavior to help people with the numerous

troubles and concerns they experience

during the course of life in their relationships,

emotions, and physical selves. For example,

a clinical psychologist might evaluate a child

using intellectual and educational tests to determine

if the child has a learning disability or

an attentional problem that might contribute

to poor school performance. Another example

includes a psychologist who treats an adult

6 Foundations and Fundamentals

experiencing severe depression following a recent

divorce. People experiencing substance

and other addictions, hallucinations, compulsive

eating, sexual dysfunction, physical abuse,

suicidal impulses, and head injuries are a few

of the many problem areas that are of interest

to clinical psychologists.

Who is a clinical psychologist? Many people

with different types of training and experience

are involved with helping understand,

assess, and treat people with problems in

living. Counselors, nurses, psychiatrists, peer

helpers, and others are involved with the areas

of concern already listed. Clinical psychologists

‘‘have a doctoral degree from a regionally

accredited university or professional school

providing an organized, sequential clinical

psychology program in a department of psychology’’

(APA, 1981, p. 641). Although many

universities offer master’s degree training programs

in clinical psychology, the doctorate is

assumed to be the minimal level of training to

be considered a clinical psychologist. Clinical

psychology is not so much a specialty separate

from psychology, but is more a unique application

of psychology to the realm of emotional

and behavioral problems (APA 1987a, 2009a;

Matarazzo, 1987; Norcross et al., 2008).

Perspective and Philosophy

Clinical psychology uses the scientific method

to approach and understand human problems

in behavior, emotions, thinking, relationships,

and health. Rigorous scientific inquiry is used

to select and evaluate assessment and treatment

approaches and activities. Treatment

outcome research helps to determine which

treatments might be most effective for people

seeking help with particular clinical problems.

However, clinical psychology is both a science

and an art. Findings from scientific investigations

must be applied to the unique and special

needs of an individual, group, or organization.

What might be helpful to one person may not

be to another even if they both experience

the same diagnosis or problems. The science

of clinical psychology informs the art while

the art also informs the science. For example,

research findings from experiments on psychotherapy

outcomes are used to determine

which type of psychotherapy is most useful

with people experiencing depression, whereas

clinical experience working with people struggling

with depression is used to better design

and implement psychotherapy outcome research.

Contemporary clinical psychology

uses integrative

evidence-based approaches to understand

and address problems in

human

behavior.

While a wealth of individual perspectives

contribute important pieces of understanding

to the puzzle of human behavior, these pieces

must often be joined in novel ways to provide

the most complete and holistic perspective.

For example, advances in biology have

provided important knowledge about the role

of neurotransmitters in depression. Similarly,

personal variables such as history of loss and

trauma, as well as sociocultural factors such

as poverty, discrimination, and community

support in depression, are well appreciated.

Ultimately, an intelligent melding of these biological,

psychological, and social factors leads

to intervention strategies that best address

the complex needs of depressed individuals.

Therefore, this book emphasizes integrative

efforts to address human behavior, referring

to biopsychosocial factors throughout.

Although individual clinical psychologists

may be closely aligned with particular theoretical

perspectives on human behavior, most

contemporary clinical psychologists also appreciate

the integral roles of biopsychological

factors in

health and illness.

The biopsychosocial

perspective, an example of an integrative

approach, will be more fully described in

Chapter 6. To understand psychology’s roots

and gradual development into its present form

as an integrative endeavor, it is important to

keep in mind the impact of biopsychosocial

issues simply as the interplay of relevant biological,

psychological, and social factors in

human behavior.

Research and practice in clinical psychology

has found that certain approaches to

understanding and treating problems may

What Is Contemporary Clinical Psychology? 7

be especially useful for certain people and

problems while different approaches might

be most helpful for others. For example,

some people who experience depression respond

well to medication while others respond

to cognitive-behavioral psychotherapy. Others

respond well to supportive therapies such

as the humanistic approach. Still others respond

to a combination of these and other

approaches. Although medication might be

useful to treat someone with depression, family

therapy, vocational counseling, and group

social skills training may enhance treatment

success.

Many people who seek the services of a

clinical psychologist often have several problems

or diagnoses occurring at the same time.

For example, the person who experiences

depression may also suffer from a chronic

illness, a personality disorder, a learning disability,

alcohol troubles, and marital discord.

Furthermore, stressful life events, intellectual

functioning, ethnic background, religious orientation,

and other factors contribute to the

manifestation of the depressive disorder and

other problems. One theoretical orientation

alone may not address the complexity of the

person seeking help. Although various clinical

psychologists may be closely aligned with one

particular theoretical or philosophical orientation,

most contemporary clinical psychologists

believe that problems in human behavior are

multidimensional. They use an integrative and

evidence-based approach that suggests that interacting

causal factors generally contribute to

human problems and that a multidimensional

approach is usually needed to tackle these issues.

Thus, many factors may contribute to

human problems and a selection of factors

must be utilized to help alleviate these concerns.

Today, many clinical psychologists use

an integrative evidence-based perspective that

maintains a biopsychosocial orientation.

The biopsychosocial perspective emphasizes

the interaction of biological, psychological,

and social influences on behavior and

psychological functioning. Each must be carefully

considered and the individual viewed

in a broader biopsychosocial context in order

to best understand the complexities of human

behavior and the most effective means of intervention

(Borrell-Carrio´ , Suchman, & Epstein,

2004; Engel, 1977, 1980; N. Johnson, 2003;

G. E. Schwartz, 1982, 1984). Although clinical

psychologists may not be able to intervene

at the biological, psychological, or social level,

they must take into consideration these influencing

factors in understanding and treating

people who seek their services. For example,

psychologists cannot prescribe medication in

most states, conduct physical examinations,

or offer surgery to their patients. They cannot

alter ethnic, religious, socioeconomic, or

cultural backgrounds. However, clinical psychologists

can work to understand these influences

on behavior and clinical problems

and can consult with others who can provide

additional services such as medication management,

surgery, and spiritual and religious

direction.

The biopsychosocial approach is a systemic

perspective (Borrell-Carrio´ et al., 2004;

Schwartz, 1982, 1984); that is, changes in one

area of functioning will likely impact functioning

in other areas. The fluid and systemic

nature of the biopsychosocial approach highlights

the mutual interdependence of each

system on each of the other systems. For

example, feelings of depression may be associated

with brain neurochemicals, interpersonal

conflicts, disappointments in life, stresses at

home and at work, unrealistic expectations,

cultural context, and many other interacting

factors. Someone might be genetically

or biologically vulnerable to depression due

to brain chemistry. Stressful life events such

as a divorce, illness, or job loss may trigger

a depressive episode. Feelings of depression

may result in poor work performance, social

isolation, feelings of hopelessness, and lower

self-esteem, which may deepen the depression

as well as trigger brain chemistry that

in turn further worsens the depression. Educational,

cultural, socioeconomic, and other

factors might influence whatever treatment,

if any, is pursued by the depressed person.

Treatment success may be influenced by both

patient and therapist motivation, expectations,

8 Foundations and Fundamentals

and comfort with the treatment plan. The

biopsychosocial model has been endorsed as

the preferred approach to understanding and

treating health-related problems and issues by

the APA (Borrell-Carri ´o et al., 2004; Fava &

Sonino, 2008; Johnson, 2003) and other organizations

(Institute for the Future, 2000).

Details on theoretical orientations and the

biopsychosocial perspective will be discussed

more fully in Chapters 5 and 6.

Education and Training

Few people are aware of the long and intensive

training process that is involved in becoming a

clinical psychologist. Most do not realize that

the training process includes experimental research

as well as clinical training in psychological

testing and psychotherapy. Although master’s

degrees are awarded in clinical psychology

as well as other areas of applied psychology

(e.g., school psychology), the doctorate is considered

the minimal educational requirement

to become a clnical psychologist (APA, 1987b).

Finally, mandatory training continues even

beyond the doctorate. The road to becoming

a clinical psychologist is a long one divided

by a number of distinct stages and phases

that include college, graduate school, clinical

internship, postdoctoral fellowship, licensure,

and finally employment, continuing education,

and advanced certification. Although a

brief overview of the training process is presented

here, details of the training of clinical

psychologists are outlined in Chapter 15.

Students interested in becoming clinical

psychologists and gaining admission to quality

graduate programs must take their college

experience very seriously. Completing courses

in psychology, research design, and statistics

as well as having excellent grades, Graduate

Record Examination (GRE) scores, and highquality

research and clinical experience during

the college years are important.

Graduate training in clinical psychology

involves coursework as well as clinical and

research experiences and training. Graduate

school in clinical psychology takes at least

five years to complete, including a one-year

clinical internship. However, many students

find that they need more than five years to

complete their graduate education. Dissertation

projects and other factors often extend

the training process to an average of six to

eight years. A student interested in obtaining

a doctorate in clinical psychology can choose

between two types of degrees: the traditional

PhD (Doctor of Philosophy) or the PsyD

(Doctor of Psychology). Although the APA

recommends a core curriculum of courses and

activities (APA, 1987b, 2009a; Norcross et al.,

2008), each program maintains its own unique

orientation based on the faculty and traditions

of the

program.

In researching graduate programs,

you will find that each program has its

own unique balance on emphasizing the roles

of biological, psychological, and social

factors

in human behavior.

Almost all graduate training programs

in clinical psychology require that students

complete a one-year, full-time (or two-year,

part-time) clinical internship prior to being

awarded the doctorate. The internship is

the most focused clinical training experience

generally available during graduate training.

The training usually occurs in hospitals,

clinics, or various clinical settings throughout

the United States and Canada. The activities

during the clinical internship focus specifically

on clinical training, such as the practice of

psychotherapy, psychological testing, and

consultation activities with a variety of patient

or client populations.

Most states now require one to two years

of postdoctoral training and supervision before

you are eligible to take the national and

state licensing examinations. However, nine

states (e.g., Washington, Ohio, Arizona, Connecticut)

allow students who have already

secured two years of supervised training to

obtain their license without a postdoctoral fellowship

year. Postdoctoral training occurs in

a wide variety of settings, including hospitals,

clinics, counseling centers, universities, and

even private practices. Postdoctoral training

can include clinical work as well as research,

teaching, and other professional activities.

What Is Contemporary Clinical Psychology? 9

SPOTLIGHT

Dr. Phil, Dr. Laura, Dr. Drew, and Other ‘‘Psychology’’

Celebrity Personalities

Phillip McGraw (aka Dr. Phil) has received a great deal of attention

during the past decade due to his highly successful television show.

Started in September 2002, it quickly became the highest rating new

syndicated television show in 16 years. Prior to The Dr. Phil Show, he

regularly appeared on the Oprah Winfrey Show starting in 1998, acting

as an expert on relationships, life strategies, and behavior. Dr. Phil is,

unlike many other well-known ‘‘psychology’’ celebrity personalities such

as Dr. Laura (Schlessinger), Dr. John Gray, and Dr. Drew (Pinsky), a clinical

psychologist and was licensed as a psychologist in Texas. He obtained his

PhD in clinical psychology from the University of North Texas and opened

a clinical practice in 1979. Dr. Phil is a clinical psychologist who uses

his professional training and skill to host his popular television show and

write popular books on relationship issues, weight loss, and so forth.

Unlike Dr. Phil, Dr. Laura (Laura Schlessinger) is not a clinical

psychologist or a psychologist at all. Her PhD degree is in physiology

from Columbia University. Although she has received training in marriage

and family therapy at the University of Southern California, she is not a

licensed psychologist. The same is true for John Gray, PhD. He is the wellknown

author of the popular Men Are from Mars and Women Are from Venus

books published by HarperCollins. He is neither a clinical psychologist,

nor a licensed psychologist. Dr. Drew Pinsky is an internal medicine

physician (neither a psychologist, nor a psychiatrist) and is a frequent

guest on television news and entertainment shows as well as hosting the

popular shows, Celebrity Rehab with Dr. Drew and the radio and television

advice show, Loveline. Many other ‘‘psychology’’ celebrities frequently

seen in television and print media, such as Cooper Lawrence and Dr. Jenn

Berman, are also neither licensed psychologists nor clinical psychologists.

Regardless of what you think about these well-known psychology

personalities, their popularity speaks to the remarkable interest the general

population has in the use of applied psychology to help people solve life

problems, improve relationships, and live better lives.

Each state offers appropriately trained psychologists

an opportunity to acquire a license

to practice psychology and offer professional

services to the public. Licensing attempts to

protect the public from untrained or unethical

practitioners helps to protect the integrity

of the profession by offering minimum standards

of care. All states use the same national

written examination for licensing (i.e.,

the Examination for Professional Practice in

Psychology, EPPP). After successful completion

of the written examination, many states

then require an oral (or sometimes an essay)

examination before obtaining the

license.

Following licensure, most states require continuing

education in order to renew the psychology

license.

After being awarded the doctorate, a clinical

psychologist is eligible to become a diplomate,

an advanced level of certification. This diploma

10 Foundations and Fundamentals

is an optional post-licensing certification that

reflects advanced competency in a subspecialty

area of professional practice. The American

Board of Professional Psychology (ABPP) acts

as the credentialing agency for psychology

diplomates in a variety of specialty areas (e.g.,

clinical psychology, counseling psychology,

neuropsychology, school psychology, health

psychology).

Activities

Clinical psychologists certainly do more than

talk to people who are distressed about personal

matters. Clinical psychologists often do

vastly different types of activities, from teaching

to psychotherapy to laboratory research.

Clinical psychologists also may be involved

in a wide range of professional activities including

teaching at the college or university

level, conducting independent and/or collaborative

research, providing consultation to

a variety of professionals and organizations,

conducting psychotherapy, and providing psychological

assessment and diagnostic services.

Clinical psychologists work in a plethora of

environments such as universities, hospitals,

clinics, schools, businesses, government agencies,

military institutions, and private or group

practices. These varied roles and settings often

assist the clinical psychologist in appreciating

multidimensional factors and integrating key

approaches into his or her work.

Research

Research is at the foundation of all clinical

psychology activities. Research conducted by

psychologists or others in the behavioral sciences

provides the basis and direction for all

professional activities. Clinical psychologists

often conduct and publish a wide variety of

research studies. Research programs help to

determine which assessment or treatment approach

might be most effective for a particular

clinical problem such as depression, anxiety,

eating disorders, or substance abuse problems.

Projects may help identify those at risk

for the development of certain psychological

problems. Other projects might evaluate methods

to better determine clinical diagnoses. The

types of research activities conducted by clinical

psychologists are extremely diverse.

Most psychologists who are actively engaged

in research are faculty members at

colleges, universities, or medical schools.

They, like faculty in other academic disciplines,

may conduct research on a wide range

of subject areas, publish their findings in professional

journals, and present their research

at international, national, and regional professional

conferences. Psychologists who are not

academic faculty members at colleges or universities

might also conduct research at their

hospitals, clinics, government agencies (e.g.,

National Institute of Mental Health), industry

(e.g., pharmaceutical companies, psychological

testing companies, managed care insurance

companies), or private practices. Research in

clinical psychology encompasses biological,

psychological, and social aspects of human behavior,

from research exploring neuroimaging

techniques, to ethnic factors in hypertension,

to spiritual aspects of love and intimacy.

Although not all clinical psychologists conduct

and publish their own research, all are

expected to be constant consumers of research

in order to inform their professional activities.

Clinical psychologists must understand

the research findings of others in order to improve

their own professional activities. Many

regularly read professional journals that cover

research topics of special interest.

Assessment

Many clinical psychologists use psychological

tests and procedures to assess or diagnose various

psychiatric (e.g., depression, psychosis,

personality disorders, dementia) as well as

non-psychiatric issues (e.g., relationship conflicts,

learning differences, educational potential,

career interests, and skills). Generally,

psychologists are the only mental health professionals

who administer psychological tests.

In fact, clinical psychologists not only conduct

What Is Contemporary Clinical Psychology? 11

SPOTLIGHT

Terrorism and Its Aftermath

The horrific terrorist events of September 11, 2001, in the United States

that claimed the lives of approximately 3,000 people have had enormous

implications for life

in America

and elsewhere. In many ways, life in the

United States is very different after September 11 than it was before that

fateful day. The new U.S. Department of Homeland Security and Congress

altered the way foreign students and visitors to the United States are

screened and evaluated. Laws and transportation policies and procedures

have been greatly changed in an attempt to increase security. Air travel

security procedures, for example, have changed dramatically following

September 11. Wars in Afghanistan and Iraq commenced with thousands

of military young people being shipped overseas and, tragically, many

did not return home. Many people from Islamic countries or religious

traditions have experienced prejudice and suspicion.

Clinical psychology has been involved with the response to terrorism

in the United States in a number of different ways. Immediately following

the terrorism events and since, psychologists have counseled those who

lost loved ones in the tragedy as well as those terribly stressed by the

events. For example, airplane phobias have always been treated by

clinical psychologists. Yet, following the terrorism events, the need for

this type of specialized counseling increased a great deal. Children and

others in the New York and Washington areas (as well as elsewhere)

experienced posttraumatic stress symptoms, such as anxiety and sleep

disturbances, that needed treatment and consultation (Cormer & Kendall,

2007). Furthermore, clinical psychologists and others have been involved

in research to help better understand the causes and risk factors for terrorist

acts as well as the psychological consequences for those impacted by these

events (e.g., Eidelson & Eidelson, 2003; La Greca, 2007; Moghaddam &

Marsella, 2004; Post, 2007; Pyszczynski, Solomon, & Greenberg, 2003).

For example, Eidelson and Eidelson (2003) have examined research on

what propels

groups

toward conflict and violence that has many useful

implications for understanding and hopefully preventing terrorism. They

have highlighted five ‘‘dangerous ideas [that include] superiority, injustice,

vulnerability, distrust, and helplessness’’ (p. 182) that act as risk factors

for conflict and violence.

Superiority refers to the belief and conviction that a person or group is

better than everyone else in a variety of important ways. For example,

someone might believe that they or their group are the only ones who

have a clear understanding of God’s will and plan. This belief has certainly

caused wars, terrorism, mass killings, and so forth for thousands of years.

This perspective is rather narcissistic in that someone or a group believes

that they have some special information, entitlement, or gifts that others

do not have or can’t have access to obtain. Injustice and victimization refer

to the belief that the person or group has been badly mistreated by specific

(continued)

12 Foundations and Fundamentals

others or the world in general. Although injustice and victimization

have been common human experiences since the dawn of time, this

perspective can lead (and has led) to retaliatory acts and rage against

others. Vulnerability refers to the notion that a person or group is highly

likely to experience danger or further victimization and that hypervigilance

and preemptive acts are needed to reduce the risk of further harm. Distrust

refers to the belief that very few people can be trusted and that only the

inner circle of true believers can be considered appropriate and trustworthy

group members. This point of view leads to paranoia and potential

misunderstandings attributing benign others as hostile and malevolent.

Finally, helplessness refers to feelings of powerlessness and dependency

that often become overly pessimistic and negative. This perspective can

lead to extreme measures to help feel more in control and more powerful.

These five dangerous beliefs can be applied to the actions of many conflicts

between nations and peoples as well as to the terrorism experienced in

America on September 11, 2001, and elsewhere. Many countries have

been dealing with terrorism for a long time. For example, Ireland, the

United Kingdom, Israel, and many other areas of the world have regularly

had to deal with terrorism for many years. Lessons learned from these

countries can be applied to the current concerns in the United States.

Psychologists in these other locations have studied and counseled those

affected by terrorism for many years.

Clinical psychology has much to offer in our efforts to help those

touched by terrorism as well as to help us better understand the factors

that contribute to such horrific violence perpetrated against others (Cormer

& Kendall, 2007).

psychological evaluations with individuals to

assess intellectual, educational, personality,

and neuropsychological functioning, but also

assess groups of people (e.g., families) and

even organizations.

There are numerous components to psychological

assessment, including cognitive,

personality, behavioral, neuropsychological,

and observational measures. For example, a

neuropsychologist may be called on to evaluate

an urban Latino adolescent boy for temporal

lobe epilepsy, which often results in impulsive

behavior and aggression. Neuroimaging

techniques conducted by a physician will augment

the findings, as well as a developmental

history, to rule out personality or environmental

factors such as trauma as causal in

the behavioral manifestations of the disorder.

Thus, while focusing on neuropsychological

measures, the psychologist needs to be keenly

aware of medical, psychological, and social

factors that may contribute to or otherwise

explain ‘‘seizure-like’’ symptomology.

Integration in assessment will be more fully

explored in conjunction with its component

elements in Chapters 7 and 8. An extremely

challenging and exciting area of clinical psychology,

assessment requires the psychologist

to be something of a psychological sleuth, utilizing

an arsenal of tools in determining subtle

and often hidden problems and syndromes in

the context of biological, psychological, and

sociocultural factors.

Treatment

Contemporary psychological interventions address

a tremendous range of human problems

What Is Contemporary Clinical Psychology? 13

through a diversity of approaches. Psychotherapy

may involve individuals, couples, families,

and groups, and address an endless array of

target problems. Anxiety, phobias, depression,

shyness, physical illness, loss, trauma, drug

addiction, eating difficulties, sexuality concerns,

hallucinations, relationship problems,

and work difficulties may all prompt individuals

to seek psychological treatment. Furthermore,

it has become increasingly incumbent

upon psychologists to become educated and

sensitized to cultural factors in treating clients,

as well as the entire spectrum of individual

differences (e.g., sexual preference, religious

faith, disabilities, ethnic identities, economic

status) that comprise today’s mosaic society.

Various treatment approaches and theoretical

models are utilized to treat psychological

and behavioral problems. Most psychologists

use an eclectic strategy, defined as integrating

a variety of perspectives and clinical approaches

in their treatment (Norcross, 2009;

Norcross & Goldfried, 2005; Norcross, Karg,

& Prochaska, 1997a, b; Weston, 2000). Others

tend to specialize in one of a number of

treatment approaches, such as psychoanalysis,

family therapy, or hypnosis. The major theoretical

schools of thought in psychology are

psychodynamic, cognitive behavioral, humanistic/

existential, and family systems. Each of

these theoretical orientations or perspectives

is discussed in detail in Chapter 4, leading

to our current understanding of integrative

models.

Efforts to develop empirically supported or

evidence-based treatments to assist clinicians

and researchers in providing structured treatments

and the use of treatment manuals

that are based on treatment outcome research

findings have received a great deal of attention

and support from the APA and others

(Addis, 2002; APA Presidential Task Force

on Evidence-Based Practice, 2006; Becker,

Stice, Shaw, & Woda, 2009; Chambless &

Ollendick, 2001; Crits-Christoph, Chambless,

Brody, & Karp, 1995; Lamberg, 2008; Sanderson

& Woody, 1995). Empirically supported

treatments hinge on the notion that psychological

treatment approaches should always

be based on solid empirical research data

and supported by professional organizations

such as the APA (APA Presidential Task Force

on Evidence-Based Practice, 2006; Chambless

& Hollon, 1998). Empirically supported

treatment approaches are manualized treatments

and have been developed for a variety of

clinical problems such as depression (Cornes &

Frank, 1994; Cuipers, van Straten, & Warmerdam,

2007; Hollon & Beck, 1994; Lamberg,

2008), anxiety (Landon & Barlow, 2004; Newman

& Borkovec, 1995), conduct disordered

children (Feldman & Kazdin, 1995; Schmidt

& Taylor, 2002), and pain control (Chou &

Huffman, 2007; Hawkins, 2001). The Clinical

Psychology Division of the American Psychological

Association (The Society of Clinical

Psychology, Division 12) maintains a web site

(www.PsychologyTreatments.org) that keeps

updated information including clinical and

research references for state-of-the-art empirically

supported treatments. For example, cognitive

and interpersonal psychotherapy have

been determined to be empirically supported

treatments for both depression and bulimia

while exposure and response prevention have

been found to be an empirically supported

treatment for obsessive-compulsive disorder

(APA Presidential Task Force on Evidence-

Based Practice, 2006; Chambless & Ollendick,

2001; Crits-Christoph et al., 1995). While

many treatment approaches are based on research

support, the concept of empirically supported

treatments and evidence-based practice

is the most recent effort to systematize service

delivery to carefully studied populations

and problems (APA Presidential Task Force

on Evidence-Based Practice, 2006; Chambless

& Hollon, 1998; Nathan & Gorman, 2007).

Controversy exists over the development of

‘‘approved’’ treatment approaches for various

clinical problems, with critics usually

highlighting the challenges of applying research

findings to complex clinical situations

(APA Presidential Task Force on Evidence-

Based Practice, 2006; Cooper, 2003; Ingram,

Hayes, & Scott, 2000; Messer, 2004). These

issues will be further discussed in detail in

Chapter 14.

14 Foundations and Fundamentals

Teaching

Clinical psychologists teach in a variety of

settings.

Some are full-time professors in colleges

and universities across the United States

and elsewhere. These professionals teach undergraduates,

graduate students, and/or postgraduate

students.

Other psychologists might

teach on a part-time basis at local colleges

and universities as adjunct professors or lecturers.

Still others might teach by providing

one-on-one clinical supervision of graduate

students, interns, or postdoctoral fellows.

During supervision, psychologists discuss the

trainees’ clinical cases in depth while providing

therapeutic guidance as they learn

psychotherapy, psychological evaluation, and

consultation skills. Teaching may occur in

hospitals, clinics, or business environments

as well. For example, a clinical psychologist

might offer a stress management course

for attorneys, business executives, nurses,

clergy, police officers, or others. A psychologist

might also teach a workshop on intimate

relationships to young couples about

to be married. A psychologist might teach

other professionals such as doctors or clergy

how to better maintain professional boundaries

or understand psychopathology among

the persons they counsel. As in psychological

treatment facilities, there are numerous

examples and opportunities for psychologists

to teach in a wide variety of professional

settings.

Highlight of a Contemporary Clinical Psychologist

Patrick

H. DeLeon

, PhD, ABPP

Photo: Courtesy Patrick

H. DeLeon

Dr. DeLeon uses his training and skills as a clinical psychologist by working

on Capitol Hill. He helps shape policy and legislation that best reflects

both the science and application of clinical

psychology.

He is a former

president of the American Psychological Association.

Birth Date: January 6, 1943

College: Amherst College (BA, Liberal Arts), 1964

Graduate Program: Purdue University (MS, Psychology), 1966; Purdue

University (PhD, Clinical Psychology), 1969; University of Hawaii (MPH,

Health Services Administration), 1973; Catholic University, Columbus

School of Law (JD), 1980

Clinical Internship: Fort Logan Mental Health Center, Denver, Colorado

Current Job: Chief of Staff, U.S. Senator D. K. Inouye, United States

Senate

Pros and Cons of Being a Clinical Psychologist:

Pros: ‘‘Substantive knowledge about people, systems, health care, etc.’’

Cons: ‘‘Most psychologists or psychology colleagues do not appreciate

how little they know about public policy and national trends.’’

Future of Clinical Psychology: ‘‘The knowledge base will continue

to expand; whether services are provided by psychologists or other

professionals is an open question. Psychology controls its own destiny—to

not seek new agendas and to not address society’s needs means to be

replaced by other professions.’’

What Is Contemporary Clinical Psychology? 15

Changes during the Past 5 to 7 Years: ‘‘We

have developed a significantly broader focus

and thus have brought the behavioral sciences

to a wider range of activities, especially within

the generic health-care arena. As our numbers

have increased, we have developed a

greater presence (i.e., influence) in defining

quality care and health-care priorities. Significantly

more colleagues are now personally

active within the public policy and political

process, thus ensuring that psychology’s voice

(and values) will be heard. The development

of postdoctoral training positions has resulted

in society developing a greater appreciation for

the importance of the psychosocial aspects of

health care. Clearly, the prescription privileges

agenda and advances in communications technology

will revolutionize all of mental health

care delivery.’’

What do you think will be the major

changes in clinical psychology during the

next several years? ‘‘The prescription privilege

agenda will continue to expand and

thereby absolutely redefine quality mental

health care. Advances in the technology and

communications fields will be found to have

direct applicability to health care and psychology

will play a major role in addressing

this challenge. Health care will become more

patient-centered and interdisciplinary in nature.

No longer will any of the health-care

professions be allowed to foster isolated or

‘silo-oriented’ training modules. The percentage

of women in the field will continue to

increase. And, clinical protocols will focus concretely

on special populations (such as the

elderly, children, and various ethnic minority

clients). Health care will become more accountable

and data driven. Distance learning

and virtual training programs will become the

norm.’’

Typical Schedule: ‘‘Every day brings new

and unexpected challenges and opportunities.

One tries to visit with a committee staff person

each day or with a colleague in another senate

office or from the administration. The key to

legislative success is to anticipate which bills

will be moving long before they do and to

convince relevant committee staff (or administration,

including house aides) to incorporate

provisions addressing one’s vision. Listening to

and interacting with Hawaii constituents and

professional lobbyists provides an excellent

opportunity to develop legislative agendas. For

Hawaii, expanding the resources for federally

qualified community health centers provides

an excellent vehicle for expanding psychology’s

agenda.’’

Consultation

Many clinical psychologists provide consultation

to churches, health-care professionals,

businesspersons, schools, lawmakers, organizations,

and even to other mental health

professionals.

Consultation might involve

an informal discussion, a brief report, or

a more ongoing and formal consultation

arrangement. For example, companies might

consult with a psychologist to help reduce

coworker conflicts or provide stress management

strategies for high-stress employees such

as business executives, firefighters, police

officers, or prison guards. Consultation might

involve helping a physician to better manage

patient noncompliance with unpleasant medical

procedures. Consultation could include

working with a religious superior in helping

to better select applicants who wish to enter

a religious order or become a clergy member.

Consultation might include working with

law enforcement professionals on violence

prevention or screening applications for the

police academy. Clinical psychologists provide

professional consultation in a wide variety of

settings using a range of

techniques.

Consultation

might also include assessment, teaching,

research, and brief psychotherapy activities.

Administration

Many clinical psychologists find themselves

(intentionally or unintentionally) in

16 Foundations and Fundamentals

administrative positions. Administrative duties

might include serving as chairperson of a

psychology department, or dean, provost, or

even president of a college or university.

Other psychologists might hold administrative

positions in hospitals, mental health clinics,

or other agencies. They may act as a unit

chief directing a psychiatric hospital unit or

ward, or directing mental health services

for a community mental health clinic. They

may act as directors of training in numerous

clinical settings. Some psychologists have

become members of Congress and even state

governors (e.g., Ted Strickland in Ohio). In

administration, these psychologists generally

manage a budget, lead a multidisciplinary

professional and support staff, make hiring

and firing decisions, develop policies and

procedures for clinical, research, or other

operations, and manage a large and populous

state such as Ohio.

Employment Settings

Clinical psychologists work in many different

employment settings including hospitals,

medical schools, outpatient clinics,

colleges

and universities, businesses and industry, and

private or group practices. Many clinical psychologists

work in some type of part-time or

full-time private practice as well (Norcross et

al., 2008; Norcross, Hedges, & Castle, 2002).

Following private practice, teaching in colleges

and universities is the second most common

employment choice for clinical psychologists

(APA, 2000a, 2009b, 2010a, b; Norcross et

al., 2002, 2008). Many psychologists work

in more than one setting, combining various

positions and activities. For example, it

is common for a clinical psychologist to work

at a hospital or clinic several days a week,

teach a course or two at a local college or

university, and conduct a private practice one

or more days each week. A clinical psychologist

may be a full-time professor teaching and

conducting research while also operating a

small private practice and offering consultation

services to various clinics, hospitals, or businesses.

The diversity of experiences available

to psychologists is quite appealing and offers

tremendous flexibility and options.

Private or Group Practices

About 35% of clinical psychologists primarily

work in solo or group private practices

(APA, 2010a, b; Norcross et al., 2008; Norcross,

Karpiak, & Santoro, 2005; Norcross,

Prochaska, & Gallagher, 1989). Professionals

in private practice may provide clinical services

in their own solo practice or in conjunction

with other mental health or health-care practitioners

in a multidisciplinary setting. However,

clinical psychologists who offer psychotherapy

service tend to do so in private practice

environments (Norcross et al., 2005, 2008).

Many psychologists are drawn to independently

providing direct clinical, consultation,

and other professional services to their own

patients and clients and enjoy being their own

boss and setting their own hours and policies.

In fact, private practitioners report more job

satisfaction (Norcross et al., 1997, 2005, 2008;

Norcross & Prochaska, 1988) and less job stress

than psychologists employed in other settings

such as academia (e.g., Boice & Myers, 1987).

However, significant changes in health-care

reform, managed health care, and insurance

reimbursement for psychological services are

likely to alter this rosy view of private practice

for many professionals in the future. Many private

practice psychologists, along with other

mental health and health-care professionals

operating practices, have experienced reductions

in profits and freedoms as a result of the

changing health-care industry.

In fact, some authors have predicted for

quite some time that solo private practice

may no longer exist in the future (Cummings,

1995). Cummings predicted that these clinicians

will be employed primarily in multidisciplinary

health settings such as health maintenance

organizations (HMOs) or very large and

comprehensive medical group practices. Others

disagree with Cummings’ pessimistic view

concerning the future of private practice, stating

that managed care accounts for a minority

What Is Contemporary Clinical Psychology? 17

of the fees collected by private practitioners.

Furthermore, the percentage of psychologists

engaged in at least part-time private practice

has not decreased even several decades after

the onset of managed health care and other

health-care changes and, as of this writing in

2010, private practice is still alive and well

for many professionals (APA, 2000a, 2009b,

2010a, b; Norcross et al., 2002, 2005, 2008).

Colleges and Universities

About 20% of clinical psychologists are

employed in academic environments (APA,

1993a, 1997, 2000a, 2010a, b; Norcross et al.,

1997a, b, 2002, 2005, 2008). Most of these

psychologists work as professors at colleges

and universities across the United States and

Canada. They generally teach psychology

courses, supervise the clinical and/or research

work of psychology students, and conduct

both independent and collaborative research.

They also typically serve on various college or

university committees, providing leadership

and assistance with the academic community.

Some clinical psychologists work in academic

clinical settings, such as student counseling

centers, providing direct clinical services to

students.

Hospitals

Many clinical psychologists work in hospital

settings (APA, 2009b, 2010). They may

conduct psychological testing; provide individual,

family, or group psychotherapy; act as

a consultant to other mental health or medical

professionals on psychiatric or general medical

hospital units; and may serve in administrative

roles, such as unit chief, on a psychiatric

ward. Many states now allow psychologists to

become full members of the medical staff of

hospitals. The CAPP v. Rank decision in California,

for example, allowed psychologists to have

full admitting, discharge, and treatment privileges

at appropriate California hospitals. Full

medical staff privileges allow psychologists to

treat their patients when they are hospitalized

and allow psychologists to participate in hospital

committees, including holding elected positions.

The majority of psychologists working

in hospital settings are affiliated with Veterans

Administration (VA) hospitals. In fact, the majority

of internship training sites are located in

VA hospitals (Association of Psychology Postdoctoral

and Internship Centers, 2009).

Medical Schools

Some hospitals and medical centers are affiliated

with medical schools. In addition to

the professional hospital activities mentioned

previously, clinical psychologists serve on the

faculties of many medical schools. They typically

act as ‘‘clinical faculty,’’ which generally

involves several hours (i.e., two to four) per

week of pro bono time contributed to training

medical center trainees. These trainees might

include psychiatry residents, other medical

residents and fellows (e.g., pediatric residents),

medical students, nursing students, or nonmedical

hospital trainees such as psychology

interns or postdoctoral fellows, social work interns,

nursing students, or chaplaincy interns.

These psychologists might teach a seminar or

provide individual case supervision and consultation.

Psychologists may also serve as academic

or research faculty at medical schools.

In fact, approximately 3,000 psychologists are

employed as faculty in medical schools (APA,

2009b; Pate, 2004; Sweet, Rozensky, & Tovian,

1991). These psychologists tend to primarily

conduct research and are often funded by national

grants (e.g., National Institute of Mental

Health, National Science Foundation, American

Heart Association) to pay their salaries,

thus allowing them to conduct their research.

Finally, many psychologists employed in medical

school settings evaluate, treat, and consult

on patient care, and others teach and train

both medical and nonmedical students.

Outpatient Clinics

Many clinical psychologists work in various

outpatient clinics such as community

mental health centers (APA, 2009b). These

18 Foundations and Fundamentals

psychologists often provide a range of clinical

services to other professionals and organizations.

For example, these psychologists might

provide psychotherapy for children who have

been abused or group therapy for adult substance

abusers. They might also provide parent

education classes. While psychologists in these

settings may conduct research, direct clinical

service is often the primary activity and priority

of these settings.

Business and Industry

Many clinical psychologists working in business

and industry settings offer consultation

services to management and assessment

and brief psychotherapy to employees, and

conduct research on various psychosocial

issues important to company functioning and

performance (APA, 2009b). For example,

these psychologists might consult with the

human resources department, provide stress

management workshops, or conduct interpersonal

skills–building workshops. Psychologists

might help managers learn to improve

their ability to motivate and supervise their

employees. They may also assist in developing

strategies for interviewing and hiring job

applicants. They may help groups develop

mission, value, and strategic plans.

Military

Many clinical psychologists are employed by

one of the branches of the U.S. military such

as the navy, air force, or army (APA, 2009b).

They often provide direct clinical services.

Some conduct research while others act as

administrators in military hospitals and clinics.

Typically, psychologists working in the military

hold an officer rank such as captain. Other

psychologists are civilians working in military

hospitals such as VA hospitals. In fact, since

World War II, VA hospitals have been among

the largest employers of clinical psychologists.

Other Locations

Clinical psychologists are also employed in

a variety of other settings, such as police

departments, prisons, juvenile halls and detention

centers, rehabilitation centers for disabled

children and/or adults, substance abuse

and/or mental illness halfway houses, battered

women’s shelters, seminaries, schools, and

many other work environments. These psychologists

provide a wide range of professional

services such as psychological assessment, consultation,

and counseling.

Subspecialties

Most clinical psychologists are trained in the

research, assessment, and treatment of a variety

of clinical issues pertaining to a diverse

set of client populations. The core curriculum

for all clinical psychologists includes coursework

on the biological, social, cognitive, and

individual influences on behavior as well as

classes on research, statistics, ethics, assessment,

and treatment. The core curriculum

can then be applied, with additional specialty

training, to various populations such

as children and adults. Further training may

be offered in many subspecialty areas. Although

a core set of competencies are expected

from all clinical psychologists, not all clinical

psychologists are trained exactly alike. Many

clinical psychologists ultimately specialize in

one or more areas of research or practice.

Just as medicine offers doctors various specialties

such as pediatrics, oncology, psychiatry,

internal medicine, and cardiology, there are

many clinical psychology subspecialties. Some

of the most common specialties include child

clinical psychology, clinical health psychology,

clinical neuropsychology, forensic psychology,

and geropsychology. Furthermore, each specialty

includes a variety of subspecialties. For

example, child clinical psychologists might

specialize in working with very young children

or adolescents. Clinical health psychologists

might choose to specialize in eating disorders,

anxiety disorders, or pain disorders.

Child Clinical Psychology

Of the 307 million Americans, there are 74

million children under the age of 18 in the

What Is Contemporary Clinical Psychology? 19

United States (U.S. Census Bureau, 2009).

Many of these children and families are in

need of professional services offered by a psychologist

specially trained to work with this

population. Child clinical psychologists specialize

in working with both children and families.

A recent survey by the APA revealed that

about 2,000 APA members (about 3%) identify

themselves as specializing in child clinical

psychology (APA, 2010a, b). A child and

family focus in clinical training has become

enormously popular within graduate training

programs (Norcross et al., 2008). In addition

to standard training in general clinical psychology,

these psychologists obtain in-depth

training in developmental psychology and

child assessment (e.g., behavioral disorders,

learning disabilities, and motor developmental

delays) and treatment (e.g., family therapy,

parent consultation). They commonly work in

schools, children’s hospitals, community clinics,

and in private practices. Child clinical psychologists

may work with children who have

experienced physical and/or sexual abuse or

who experience attention deficit/hyperactivity

disorder, conduct disorders, autism, enuresis

(bed wetting), learning disabilities, serious

medical illnesses, school phobia, posttraumatic

stress disorder, or a host of other emotional,

behavioral, or medical problems. These psychologists

may provide consultation to teachers,

school counselors, pediatricians, day-care

workers, parents, and others. They may assist

teachers in classroom behavior management

or parents in developing better parenting skills.

Pediatric psychologists are child clinical

psychologists who generally work with children

and families in hospital settings where

the child has a significant medical disorder

(Brown, 2003). These medical problems might

include cancer, epilepsy, diabetes, cystic fibrosis,

and neurological disorders and disabilities.

The pediatric psychologist might offer pain

management strategies to a child while helping

the family cope more effectively with and

locate community resources. He or she may act

as a consultant to various medical units and

departments to help physicians, nurses, and

others deal with the emotional and behavioral

consequences of severe medical illnesses

in children. For example, a pediatric psychologist

might consult with a physician about an

adolescent with diabetes who refuses to monitor

his or her blood sugar level due to concerns

about being different relative to peers. A pediatric

psychologist might consult with nurses

about a child who is hospitalized with cystic

fibrosis and struggling with significant depression

and social isolation.

Clinical Health Psychology

The field of clinical health psychology formally

began around 1980 (Matarazzo, 1980)

and has been defined as:

. . . the aggregate of the specific educational,

scientific, and professional contributions

of the discipline of psychology to

the promotion and maintenance of health,

the prevention and treatment of illness,

the identification of etiologic and diagnostic

correlates of health, illness, and related

dysfunction, and to the analysis and improvement

of the health care system and

health policy formation. (Matarazzo, 1982,

p. 4)

Since its inception during the early 1980s,

health psychology has become one of the

fastest growing areas of clinical psychology

and one of the most popular areas of research

in graduate training programs (Norcross et al.,

2008). This subspecialty serves as an excellent

example of integrative trends in the field

(Johnson, 2003; Taylor, 2009).

It has been estimated that 50% of all deaths

are caused by lifestyle factors such as smoking

cigarettes, drinking too much alcohol, eating

high fat foods, not exercising, and refusing to

wear seatbelts (Centers for Disease Control,

2009). Furthermore, over 15% of the gross

national product is devoted to health care

(Centers for Disease Control, 2009). Health

psychologists work to help healthy people

stay healthy and assist people with various

20 Foundations and Fundamentals

illnesses or risk factors to cope more effectively

with their symptoms. Health psychologists

work toward helping others develop

health-enhancing lifestyles, which can be a

surprisingly difficult task. For example, about

95% of those who lose weight tend to regain

all their lost weight within 5 years (Brownell,

1993; Wadden, Sternberg, Letizia, Stunkard,

& Foster, 1989). Over 50% of those who start

an exercise program drop it within 6 months,

while 75% drop it within nine months (Dishman,

1982). About a half-million people die

in the United States each year due to smoking

tobacco (Centers for Disease Control, 2008).

Health psychologists work with individuals

and groups in order to maximize healthenhancing

behaviors (e.g., exercise, low-fatfood

consumption, smoking cessation) and

minimize health-damaging behaviors (e.g.,

smoking, stress, drinking alcohol). They also

help in the treatment of chronic pain, panic

disorders, and migraine headaches, and other

physical conditions with prominent biopsychosocial

features (S. Taylor, 2009).

Health psychologists are often trained in

clinical psychology, counseling psychology,

social psychology, or child clinical psychology

but specialize in health-related problems

and interventions. Health psychologists typically

work in hospital settings; however, many

also work in academic, business, and outpatient

clinic settings. Health psychologists often

utilize specialized techniques such as biofeedback,

hypnosis, relaxation training, and selfmanagement

strategies in addition to general

psychotherapy in the course of the overall

treatment process.

Clinical Neuropsychology

Neuropsychology focuses on brain–behavior

relationships. These are defined as how brain

functioning impacts behavior and behavioral

problems. Neuropsychologists assess brain and

behavioral functioning and offer strategies for

patients suffering from brain impairment due

to a large range of problems such as dementia,

head injuries, tumors, autism, stroke,

AIDS, Alzheimer’s disease, epilepsy, and other

problems that result in cognitive and neurological

dysfunction. Neuropsychologists are

well trained in assessing a range of cognitive

abilities, including executive or higher order

cognitive functioning (i.e., planning, judgment,

problem solving), sensory and motor

functioning, and memory skills and abstract

reasoning, and use a variety of specialized tests

to assess these brain–behavior relationships.

Many psychologists who specialize in neuropsychology

are trained as clinical or counseling

psychologists or they may be trained

in cognitive science or neuroscience. Most

neuropsychologists work in hospital, rehabilitation,

or clinic settings. Some specialize in

working with children. Many also work in

private or group practice environments.

Forensic Psychology

Forensic psychology is usually defined as

the ‘‘application of psychology to legal issues’’

(Cooke, 1984, p. 29). Forensic psychologists

specialize in using principles of human behavior

in the judicial and legal systems (Otto

& Heilbrun, 2002). They are often trained as

clinical or counseling psychologists with a specialty

in forensic work. Forensic psychologists

may conduct psychological evaluations with

defendants and present their findings as an

expert witness in court. They may also provide

evaluations for child custody arrangements, or

be asked to predict dangerousness or competency

to stand trial. They may be asked to

participate in worker’s compensation claims,

or serve as consultants to attorneys who are

selecting a jury.

Geropsychology

Psychologists who specialize in geropsychology

provide a range of psychological services

to elderly members of society. The elderly are

the largest growing segment of today’s society

and are often in need of professional psychological

services. In fact, the number of elderly

Americans has increased from 3.1 million to

What Is Contemporary Clinical Psychology? 21

35 million during the twentieth century, now

representing 1 in 8 Americans, and will likely

grow to more than 15% of all Americans by

2020 (U.S. Census Bureau, 2008). Geropsychologists

might consult with senior centers,

convalescent or nursing homes, and hospital

medical units that serve elderly patients. These

psychologists might provide psychological or

neuropsychological testing, and brief individual

or family psychotherapy, and consult on

strategies to maximize independence and selfcare.

These psychologists might develop activities

to enhance self-esteem and control and

alleviate depression among elderly patients.

Organizations

As in most professions, clinical psychology

boasts a variety of professional organizations.

These organizations provide an opportunity

for their members to meet and collaborate,

attend yearly conventions and learn about

new advances in the field, and participate in

a number of activities that help psychologists

as well as the public. These organizations are

international, national, regional, and local.

American Psychological Association

Clinical psychologists are usually members of

several professional organizations. Most are

members of the American Psychological

Association (APA). The APA was founded

in 1892 and is the largest organization of psychologists

anywhere in the world. There are

150,000 members of the organization (APA,

2010a, b) representing all specialties within

psychology (e.g., clinical psychology, social

psychology, school psychology, experimental

psychology). Students of psychology and

associates of psychology (e.g., high school psychology

teachers) are also included in the APA.

In recent surveys, approximately half of APA

members identified themselves within clinical

psychology (APA, 2000a, 2009) and about

half have a license to practice in one or more

states (APA, 2000a, 2009, 2010a, b). The APA

was incorporated in 1925 and is located in

Washington, DC. Since the first meeting in

Philadelphia in 1892, the APA holds a yearly

national convention each August in a large

American or Canadian city. The APA is divided

into four directorates focusing on professional

practice, education, public policy, and science.

The APA is also home to 56 topic interest

divisions (e.g., Division 2 is Teaching of Psychology;

Division 12 is Clinical Psychology).

About 6,000 psychologists are members of the

APA’s Division 12

(Clinical Psychology).

The

APA publishes numerous professional journals

(e.g., American Psychologist, Professional Psychology:

Research and Practice, Journal of Consulting

and Clinical Psychology, Journal of Abnormal Psychology)

as well as many books. The APA acts

as a lobbying force in Washington, DC, promoting

legislation that will be favorable to

psychology as a profession and to consumers

of psychological services. The APA also provides

standards for the education, certification,

and ethical conduct of psychologists.

American Psychological Society

In 1988, the American Psychological Society

(APS) was founded. Many of the psychologists

in the APA who regarded themselves

as academically and scientifically focused felt

that the APA no longer adequately represented

their interests. Founding members of the APS

felt that the APA had become too focused

on professional practice and was becoming

neglectful of the science of psychology. A proposal

was considered to either reorganize the

APA to reflect these concerns or start a new

organization dedicated to the science of psychology

only. Clinical psychologists who were

especially interested in the science of psychology

joined APS. Many psychologists belong to

both organizations while others resigned from

the APA to join the APS.

State and County Psychological

Associations

Each state and most counties maintain psychological

associations. Many practicing clinical

psychologists join their state psychological

22 Foundations and Fundamentals

association and may also join their county

psychology

association.

Approximately 40%

of APA members (both clinical and other

psychologists) are also members of their

state psychological association (APA, 2000a,

2010a). These organizations provide networking

opportunities for psychologists as well as

assistance in lobbying state legislatures regarding

issues important to psychologists and

the public’s psychological welfare. Most state

and county psychological associations provide

workshops and conferences for their members

that address various clinical and research

topics. The state psychological associations frequently

work closely with the state boards of

psychology to assist in the policing of unethical

and illegal conduct of psychologists as well

as in developing licensing laws and criteria for

acceptable professional practice.

American Board of Professional

Psychology

The American Board of Professional Psychology

(ABPP) was founded in 1947 as

an

agency that would certify psychologists in

several specialty areas. The ABPP diploma

is

considered an advanced level of accomplishment

beyond a state license to practice as a

psychologist. The ABPP is an independent organization

closely associated with the APA.

The ABPP diploma is offered in a number of

specialty areas: The majority of diplomas are in

clinical psychology. Approximately 1,000 psychologists

hold the ABPP diploma in clinical

psychology (APA, 2010a).

Other Organizations

There are a number of other international, national,

and regional organizations that many

clinical psychologists may join depending on

their specialty interests. For example, many

clinical psychologists are members of the Society

of Behavioral Medicine (SBM), the Society

of Pediatric Psychology, the International Neuropsychology

Society (INS), the Association of

Behavior Analysis (ABA), the International

Society of Clinical Psychology (ISCP), or many

other organizations. Most of these organizations

sponsor a yearly national conference,

publish one or more professional journals,

are involved in lobbying efforts of interest to

their membership, and provide members with

a range of services.

Many other countries also maintain psychological

associations. The Canadian Psychological

Association (CPA), for example,

has a long and distinguished history providing

yearly conventions, maintaining an ethics

code, and accrediting programs throughout

Canada, among other activities. This is also

true for the British Psychological Society

(BPS). Chapter 15 lists the contact information

for many of these organizations.

How Does Clinical Psychology Differ

from Related Fields?

Many people are unaware of the similarities

and differences between clinical psychology

and related fields. For example, a popular

question is, ‘‘What is the difference between

a psychologist and a psychiatrist?’’ It can be

confusing to the public (and even to many

professionals in the field) to understand the

similarities and differences between mental

health disciplines. Since almost all of the mental

health disciplines share certain activities

such as conducting psychotherapy, understanding

differences between these fields can

be very challenging.

Many professionals and members of the

public wonder how clinical psychology differs

from related mental health fields such

as counseling psychology, school psychology,

psychiatry, nursing, social work, and counseling.

A brief overview of these disciplines will

be provided in Table 1.1.

Counseling

Psychologists (PhD)

Of all the different mental health professionals,

counseling psychologists are perhaps the

most similar to clinical psychologists in actual

What Is Contemporary Clinical Psychology? 23

Table 1.1 Mental Health Professionals

Years of

Years of Training Postdegree

Degree Program Prior to Degree* Training License

PhD Clinical Psych 4–5 1–2 Psychologist

PhD Counseling Psych 4–5 1–2 Psychologist

PhD School Psych 4 1–2 School Psychologist

PsyD Clinical Psych 4–5 1–2 Psychologist

MA/MS Clinical Psych 2 1–2 MFT

MA/MS Counseling Psych 2 1–2 MFT

MA/MS School Psych 2 1 School Psychologist

MSW Social Work 2 1–2 Social Worker

MD Medicine 4 3–4 Physician (e.g., Psychiatrist)

∗While graduate school can take 4 to 5 years to complete, this is highly variable. Research projects such as dissertations

as well as practicum experiences often result in a longer period of time to complete training.

practice. While there are generally differences

in philosophy, training emphases, and curriculum

between clinical and counseling graduate

programs, differences between clinical

and counseling psychologists are subtle. Like

clinical psychologists, counseling psychologists

generally major in psychology as undergraduates,

attend a four-year graduate training

program (however, in counseling psychology

rather than clinical psychology), complete

a one-year clinical internship, and complete

postdoctoral training prior to obtaining their

license as a psychologist. The differences between

clinical and counseling psychology were

more dramatic several decades ago in comparison

to current times.

Historically, counseling psychologists

worked in outpatient, college, and vocational

settings with people who did not experience

major psychiatric difficulties. They often

provided educational and occupational counseling

to students and employees. Testing

conducted by counseling psychologists generally

involved career and vocational interests

and skills. Today, counseling psychologists

can be found in hospital, clinic, industry, and

private practice settings. In fact, in most states,

counseling psychologists practice under the

same license as clinical psychologists. Some

authors have argued that distinctions between

clinical and counseling psychology, along with

separate training programs, may no longer

be warranted (e.g., Beutler & Fisher, 1994).

There are about three times more clinical

psychologists than counseling psychologists

in the United States. For example, while

1,185 doctorates were awarded in clinical

psychology in 1999, 367 were awarded

in counseling psychology (APA, 2000a).

According to surveys conducted by the APA

(2000a, 2009b), about 11% of APA members

identify themselves as counseling psychologists

and about 15% of all doctorates awarded

in psychology are awarded in counseling

psychology.

School Psychologists (MA or PhD)

While doctorates in school psychology are

available (e.g., 130 were awarded in 1999;

APA, 2000b), a master’s degree is generally

the degree of choice for school psychologists.

Surveys by the APA (2000a, 2009b) revealed

that about 4% identify themselves as working

in the field of school psychology and about

3% of all doctorates awarded in psychology

24 Foundations and Fundamentals

are awarded in school psychology. School

psychologists typically work in elementary,

secondary, or special education schools providing

cognitive testing, brief counseling, and

consultation to schoolteachers, administrators,

parents, and students. Some school psychologists

also provide tutoring help and some

maintain private practices. School psychologists

often work with children receiving special

education services for problems such as

attention deficit/hyperactivity disorder, learning

disabilities, or mental retardation. These

professionals often provide guidance to both

children and their families concerning educational

and psychological concerns. School

psychologists interested in careers in research,

academics, or administration usually choose

PhD programs while those most interested in

practice with children and families generally

choose MA programs.

Psychiatry (MD)

Psychiatrists are physicians who earn a medical

degree (MD) and complete residency training

in psychiatry. The American Psychiatric

Association reports that there are approximately

40,000 psychiatrists who are members

of the association (American Psychiatric Association,

2010). Approximately 40% of psychiatrists

work in solo private practices (American

Psychiatric Association, 2010). Typically, psychiatrists

receive their bachelor’s degrees in

premedical related fields (e.g., biology, chemistry),

and then complete 4 years of medical

school to obtain an MD degree. Subsequently,

a one-year medical clinical internship is completed,

prior to a residency (usually three

years) in psychiatry. Unlike the internship

completed in clinical psychology, the medical

internship focuses on general medical

(not psychiatric) training. While the residency

training years may include some training activities

similar to that obtained by clinical

psychology interns (e.g., psychotherapy), most

programs focus on medication management

and other pharmaceutical approaches to psychiatric

disorders. The residency is usually

completed in a hospital or medical center

environment. However, residency training can

also occur in outpatient settings such as community

mental health clinics. These physicians

obtain their medical license following medical

school and often take their boards to become

board certified in a specialty area (e.g., child

psychiatry) when they complete their residency

program.

Because psychiatrists are physicians, they

use their medical training to diagnose and

treat a wide spectrum of mental illnesses.

Psychiatrists, as MDs, can prescribe medication,

treat physical illnesses, and may utilize

other biological interventions (e.g., electroconvulsive

therapy). Although there are exceptions,

psychiatric training generally focuses

on clinical diagnoses and treatment of major

psychopathology (i.e., affective or mood disorders,

such as bipolar disorder, and psychotic

disorders, such as schizophrenia). Training in

general human behavior and research is usually

minimal.

Relative to other mental health disciplines,

there are a variety of pros and cons to being

a psychiatrist. Advantages include several

factors. First, as physicians, psychiatrists have

extensive training in the biological basis of behavior

and behavioral problems. They are able

to use this expertise to understand and treat

a wide range of medical and psychiatric problems.

Psychiatrists have superior knowledge of

medical aspects of certain disorders, and have

been trained to take a leadership role vis- `avis

these patients. Thus, they can prescribe

medication and other biological treatments for

their patients, whereas most other clinicians

must refer patients to an MD if medication

or other biological interventions are indicated.

However, psychologists are able to prescribe

medication in several states (e.g., New Mexico,

Louisiana; Beutler, 2002). Second, psychiatrists

have a much higher earning potential

than any other mental health professional.

Starting salaries typically are over $100,000,

with average salaries about $150,000 depending

on the work setting. In comparison, the

average starting salary for practicing psychologists

is about two-thirds of psychiatrists at

What Is Contemporary Clinical Psychology? 25

about $70,000 (American Psychological Association,

2008). Third, as physicians, psychiatrists

generally hold greater status and positions

of greater authority, especially in hospital

or other medical settings. Higher salaries and

prestige are due to the costs and competitiveness

of medical education as well as society’s

admiration of physicians in general.

There are several important disadvantages

to becoming a psychiatrist. First, the costs

of medical training are extremely high compared

with the training costs of other mental

health professionals. Second, psychiatrists

tend to have much less training in general

human behavior and psychotherapy than

most other mental health professionals. For

example, while most psychologists spend four

undergraduate, five graduate, and one to two

postdoctoral years focusing specifically on psychology

and psychotherapy, psychiatrists only

spend the three residency years focused on

psychiatry, which tends to primarily train

these professionals on using medications for

behavioral and emotional problems. Thus,

many first-year psychiatry residents are far

‘‘greener,’’ for example, than most advanced

psychology graduate students or predoctoral

psychology interns. Third, psychiatrists also

are not trained in psychological testing and

assessment, and must defer to clinical psychologists

in order to acquire this often-critical

information. Fourth, psychiatrists are rarely

trained as extensively as clinical psychologists

in rigorous research methodology. Finally,

fewer and fewer medical students choose psychiatry

as a specialty, in fact dropping by 40%

since the 1980s alone (Tamaskar & McGinnis,

2002). Psychiatric salaries, although high

in comparison to non-MD mental health professionals,

are very low compared with other

physicians. In recent decades, traditional psychodynamic

and interpersonal relational approaches

to psychiatry have given way to more

biological approaches, partially due to new discoveries

in the neurosciences, psychopharmacology,

genetics, and other medical areas (e.g.,

Fleck, 1995; Glasser, 2003; Michels, 1995), as

well as the demand by managed care insurance

companies and patients for quicker acting

treatment approaches (e.g., Cummings, 1995).

Finally, the lobbying efforts of the pharmaceutical

industry have also influenced the reliance

on medications to treat all sorts of behavioral

and emotional concerns (Glasser, 2003).

Social Work (MSW)

There are approximately 150,000 members of

the National Association of Social Workers

(NASW, 2010). Social workers have typically

obtained a bachelor’s degree in a social science

such as psychology or sociology and subsequently

entered a two-year graduate program

to attain their master’s degree in social work

(MSW). Next, they must complete up to two

years of supervised clinical experience (depending

on the state) to become a Licensed

Clinical Social Worker (LCSW). Similar to

the clinical psychology internship, many social

workers receive training in psychotherapy

and psychiatric diagnoses during their year or

years of supervised clinical experience. Unlike

in psychology, they generally do not obtain

extensive training in conducting research or

using psychological testing instruments. However,

those who earn a doctorate degree in

social work (DSW) often are interested in

research and academic careers.

Historically, social workers focused on

patient case management (i.e., helping the

patient get the most out of his or her inpatient

or outpatient treatment and helping patients

transition to work or further treatment

following discharge), patient advocacy, and

a liaison to optimal social service agencies

and benefits. Whereas psychiatrists have

historically focused on biological theories and

interventions and psychologists have focused

on psychological theories and intervention,

social workers have focused on social theories

and interventions. Today, social workers can

conduct psychotherapy with individuals, families,

or groups, or undertake administrative

roles within agencies, hospitals, or social service

settings. Providing direct clinical services

to clients and patients is the most frequently

reported activity of social workers (National

26 Foundations and Fundamentals

Association of Social Workers, 2010). Social

workers can be employed in numerous

settings including schools, hospitals, clinics,

and

private practice.

Employment in social

service agencies and both inpatient and outpatient

health facilities are the most common

settings for social workers while about 12%

are engaged in private practice (National

Association of Social Workers, 2010). Social

workers also may act as patient case managers

and advocates, securing necessary follow-up

care and social services following hospital

discharge, for example.

Advantages to becoming a social worker

include first a shorter (and, thus, less expensive)

length of graduate training (i.e., two

years as opposed to the minimum five years

necessary for a PhD degree in clinical psychology).

Second, training in social work tends to

highlight social factors such as poverty, crime,

racism, and oppression that influence individual,

group, and organizational behavior as

well as emphasizing advocacy for the rights of

others. Third, no dissertation or large research

study master’s thesis is required for those who

are not interested in conducting these types

of large-scale research projects. Disadvantages

include less training and emphasis on the

biological influences on behavior and less attention

on research. Additional disadvantages

include lower earning ability than psychologists

and psychiatrists. Average salaries tend

to be about $50,000 depending on the position

and location. Social workers, like any

clinician, can specialize and become expert in

any nonprescribing or nonpsychological assessment

enterprise.

Psychiatric Nursing (RN)

There are over 11,000 psychiatric nurses

who have specialty training in psychiatric

illnesses and treatment (American Psychiatric

Nurses Association, 2009). They usually

obtain both an undergraduate and master’s

degree in nursing. They are licensed as

registered nurses (RN) following the completion

of their undergraduate degree. During

their training, they, like other mental health

professionals, learn about psychiatric diagnosis

and treatment. However, they also learn

about psychopharmacology and are often

involved in the dispensing of psychotropic

medications to patients. Psychiatric nurses

provide psychotherapy to individuals, families,

and groups as well as assisting in medical

management of psychotropic medications.

Many psychiatric nurses are employed in

hospitals and clinics; however, many maintain

private practices as well.

Marriage and Family

Therapists (MFT)

The mental health discipline of marriage and

family therapists is very popular in California

and several other states. There are approximately

25,000 MFTs in California alone

and about 50,000 nationally. The Association

of Marriage and Family Therapists has about

25,000 members nationally. MFTs typically

complete a bachelor’s degree in any field (typically

a social science discipline such as psychology,

sociology, or education), and later pursue

a master’s degree in a terminal master’s counseling

or psychology program. Following up to

two years of supervised experience, MFTs can

be licensed to practice independently in most

but not all states. Despite the title, MFTs are

not necessarily experts solely in marriage and

family counseling. Often, they treat adults in

individual therapy, as well. Advantages to becoming

an MFT include the ease of acceptance

into programs and the one to two years necessary

to obtain amaster’s degree. Disadvantages

include the general mixed quality and training

of professionals in this field.

Many states offer licensure as a Licensed

Professional Counselor (LPC) designed for

master’s-level practitioners. The training and

experience for this profession tends to be

similar to those outlined for MFTs.

Other Counselors

Many hospitals and clinics employ a variety

of counselors such as occupational therapists,

activity therapists, alcohol counselors, art

What Is Contemporary Clinical Psychology? 27

therapists, psychiatric technicians, and others.

These professionals provide a wide variety

of services to patients including individual,

family, and group counseling, and therapeutic

activities such as art, dance, and music

groups. Some of these professionals obtain

a license or certification to practice (e.g.,

occupational therapists) while others do not

(e.g., psychiatric technicians). Legislation

in many states, such as Missouri, has been

proposed or passed allowing occupational

therapists, for example, to be licensed as

‘‘mental health professionals.’’

Other Psychologists

There are many different types of psychologists

besides the clinical, counseling, and school

psychologists previously described. Cognitive,

developmental, experimental, social, personality,

industrial-organizational, physiological,

and other types of psychologists are represented

in

the field.

They complete a doctoral

degree in psychology with specialization in

one or more of the areas already listed. Unlike

clinical psychologists, they are not mandated

to complete an internship or postdoctoral fellowship.

These psychologists work in educational

settings such as colleges and universities

as well as in business, government, and the

military. They conduct research, consult with

individuals and groups, and develop policies.

They have different areas of expertise and skill

but generally do not assess or treat patients

experiencing emotional, behavioral, interpersonal,

or other clinical problems. They are not

considered mental health professionals and

may not even be interested in human behavior.

For example, an experimental psychologist

might conduct research on the memory functioning

of rats or the visual functioning of

cats. A social psychologist might be interested

in the social functioning of groups of primates.

A physiological psychologist might be interested

in how organisms such as birds learn

new behaviors. These psychologists might be

interested in human behavior but not in abnormal

or clinical problems. For example, an

industrial-organizational psychologist might

help an executive interact with employees

to improve performance or morale. A cognitive

psychologist might study how medications

impact attentional processes and sleeping behavior.

A developmental psychologist might

be interested in how children who are in

full-time day care that starts during the first

weeks of life bond with their mothers. With

the exception of industrial-organizational psychologists,

these psychologists do not obtain

a license to practice psychology and therefore

do not treat clinical problems.

The Big Picture

The goals, activities, and contributions of clinical

psychologists are very appealing to many

who are fascinated by human behavior and relationships.

Contemporary clinical psychology

can be defined as the assessment, treatment,

and study of human behavior in the context

of biological, psychological, and social factors.

Thus, integration as well as awareness of such

individual differences such as culture, ethnicity,

and gender is part and parcel of the state

of this current art and science. The enormous

popularity of psychology as an undergraduate

major, of clinical psychology as a career path,

and of popular psychology books, shows, web

sites, and blogs are a testament to the inherent

interest of clinical psychology. Most psychologists

report a high degree of satisfaction with

their career choice, and enjoy the tremendous

flexibility and diversity of potential employment

settings, the opportunity to work with

people from diverse backgrounds, and participation

in the rapid scientific advances impacting

the field. However, changes in health-care

delivery and reimbursement, the large number

of degrees being awarded in clinical psychology

and other mental health disciplines, and

the modest salaries of most psychologists must

be viewed realistically along with the many

advantages of clinical psychology as a career.

The goals and activities of clinical psychology

are noble: to use the principles of psychology

and our understanding of human behavior

28 Foundations and Fundamentals

to promote health, happiness, and enhanced

quality of life.

Key Points

1. Clinical psychology focuses on the diagnosis,

treatment, and study of psychological

and behavioral problems and disorders.

Clinical psychology attempts to use the

principles of psychology to better understand,

predict, and alleviate ‘‘intellectual,

emotional, biological, psychological, social,

and behavioral aspects of human functioning’’

(APA, 2009).

2. The road to becoming a clinical psychologist

is a long one divided by a number of distinct

stages and phases, which include college,

graduate school, clinical internship, postdoctoral

fellowship, licensure, and finally

employment. However, academic positions

are usually available following receipt of a

doctorate degree and prior to licensure.

3. One of the great advantages of being a

clinical psychologist is that there are a

wide variety of activities and employment

settings in which to work. Becoming a

clinical psychologist allows one to teach

at the university level, conduct research,

provide consultation to a wide variety

of professionals and organizations, and

conduct psychotherapy and psychological

testing with a wide range of populations.

4. Clinical psychologists work in many different

employment settings including hospitals,
medical schools, outpatient clinics,

colleges and universities, business and industry

settings, and private or group practices.

The majority of clinical psychologists

work in some type of part-time or full-time

private practice. Following private practice,

educational settings, such as academic careers

in colleges and universities, are the

second most common employment setting

for clinical psychologists.

5. Many clinical psychologists ultimately specialize

in one or more areas of research

or practice. While there are many types of

clinical psychology subspecialties, the most

common include child clinical psychology,

health psychology, neuropsychology, and

forensic psychology.

6. Clinical psychologists are organized into a

wide variety of professional organizations.

Most psychologists are members of the

APA. The APA is also divided into 56 topic

interest divisions. About 6,000 psychologists

are members of the APA Division 12

(Clinical Psychology).

7. In 1988, the American Psychological Society

(APS) was founded by many of the

academic or science-minded psychologists

in the APA who felt that the APA no

longer adequately represented their interests.

Founding members of the APS felt that

the APA had become too focused on professional

practice and was becoming less and

less attuned to the science of psychology.

8. Each state and most counties maintain

psychological associations. Most clinical

psychologists join their state psychological
association and may also join their county
psychology association.

9. The American Board of Professional Psychology

(ABPP) was founded in 1947 as an

agency that would certify psychologists in
several specialty areas. The ABPP diploma

is considered an advanced level of recognition

and is certification beyond a state

license to practice as a psychologist.

10. Clinical psychology maintains both similarities

and differences with other mental

health–related fields such as counseling

psychology, school psychology, psychiatry,

social work, nursing, and marriage, family,

and child counseling.

11. Changes in health-care delivery and reimbursement,

the large number of degrees

being awarded in clinical psychology and

other mental health disciplines, and the

moderate salaries of most psychologists can

be viewed as some disadvantages of clinical

psychology as a career option.

12. The field of clinical psychology is dedicated

to humanitarian concerns. Clinical

psychology seeks to use the principles of

human behavior to minimize or eliminate

human suffering and enhance and improve

Chapter 2

Today, clinical psychology is a complex

and diverse field encompassing numerous

subspecialties and a continuum of scientific

and practitioner-focused enterprises. In

seeking to alleviate human suffering in emotional,

behavioral, and physical realms, clinical

psychology has borrowed from philosophical,

medical, and scientific advances throughout

the centuries. Chapters 2 and 3 highlight the

seminal historical influences and fundamental

contributors to the ever-evolving science and

practice of today’s clinical psychology. First,

the evolution of Western medicine from a

nonscientific endeavor to today’s high-tech

standard of practice is traced. Central to this

evolution has been the titanic human struggle

to understand abnormal behavior in the context

of the mind and the body. As you will see,

an integration between the forces of mind and

body has been long in coming, developing in

fits and starts throughout the ages into today’s

biopsychosocial appreciation for the dynamic

forces that join to create behavior. And just as

this mind–body integration has developed, the

practice and training of clinical psychologists

have mirrored landmark scientific changes in

this evolving field of study.

This chapter highlights the early influences

and foundations that led to the development

of clinical psychology as an independent science

and profession. It traces the history and

development of issues relevant to contemporary

clinical psychology, from ancient times

until World War I. Ideas, events, institutions,

and people associated with this history are

highlighted. Also, Table 2.1 provides an outline

of significant events in the field prior to

World War II. The influence of biological, psychological,

and social factors and the roots of

31

32 Foundations and Fundamentals

Table 2.1 Significant Events in Clinical Psychology Prior to World War II

Before Psychology Was Founded as a Field

2500–500 B.C. Supernatural, magic, herbs, and reason was the approach to mental and physical illness.

470–322 B.C. Greeks use holistic approach to illness, which is attentive to biological, psychological, and

social influences.

130–200 A.D. Galen develops foundation of Western medicine based on the influence of the Greeks,

which lasts 1,000 years.

500–1450 Middle Ages believe supernatural forces

influence health and illness.

1225–1274 Saint Thomas Aquinas uses scientific thinking to help explain health and illness.

1490–1541 Paracelsus suggests that the movements of the stars, moon, sun, and planets influence

behavior.

1500–1700 Renaissance witnesses numerous scientific discoveries suggesting that biological factors

influence health and illness.

1596–1650 Ren´e Descartes develops mind/body dualism.

1745–1826 Pinel, in France, develops humane moral therapy to treat mentally ill.

1802–1887 Dorothea Dix advocates for humane treatment of mentally ill in America.

1848 New Jersey becomes first state to build a hospital for mentally ill patients.

After Psychology Was Founded as a Field and until World War II

1879 Wilhelm Wundt develops first laboratory in psychology.

1879 William James develops first American psychology laboratory at Harvard.

1883 G. Stanley Hall develops second psychology laboratory at Johns Hopkins.

1888 James McKean Cattell develops third American psychology laboratory.

1890 James publishes Principles of Psychology.

1890 Cattell defines mental test.

1892 American Psychological Association founded.

1896 Lightner Witmer establishes first psychology

clinic at the University of Pennsylvania

.

1900 Freud publishes The Interpretation of Dreams.

1904 Alfred Binet begins developing an intelligence test.

1905 Binet and Theodore Simon offer Binet-Simon scale of intelligence.

1905 Carl Jung creates a word association test.

1907 Psychological Clinic, first clinical journal, is published.

1908 Clifford Beers begins mental hygiene movement.

1909 Clinical psychology section formed at APA.

1909 Freud’s only visit to America at Clark University.

1909 William Healy develops child guidance clinic in Chicago.

1916 Lewis Terman develops Stanford-Binet

Intelligence Test

.

1917 Clinicians of APA leave to form American Association of Clinical Psychologists (AACP).

1917 Robert Yerkes and committee develop Army Alpha test.

(continued)

Foundations and Early History of Clinical Psychology 33

Table 2.1 Continued

After Psychology Was Founded as a Field and until World War II

1919 AACP rejoins APA.

1921 Cattell develops Psychological Corporation.

1921 Hermann Rorschach presents his inkblot test.

1924 Mary Cover Jones uses learning principles to treat children’s fears.

1935 APA Committee on Standards and Training define clinical psychology.

1936 Louttit publishes first clinical psychology textbook.

1937 Clinicians leave APA again to form American Association of Applied Psychology (AAAP).

1937 Journal of Consulting Psychology begins.

1939 The Wechsler-Bellevue Intelligence Scale is published.

1945 AAAP rejoins APA.

1945 Connecticut passes first certification law for psychology.

integration of perspectives are noted. It is unlikely

that the people associated with these

ideas and events could have predicted how

they might influence further generations to

derive the perspectives of today. Chapter 3 examines

the more recent developments in the

field, from World War II until the present.

A full understanding of contemporary clinical

psychology hinges on a sound appreciation

and understanding of its foundation and

history.

Early Conceptions of Mental Illness:

Mind and Body Paradigms

The Greeks

Several Greek thinkers were pivotal in the

early development of integrative approaches

to illness, and, thus, were precursors to a

biopsychosocial perspective. Although the ancient

Greeks felt that the gods ultimately

controlled both health and illness, they looked

beyond supernatural influences and explored

biological, psychological, and social influences

on illness (Maher & Maher, 1985a). The

Greeks believed that the mind and body were

closely interconnected. Somewhat similar to

today’s health resorts, ailing Greeks often

would spend a few days at a temple where they

would engage in treatments that might include

prayer, special foods, bathing, dream analysis,

and animal sacrifice. The doctor-priest who

conducted these treatments believed that healing

could occur through activation of a life

force stimulated by the treatment protocols

(Mora, 1985).

The famous Greek physician,

Hippocrates

(460–377 B.C.), who led the writing of the Hippocratic

Corpus, felt that disease was primarily

the result of an imbalance in four bodily fluids

or humors, rather than of spiritual factors (Maher

& Maher, 1985a). These fluids were black

bile, yellow bile, phlegm, and blood. Furthermore,

Hippocrates felt that the relationship

between these bodily fluids also determined

temperament and personality. For example,

too much yellow bile resulted in a choleric

(angry, irritable) temperament, whereas too

much black bile resulted in a melancholic (sadness,

hopelessness) personality. Hippocrates

felt that these imbalances might originate in

the patient’s environment. For example, it was

believed that water quality, altitude, wind, and

time of year were important considerations in

the etiology of illness. Hippocrates encouraged

fellow doctors to be gentle and patient

with their patients because various stressors

were viewed as capable of preventing healing.

34 Foundations and Fundamentals

Hippocrates maintained a holistic approach to

health and illness reflected in his statement:

‘‘In order to cure the human body, it is necessary

to have a knowledge of the whole of

things.’’ He felt that head trauma and heredity

could also account for abnormal behavior and

illness. He was sensitive to interpersonal, psychological,

and stress factors that contribute to

problem behavior. The thinking and writing of

Hippocrates helped to move from a spiritualistic

toward a more naturalistic view or model of

health and illness. Hippocrates suggested that

biological, psychological, and social factors all

contribute to both physical and emotional illness.

This early biopsychosocial perspective

was further championed by Plato, Aristotle,

and Galen until its temporary demise in the

Middle Ages.

Plato (427–347 B.C.) saw the spirit or soul as

being in charge of the body and that problems

residing in the soul could result in physical

illness (Mora, 1985). Plato quoted Socrates

(470–399 B.C.) as stating: ‘‘As it is not proper

to cure the eyes without the head, nor the

head without the body, so neither is it proper

to cure the body without the soul.’’ Plato felt

that mental illness resulted from sickness in

the logistikon or the part of the soul that operates

in the head, controlling reason. He felt

that personality, a lack of harmony, and ignorance

about the self were responsible for

mental illness symptoms. Aristotle (384–322

B.C.) maintained a scientific emphasis and felt

that certain distinct emotional states including

joy, anger, fear, and courage impacted the

functioning of the human body. Aristotle felt

that treatment for mental problems should include

talking and the use of logic to influence

the soul and psyche (Maher & Maher, 1985a).

The use of logic and reason to influence emotional

and behavioral problems is one of the

major principles behind today’s cognitive therapy.

These Greek philosophers and physicians

viewed health, illness, personality, and behavior

as being intimately interconnected.

Galen (A.D. 130–200) was a Greek physician

who integrated the work and perspectives

outlined by Hippocrates, Plato, Aristotle, and

others and developed a holistic program of

medical practice that became the foundation

of medicine in Europe for 1,000 years (Maher

& Maher, 1985a; Mora, 1985). Like his Greek

colleagues, Galen also used the humoral

theory of balance between the four bodily

fluids discussed previously as a foundation

for treatments. Induced vomiting to treat

depression as well as induced bleeding or

bloodletting to treat a variety of ailments

were common treatments used for centuries

(Burton, 1621/1977; Kemp, 1990). Galen also

felt that the brain was the rational soul and the

center of sensation and reason. Additionally,

he thought that humans experienced one of

two irrational subsouls, one for males and one

for females. The male subsoul was thought to

be located in the heart, whereas the female

subsoul was thought to be located in the liver.

Unlike Plato, Galen felt that the soul was the

slave and not the master of the body, and

that wishes of the soul in the body resulted in

health and illness.

Together, the Greeks developed a remarkably

holistic perspective in which we can see

many of the roots of our current beliefs on

mind and body interactions in mental and

physical illness. However, the ensuing Middle

Ages would temporarily derail from this line

of reasoning, instead embracing largely supernatural

views of illness.

The Middle Ages

During the Middle Ages (A.D. 500–1450), earlier

notions regarding the relationship among

health, illness, mind, and body

reemerged

(Kemp, 1990). Perhaps as a response to the

highly turbulent, frightening, and stressful

times during the Black Plague, numerous

wars, and the split within the Roman Catholic

Church resulting in two Catholic centers and

popes, the focus on supernatural influences to

explain events became commonplace. Disease

and ‘‘insanity,’’ many believed, were caused

by spiritual matters such as the influence of

demons, witches, and sin. Therefore, healing

and treatment became, once more, a spiritual

rather than a medical issue using integrative

biopsychosocial strategies. Those who were ill

Foundations and Early History of Clinical Psychology 35

would consult with priests or other clergy, and

atonement for sins would likely be prescribed

as the road to recovery. People who were ‘‘insane’’

would often be treated by exorcism.

Some were chained to church walls in order

to benefit from prayers; some were tortured

and killed. In 1484, Pope Innocent VIII issued

a papal statement approving of the persecution

of ‘‘witches.’’ Although the mentally ill

were certainly not the only people targeted, it

has been estimated that 150,000 people were

executed in the name of religion during this

time period (Kemp, 1990).

Although most modern people would disagree

with the supernatural emphasis and

inhumane treatments during the Middle Ages,

some of the same type of thinking and blaming

of the victim is found today. For example,

many of the problems of the Germans during

the 1930s and early 1940s were blamed on

the Jews. During the 1980s, many (including

several U.S. senators) suggested that AIDS was

a plague from God for ‘‘immoral’’ homosexual

behavior. Today, many blame illegal immigration

as a critical factor in many societal ills,

including problems such as economic woes,

violence, and youth crime.

Not everyone during the Middle Ages believed

that good and evil, spirits and demons,

sorcery and witchcraft contributed to mental

illness (Kemp, 1990; Maher & Maher,

1985a). Some, such as Saint Thomas Aquinas

(1225–1274), felt that there was both theological

truth and scientific truth. For example,

Aquinas reasoned that the soul was unable

to become ‘‘sick’’ and, therefore, mental illness

must have a physical cause or be due to

problems in reason or passion (Aglioni, 1982).

The late fourteenth-century French bishop

Nicholas Oresme felt that abnormal behavior

and mental illness were due to diseases such

as melancholy (today’s depression). Furthermore,

the insane were sometimes humanely

and compassionately cared for by people living

in rural villages.

Another model to explain abnormal behavior,

which became especially popular during

the sixteenth century, was the influence of

the moon, stars, and alignment of the planets.

A Swiss physician, Paracelsus (1490–1541),

popularized the notion that various movements

of the stars, moon, and planets influenced

mood and behavior. Paracelsus also

focused on the biological foundations of mental

illness and developed humane treatments.

Juan Luis Vives (1492–1540) and Johann

Weyer (1515–1588) helped to shift theories

of mental illness from a focus on the soul

to an emphasis on behavior and promoted

humane treatments of the mentally ill. During

the Middle Ages, the biological, psychological,

social, astrological, and supernatural

influences on behavior were believed to be

responsible for mental illness and abnormal

behavior. Different institutions, groups, and

individuals maintained different opinions concerning

which of these factors could explain

behavior the best. Sadly, some of these beliefs

resulted in poor or no treatment as well as

inhumane behavior toward others.

The Renaissance

During the Renaissance, renewed interest in

the physical and medical worlds emerged,

overshadowing supernatural and religious

viewpoints. Interest in the mind and soul were

considered unscientific and thus relegated to

the philosophers and clergy. New discoveries

in chemistry, physics, biology, and mathematics

unfolded rapidly and were met with great

enthusiasm (Mora, 1985). Giovanni Battista

Morgagni (1682–1771), for example, discovered

through autopsy that a diseased organ

in the body could cause illness and death.

Andreas Vesalius (1514–1564), a Dutch physician,

published an anatomy textbook in 1543

delineating dissection of the human body.

The emphasis on scientific observation and

experimentation rather than reason, mythology,

religious beliefs, and dogma provided a

model for future research and teaching. When

William Harvey, an English physician, used

the scientific method in 1628 to determine

that blood circulated through the body because

of the function of the heart, the Greek

36 Foundations and Fundamentals

notion of imbalance of bodily fluids vanished

from medical thinking.

New medical discoveries during the Renaissance

resulted in biomedical reductionism

in

that disease, including mental illness, could be

understood by scientific observation and experimentation

rather than beliefs about mind

and soul. The biological side of the integrative

biopsychosocial perspective was emphasized.

Ren´e Descartes (1596–1650), a French

philosopher, argued that the mind and body

were separate. This dualism of mind and body

became the basis for Western medicine until

recently. The mind and body were viewed historically

as split, in that diseases of the body

were studied by the medical sciences while

problems with the mind or emotional life

were delegated to the philosophers and clergy.

However, mental illness was often considered

a disease of the brain, and thus the insane

were treated using the medical orientation of

the time.

Treatment of mental illness, however,

lagged behind these medical developments.

During this period, physicians treated people

who were considered deviant or abnormal

by confining them to hospitals and asylums.

Little treatment, other than custodial care,

was provided to these patients and thus these

asylums were renowned for their prison-like

environments. The term bedlam (a variant

of Bethlehem), connoting chaos and hellish

circumstances, originated when St. Mary’s

of Bethlehem was opened in London during

1547. Active treatments, besides custodial

care, included restrictive cribs, hunger cures,

bloodletting, cold-water dunking or hydrotherapy,

and other painful treatments (Kemp,

1990; Mora, 1985).

The Nineteenth Century

In the nineteenth century, numerous advances

in understanding mental and physical

illness allowed for a more sophisticated understanding

of the relationship between body

and mind in both health and illness. A breakthrough

of the nineteenth century involved

the discovery by Rudolf Virchow (1821–1902),

Louis Pasteur (1822–1895), and others that

disease and illness could be attributed to dysfunction

at the cellular level (Maher & Maher,

1985a). For example, the discovery that

syphilis was caused by microorganisms entering

the brain following sexual activity helped

to support the biological model of mental illness.

The laboratory thus took center stage as

the arena for the investigation of disease. The

nineteenth-century discovery that germs or microorganisms

can cause disease, along with

the twentieth-century advances in medical,

genetic, and technological discoveries, have

continued to support the ‘‘Cartesian dualism’’

perspective of Descartes in the seventeenth

century.

However, dualism was tempered in the

last part of the eighteenth century and during

the nineteenth century due to the work and

influence of a variety of physicians who believed

that the mind and body were connected,

not separate. Benjamin Rush (1745–1813) authored

the first American text in psychiatry,

positing that the mind could cause a variety

of

diseases.

Franz Mesmer (1733–1815), an

Austrian physician, and others noticed that

many people experiencing paralysis, deafness,

and blindness had no biomedical pathology,

leaving psychological causes suspect. Claude

Bernard (1813–1878) was a prominent physician

who argued for recognition of the role

of psychological factors in physical illness.

Jean Martin Charcot (1825–1893), a French

physician, used hypnosis to treat a wide variety

of conversion disorders (i.e., physical

symptoms such as paralysis, blindness, deafness

without apparent physical cause). Thus,

many nineteenth-century physicians laid the

groundwork for today’s current theories and

practices integrating the influences of physical,

psychological, and social factors on health

and well-being.

These advances lead to greater sensitivity

and sophistication regarding the treatment of

individuals with mental illness. A psychosocial

approach to mental illness called moral

therapy emerged during this time. Moral

therapy sought to treat patients as humanely

Foundations and Early History of Clinical Psychology 37

as possible and encouraged the nurturance

of interpersonal relationships. Its founder,

French physician Philippe Pinel (1745–1826),

did much to improve the living conditions and

treatment approaches used by mental hospitals

during the nineteenth century. He became

director of several mental hospitals in France

and altered the treatment facilities to maximize

patient welfare and humane forms of

treatment. Using the same principles in the

United States, Eli Todd (1769–1833) developed

a retreat-like program for the treatment

of the mentally ill in Hartford, Connecticut.

This program is still in operation today and is

called the Institute of Living. William Tuke

(1732–1822) also developed more humane

treatment approaches in English mental hospitals.

Dorothea Dix (1802–1887), a Massachusetts

school teacher, worked heroically

for 40 years to improve treatment conditions

for the mentally ill in the United States. During

the Civil War, she acted as the head nurse

for the Union Military. Due to her efforts, New

Jersey became the first state to build a hospital

for the mentally ill in 1848. Many states

quickly followed suit.

Significant improvements in the diagnosis

of mental illness emerged during this time as

well. Efforts to apply scientific methodology to

better classify and diagnose abnormal behavior

were implemented. For example, influential

German physician Emil Kraeplin (1856–1926)

defined the term dementia praecox to describe

the constellation of behaviors we generally

now consider schizophrenia [named by Eugen

Bleuler (1857–1930)]. Kraeplin also asserted

that mental disorders were brain disorders,

and mental illness could be classified as

rising from either exogenous or endogenous

influences. The thinking and work of Kraeplin,

Bleuler, and others during this period not only

helped to clarify mental disorders as medical

problems but also assisted in developing a

classification system for understanding and

categorizing many mental disorders.

Franz Alexander (1891–1964) also studied

the association between psychological factors

and both physical and mental illnesses (Mora,

1985). He proposed that as a specific stressor

occurred, a genetically predetermined organ

system of the body responded. By repressing

conflict, for example, Alexander felt that

psychic energy could be channeled into the

sympathetic division of the autonomic nervous

system, thus overstimulating this system

and producing disease. Therefore, while one

person might repress conflict and eventually

develop an ulcer (due to gastric acid secretion),

another person might develop colitis,

headache, or asthma. Alexander argued that

specific personality styles, as opposed to unconscious

conflicts, resulted in specific disease.

For example, he felt that dependence would

typically result in the development of ulcers

while repressed rage would result in hypertension.

Research continues to reveal biological,

psychological, and social influences in the development

of ulcers, hypertension, and other

diseases.

A confluence of factors thus led to the birth

of psychology as an independent discipline and

science separate from, but related to, philosophy,

medicine, and theology. We can see

the roots of today’s mind–body integrative

and biopsychosocial perspective. The evolution

of the Western view of medicine and of

abnormal behavior; the use of the scientific

method to make new discoveries in biology,

chemistry, physics, and math; the emergence

of psychoanalytic thinking; and the interest

in individual differences in behavior together

combined to set the stage for the subsequent

emergence of the science and practice of psychology.

The Birth of Psychology

In 1860, Theodor Fechner (1801–1887) published

The Elements of Psychophysics while Wilhelm

Wundt (1832–1920) published the Principles

of Physiological Psychology in 1874. These

publications were the first to indicate clearly

that techniques of physiology and physics

could be used to answer psychological questions.

The first laboratory of psychology was

subsequently developed by Wundt at the University

of Leipzig, Germany, in 1879, and

38 Foundations and Fundamentals

psychology was born. Wundt was especially

interested in individual and group differences

in sensation and perception, studying human

reaction times in various laboratory experiments.

He was also interested in using both

the scientific method and introspection to better

understand the structure and components

of the mind. William James also established

a psychology laboratory at Harvard University

at about the same time that Wundt was developing

his laboratory. Whereas Yale University

offered the first formal PhD in ‘‘Philosophy

and Psychology’’ in 1861, Harvard University

offered the first American PhD in psychology

in 1878. G. Stanley Hall established the

second American psychology laboratory at

Johns Hopkins University in 1883 while James

McKeen Cattell established the third American

laboratory in 1888. Hall also established

the first independent psychology department

at Clark University in 1887.

In 1890, James published Principles of Psychology,

which became the first classic psychology

text. In 1891, James Baldwin established

the first psychology laboratory in Canada at

the University of Toronto. In 1892, the American

Psychological Association (APA) was

founded, and G. Stanley Hall was elected its

first president. During the beginning months

and years of this new field, American psychology

nurtured its roots in experimental

psychology and was less interested in clinical

or applied psychology. The early members of

the APA tended to be academics in universities

conducting empirical research.

In addition to sensation, perception, and

understanding the dimensions of the mind

through experimentation, the early psychologists

were interested in the development and

use of mental tests. Although not a psychologist,

Francis Galton, a relative of Charles

Darwin, was interested in statistical analysis

of differences among people in reaction time,

sensory experiences, and motor behavior. He

developed a laboratory in England to study

these issues in 1882. In the United States,

James McKeen Cattell (1860–1944) also studied

reaction time and other differences in

human behavior. Cattell coined the term mental

test in 1890 to refer to measures that he

developed in the hopes of tapping intellectual

abilities. At the University of Freiburg,

Germany, Hugo Mu¨ nsterberg also developed

a series of tests to investigate the mental abilities

of children in 1891. This emerging interest

in testing later grew into one of the fundamental

cornerstones and contributions of the

discipline of clinical psychology.

Thus, psychology was founded, and its

early years were launched by academic psychologists

interested in empirically measuring

various aspects of human behavior to better

understand the components of the mind.

They had very little interest in applying

their findings to assist people with emotional,

behavioral, or intellectual problems or disorders.

The desire to apply these newly developed

methods and principles of psychology

to people in need was soon to result in the

birth of clinical psychology (Maher & Maher,

1985b).

The Founding of Clinical Psychology

While psychology was born as a distinct discipline

with the founding of the APA in 1892,

the birth of clinical psychology as a specialty

area occurred four years later in 1896 with

the opening of the first psychological clinic

at the University of Pennsylvania by Lightner

Witmer (1867–1956). Witmer completed

his undergraduate studies at the University of

Pennsylvania in 1888 and earned his PhD in

psychology at the University of Leipzig under

Wilhelm Wundt in 1892. Following his

doctoral studies, Witmer returned to the University

of Pennsylvania to become director of

their psychology laboratory.

Witmer became the first psychologist to

use his understanding of the principles of

human

behavior to help an individual with

a particular problem. He was asked by a

teacher to help one of her students who

was

not performing well in school. After assessing

the child’s problem, Witmer developed a

Foundations and Early History of Clinical Psychology 39

specific treatment program. He found that the

child had difficulty in spelling, reading, and

memory, and recommended tutoring, which

later proved to be a successful intervention

(McReynolds, 1987).

In 1896, Witmer described his methods

of diagnosis and treatment to members of

the newly formed APA. He proposed that a

psychological clinic could be devoted to diagnosis

and evaluation, individual treatment,

public service, research, and the training of

students. Apparently, his thoughts were not

well received by his professional colleagues at

the time (Brotemarkle, 1947; Reisman, 1976).

His colleagues disliked the notion that psychology

as a science should be applied to

actual clinical problems. It is important to

note that during this time, psychology was

considered a science and its purpose was to

better understand general (not abnormal or

dysfunctional) human behavior. Despite the

lukewarm reception, Witmer independently

developed his psychological clinic at the University

of Pennsylvania along with programs

to assist children with primarily school-related

difficulties and challenges.

Many of the principles that Witmer developed

in his psychological clinic are still used

today. For example, he favored a diagnostic

evaluation prior to offering treatment

procedures and services. He favored a

multidisciplinary team approach as opposed

to individual consultation. He used interventions

and diagnostic strategies based on

research evidence. Finally, he was interested

in preventing problems before they emerged.

Highlight of a Contemporary Clinical Psychologist

Rev. Gerdenio ‘‘Sonny’’ Manuel, SJ, PhD

Photo: Courtesy Rev.

Gerdenio Manuel

As a clinical psychologist, Catholic priest, and university professor,

Fr. Manuel’s general area of interest is higher education, particularly

curricular and co-curricular programs that enable faculty and students

to develop the habits of mind and heart that lead them to reflective

engagement with the world and that deepen their commitment to

fashioning a more humane and just world, especially for those in greatest

need.

Birth Date: June 8, 1951

College: University of San Francisco (BA, Political Science), 1971

Graduate Program: Duke University (MA, PhD, Clinical Psychology),

1985

Clinical Internship: Cambridge Hospital/Harvard University School of

Medicine (1984–1985)

Postdoctoral Fellowship: Cambridge Hospital/Harvard University

School of Medicine (1985–1986)

Current Job: Rector, Santa Clara University Jesuit Community

Pros and Cons of Being a Clinical Psychologist:

Pros: ‘‘Insight into life and life’s meaning, an appreciation of the lights,

shadows, and dreams of human life.’’

Cons: ‘‘Allowing oneself spontaneity in nonclinical situations; it’s hard to

give up the therapist role in off hours.’’

40 Foundations and Fundamentals

Future of Clinical Psychology: ‘‘The role

of clinical psychology will be enhanced as we

continue to strive for ways to stay in touch

with our humanity and deepest desires in

an increasingly technological and stress- and

strife-filled world.’’

Typical Schedule:

8:00 E-mail correspondence

9:00 University or Jesuit Community meetings

11:00 Clinical consultation–individual and

groups

12:00 Working lunch—University trustees,

faculty groups, etc.

2:00 Teaching Clinical Foundations of Pastoral

Counseling

3:00 Writing and research

5:30 Liturgy, prayer

8:00 Pastoral counseling, spiritual direction

By 1904, the University of Pennsylvania

began offering formal courses in clinical psychology.

In 1906, Morton Price published

the first edition of the Journal of Abnormal

Psychology. By 1907, Witmer began the first

professional journal dedicated to the field of

clinical psychology, entitled The Psychological

Clinic. Through these activities and landmark

events clinical psychology was born. However,

while Witmer helped launch the clinical psychology

specialty, a variety of other people

and events further molded clinical psychology

into its current form.

The Influence of Binet’s

Intelligence Test

In 1885, Alfred Binet, a French scientist and

attorney, founded (along with Henri Beaunis)

the first psychology laboratory in France. Binet

and his colleagues were especially interested in

developing tests to investigate mental abilities

in children. In 1904, a French commission

invited Binet and his colleague, Theodore

Simon, to develop a method to assist in

providing mentally disabled children with

appropriate educational services. Binet and

Simon developed an intelligence test that

could be used with children in order to assist

teachers and schools in identifying children

whose mental abilities prevented them from

benefiting

from regular classroom instruction.

The Binet-Simon scale was then developed

in 1908 specifically for school use. Binet felt

that the test did not provide a comprehensive

and objective index of intellectual functioning

and highlighted the limitations of his testing

methods for use beyond the classroom.

Henry Goddard, who had developed a clinic

for children at the Vineland Training School

in New Jersey, learned about the Binet-

Simon scale while in Europe during 1908.

He was impressed with the scale and brought

it back to the United States for translation and

use. In 1916, Stanford University psychologist

Lewis Terman revised the scale and renamed

it the Stanford-Binet. The Binet approach

to testing became remarkably popular in

the United States, as various institutions

throughout the country adopted the Binet-

Simon and later the Stanford-Binet tests to

assess children.

By 1914, over 20 university

psychology clinics were utilizing the Binet

approach. Measuring the intellectual abilities

of children quickly became a major activity of

clinical psychologists during the early days of

the field.

The Influence of the Mental Health

and Child Guidance Movement

The momentum achieved through the emergence

of psychological clinics and psychological

testing soon progressed into the realm

of mental illness and problematic behavior.

A former mental patient, Clifford Beers, who

may be credited with the expansion, founded

the National Committee for Mental Hygiene,

which later became known as the National

Association for Mental Health. Beers was hospitalized

with severe depression that also included

episodes of mania. Today, he would

have likely been diagnosed with bipolar disorder

(manic depression). His treatment, from a

contemporary viewpoint, would be considered

Foundations and Early History of Clinical Psychology 41

inhumane although it was common at the

time. Once he was released from the hospital,

he wrote a book entitled A Mind That Found

Itself, published in 1908. The book focused

on the inhumane treatment he experienced

while hospitalized. The mission of his posthospitalization

life and his newly founded

association was to improve the treatment of

those suffering from mental illness.

Beers and his organization were successful

due in part to the support of prominent psychologist

and Harvard professor William James

and prominent psychiatrist Adolf Meyer. This

success led to the opening of William Healy’s

Juvenile Psychopathic Institute in 1909 and

to the subsequent establishment of child guidance

clinics throughout the country. Unlike

Witmer’s focus on learning differences and

educational challenges, the child guidance

clinics, such as the one developed by Healy,

focused on disruptive behaviors of children interacting

with schools, police, and the courts.

The philosophy of these clinics was based on

the view that disruptive behavior in children

was due to mental illness and that intervention

should occur early before significant

problems such as stealing, fire setting, and

robbery began. In 1917, Healy founded the influential

Judge Baker Foundation in Boston,

Massachusetts. The child guidance movement

applied the new principles of psychology to

the treatment of children and their families

encountering mental illness

and problem behaviors.

Thus, the child guidance perspective

helped to emphasize the psychological and social

influences of behavior and mental illness.

The Influence of

Sigmund Freud

in America

The work and writings of Sigmund Freud

(1856–1939) and his colleagues were highly

influential in further understanding the connection

between the mind and body. Freud

proposed that unconscious conflicts and emotional

influences could bring about mental

and physical illness. Freud reawakened earlier

Greek notions that a more holistic view of

health and illness including the study of emotional

experience was necessary for a fuller

understanding

of health, illness, and abnormal

behavior. Freud’s 1900 publication of The Interpretation

of Dreams resulted in mainstream

acceptance of the psychoanalytic perspective.

Freud had little influence on the development

of clinical psychology in the United

States until September 1909. At that time,

Freud made his landmark and only trip to

the United States in response to an invitation

by G. Stanley Hall (the APA’s first president

and president of Clark University in Worcester,

Massachusetts). Clark University was celebrating

its twentieth anniversary as an institution

and Hall invited a large number of prominent

psychologists, psychiatrists, and academics for

a series of lectures. In addition to Sigmund

Freud, Carl Jung, Otto Rank, Sandor Ferenczi,

James McKeen Cattell, E. B. Titchener, and

William James were also in attendance—a

veritable ‘‘who’s who’’ of influential names

at the time. This conference stimulated the

widespread acceptance of Freud’s psychoanalytic

theories in the United States. The psychological

and child guidance clinics, quickly

growing in the United States at the time,

tended to adopt Freud’s orientation to mental

illness and treatment after the 1909 lectures.

Thus, the psychoanalytic perspective to behavioral

and mental problems was highlighted

in these clinics. Furthermore, the enthusiasm

afforded psychological testing in the wake of

the Binet-Simon scale grew dramatically during

this period as well.

The American Psychological Association

and Early Clinical Psychology

The first two decades of the twentieth century

witnessed tremendous growth in the

field of clinical psychology. During this time,

the APA was interested primarily in scientific

research in academic settings and was

largely disinterested in clinical applications

in the field. Therefore, these rapid developments

in the provision of psychological

services in psychological clinics and child

42 Foundations and Fundamentals

SPOTLIGHT
Sigmund Freud

Sigmund Freud was born in what is now Austria on May 6, 1856, and

spent most of his childhood in Vienna. He came from a large family and

was the oldest of seven children. He appeared to have been the favorite

child, getting attention and perks that other children in the family didn’t

get. Like many Jews at the time, he experienced discrimination that led

him to make certain life sacrifices. For example, he wanted to become a

university professor but, as a Jew, he was unable to pursue this desire

since Jews were not allowed these types of positions at the time. He

chose medicine as an alternative and completed his medical degree at

the University of Vienna in 1881. He initially was attracted to research

endeavors and published several medical articles but eventually switched

to private practice. Freud was not a psychologist or a psychiatrist; he was a

neurologist. He married Martha Bernays and had six children; one, Anna,

became a well-known psychoanalyst.

Freud’s most notable books include Studies on Hysteria (published in

1895) and The Interpretation of Dreams (published in 1900). His influence

grew and by the early 1900s he was highly respected. The influence of his

thinking, writing, and theories had grown enormously in the professional

community. He made one trip to the United States in 1909 to give a series

of lectures at Clark University in Wooster, Massachusetts. Curiously, it

was a trip he later regretted due to the hassles of such travel with few

rewards.

Freud had two great loves: antiquities and cigars. His office was full

of small antiquities and he spent a great deal of time (and money) on

his hobby. Although his love of cigars resulted in throat cancer and a

number of years of pain and surgeries, he found it impossible to give up

the unhealthy habit that ultimately killed him. Due to Nazi persecution,

he fled Austria in 1938 and moved to a residential neighborhood in north

London where he continued writing and seeing patients until just a few

days before his death in September 1939. His London home is now a

museum where many of his antiquities as well as his famous couch and

desk can still be viewed.

guidance clinics were generally ignored by the

association.

The growth of clinical psychology therefore

occurred not because of the APA but in spite

of it. Clinicians frustrated with the lack of

interest and support by the APA decided to

leave the organization and form the American

Association of Clinical Psychologists (AACP) in

1917. This separation did not last and in 1919,

the AACP and APA agreed to a reconciliation

of sorts and the AACP rejoined the APA as a

clinical section.

The Influence of World War I

When the United States entered World War I

in 1917, a large number of recruits needed

to be classified based on their intellectual

and psychological functioning. The U.S. Army

Foundations and Early History of Clinical Psychology 43

Medical Department contacted the current

president of the APA (Robert Yerkes) to assist

in developing an appropriate test for the

military recruits. A committee was formed

that included Henry Goddard, Lewis Terman,

and Guy Whipple (who had published a book

entitled Manual of Mental and Physical Tests in

1910). The committee developed what became

known as the Army Alpha and Army Beta

intelligence tests. The Army Alpha was a verbal

test while the Army Beta was a nonverbal test.

Unlike intelligence tests such as the Stanford-

Binet that could be administered to only

one subject at a time, the Army Alpha and

Army Beta tests could be administered to very

large groups of people. Furthermore, the tests

could be used for both literate and nonliterate

adults. To assess psychological functioning, the

committee suggested that the Psychoneurotic

Inventory (developed by Robert Woodworth

in 1917) also be used. Approximately two

million people were evaluated using these

tests by 1918. This opportunity for psychology

to contribute to the war effort through the

application of psychological tests increased the

status and visibility of psychologists and of

psychological testing.

Clinical Psychology between

the World Wars

Psychological Testing

Following World War I, psychologists became

well known for their testing skills (Kiesler

& Zaro, 1981; B. A. Maher & W. B. Maher,

1985b). A testing development explosion

occurred, such that by 1940 over 500 psychological

tests had been produced. These tests included

both verbal and nonverbal intelligence

tests, personality and psychological functioning

tests, and career interest and vocational

skill tests. Tests were available for children

of all ages and abilities as well as for adults.

The more popular and well-known tests included

the Rorschach Inkblot Test (1921), the

Miller Analogies Test (1927), the Word Association

Test developed by Carl Jung (1919), the

Goodenough Draw-A-Man Test (1926), the

Thematic Apperception Test (1935), and the

Wechsler-Bellevue Intelligence Scale (1939).

In fact, testing boomed to such an extent

that in 1921, James McKeen Cattell founded

the Psychological Corporation to sell psychological

tests to various organizations and

professionals.

Projective testing became very popular with

the 1921 publication of Hermann Rorschach’s

Psychodiagnostik, the famous inkblot test.

Rorschach was a Swiss psychiatrist who died

shortly after the publication of his famous test.

In 1937, S. J. Beck and Bruno Klopfer both

published comprehensive scoring procedures

for the Rorschach Inkblot Test that facilitated

much more research to be conducted using the

instrument. In 1939, David Wechsler developed

the first comprehensive and individually

administered intelligence test for adults. The

Wechsler-Bellevue (and subsequent revisions)

quickly became the standard measure with

which to assess adult intellectual abilities.

By the 1930s, 50 psychological clinics and

about 12 child guidance clinics were operating

in the United States. By the end of the 1930s,

some clinical psychologists began to offer their

professional services to clients and patients in

private practice.

Psychotherapy

The early work of clinical psychologists involved

primarily psychological and intellectual

testing. Psychotherapy and other treatment

services for those suffering from mental illness

were conducted primarily by psychiatrists.

Most psychotherapy during this time

utilized Freud’s psychoanalytic principles and

techniques. Although Freud disagreed (Freud,

1959), psychiatrists in the United States believed

that only physicians could adequately

provide psychotherapy, thus preventing clinical

psychologists and other nonphysicians

from conducting psychotherapy services. In

fact, it wasn’t until a major lawsuit in the late

1980s that psychologists won the right to be

44 Foundations and Fundamentals

admitted as full members of American psychoanalytic

institutes, resulting in their current

ability to conduct psychoanalysis with patients

(De Angelis, 1989). Prior to the lawsuit, most

psychoanalytic institutes admitting psychologists

required that they use their training for

research rather than clinical purposes.

Despite this initial prohibition, clinical psychologists

gradually began providing consultation

as an outgrowth of their assessment

work with children. Consultation as well as

treatment evolved naturally from the testing

process. Consultation with teachers, children,

and parents eventually led to the provision

of a full range of psychotherapy and other

intervention services. Unlike the psychoanalytic

treatment provided by psychiatrists at the

time, psychological treatment was more behavioral

in orientation, reflecting the research

developments in academic laboratories. For

example, in 1920, John Watson detailed the

well-known case of little Albert who was conditioned

to be fearful of white furry objects

(Watson & Rayner, 1920), while Mary Cover

Jones (1924) demonstrated how these types

of fears could be removed using conditioning

techniques.

Training

By the early 1940s, there were no official

training programs or policies regulating the

field of clinical psychology. Though the majority

of clinical psychologists had earned BA

degrees, very few had earned PhD or even

MA degrees. To be employed as a clinical psychologist,

one merely needed to have a few

courses in psychological testing, child development,

and abnormal psychology. The APA was

of little help because of their discomfort with

‘‘applied’’ psychology. The vast majority of the

APA membership still consisted of academics

primarily interested in research rather than

practice applications. However, in 1935, the

APA Committee on Standards of Training in

Clinical Psychology recommended that a PhD

and one year of supervised clinical experience

be required to become a clinical psychologist.

The recommendation was largely ignored because

the APA did nothing to enforce their

recommendation at that time (Shakow, 1947).

Organizational Split and New

Publications

As in 1917, a large group of clinicians again

left the APA in frustration during 1937 to

form a new organization, the American Association

of Applied Psychology (AAAP). History

repeated itself when this new organization rejoined

the APA, this time eight years later in

1945. The split between basic experimentalists

and those interested in applied areas of

psychology has ebbed and flowed throughout

psychology’s history. Nonetheless, clinical psychology

continued to develop and define itself.

The first clinical psychology textbook was published

in 1936 by Chauncey Louttit while the

Journal of Consulting Psychology (now called the

Journal of Consulting and Clinical Psychology) was

first published in 1937.

The Influence of World War II

With U.S. involvement in World War II, the

need to assess military recruits again became

pressing. As during World War I, a committee

of psychologists was formed to develop an

assessment procedure to efficiently evaluate

intellectual and psychological functioning as

well as other skills of potential soldiers (Maher

& Maher, 1985b). Reflecting the rapid development

in psychological testing since World

War I, the testing conducted during World War

II was much more extensive and sophisticated

than the Army Alpha and Army Beta used

earlier. The committee developed a groupadministered

intelligence test called the Army

General Classification Test. The committee also

recommended several other tests, such as the

Personal Inventory, which assessed psychiatric

problems, and brief versions of the Rorschach

Inkblot Test and the Thematic Apperception

Test to assess personality. Additionally, various

ability tests were used to assess military

officers and certain specialty military groups.

Foundations and Early History of Clinical Psychology 45

These tests were given to over 20 million people

during World War II (Reisman, 1976). Due

to the military’s desperate need for psychological

services beyond testing, psychologists

were called upon to provide other clinical services

such as psychotherapy and consultation

(Maher & Maher, 1985b; J. Miller, 1946).

In addition to the enormous needs of the

military during the war effort, additional advances

and developments were associated

with the growth of clinical psychology. For

example, new tests were developed such as the

Minnesota Multiphasic Personality Inventory

(MMPI; Hathaway, 1943). The MMPI was developed

as an objective personality inventory

geared toward assessing psychiatric problems.

The MMPI and current revisions (MMPI-2,

MMPI-A) are among the most widely used

psychological tests today. In 1949, David

Wechsler published the Wechsler Intelligence

Scale for Children (WISC), which became the

first significant alternative to the well-known

and most often used Stanford-Binet. The current

version of the WISC (the WISC-IV) is

the most commonly used intelligence test for

children ages 6 to 16 given today.

In 1945, Connecticut became the first of

many states to pass a certification law for psychologists,

thereby launching the regulation of

the practice of clinical psychology among qualified

professionals. Thus, only those deemed

qualified by training and experience could call

themselves ‘‘psychologists’’ and offer services

to the public for a fee. In 1946, the first edition

of the American Psychologist was published,

and the American Board of Examiners in Professional

Psychology (ABEPP) was created to

certify psychologists. The ABEPP developed a

national examination for all clinical psychologists

seeking licensure. This frequently revised

examination is now used in every state.

The Big Picture

Although clinical psychology did not become

a specialty within psychology until 1896, the

many perspectives in understanding, assessing,

and treating emotional and behavioral

problems during the preceding centuries set

the stage for its development. Understanding

the influences of biological, psychological, and

social factors in the development and maintenance

of problem behavior and emotional

distress evolved over many years. Each generation

grappled with trying to best understand

the influences of various factors on behavior.

As more and more scientific discoveries were

revealed, theories about the relative importance

of biological, psychological, and social

factors in behavior and emotions were altered

to accommodate the most up-to-date discoveries

and thinking. However, historical events,

influential people, and social perspectives influenced

past and current thinking about topics

of interest to clinical psychology.

Prior to World War II, clinical psychology

was essentially defining itself, struggling with

its relationship with the APA, and making scientific

and clinical inroads. However, World

War II and especially the aftermath of the

war changed clinical psychology significantly.

Chapter 3 chronicles the history and development

of clinical psychology in modern times

following World War II.

Humankind has struggled inexorably to

make sense of human behavior in the context

of changing social, theological, and political

times. Changing notions of how the mind,

body, and environment interact to create mental

health and illness has developed through

fits and starts into the roots of our current

integrative appreciation for the dynamic interplay

of biological, psychological, and social

factors. Psychology as a science and clinical

psychology as a discipline emerged in these

early eras through experimentation, testing,

and, eventually, consultation and treatment.

Yet to come, however, is the modern era of

clinical psychology, and the exciting explosion

of ideas, methods, and practices applied to

human problems in our contemporary world.

Key Points

1. Before Lightner Witmer opened the first

psychological clinic at the University of

46 Foundations and Fundamentals

Pennsylvania and coined the term clinical

psychology in 1896, a number of events

during the course of history set the stage

for the development of clinical psychology

as a profession.

2. The ancient Greeks felt that the gods were

the cause of both health and illness and

that the mind and body were closely interconnected.

The famous Greek physician,

Hippocrates (460–370 B.C.), believed that

disease was primarily the result of an imbalance

of four bodily fluids or humors rather

than of spiritual factors.

3. During the Middle Ages (A.D. 500–1450),

the early notions of the relationship between

health, illness, mind, and body

returned. Disease and insanity, it was believed,

were caused by spiritual matters

such as the influence of demons and

witches and the results of sin.

4. During the Renaissance, renewed interest

in the physical and medical world emerged

once again with diminishing influences of

the supernatural or religious viewpoints.

New medical discoveries during the Renaissance
resulted in biomedical reductionism

in that disease, including mental illness,

could be understood by scientific observation

and experimentation rather than

beliefs about mind and soul.

5. It wasn’t until the work of Sigmund

Freud (1856–1939) and colleagues that

the connection between mind and body

reemerged. Freud demonstrated that unconscious

conflicts and emotional influences

could bring about diseases. As the

ancient Greeks believed, Freud reawakened

the notion that a more holistic view of

health, which included the role of emotional

life, was necessary to a fuller understanding

of health, illness, and abnormal
behavior.

6. Psychology was born when the first laboratory

of psychology was developed by Wilhelm

Wundt at the University of Leipzig,

Germany, in 1879. In 1890, William James

published Principles of Psychology, which became

the first classic psychology text, and

in 1892, the APA was founded and elected

G. Stanley Hall as its president.

7. The birth of clinical psychology occurred

in 1896 with the opening of the first psychological

clinic at the University of Pennsylvania

by Lightner Witmer (1867–1956).

Witmer became the first psychologist to use

his understanding of the principles of human

behavior to help an individual with

a particular problem: He was asked by a

teacher to help one of her students who

was not performing well in school.

8. Alfred Binet and Theodore Simon developed

an intelligence test that could be

used with children in order to assist teachers

and schools identify children whose

mental abilities prevented them benefitting

from regular classroom instruction.

The Binet-Simon scale was developed in

1908 specifically for school use. In 1916,

Stanford University psychologist Lewis Terman

revised the scale and renamed it

the Stanford-Binet. The Binet approach to

testing became remarkably popular in the

United States. Various institutions throughout

the country adopted the Binet-Simon

and later the Stanford-Binet approach to

assess children.

9. Former mental patient Clifford Beers

founded the National Committee for

Mental Hygiene, which was concerned

about the inhumane treatment mental

patients experience while hospitalized. The

mission of Beers’ post-hospitalization life

and his newly founded association was

to improve treatment for those suffering

from mental illness as well as assist in

the prevention of mental disorders. Beers

and his association founded the child

guidance movement, which used the new

principles of psychology to help children

and their families deal with mental illness

and problem behaviors.

10. During World War I and World War II,

millions of recruits needed to be evaluated

for psychological and intellectual functioning.

The military turned to psychology to

provide them with testing to evaluate the

troops.